Category: Cultural Diversity / Vulnerable Populations

Symposium

Targeting Underserved Groups for Psychotherapy in Global Mental Health Settings: DBT in Rural Nepal

Sunday, November 19
10:15 AM - 11:45 AM
Location: Indigo 202, Level 2, Indigo Level

Keywords: Suicide | DBT (Dialectical Behavior Therapy) | Diversity
Presentation Type: Symposium

Background: Suicide and suicidal behavior are serious global public health concerns (World Health Organization, 2014). In Nepal, suicide accounts for 16% of all deaths among women of childbearing age, rendering it the number-one cause of mortality in this demographic (Suvedi et al., 2009). Despite the existence of evidence-based treatments for suicide prevention, targeting suicidal and self-harming clients for treatment in resource-poor settings remains a significant barrier in global mental health settings. The aim of the present study is to explore the impacts of a culturally adapted Dialectical Behavior Therapy program (DBT) skills training program on treatment linkage and outcomes for Nepali women with histories of suicide and non-suicidal self-injury (NSSI). 


Method: A theory-driven, tri-phasic approach was used to culturally adapt and evaluate DBT for low-literacy, rural Nepali women. In Study 1, interviews with major Nepali mental health stakeholders explored cultural factors related to poor treatment initiation and utilization among suicidal and self-harming clients. Data from this study were used to inform the development of a culturally adapted DBT treatment manual. In Study 2, an adaptation workshop with 15 Nepali counselors was conducted to generate adapted treatment content, with an emphasis on modifications targeting preliminary linkage to care. The resulting intervention (Dialectical Behavior Therapy for Nepali populations; DBT-N) was then piloted in one rural district using single-case experimental design (SCED) methodology.


Results: Due to low literacy levels, community stigma, and resistance to traditionally Western models of care, numerous adaptations were required.  An 82% program completion rate, however, suggests utility of modifications made to the structured, skills-based treatment.


Conclusion:  This adaptation process informs future research on addressing issues of poor treatment utilization among suicidal and self-harming women using culturally sensitive psychotherapy. Recommendations are made for providers in resource-constrained settings working with members of this population. 

Megan Ramaiya

PhD student
University of Washington

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