Suicide and self harm in Nepal: A scoping review

Background: Suicide and self harm behavior has become a major public health issue in recent years in Nepal. This small south Asian country was ranked 7th by suicide rate globally by the 2014 World Health Organization report with an estimated 6,840 suicides annually, or 24.9 suicides per 100,000 people. We decided to explore the epidemiology of suicidal behaviour and self harm, modes of attempt, associated risk factors and trends in specific population. Methodology: Two researchers independently reviewed 47 studies published in the US National Library of Medicine's PubMed electronic Database and Google Scholar till December 2016. Finally, twenty articles meeting the objective were included. This article summarizes findings on epidemiology of suicidal behavior, associated patterns, risk factors and trend in specific population in Nepal. Results: Most of the data available till date are hospital based and either cross-sectional or retrospective. Some of the studies have relied on mortality statistics whereas few have done community based screening. Some of the key findings include higher rate among women and younger age group, a rising trend among specific groups such as marginalized, migrant workers and disaster affected population. The studies also show role of mental illness, predominantly mood disorders and psycho-social factors such as interpersonal or marital conflicts and socio-economic issues in triggering suicide and self harm behavior. Conclusion: Overall, the studies provide satisfactory information about the burden of suicide in Nepal. Some of the limitations include discrepancy in suicide reporting, lack of longitudinal follow up and qualitative studies and absence of studies on preventive aspects. Further, more research is warranted in this area not only at the assessment level but also at an intervention level. Several challenges such as poor distribution of mental health resources, social attitude towards mental illness and suicide in particular need to be addressed.