Suicide is a major public health challenge, with more than 700 000 deaths (one in every 100 deaths) each year globally.  Every year, more people die as a result of suicide than HIV, malaria or breast cancer or war and homicide. Each suicide has far-reaching social, emotional, and economic consequences, and deeply affects individuals and communities worldwide¹.

The triennial theme for World Suicide Prevention Day for 2024-2026 is “Changing the Narrative on Suicide” with the call to action “Start the Conversation” was marked today on 10^th of September, 2024. This theme aims to raise awareness about the importance of reducing stigma and encouraging open conversations to prevent suicides. Changing the narrative on suicide is about transforming how we perceive this complex issue and shifting from a culture of silence and stigma to one of openness, understanding, and support¹.

“Changing the narrative on suicide”

As the world observes World Suicide Prevention Day on September 10, Nepal stands at a critical juncture in its battle against an escalating mental health crisis. Over the past decade, suicide rates in Nepal have risen alarmingly, with many cases linked to untreated mental health issues, such as depression, anxiety, and substance use disorders. On an average, 19 people die by suicide every day in Nepal, which equates to one death approximately every 75 minutes. This psychological  emergency calls for immediate action, not only to prevent suicides but to address the deeper mental health issues facing Nepal.

The “Changing the narrative on suicide” is being observed with rallies and gatherings, awareness raising through media such as Kantipur Nepal, The Kathmandu Post and by NGOs and INGOs such as CMC Nepal, CMCS Nepal, TPO Nepal, WHO Nepal, UNICEF Nepal and government institutions such as the Palikas and Wadas.

There is rally program which will start from the Mental Hospital Lagankhel, the only government level hospital in Nepal, will travel through the streets of Lalitpur and Kathmandu and will return and end at Mental Hospital Lagankhel tomorrow morning at 7AM.

According to WHO, suicide is a global public health concern, accounting for over 700 000 deaths annually.² Of all global suicides, 73% occur in low- and middle-income countries (LMICs)². Suicide is the third leading cause of death among 15-29 year olds². Low- and middle-income countries see a staggering 70% of violent deaths in women and 44% of violent deaths in men are due to suicide³. Almost all countries in the world are struggling with the issue of suicide. Nearly 45,000 lives were lost to suicide in 2016 according to CDC. Suicide rates went up more than 30% in half of in the United States since 1999 according to the same study. The CDC reports that More than half of people (54%) who died by suicide did not have a known mental health condition³. Identifying factors associated with suicide can improve risk stratification and help target interventions for high-risk groups⁴.

CDC outlines a number of risk factors for suicide. The main factors are individual factors, relationship factors, community related factors, and societal factors⁵. World Mental Health Day is observed every year on 10th of October to mark the importance of mental health, raise awareness, reduce stigma and bring mental health issues which is one of the leading causes of suicide, as a health priority.

Individual Risk Factors are the These personal factors contribute to risk such as Previous suicide attempt, History of depression and other mental illnesses, Serious illness such as chronic pain, Criminal/legal problems, Job/financial problems or loss, Impulsive or aggressive tendencies, Substance use, Current or prior history of adverse childhood experiences, Sense of hopelessness, Violence victimization and/or perpetration.

The Relationship Risk Factors are the harmful or hurtful experiences within relationships that contribute to suicidal risk such as Bullying, Family/loved one’s history of suicide, Loss of relationships, High conflict or violent relationships, social isolation

Community related Risk Factors are those challenging issues within a person’s community contribute to suicidal risk such as Lack of access to healthcare, Suicide cluster in the community, Stress of acculturation, Community violence, Historical trauma, Discrimination,

Societal Risk Factors are the cultural and environmental factors within the larger society contribute to suicidal risk such as Stigma associated with help-seeking and mental illness, Easy access to lethal means of suicide among people at risk.

Rising Suicide Rates in Nepal: A National Crisis

Recent studies and media reports highlight a concerning increase in suicides in Nepal, particularly since the COVID-19 pandemic. According to data provided by the Nepal Police, 7,223 people killed themselves in the fiscal year 2023-024, which is the highest ever recorded in a year, followed by 6993 in 2022-2023 and 6792 in 2021-2022⁶. Around 20 people killed themselves on an average every 24-hour in the last fiscal year,” said the chief of EDCD and Mental Health Section, Dr. Pomawati Thapa⁶.

Suicide has become the leading cause of death among women aged 15-49 in Nepal and a significant cause of death for men in various age groups⁷. According to the Nepal Police, 6,211 suicides were reported in the fiscal year 2020/21, a notable increase from previous years⁶.

Major Causes of Suicide in Nepal

1. Mental Health Issues

• Depression is a key factor in Nepal’s suicide crisis. Lack of awareness, social stigma, and an absence of treatment options exacerbate the condition for many.
• Anxiety disorders and post-traumatic stress disorder (PTSD), especially in the wake of natural disasters like the 2015 earthquake, have left many Nepalis vulnerable.
• Substance use disorders, often linked with depression, contribute to the rising suicide rates, particularly in urban areas.

2. Lack of Trained Mental Health Professionals

Nepal faces a significant shortage of mental health professionals, with fewer than 200 psychiatrists and an even smaller number of clinical psychologists serving a population of nearly 30 million. This gap in services is most pronounced in rural areas, where mental health awareness is low, and access to trained professionals is nearly non-existent.

3. Socioeconomic Factors

Unemployment, poverty, and financial instability have been linked to a higher risk of suicide. During the COVID-19 pandemic, many Nepalis lost their jobs, increasing economic pressures on families, and contributing to a rise in suicide rates. Financial struggles, particularly in the farming communities of provinces like Province 5 and Karnali Province, have been noted as leading causes.

Demographic Factors Influencing Suicide in Nepal

1. Age

Suicide data collected by the police in 2009/2010 demonstrated that the suicide rate peaked among women aged between 20–24 years at 7.4 per 100,000⁸. Among all suicide 63% of deaths by suicide occurred among women of 15-29 years old.⁹

WHO also mentions that among young individuals 15-29 years of age, suicide was the fourth leading cause of death after road injury, tuberculosis and interpersonal violence¹⁰.

2. Gender

More than twice as many males die due to suicide as females (12.6 per 100 000 males compared with 5.4 per 100 000 females). Suicide rates among men are generally higher in high-income countries (16.5 per 100 000). For females, the highest suicide rates are found in lower-middle-income countries (7.1 per 100 000).

Suicide rates in the WHO African (11.2 per 100 000), European (10.5 per 100 000) and South-East Asia (10.2 per 100 000) regions were higher than the global average (9.0 per 100 000) in 2019. The lowest suicide rate was in the Eastern Mediterranean region (6.4 per 100 000).

3. Ethnicity, Caste, and Religion

Research has shown that marginalized ethnic groups and lower-caste communities, such as Dalits, are disproportionately affected by suicide. These groups often face systemic discrimination, which can lead to social isolation, economic hardship, and limited access to healthcare.

4. Marital Status

In most studies, the majority of suicide/DSH victims were married^11–15. For example, in the 2008/2009 MMMS study, 73% of the women who committed suicide out of a total 239 suicide deaths among WRA were married in comparison to 20.9% of women who committed suicide were unmarried, and police reported for 2003–2011, 84.1% of all ages of women who committed suicide were married^8,9

5. Geographical Disparities

Suicide rates vary across Nepal’s geographical regions. Rural districts, especially in the Far-Western Region, have seen a higher incidence of suicides. This can be attributed to the remoteness of these areas, lack of access to mental health services, and economic hardships. Urban areas like Kathmandu Valley are also witnessing a surge in suicides, driven by modern stressors such as job competition, academic pressure, and relationship issues.

6. Education

Lower levels of education have been linked to higher suicide rates. Those with limited education are often less aware of mental health issues and are more susceptible to economic pressures, which can trigger mental health crises.

7. Economic and Financial Factors

Nepal’s fragile economy, exacerbated by frequent natural disasters and political instability, has left many individuals in dire financial conditions. Farmers burdened by debt, especially in provinces like Province 2 and Gandaki Province, often see suicide as their only escape from financial ruin.

Province-wise Distribution of Suicides

Madhesh Province:

High rates of suicide in Province 2 are often attributed to caste-based discrimination, poverty, and a lack of access to healthcare. The suicide rate in the Terai region of Province 2 is particularly concerning.

Karnali Province:

Karnali has one of the highest suicide rates in Nepal, driven by extreme poverty, food insecurity, and the lack of mental health services. Jumla and Dolpa districts have seen a significant rise in suicides in recent years¹⁶.

Bagmati Province:

Urbanization and increased stress from academic and professional environments have led to higher suicide rates in Kathmandu, Bhaktapur, and Lalitpur. Many young students face pressure to succeed academically, and the absence of mental health support in schools contributes to the problem.

Means of Suicide

Poisoning stood out as the most common method of suicide and DSH in 88% of studies with most of the suicide victims consuming pesticide (commonly organophosphates)^{11–13,17–19}. In 16% of the studies, hanging was the method employed for suicide^20,21.

Recent High-Profile Suicide Cases

Nepal has recently seen several high-profile suicides that have caught national attention. In 2023, a prominent social worker from Lalitpur tragically ended her life, highlighting the pressures faced by those in the helping professions. Similarly, the suicide of a well-known businessman in Kathmandu due to financial pressures sparked widespread discussion on the lack of mental health support for entrepreneurs and professionals.

The Urgent Need for Action

Nepal is facing a mental health crisis that requires immediate intervention. The government must prioritize:

• Increasing the number of mental health professionals by offering scholarships and training programs for aspiring psychiatrists, psychologists, and counselors.
• Raising awareness about mental health through national campaigns and incorporating mental health education into school curricula.
• Strengthening the mental health infrastructure, especially in rural areas, where access to care is extremely limited.
• Addressing stigma around mental health by involving community leaders, religious figures, and local governments.

Conclusion

On this World Suicide Prevention Day, Nepal must recognize the gravity of its mental health crisis. Immediate steps need to be taken to prevent more lives from being lost to suicide. Only through a collective effort involving the government, mental health professionals, and society at large can Nepal hope to turn the tide on this urgent issue.

References:

1. World Health Organization. World Suicide Prevention Day 2024. https://www.who.int/campaigns/world-suicide-prevention-day/world-suicide-prevention-day-2024.
2. World Health Organization. Suicide. https://www.who.int/news-room/fact-sheets/detail/suicide.
3. World Health Organization. Preventing Suicide: A Global Imperative. (World Health Organization, Geneva, 2014).
4. Stone, D. M. et al. Vital Signs: Trends in State Suicide Rates — United States, 1999–2016 and Circumstances Contributing to Suicide — 27 States, 2015. MMWR Morb. Mortal. Wkly. Rep. 67, 617–624 (2018).
5. CDC. Risk and Protective Factors for Suicide. Suicide Prevention https://www.cdc.gov/suicide/risk-factors/index.html (2024).
6. Nepal witnesses unprecedented rise in suicide cases. https://kathmandupost.com/health/2024/08/19/nepal-witnesses-unprecedented-rise-in-suicide-cases.
7. Kasaju, S. P., Krumeich, A. & Van der Putten, M. Suicide and deliberate self-harm among women in Nepal: a scoping review. BMC Womens Health 21, 407 (2021).
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9. Pradhan, A., Suvedi, B. K., Barnett, S., Sharma, S. K. & Puri, M. Nepal Maternal Mortality and Morbidity Study 2008/2009: Summary of Preliminary Findings. (2010).
10. One in 100 deaths is by suicide. https://www.who.int/news/item/17-06-2021-one-in-100-deaths-is-by-suicide.
11. Ghimire, S., Devkota, S., Budhathoki, R., Sapkota, N. & Thakur, A. Psychiatric Comorbidities in Patients with Deliberate Self-Harm in a Tertiary Care Center. JNMA J. Nepal Med. Assoc. 52, 697–701 (2014).
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13. Thapaliya, S., Gupta, A. K., Tiwari, S., Belbase, M. & Paudyal, S. Pattern of Suicide Attempts in Southern Nepal: A Multi-Centered Retrospective Study. Med Phoenix 3, 41–47 (2018).
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16. Acharya, B., Subedi, K., Acharya, P. & Ghimire, S. Association between COVID-19 pandemic and the suicide rates in Nepal. PLOS ONE 17, e0262958 (2022).
17. Subba, S. H. et al. Pattern and trend of deliberate self-harm in western Nepal. J. Forensic Sci. 54, 704–707 (2009).
18. Singh, D. P. & Aacharya, R. P. Pattern of Poisoning Cases in Bir Hospital. J. Inst. Med. Nepal 28, 3–6 (2006).
19. Pyakurel, R. et al. Cause of Death in Women of Reproductive Age in Rural Nepal Obtained Through Community-Based Surveillance: Is Reducing Maternal Mortality the Right Priority for Women’s Health Programs? Health Care Women Int. 36, 655–662 (2015).
20. Subedi, N., Chataut, T. & Pradhan, A. A Study of Suicidal Deaths in central Nepal. in European Journal of Forensic Sciences vol. 2 5 (2015).
21. Hagaman, A. K., Khadka, S., Lohani, S. & Kohrt, B. Suicide in Nepal: a modified psychological autopsy investigation from randomly selected police cases between 2013 and 2015. Soc. Psychiatry Psychiatr. Epidemiol. 52, 1483–1494 (2017).