Research finding · November 2025
Nepalese emergency departments can take steps towards addressing suicide risk
Globally, most suicide deaths occur in low- and middle-income countries (LMICs), yet most suicide prevention research has been conducted in high-income, Western settings. Emergency departments (EDs) are often the first point of contact for people in suicidal crisis, but the feasibility of suicide screening and referral in resource-limited settings remains poorly understood. In Nepal, suicide remains a major public health issue, with poverty, negative attitudes about suicide, and family conflict often preventing individuals from seeking help. Despite the urgent need, Nepal has no standardized suicide prevention protocols, and ED clinicians face high patient loads and limited mental health resources. Understanding hospital staff feelings towards implementing suicide screening, in addition to what barriers and supports exist, is a critical first step toward designing culturally appropriate, effective prevention programs.
With her AFSP grant, Dr. Ashley Hagaman conducted a study in a large emergency department in Nepal to assess how ready clinicians feel about screening and referral to care for suicide risk. Over three months, the research team observed clinical care, conducted focus groups and interviews with staff, and surveyed 26 providers. Most clinicians believed suicide prevention was part of their role and felt supported by hospital leadership, yet many expressed a sense of hopelessness about their ability to help. Practical barriers, such as high patient volume, minimal privacy, and lack of specialized training, made screening difficult to implement. Still, staff showed strong motivation to learn and improve. They emphasized the need for dedicated suicide prevention training, better coordination between departments, and more supportive work environments. The findings suggest that effective suicide prevention in Nepal and similar settings must be developed in collaboration with local providers, combining culturally grounded approaches with feasible, system-level changes that empower frontline clinicians to respond confidently and compassionately to people in crisis.
Citation: Shrestha, A. P., Shrestha, R., Risal, A., Shakya, R., Sigdel, K., Bajracharya, R., Paudel, P., Gumudavelly, D., Egger, E., Zhuang, S., Vijayakumar, L., & Hagaman, A. (2025). Evaluating implementation preparedness for suicide screening and referral in a Nepali emergency department: A mixed-methods study. Implementation research and practice, 6, 26334895251343644. https://doi.org/10.1177/26334895251343644
This finding comes from an AFSP-funded study — see the grant below ↓
