Exploring factors contributing to suicide and suicide attempts among adults aged 20 to 45 years in Ikelenge Central, Ikelenge District, Zambia: a phenomenological study

Technical Summary: Factors Contributing to Suicide and Suicide Attempts in Ikelenge Central, Zambia

Problem Statement
Suicide remains a critical public health challenge globally and within Zambia. While local police and district health records indicate recurring suicide cases in Ikelenge District between 2019 and 2023, there is a significant gap in published evidence regarding rural settings. Existing literature largely relies on epidemiological patterns, risk estimates, and national trends, which often fail to capture the lived realities and specific causal narratives of affected individuals and families. This study addresses the lack of context-specific evidence on how community members in rural Zambia understand the causes of suicide, the support mechanisms available post-event, and the interventions they perceive as most effective for prevention.

Methodology
The research employed a qualitative phenomenological study design to explore the subjective experiences and meanings attributed to suicide and suicide attempts.

• Setting: Ikelenge Central, Ikelenge District, Zambia.
• Population: Adults aged 20 to 45 years who had either survived a suicide attempt or had a direct family experience of suicide or an attempted suicide.
• Sampling: Purposive sampling was utilized to select participants capable of providing rich, relevant accounts. Fifteen individuals were selected, with 13 participating in the study. Data saturation was reached between the tenth and thirteenth interview.
• Data Collection: In-depth interviews were conducted using a semi-structured guide covering demographics, suicide history, perceived causes, post-event support, and suggested prevention strategies.
• Analysis: Thematic analysis was performed on transcribed audio recordings using Atlas.ti. Codes were grouped into sub-themes and merged into broader themes.
• Ethics: The study received approval from the Lusaka Apex Medical University Biomedical Research Ethics Committee (Ref. LAMUBREC No. 042302042025) and clearance from the Zambia National Health Research Authority, adhering to the National Health Research Act No. 2 of 2013.

Key Contributions and Results
The study identifies that suicide and suicide attempts in this context are not the result of a single cause but arise from an accumulation of interlinked pressures across six domains:

1. Social Factors: Major drivers included parent-child conflict, wider family conflict, marital breakdown, and intimate partner conflict. These were described as damaging relationships, reducing emotional support, and fostering feelings of shame, isolation, and hopelessness.
2. Economic Factors: Poverty, financial debt, and unemployment were central stressors. In a rural setting with limited opportunities, these factors were perceived as trapping individuals, threatening their dignity and ability to meet family expectations.
3. Psychological Factors: Participants linked suicidal behavior to depression, psychosis, post-traumatic stress disorder (PTSD), and alcohol misuse. These conditions were seen as interacting with social and economic hardships rather than occurring in isolation.
4. Physiological Factors: Chronic illnesses, specifically HIV, cancer, and the impact of COVID-19, were cited as sources of suffering and fear contributing to risk.
5. Biological Factors: Some participants noted family history or genetic predisposition as a contributing element.
6. Environmental Factors: Easy access to means of suicide was identified as a condition that increases the likelihood of an attempt during a crisis.

Support and Interventions

• Current Support: Post-event support reported included hospital management, bereavement assistance, financial literacy training, and integrated care. However, participants noted that support is often uneven and focused on the aftermath rather than early prevention.
• Preferred Interventions: Community members proposed a multi-sectoral approach including:
  • Strengthening mental health services (counselling and outreach).
  • Improving emergency preparedness and crisis response.
  • Expanding economic and vocational support (livelihood strengthening).
  • Increasing community sensitization to reduce stigma and encourage help-seeking.

Significance and Claims
The paper claims that suicide in Ikelenge Central is best understood through an integrated motivational-volitional framework, where risk develops through the interaction of multiple vulnerabilities and stressors rather than a single pathway.

The study's significance lies in its provision of lived experience data from a rural Zambian setting, a context previously underrepresented in qualitative literature. By capturing the community's own explanations, the findings suggest that effective prevention cannot be framed solely as a clinical task. Instead, the paper argues for a community-informed prevention strategy that combines:

• Mental health care and social support.
• Livelihood strengthening and economic development.
• Local awareness efforts.

The authors conclude that a robust local response must move beyond narrow clinical interventions to address the overlapping social, economic, and environmental pressures identified by the community. The study acknowledges limitations regarding the small, purposively selected sample, noting that findings are not statistically generalizable but offer practical value for local planning and policy formulation in similar rural contexts.