Journal Article

Assessment and management of suicidality in a mental health survey among poverty affected adolescents in Nepal

Khanal, Parinati, Jordans, Mark J. D., Maharjan, Sabina, Gautam, Kamal, Garman, Emily, Chhetri, Karuna, Lund, Crick, Singh, Rakesh, Luitel, Nagendra

2025

Overview

Background Adolescent suicidality currently ranks as the third leading cause of death among adolescents, affecting global adolescent population, particularly in low- and middle-income countries (LMICs) like Nepal. This study explores the assessment of suicidality as an adverse event in adolescent mental health research in Nepal and outlines practical strategies for integrating suicide management protocols into mental health surveys in LMICs. It offers guidance on suicide risk assessment and referral pathways for vulnerable adolescents and contribute to suicide prevention efforts. Methods This study, a part of a cross-sectional survey with 490 adolescents aged 13–15 in public secondary schools in Kathmandu valley, used a three step approach of the Suicide Management Protocol (SMP) to identify and manage participants at risk of suicidality. Using the specific item under the measurement of mental health among adolescents and young people at the population level (MMAPP) tool followed by administering the suicide screening tool, those at risk of suicidality were identified by the researchers. Clinical assessments were then conducted by the psychosocial counsellor to categorize risk levels using Beck Suicide Intent Scale (BSIS) and provided appropriate management according to the severity. Results Of total 490 participants, while the single item under the MMAPP assessment identified 33 (6.7%) participants at risk, further screening using the suicide screening tool confirmed 25(5.1%) as positives, by the researchers. The psychosocial counsellor clinically assessed the 25 participants screened as suicide risk positive and found that 10 (40%) as high risk, 8 (32%) as moderate, and 7 (28%) as low risk. The clinical management of the cases at a differing level of risk was then managed as per the designated clinical pathways by developing protective behavior and reducing suicide related risk factors. All the participants were found to be safe and functioning normally through the course of clinical management, ranging from 2 to 6 sessions. Conclusions Overall, integrating suicidality measures in mental health surveys was found to be effective suicide assessment and preventive strategy for adolescents in Nepal. Developing suicide management protocols within mental health surveys is essential and feasible for real-time monitoring and response to suicidal behavior among at-risk populations in LMICs, including Nepal.

• Publisher: BioMed Central,BioMed Central Ltd,Springer Nature B.V,BMC
• Subject: Adolescent / Adolescent Behavior - psychology / Adolescent Health - statistics & numerical data / Adolescent Health Services / Adolescent suicidality / Adolescents / Analysis / Behavior Rating Scale / Biostatistics / Child & adolescent mental health / Counseling / Cross-Sectional Studies / Environmental Health / Epidemiology / Female / Health aspects / Health risk assessment / Health Surveys / Humans / Intervention / Male / Management / Medical research / Medicine / Medicine & Public Health / Mental depression / Mental disorders / Mental health / Mental Health - statistics & numerical data / Mental health survey / Methods / Nepal - epidemiology / Polls & surveys / Poverty / Poverty - psychology / Prevention / Protective behavior / Psychological aspects / Public Health / Real time / Researchers / Risk assessment / Risk Assessment - methods / Risk factors / Risk levels / Risk taking / Schools / Social aspects / Suicidal behavior / Suicidal ideation / Suicidality assessment / Suicidality management / Suicide / Suicide - psychology / Suicide - statistics & numerical data / Suicide management protocol / Suicide prevention / Suicide Prevention - methods / Surveys / Teenagers / Vaccine / Young adults / Youth