Exploring the Underlying Causes and Contextual Determinants of Suicide Among Adolescents Under 19 Years of Age in Dezful, Iran: A Qualitative Study (2024–2025)

Every year, roughly 700,000 people around the world take their own lives, a figure that surpasses the death toll of many wars. For teenagers, this act is one of the leading causes of death, cutting short lives during a time when they are still forming their identities and learning to navigate the world. While doctors and researchers have long known that mental illness plays a role, the full picture is often more complicated than a single diagnosis. Suicide is rarely just about a broken mind; it is frequently the result of a person's internal struggles colliding with the pressures of their family, their community, and the economic realities they face. Understanding why a young person reaches this point requires looking beyond the hospital room and into the messy, often painful details of their daily lives.

In the city of Dezful, located in the southwestern part of Iran, a team of researchers set out to understand these specific pressures. They focused on adolescents under the age of 19, a group navigating the turbulent transition from childhood to adulthood. Rather than simply counting how many attempts occurred or looking for statistical patterns, the researchers wanted to hear the stories behind the numbers. They conducted a deep, qualitative study, which means they prioritized listening to personal experiences over gathering large datasets. Between 2024 and 2025, they sat down with 31 young people who had survived suicide attempts. These interviews took place in safe, private settings, often in a psychiatrist's office, where the participants could speak freely about their lives without fear of judgment. The goal was not to blame anyone, but to map the complex web of factors that led these teenagers to the edge.

The researchers found that the path to a suicide attempt was never a straight line. Instead, it was a tangled knot of nine major themes that intertwined to create a sense of hopelessness. The most prominent of these was the environment of the home itself. Many of the young people described growing up in households marked by violence, humiliation, and constant conflict. They spoke of parents who used harsh words, physical punishment, or emotional neglect to discipline them. In some families, the presence of addiction or the chaos of divorce created an atmosphere of instability where the child felt unsafe and unloved. For these adolescents, the home was not a sanctuary but a source of deep pain, where they felt rejected or trapped by excessive control.

Beyond the family walls, the researchers uncovered a heavy weight of economic hardship. Poverty was not just a background detail; it was an active force that stripped away dignity and future possibilities. Many participants lived in rural areas or struggled with unemployment, feeling that they had no way to support themselves or contribute to their families. This financial strain often amplified the tension at home, turning minor disagreements into crises. When a teenager feels they are a burden to a family that cannot afford basic needs, the sense of worthlessness can become overwhelming. The lack of money was not just about missing out on things; it was about a fundamental feeling of being stuck with no way forward.

The study also highlighted the intense struggle with identity, particularly regarding how young people saw themselves in relation to their society. Some adolescents felt a deep conflict between who they were and the strict social norms expected of them. This was especially true for those questioning their gender identity or those whose personal choices clashed with cultural traditions. In a society where reputation and family honor are paramount, the fear of judgment or rejection could be paralyzing. These teenagers felt isolated, believing that no one would understand them or accept them if they were truly seen. This sense of not belonging, combined with the pressure to conform, created a silent crisis that many felt they could not survive.

Mental health struggles were, of course, a central part of the story, but they often appeared as a reaction to these external pressures rather than the sole cause. Depression, feelings of emptiness, and a weariness with life were common threads. Some participants described hearing voices that told them to end their lives, a sign of severe psychological distress that required immediate medical attention. Others turned to substance abuse, not just as a habit, but as a way to numb the pain of their circumstances. The researchers noted that for many, a suicide attempt was not a sudden impulse but a culmination of long-term suffering, where the pain of living felt heavier than the fear of dying.

The social fabric of the community also played a critical role. The researchers found that the fear of social stigma often prevented young people from seeking help. In many cases, the shame associated with mental health problems or family conflicts meant that suffering was kept secret. When a teenager faced a romantic breakup, a betrayal, or an assault, the lack of a supportive network left them to deal with the trauma alone. The pressure to maintain a perfect image for the community, to hide the cracks in their family life, added a layer of isolation that made the pain feel inescapable. Even spiritual beliefs, which can sometimes offer comfort, were described by some as having crumbled under the weight of their suffering, leaving them feeling disconnected from any higher purpose.

Finally, the study pointed to gaps in the systems meant to protect these young people. There was a noticeable lack of accessible mental health services, legal support, and social safety nets. The researchers observed that when families and communities failed to provide a buffer against these crises, the structural weaknesses of the society became apparent. The absence of effective intervention meant that many at-risk adolescents fell through the cracks, with no one to catch them before they reached the breaking point. The findings suggest that the problem is not just about individual weakness or illness, but about a system that has not yet learned how to support its most vulnerable members.

This research offers a clear, if sobering, view of the reality in Dezful. It shows that preventing suicide among adolescents requires more than just treating depression; it demands a comprehensive approach that addresses family violence, economic inequality, social stigma, and the need for better mental health care. The stories of these 31 young people reveal that when a child feels trapped by poverty, abuse, and a lack of hope, the solution lies in changing the environment around them. By understanding the specific cultural and social pressures that drive these teenagers to despair, communities can begin to build the support systems necessary to keep them safe. The path forward involves listening to these voices, acknowledging the complexity of their struggles, and creating a world where every young person feels seen, valued, and supported.