Suicide prevention in primary care clinics in Nepal

Integrating a Suicide Prevention Package of Strategies Into Decentralized Primary Health Care Systems: an Implementation Pilot Study in Rural Nepal

This project will try a package of tools and training to help primary care providers in Bagmati Province, Nepal, better find and manage patients at risk of suicide.

Quick facts

• Phase: Not applicable
• Study type: Interventional
• Enrollment: 147 (estimated)
• Ages: 18 Years and up
• Sex: All
• Sponsor: Yale University (Academic / other)
• Locations: 1 site (Dolakhā)
• Trial ID: NCT07362056 on ClinicalTrials.gov

What this trial studies

This interventional implementation study will introduce a Suicide Prevention Package (PSuPP) into government primary care facilities and work with providers and patients to integrate mhGAP suicide-risk procedures into routine care. The team will use experience-based co-design with a community advisory board alongside the RE-AIM framework to guide adoption, reach, and sustainability. Participants include licensed primary care providers and patients who speak Nepali and meet mhGAP-defined suicide risk levels; outcomes focus on feasibility, acceptability, and improvements in detection, referral, and follow-up. Yale University, NIMH, and local partners will coordinate implementation in selected sites such as Dolakhā within Bagmati Province.

Who should consider this trial

Good fit: Ideal participants are Nepali-speaking patients who live in the study sites, receive care from a participating primary care provider, and meet any level of suicide risk per mhGAP 2.0 criteria.

Not a fit: Patients who need immediate hospitalization or who are unable to provide informed consent are excluded and will not directly benefit from this outpatient implementation approach.

Why it matters

Potential benefit: If successful, the package could increase identification, referral, and follow-up of people at suicide risk in primary care and reduce suicide-related harm in participating communities.

How similar studies have performed: Related mhGAP-based task-sharing and implementation efforts in low-resource settings have shown promise for improving detection and treatment of mental disorders, but rigorous evidence specifically for integrating suicide prevention into primary care remains limited.

Eligibility criteria

Inclusion Criteria:

Primary Care Providers

* Health workers with a prescribing license employed in government health facilities in Bagmati Province.
* Are between 21-65 years, per government health system criteria.
* Participants will be required to have competency in Nepali, be actively engaged in care provision within their health facility

Patients:

* Patient lives in the study site
* Is under the care of a PCP at a facility site.
* Patient meets any level of suicide risk based on mhGAP 2.0 criteria.
* Patients who have been treated for mental illness before or presently (expected in both groups).
* Speaks Nepali.
* Levels of Suicide Risk (as defined by mhGAP 2.0)

Exclusion Criteria:

Primary Care Providers

* Healthcare workers without proper government credentials will be excluded.
* Health workers who plan to migrate or who do not intend to stay in the study area for at least a year.

Patients:

* Patient requiring immediate hospitalization
* Unable to consent as determined by the diminished capacity tool.

Where this trial is running

Dolakhā

• Primary care facilities — Dolakhā, Nepal (Recruiting)

Study contacts

• Principal investigator: Ashley K Hagaman, PhD, MPH — Yale School of Public Health
• Study coordinator: Ashley K Hagaman, PhD, MPH

Conditions Suicide; Primary Care; suicide prevention; primary care; implementation science; Nepal