Background: Child and adolescent mental health problems are major contributors to the global burden of disease in low- and middle-income country (LMIC) settings. To advance the evidence base for adolescent mental health interventions in LMICs, we evaluated the feasibility and acceptability of a school-based emotion regulation prevention intervention (READY-Nepal) for adolescents who had a recent exposure to a humanitarian disaster. Methods: A mixed-method, non-randomized controlled trial was conducted with Nepali secondary school students in one heavily affected post-earthquake district. Students (N = 102; aged 13 to 17 years) were enrolled in the intervention (n = 42) and waitlist control (n = 60) conditions. Feasibility and acceptability were examined via attendance, and by qualitative interviews with a subset of students (n = 15), teachers (n = 2), and caregivers (n = 3). Preliminary efficacy was examined on primary outcome (emotion regulation) and secondary outcomes (anxiety symptoms, posttraumatic stress symptoms, functional impairment, resilience, coping skills), which were measured at baseline and post-intervention (four weeks). Results: Delivering the intervention was feasible and acceptable, as demonstrated by low dropout (8%) and high program attendance (6.7 of 8 sessions). Qualitative data suggested high uptake of anger regulation skills, but lower uptake of mindfulness skills. Despite this, there were no significant differences by condition on primary or secondary outcomes at four-week follow-up. Students provided suggestions for improvement of the program. Conclusion: Further research on longitudinal outcome measurement, use of alternatives to retrospective self-report data, and rigorous development of culturally grounded models of emotion regulation is necessary to explore the utility of school-based emotion regulation interventions in Nepal and other LMICs.

Background: Suicide is one of the major public health concerns today in all age groups. Suicide has often been neglected in adolescents. We aimed to find out the prevalence of suicidal ideas and attempts, and explore its association with family support and self-esteem among school going students of Kathmandu valley. Methods: We performed a cross-sectional study using a semi structured proforma, P4 Suicide screener, Nepali family support and difficulties scale and Rosenberg self-esteem scale among 211 students of grade eight to ten of two community schools of Kathmandu valley. Socio-demographic and clinical data were tabulated and descriptive analysis were done. The tests for normal distribution were performed initially and then Fisher exact test (categorical) and Mann Whitney U test (continuous variable) were used as applicable. Results: The P4 suicide screen showed 27.96% of the students to be positive. The risk stratification revealed that the maximum percentage (76.3%) of screen positive students had higher risk. The group of students who had no suicidal risk had significantly higher score in family support and difficulty scale as compared to the student with suicidal risk. However, the self-esteem score had no statistically significant difference between the two groups. Conclusion: The suicide risk was present among one-third of the students with high risk among the majority. Considering this high prevalence, it is crucial for parents, teachers and all healthcare providers to be proactive and look for warning signs with all children and adolescents.