Burden of suicidal attempts and its associated factors in adolescents: A community-based mixed method study in a rural part of Eastern Nepal

Background: Mental disorders contribute to 13% of the global burden of disease among adolescents aged 10 to 19 years. Adolescent suicide is often unreported due to the stigma attached to mental health issues and the unavailability of reporting mechanisms, particularly in developing countries. The current study aimed to determine the suicidality burden and associated factors in adolescents in a rural part of Eastern Nepal through a mixed methods approach.Methods: A community-based mixed methods cross-sectional study was conducted from October to November 2020 among 443 adolescents (aged 13 to 19 years, mean = 15.93 years, SD = 1.79 years). Frequencies and percentages were computed to assess suicidality burden, while bivariate and multivariate logistic regressions were performed to identify the factors associated with suicidality. Braun and Clarke's thematic analysis was used to explore qualitative factors associated with adolescent suicidality.Results: The quantitative findings revealed that the prevalence of suicidal attempts over the past year was 12.42 % among adolescents. The multivariate analysis revealed a significant relationship between suicidal attempts and depressive symptoms (AOR, 8.84, p = 0.001). Parental support was a protective factor against suicidal attempts (AOR, 0.08, p = 0.012). Qualitative findings indicated that loneliness, substance misuse, a lack of support system from family, and friends influenced adolescents' suicidality.Conclusions: The study provided evidence that Nepalese adolescents in rural Eastern areas are at a high risk of suicidality, likely due to limited access to mental health services and support systems. Addressing this issue requires systemic changes to expand mental health resources in rural Nepal, where such services remain significantly less available than in urban areas.