Community perceptions about causes of suicide among young men in Botswana: an analysis based on fuzzy cognitive maps

ABSTRACTSuicide is common in Botswana, particularly among young men. Fuzzy cognitive mapping (FCM) can support participatory research by depicting local stakeholder knowledge about causes of health outcomes. This study used FCM to explore local perceptions about causes of suicide among young men in rural communities close to the capital, Gaborone. In nine sessions, groups of young men, young women, older men, and older women separately mapped their knowledge of factors related to suicide among young men (46 people in total). Two trained facilitators, fluent in the local language, led the group sessions. The maps depicted risk and protective factors as nodes connected by arrows to show causal relationships. Participants also ranked the strength of each link on a scale of one (weakest) to five (strongest). Fuzzy transitive closure calculated the maximum influence of each factor, taking into account all other influences on the map. We combined maps by different stakeholders and grouped the 130 unique factors across the maps into 17 broader categories which emerged from an inductive thematic analysis of all the node labels. Financial difficulties, relationship problems, and family issues were the strongest categories of perceived causes of suicide by young men. Mental health problems played an intermediary role between more distal causes and suicide. There were differences in maps of different gender and age groups, but the strongest influences were consistent across groups. Young women, but not young men, identified men’s lack of self-esteem as a strong cause of suicide. The FCM findings offer a starting point for community discussions to seek local solutions to youth suicide.KEYWORDS: Southern Africamental healthself-harmcommunity interventionsparticipatory researchviolence AcknowledgmentsWe thank the men and women who contributed their time and knowledge in the FCM sessions. Sandra Cano checked the digitised maps.Disclosure statementNo potential conflict of interest was reported by the author(s).Data availability statementThe data supporting this study’s findings are available on request from the corresponding author. According to agreements with participating communities and to ensure the protection of participants and data governance, the requester will need to present a plan for data analysis, and participating communities must authorise their use for the specified purposes.Ethics reviewThis study is part of a Grand Challenges Canada project (Grant number R-ST-POC-1909–28463), which received ethical approval from the Botswana Ministry of Health under the Health Research and Development Division IRB (Reference HPDME 13/18/1).Additional informationFundingThis work was supported by Grand Challenges Canada under Grant number R-ST-POC-1909-28463Notes on contributorsIván SarmientoIván Sarmiento is an independent researcher at CIET, a member of the Groups of Studies in Traditional Health Systems, and the program administrator of Participatory Research @ McGill (PRAM). He has over two decades of experience collaborating with local and Indigenous groups in Colombia. His main interest is in promoting intercultural dialogue between Indigenous traditional medicine and Western medicine, particularly for primary health care. He has contributed to developing procedures for participatory modelling of health issues using fuzzy cognitive mapping, applying these methods in over 20 projects across eight countries.Leagajang KgakoleLeagajang Kgakole is an experienced fieldwork coordinator working with CIET in Botswana since 2007. He has a profound knowledge of local communities and their cultural ways, which has been pivotal for their engagement in participatory research.Puna MolatlhwaPuna Molatlhwa has worked with CIET in Botswana since 2010. She has coordinated CIET training in evidence-based planning for researchers and planners in 14 countries in the Southern Africa Development Community (SADC). As a seasoned fieldworker, she has trained and supervised fieldworkers for both quantitative and qualitative data collection in Botswana communities. She has a particular interest in the prevention of violence against young women.Indu GirishIndu Girish brings over 25 years of experience as a training and project management specialist in the education and NGO sectors. Her work in Botswana and India has centred on community development, education for women and children in remote areas, health communication, and economic empowerment.Neil AnderssonNeil Andersson is a Professor of Family Medicine, director of the amalgamated CIET and Participatory Research at McGill (PRAM) and co-director of the McGill Institute of Human Development and Well-being. His main focus is on method development for large scale participatory approaches that address different health issues. He is particularly concerned about reproducible and culturally safe techniques to build stakeholder voices into systematic reviews, research conceptualization and co-design, intervention development, implementation and analysis. Dr. Andersson’s current interest is in community-led randomized trials of older adult participation in dementia prevention.Anne CockcroftAnne Cockcroft is a professor of family medicine in CIET-Participatory Research at McGill (PRAM) with a background in respiratory and occupational medicine. Over the last 25 years, she has undertaken large scale community-based participatory research projects in some 20 countries. She works with vulnerable populations to document their access to and experience of health and other services, and with service providers and policy makers to use evidence to develop equitable and effective services. In the last decade, her work has focussed on co-designing interventions, implementing them, and measuring the impact. Her current work includes participatory research to improve adolescent sexual and reproductive health and community responses to the impacts of COVID-19 pandemic in Bauchi State, Nigeria, and a study of community-based interventions to reduce youth personal and interpersonal violence in Botswana.