Suicide remains a leading cause of death worldwide, accounting for nearly 800,000 deaths each year. The burden falls disproportionately on low- and middle-income countries, which account for about 75% of global suicides. In South Asia, where suicide rates are among the highest globally, stigma and legal barriers often make prevention efforts especially challenging.
For Ashley Hagaman, PhD, MPH, associate professor of public health (social and behavioral sciences) at Yale School of Public Health (YSPH) and a faculty affiliate of the Yale Institute for Global Health (YIGH), addressing this issue means developing solutions that are not only evidence-based, but also locally feasible and culturally grounded.
“Suicide is one of our most intractable problems – we really haven’t seen meaningful progress at scale,” Hagaman adds. “Despite disproportionately impacting low- and middle-income countries, most of our interventions come from Western, high-income contexts.”
Hagaman is a member of the Yale Network for Global Non-Communicable Diseases at YIGH, and her work shows a longstanding commitment to global health and health equity. The Global Non-Communicable Diseases Network is part of YIGH’s broader faculty network program, which supports interdisciplinary collaboration to address complex global health challenges.
“Much of my current work focuses on assembling and supporting teams in South Asia to develop their own theories of suicidality, and then using those theories to design interventions at multiple levels,” Hagaman says.
As part of this work, Hagaman received a YIGH Spark Award in 2023. The biannual award supports early-stage global health initiatives and enabled her team to develop community-based approaches for suicide screening and referral in peri-rural Pakistan.
“We were focused on building community-driven interventions in rural Pakistan, but we first needed a reliable, safe way to identify who was at risk,” Hagaman says.
Traditional Western screening methods often ask individuals to quantify how often they think about suicide or how likely they are to act on those thoughts, but these questions can be difficult to interpret consistently across cultural contexts. “Those approaches don’t always translate well, and responses are often inconsistent,” Hagaman adds.
Hagaman and her team worked with a community advisory board to develop a screening approach for suicide in Pakistan, grounded in how people in the country actually describe their thoughts, feelings, and experiences. This allowed their team to more accurately identify individuals at risk for suicide in the community, compared to Western screening methods. “There was no validated screening tool for this setting, and the Spark Award allowed us to address that gap,” says Hagaman.
Many of Hagaman’s research teams and collaborators are female-led, reflecting her commitment to supporting women scholars and strengthening leadership pipelines within the regions where she works.
Building on the team’s initial screening tool, Hagaman has since secured two NIMH R34 grants to further develop and test culturally grounded suicide prevention interventions, with additional funding proposals underway. The project has also generated new scholarship, including a manuscript that advances a more context-specific understanding of suicidality among women in Pakistan and highlights the importance of locally informed approaches to prevention.
“Given the stigma and complexity around suicide, much of this work has been intentionally small and deliberate,” Hagaman says. “Moving forward, the focus is on scaling these interventions and testing them in larger trials using the tools we’ve developed to better measure what matters.”
Hagaman also received support from YIGH to translate her team’s research into Urdu, allowing their findings to be shared more directly with communities and collaborators in Pakistan.
“That’s not something most grants really cover, but it makes a difference,” Hagaman says. “Being able to share our work in Urdu means the people we’re working with can actually engage with it.”
Lastly, this work has also informed how Hagaman thinks about suicide intervention design beyond South Asia. Many of the interventions Hagaman has identified rely very little on written language; as a result, these insights could help shape interventions for a range of populations domestically and internationally, including neurodivergent individuals or pediatric patients, where traditional, text-heavy models may not be as effective.
“Part of this work is centering different ways of knowing and learning, and applying what we find to diverse populations around the globe,” Hagaman says.
Yale faculty engaged in global health can become YIGH Affiliates, gaining access to funding opportunities, grant support, and expanded visibility through YIGH communications. To learn more about affiliation, contact Mike Skonieczny.