Depression and suicide ideation remain leading causes of death among women of reproductive age worldwide. Despite this growing issue, many countries do not have adequate resources to address and improve mental health. In Pakistan, where Dr. Ashley Hagaman collaborates with her research partners, peer mothers have connected with mothers in the community to provide them with treatment and care for depression. Through extensive previous research in Pakistan, Dr. Hagaman and her colleagues have discovered how profoundly peer mothers have impacted women's mental health in their communities and gained a powerful identity in a country facing severe gender inequality.
Ashley Hagaman, PhD, MPH, an Assistant Professor in the Department of Social and Behavioral Sciences at the Yale School of Public Health and a faculty member at the Center for Methods in Implementation and Prevention Science, focuses her research on understanding the impacts and determinants of suicidal behaviors in low- and middle-income contexts (Pakistan and Nepal). Specifically, her research leverages an existing complex birth cohort of women with embedded mental health and child development interventions and is implemented alongside the Human Development Research Foundation.
To support her current research with mothers in Pakistan and further her behavioral science investigations more broadly, Dr. Hagaman has received a prestigious K01 grant from the National Institutes of Health. This funding helps facilitate close collaboration with global experts in social epidemiology (Asia Maselko, University of North Carolina at Chapel Hill), biostatistics and implementation science (Donna Spiegelman, Yale University; Byron Powell, Washington University in St. Louis), intervention development (Atif Rahman, University of Liverpool and Siham Sikander, Health Services Academy), and suicide (Nusrat Husain, University of Manchester; Paul Pfeiffer, University of Michigan).
Dr. Hagaman emphasized that investigating suicide among high-risk Pakistani women around reproductive age is particularly important because it is "an event that is so stigmatized, particularly in Islam and in social contexts where there are so many implications for what suicidal behaviors mean not just on you, but on your family." Her research findings on Pakistani mothers' experiences with suicidal ideation and the roles of peer health workers in suicide detection will be used to structure her team's peer-driven pilot suicide prevention package (SuPP), which is highly sensitive to this delicate social context.
"It's a really important topic to address in a very thoughtful and community-engaged way," Dr. Hagaman highlighted, "because we know that by investigating something like suicide, there are so many considerations that we have to make by engaging our communities and our workforce." Dr. Hagaman and her team have therefore prioritized the use of a community-engaged co-design process to develop SuPP, which will be deployed through the community health system in Pakistan.
Dr. Hagaman also plans to use the World Health Organization's existing interventions for mental health, the Thinking Healthy Program Peer-Delivered Plus and the Mental Health Gap Action Program, as a foundation for implementing SuPP. Through her work, Dr. Hagaman and her collaborators ultimately aim to integrate suicide screening and prevention methods into routine care, increase access to community-based mental health services, and improve family and social contexts through suicide prevention in Pakistan and other low- and middle-income countries around the world.