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Risk factors identified in high income countries (HIC) often fail to predict risk in lower income settings. Southern Indian states like Kerala exemplify the limitations of HIC risk models: it has well-developed education and health infrastructure with high literacy, living standards, and life expectancy. Yet, it has one of the highest suicide rates in the country, 6 times higher than in the US.

Building on previous work on suicide attempts among women in Goa, India (Maselko and Patel, JECH 2008), I began developing a research program to elucidate the mechanisms driving very high rates of suicide and among women and youth in Kerala. In this population, risk emerges in adolescence and is thought to be strongly influenced by a sociocultural context of rapid and uneven economic development, combined with changing family environments and education pressures. My overarching goal is to examine how these social environmental factors shape specific domains of adolescent neuropsychological development which, in turn, may impact risk of mental health problems.

As a first step, we conducted a mixed methods study with adolescents and adults. Preliminary findings from the qualitative interviews suggest high levels of distress attributed to educational pressures, smaller and more isolated families, as well as ‘excessive’ use of technology (manuscript under review). In preparation for the next phase of this project, and in collaboration with colleagues working with youth in Nepal, we recently concluded a pilot assessing the feasibility of tablet-based administration of neuropsychological tests of domains such as cognitive flexibility, impulse control and implicit associations among 9th graders in Kerala and Jumla, Nepal.

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