Planning for Suicide Prevention Strategies: A System Dynamics Approach to Plan for Optimized Suicide Prevention Strategies for Populations Living in Displacement

Introduction: Suicide is a leading cause of mortality worldwide, and rates for refugee and displaced populations are thought to be even higher, likely due to a combination of elevated traumatic exposure, socioeconomic factors, and unequal access to services. However, very little is known about how to prevent suicide in the context of displacement, with no known programs or studies for these populations. In refugee camps in Western Thailand, there has been an alarming increase in the number of suicide attempts and deaths. Local organizations are interested in preventing suicide, but selecting and prioritizing prevention targets or strategies is challenging.

Methods: This paper will focus on our use of an innovative, participatory, and generalizable method, Community Based Systems Dynamics (CBSD), to guide planning for the implementation of suicide prevention strategies in refugee camps in Western Thailand. We held a series of workshops with local experts and experts in the field of suicide prevention and health systems research. Local experts were drawn from organizations working directly with displaced populations and who had some direct experience with responding to suicidal behaviors. Suicide prevention and health systems experts were from Johns Hopkins University. As part of these workshops, we generated a dynamic systems model of suicidal behavior in refugee populations to help inform the selection of targets for preventative interventions. We then simulated the impact of four prevention strategies to examine their effects on reducing suicide rates within our model and assist local partners in selecting the most promising strategies for implementation and evaluation.

Results: The causes and consequences of suicidal behaviors were complex. Domestic violence, increased abuse of substances, stress, lack of participation in ongoing social and educational programs, fear of repatriation, scarcity of rations, all were considered causes of suicidal behaviors. Decreases in intact families, burdens on health systems, decrease in income, were all considered consequences of suicidal behavior. Based on these variables a systems model was generated showing the relationship between these variables at multiple levels. Targets for intervention included social support, existing program participation, domestic violence, and awareness raising. The results of data simulations and how this guided our ultimate selection of an appropriate and optimized prevention strategy will be discussed.

Conclusions: Our research illustrates the application of a novel methodology that aims to account for the complexities of suicide prevention in the context of displacement, helps to optimize local suicide prevention efforts, and ultimately promote health equity for vulnerable groups.