3184.0 Maternal suicidality in Pakistan: Developing a grounded theory to better inform suicide prevention interventions

Session: Suicide Risk and Prevention: Systemic, Programmatic and Individual Approaches

Program: Mental Health

Time: 12:30 - 1:30 PM

Presenters:

Gul Saeed

Ashley Hagaman, PhD, MPH

Abstract

Background: South Asia has the highest rate of suicide fatalities globally. Evidence from Pakistan, the fifth most populous country in the world, suggests that suicide has been on the rise since 2016, particularly among women of reproductive age. However, the underlying factors and processes that contribute to suicidal behavior among women in Pakistan remain underexplored. This study aimed to decolonize existing western-based theories of suicide and generate a theory informed by women in Pakistan’s lived experiences of suicide, including how they experience and subsequently negotiate suicidality.

Methods: We employed a decolonized form of grounded theory, informed by critical feminist theory and Pakistani feminist scholarship, to explore the experiences of suicidal thoughts and behaviors among 12 mothers with a chronic history of suicidality in Kallar Seydan, Pakistan. The study sample was part of a larger mixed-methods pilot trial co-designing and testing a community-based suicide prevention intervention. Data were analyzed in Urdu by female Pakistani scholars using constant comparison with open, axial, and selective coding stages.

Results: We generated a grounded theory of suicide among women in Pakistan. Women's suicidal thoughts and behaviors were largely influenced by their positionality within their husbands’ households and relationship dynamics, which were characterized by emotional and physical abuse, neglect from their husbands, and invalidation from their in-laws. Resulting from these dynamics, in the context of women grieving their loss of agency and natal-home lives, were feelings of abandonment, resentment, disrespect, and helplessness, which reduced women’s threshold for maintaining patience, a key moral protective role identified by most women. While anger and desire to escape abuse prompted suicide attempts, suicidal death threatened women’s relationship with Allah and peace in their afterlife. Among women’s reasons for living, trust in Allah's plan was the strongest reason followed by a unique duty for their children.

Conclusion: This grounded theory study challenges Western interpersonal theories of suicide and provides insights into the complex and context-specific factors that influence suicide among women in Pakistan. Our findings can guide the development of culturally appropriate suicide prevention interventions sensitive to Pakistan’s unique sociocultural and religious context and ultimately, reduce the national burden of suicide.