Interpersonal violence and suicidality among former child soldiers and war-exposed civilian children in Nepal

Abstract

Background.Suicide risk reduction is crucial for 15–29-year-old youth, who account for 46% of suicide deaths in low- and middle-income countries. Suicide predictors in high-resource settings, specifically depression, do not adequately predict suicidality in these settings. We explored if interpersonal violence (IPV) was associated with suicidality, independent of depression, in Nepal.Methods.A longitudinal cohort of child soldiers and matched civilian children, enrolled in 2007 after the People's War in Nepal, were re-interviewed in 2012. The Depression Self-Rating Scale and Composite International Diagnostic Interview assessed depression and suicidality, respectively. Non-verbal response cards were used to capture experiences of sexual and physical IPV.Results.One of five participants (19%) reported any lifetime suicidal ideation, which was associated with sexual IPV, female gender, former child soldier status and lack of support from teachers. Among young men, the relationship between sexual IPV and suicidality was explained by depression, and teacher support reduced suicidality. Among young women, sexual IPV was associated with suicidality, independent of depression; child soldier status increased suicidality, and teacher support decreased suicidality. Suicide plans were associated with sexual IPV but not with depression. One of 11 female former child soldiers (9%) had attempted suicide.Conclusion.Sexual IPV is associated with suicidal ideation and plans among conflict-affected young women, independent of depression. Reducing suicide risk among women should include screening, care, and prevention programs for sexual IPV. Programs involving teachers may be particularly impactful for reducing suicidality among IPV survivors.

Delivering mental health and psychosocial support interventions to women and children in conflict settings: a systematic review

“…Of the 643 potentially relevant publications screened in full text, 125 were identified as eligible for this review. The grey literature search identified another 25 eligible publications, and a further seven were identified through reference list of previous reviews, with a total of 157 publications finally included in the review 24–154Table 1. summarises the characteristics of all included publications.…”

Interpersonal violence and mental health: a social justice framework to advance research and practice

“…Several studies have looked at IPV as a particular form of interpersonal violence – covering various stages across the life course. A longitudinal study in Nepal with former child soldiers and matched civilian children ( n = 290) (on average 16 years old at the time of recruitment) found that exposure to sexual IPV (18% in women, 7% in men) was a predictor for suicidal attempts 5 years later (Bhardwaj et al ., 2018). In a longitudinal study amongst perinatal women in informal settlements in South Africa ( n = 425), IPV victimization at baseline was associated with higher levels of psychological distress, food insecurity, and rates of alcohol misuse (Schneider et al ., 2018).…”

Elucidating adolescent aspirational models for the design of public mental health interventions: a mixed-method study in rural Nepal

“…Suicide is the single leading cause of mortality among women of reproductive age [ 36 ], and in Jumla, the area where this study was conducted, 85% of suicides among women occur before the age of 25 years [ 37 ]. Work on suicide and mental health in this region of the country and elsewhere in Nepal has highlighted the importance of alcohol use, interpersonal conflict, thwarted life goals, emotional dysregulation, and lack of coping skills as risk factors [ 38 – 40 ]. The six themes were piloted in four initial interviews conducted jointly by the first and last authors and through ethnographic observation in Jumla.…”