The Impact of Gender on the Relationship between Coping, Self-Validation, and Suicidality Among Earthquake-Affected Adolescents in Nepal

Purpose. Suicide is the second leading cause of death globally among young adults 15-29 years old. Addressing adolescent suicidal thoughts and behavior (STB) is especially important in low and middle income countries (LMIC) where 46% of suicides occur before 25 years of age. This burden is highest in Asia, with adolescent rates two times greater than the global average. This study examines the role of gender in influencing the relationship between coping dysfunction, self-validation, and suicidality among adolescents in the context of a school-based mental health promotion program in post-earthquake Nepal.

Methods. In this mixed-methods study, adolescents (N = 102, 50% female) attending secondary school (12 – 18 years old, average age 14.3 years) in a highly earthquake-affected region near Kathmandu, Nepal, completed the Ways of Coping Checklist, Self-Validation/Self-Invalidation Questionnaire, and the Suicide Screener Questionnaire. Participants of semi-structured interviews included 23 students, 2 teachers, and 3 caregivers. Gender-stratified focus group discussions (n = 2) were also conducted among students.

Results. The stressor that students identified most frequently (71.4% of interviewees) in qualitative interviews was academic-related sources. Scores on the Ways of Coping Checklist skills and dysfunction scales did not differ significantly by gender. However, girls scoring high in coping dysfunction (t = -2.511, p = 0.015) and low in self-validation (t = 2.916, p = 0.005) were significantly more likely to endorse suicidal ideations in the past two weeks compared to boys with similar dysfunction (t = -0.237, p = 0.813; and self-validation scores t = 1.087, p = 0.282).

Conclusions. Although gender differences in coping skills and coping dysfunction were not quantitatively observed, qualitative analyses revealed that dysfunctional coping was more frequently reported by girls. Future studies should examine the temporal relationship between coping strategies and suicidality. Suicide risk reduction programs should evaluate enhancing adaptive coping skills usage as a mechanism of action to reduce suicidality among girls. Additional research is needed to identify salient risk factors for boys.