Pathways to suicide attempts in rural Uganda: a qualitative study of survivors, family members, and healthcare providers, and community health workers.

INTRODUCTION: Suicide is a critical public health issue worldwide. Risk factors are exacerbated by cultural stigma, socioeconomic hardship, and limited mental healthcare access. However, few studies have examined the lived experiences of suicide attempt survivors in Africa to probe the underlying drivers. OBJECTIVES: To explore the lived experiences and perceived drivers of suicide attempts in rural Uganda among individuals with lived experience, their families, healthcare providers, and community health workers. METHODS: We conducted in-depth qualitative interviews in Buyende District, Uganda from June to August 2023 with a purposive sample of 54 participants aged 23 to 70: people who had survived a suicide attempt (n = 18) and their family members (n = 17), healthcare providers (n = 10), and community health workers (n = 9). Interviews were recorded, transcribed, translated, and analyzed using a thematic framework method. RESULTS: Four main themes emerged as critical factors leading to suicide attempts: (1) familial and spousal conflict, involving relationship breakdown, resource denial, and social isolation; (2) financial stress, including chronic poverty, acute debts, and perceived socioeconomic failure; (3) mental illness and substance use, notably depression, psychotic symptoms, and alcohol use complicating existing psychological distress; and (4) religious and spiritual influences on the attribution of suicidal thoughts. CONCLUSION: In this qualitative study from rural Uganda, suicide attempts across were perceived to result from intertwined interpersonal, economic, mental health, and spiritual factors. Participants rarely framed suicide as the result of a single cause, but rather as a response to cumulative and unresolved distress. Moments of missed support suggest opportunities for targeted intervention.