Written in Fate: Nepali Older Adults' Understanding of Suicide.

Objectives: This study aimed to explore Nepali older adults' understanding of suicide and its solutions.

Methods: Focus groups were conducted to understand culturally appropriate ways to start conversations about suicide with Nepali older adults. Informed by the focus group findings, 24 interviews were then conducted with older adults in rural and urban areas.

Results: Thematic analysis resulted in three key themes: 1) meanings of suicide (damnation, fate, unnatural death, dishonor), 2) causes of suicide (lack of social support, limited resources, declining functioning, impaired cognition, mental pain, bad deeds), and 3) solutions (family/friends support, governmental/community role).

Conclusions: Cultural beliefs have shaped the perception of suicide among Nepali older adults. Their belief in fate can be a barrier to preventing suicide. However, their belief that suicide results in bad afterlife consequences can be exploited to potentially prevent it. Moreover, older adults thought that suicide prevention involves roles for family, community, and government.

Clinical implications: Interventions designed to increase mental health literacy and to capitalize on the practice of mindfulness associated with local religions may help to prevent suicide among Nepali older adults. Moreover, community resources should be available to assess the risks of suicide and offer support to vulnerable older adults.