Sociocultural perspectives on suicidal behaviour at the Coast Region of Kenya: an exploratory qualitative study

Abstract

ObjectivesTo explore perceived sociocultural factors that may influence suicidality from key informants residing in coastal Kenya.DesignWe used an exploratory qualitative study design.SettingMombasa and Kilifi Counties of Coastal Kenya.Participants25 key informants including community leaders, professionals and community members directly and indirectly affected by suicidality.MethodsWe conducted in-depth interviews with purposively selected key informants to collect data on sociocultural perspectives of suicide. Thematic analysis was used to identify key themes using both inductive and deductive processes.ResultsFour key themes were identified from the inductive content analysis of 25 in-depth interviews as being important for understanding cultural perspectives related to suicidality: (1) the stigma of suicidal behaviour, with suicidal victims perceived as weak or crazy, and suicidal act as evil and illegal; (2) the attribution of supernatural causality to suicide, for example, due to sorcery or inherited curses; (3) the convoluted pathway to care, specifically, delayed access to biomedical care and preference for informal healers; and (4) gender and age differences influencing suicide motivation, method of suicide and care seeking behaviour for suicidality.ConclusionsThis study provides an in depth understanding of cultural factors attributed to suicide in this rural community that may engender stigma, discrimination and poor access to mental healthcare in this community. We recommend multipronged and multilevel suicide prevention interventions targeted at changing stigmatising attitudes, beliefs and behaviours, and improving access to mental healthcare in the community.

Perspectives on reasons for suicidal behaviour and recommendations for suicide prevention in Kenya: qualitative study

“…They documented that the stigma was mainly driven by the dilapidated and neglected state of these facilities, as well as the lack of medication and affordable counselling services. 27 Often, because of the belief that suicidal behaviour may be linked to supernatural elements such as witchcraft or curses, 12 some people are more likely to seek mental health-related support from traditional and faith healers. 28 These services are arguably less effective or potentially harmful if the healer lacks a good understanding of mental health problems and when to refer severe cases.…”

“…The first paper explored how suicidal behaviour is conceptualised in this region, with a focus on sociocultural factors influencing suicidality. 12 It showed that suicide is conceptualised as a supernatural phenomenon in this area, perceptions around suicidality differed by gender and age, and suicidal behaviour remains highly stigmatised, leading to a convoluted self-harm care pathway.…”

“…11 Earlier work with this same cohort specifically explored social cultural conceptualisation of suicidality in this population. 12 In this paper, we report on overall reasons influencing suicidal behaviour in the Coast regionof Kenya, with a focus on recommendations for suicide prevention based on opinions, experiences and perspectives of persons residing in this region. Our study was situated in the Coast region of Kenya, where both incidence and prevalence of suicidal behaviour is known to be high; 6,13 the treatment gap for mental disorders is large and compounded by the absence of a universal healthcare coverage; 14 qualitative, in-depth understanding of suicide is lacking 15 and suicide is unfortunately still criminalised.…”

“…An earlier published paper reported on cultural context-specific exploration. 12 At the end of each interview, the participants were invited to give any additional comments or ask questions that were not covered in the interview. These comments were captured as part of the audio recordings.…”

Shine a light on suicide

“…Few studies in Kenya have examined risk factors for suicidal behaviour. Many of these studies have been quantitative surveys thereby lacking explanations and an in-depth understanding behind these factors (4,5). Some suicide risk factors repeatedly highlighted in these quantitative studies include having a mental health condition and primarily depression and substance use disorders (5).…”