Suicide Prevention in Rural Nepal: A Cultural Adaptation of Dialectical Behavior Therapy

Abstract

Published research on suicide and suicidal behavior has expanded rapidly in recent years and indicates the presence of a growing global public health concern. In Nepal, suicide is the number one of cause of mortality in women of childbearing age, accounting for 16 percent of deaths within this age group. Although treatments and therapies for suicide vary considerably, adapting existing interventions to allow them to remain culturally congruent with the worldviews of ethnic and racial minority groups is becoming an essential practice. In this study, we conducted a cultural adaptation, training, and piloting of manualized dialectical behavior therapy (DBT) in rural Nepal. DBT is a pliable, evidence-based treatment that is proven effective for risk reduction of suicidal behavior and non-suicidal self-injury (NSSI). However, its feasibility and acceptability has yet to be studied in a low-resource, international setting. In this study, the formative process used to guide modification of the standard DBT regimen is outlined. Qualitative research including focus group discussions and key informant interviews aided in incorporation of crucial elements of Nepali ethnopsychology, and a training based on the manualized adaptation with psychosocial counselors was conducted. Culturally adapted DBT (CA-DBT) was then piloted with ten women in a rural district in Northwest Nepal. Preliminary data suggests that, with additional modification and piloting, CA-DBT holds promising potential as a psychological intervention in Nepal. A number of qualitative successes and challenges in implementation are highlighted, as are suggestions for program bolstering and further testing.