ETIOLOGY ORIGINAL RESEARCH PAPER Interpersonal violence and suicidality among former child soldiers and war-exposed civilian children in Nepal Anvita Bhardwaj 1 , Christine Bourey 2 , Sauharda Rai 1,3 , Ramesh Prasad Adhikari 3 , Carol M. Worthman 4 and Brandon A. Kohrt 1,3 * 1 The Department of Psychiatry & Behavioral Sciences, The George Washington University, Washington, DC, USA 2 Psychiatric Consultation-Liaison Service, Legacy Health, Portland, OR, USA 3 Transcultural Psychosocial Organization (TPO) Nepal, Kathmandu, Nepal 4 Department of Anthropology, Emory University, Atlanta, USA Global Mental Health (2018), 5, e9, page 1 of 14. doi:10.1017/gmh.2017.31 Background. Suicide risk reduction is crucial for 15–29-year-old youth, who account for 46% of suicide deaths in low- and middle-income countries. Suicide predictors in high-resource settings, specifically depression, do not adequately predict suicidality in these settings. We explored if interpersonal violence (IPV) was associated with suicidality, inde- pendent of depression, in Nepal. Methods. A longitudinal cohort of child soldiers and matched civilian children, enrolled in 2007 after the People’s War in Nepal, were re-interviewed in 2012. The Depression Self-Rating Scale and Composite International Diagnostic Interview assessed depression and suicidality, respectively. Non-verbal response cards were used to capture experiences of sexual and physical IPV. Results. One of five participants (19%) reported any lifetime suicidal ideation, which was associated with sexual IPV, female gender, former child soldier status and lack of support from teachers. Among young men, the relationship between sexual IPV and suicidality was explained by depression, and teacher support reduced suicidality. Among young women, sexual IPV was associated with suicidality, independent of depression; child soldier status increased sui- cidality, and teacher support decreased suicidality. Suicide plans were associated with sexual IPV but not with depres- sion. One of 11 female former child soldiers (9%) had attempted suicide. Conclusion. Sexual IPV is associated with suicidal ideation and plans among conflict-affected young women, independ- ent of depression. Reducing suicide risk among women should include screening, care, and prevention programs for sex- ual IPV. Programs involving teachers may be particularly impactful for reducing suicidality among IPV survivors. Received 7 March 2017; Revised 20 October 2017; Accepted 25 October 2017 Key words: Armed conflict, child soldiers, interpersonal violence, sexual violence, suicide. BACKGROUND Suicide accounted for 804 000 deaths worldwide in 2012 and was the second leading cause of death globally among young adults aged 15–29 years old (WHO, 2014). These youth and young adult suicides constitute 46% of suicides in low- and middle-income countries (LMIC), with the greatest youth suicide bur- den in Asian countries (WHO, 2014). These statistics likely underestimate incidence due to inaccurate and absent reporting and monitoring infrastructure (Hagaman et al. 2016; Jordans et al. 2014). Although * Address for correspondence: B. Kohrt, MD, PhD, Department of Psychiatry, The George Washington University School of Medicine, 2120 L St NW, Suite #600, Washington, DC 20037, USA. (Email: bkohrt@gwu.edu) © The Author(s) 2018. This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited. global mental health https://www.cambridge.org/core/terms. https://doi.org/10.1017/gmh.2017.31 Downloaded from https://www.cambridge.org/core. IP address: 54.163.42.124, on 17 Jun 2020 at 21:08:09, subject to the Cambridge Core terms of use, available at