Peer Delivered Youth Suicide Prevention in Nepal

South Asia has the highest suicide rate in the world with important risk profile differences from high-income settings. Investigators will conduct formative research to co-design a package of brief interventions and implementation strategies to prevent youth-suicide and then test the package in a pilot feasibility hybrid type 2 cluster randomized controlled trial in Nepal. Potential health impacts may be substantial as results can be applied not only in similar South Asian primary healthcare contexts, but also in low-resource settings in the US and abroad, where the suicide burden remains high. Using experience-based co-design and equity-focused implementation frameworks, this study will assess the feasibility and acceptability of a Youth-focused, Peer-delivered, Family-engaged Suicide Prevention Package (YPF-SuPP) integrated within existing mhGAP services in Nepal's decentralized primary healthcare system. This pilot trial will generate preliminary data to inform the design of a future fully powered effectiveness trial and potential scale-up of youth suicide prevention strategies.

Inclusion Criteria: Peer Volunteers * Age ≥18 years * No current untreated mental disorder or suicide risk, as assessed and confirmed by a Nepali mental health specialist (MD or PhD) * Meets hiring and eligibility criteria of the local implementing partner NGO * Fluent in spoken Nepali Trial Youth Patient Participants * Age 12-24 years * Resident of the study site * Screens positive to the Nepali Ask Suicide Screening Questions or a lifetime history of a suicide attempt * Ability to provide informed consent or assent * For participants under 18 years of age, written informed consent from a legal guardian * Fluent in Nepali Family Members (intervention group only) * Family member (defined as any individual that is a parent, grandparent, aunt/uncle, or cousin as well as significant others) selected by the youth participants enrolled in the study * Resident of the study site * Over 18 years of age * Ability to provide informed consent or assent * Fluent in Nepali Exclusion Criteria: Peer Volunteers * Plans to leave the peer volunteer role within the next 6 months * Unable to provide voluntary informed consent for any reason Trial Youth Patient Participants * Requires immediate psychiatric hospitalization at the time of assessment * Unable to provide informed consent or assent due to impaired decision-making capacity * Participants under 18 years of age without written informed consent from a legal guardian * Planning to leave the study area in the next 6 months Family Members * Requires immediate psychiatric hospitalization at the time of assessment * Unable to provide informed consent or assent due to impaired decision-making capacity * Planning to leave the study area in the next 6 months