Planning for suicide prevention in Thai refugee camps: Using community-based system dynamics modeling.

Abstract

Suicide and associated behaviors represent a significant health disparity among refugees and displaced persons. Despite this burden, evidence for prevention programing in these populations is limited. This study aimed to inform the selection and implementation of suicide prevention strategies in refugee camps in Northwestern, Thailand—camps that had experienced recent spikes in suicides and suicide attempts at the time of the study. We leveraged community-based system dynamics (CBSD) modeling through a series of four workshops with key local stakeholders and suicide prevention experts, to build a qualitative systems model that accounts for complexities and is aimed at assisting local partners with selecting the most promising strategies for implementation and evaluation. The process expanded local understanding of the causes and consequences of suicide and resulted in selection of priority interventions aimed at reducing suicide in this context. Our research illustrates the application of a novel methodology that aims to account for the complexities of suicide prevention in the context of displacement and helps to optimize local suicide prevention efforts.

Applications of Participatory System Dynamics Methods to Public Health

“…29 One of the more powerful advantages of applying a systems thinking lens to public health problems is the ability of SD and system diagrams to demonstrate and communicate complexity effectively. [30][31][32][33][34][35] By utilizing stakeholder input to develop system diagrams, PSD methods allow for the explicit acknowledgment of the complexity of wicked public health problems. [30][31][32][33][34][35] Several articles described PSD methods as approachable tools for understanding and communicating complex concepts into understandable stories accessible to a wide variety of professionals and laypersons alike.…”

“…[30][31][32][33][34][35] By utilizing stakeholder input to develop system diagrams, PSD methods allow for the explicit acknowledgment of the complexity of wicked public health problems. [30][31][32][33][34][35] Several articles described PSD methods as approachable tools for understanding and communicating complex concepts into understandable stories accessible to a wide variety of professionals and laypersons alike. 30,31 The collective act of creating CLDs in PSD methods facilitates a visual storytelling practice that not only accessibly communicates complex concepts H. Decker and M. Wendel…”

“…Reconceptualizing public health issues as complex, dynamic, and adaptive systems broadens and shifts existing perspectives of the central issue, which allows for the identification of innovative leverage points of intervention. 23,25,30,32,33,[42][43][44][45][46][47][48][49][50][51] Another benefit of visualizing public health issues as complex and adaptive systems is that it allows participants to think creatively about solutions, and even identify meaningful solutions that otherwise may have seemed counterintuitive using conventional research approaches. 33,43 Engaging in PSD is thus helpful in developing creative approaches to intervention that avoid "band-aid" solutions.…”

Introduction to special issue on promoting health and well-being in forcibly displaced asian populations.

“…This special issue of the Asian American Journal of Psychology aims to provide a better understanding of the factors impacting the health and well-being of forcibly displaced Asian populations. Reflecting the current humanitarian crisis in Myanmar, half of the papers in this collection focus on refugees from that country: the Chin living in Malaysia (Cowling & Anderson, 2021; Gosnell et al, 2021), the Karen and Burman living in Thailand (Haroz et al, 2021), and the Rohingyas living in Bangladesh (Mozumder & Islam, 2021). Other papers in this collection focus on Lhotshampa Bhutanese refugees living in the United States (Meyerhoff et al, 2021) and on Sri Lankan populations both internally displaced due to war and tsunami (Demaske et al, 2021; Wessells & Kostelny, 2021) and living abroad as refugees (in Canada; Pandalangat & Kanagaratnam, 2021).…”

“…Two papers in this collection focus on suicide, rates of which are likely higher in forcibly displaced populations (Vijayakumar & Jotheeswaran, 2010). Haroz et al (2021) use a novel methodology-community-based system dynamics modeling-to develop a suicide prevention program that takes into account the many context-specific variables that influence suicide in a refugee camp context. Here, locally derived causes and consequences of suicide and potential points for intervention are identified through workshops with local informants.…”