“Nou bezwen anpil chita” (we need many chairs): Perceptions of and attitudes towards suicide in rural Haiti

Suicide is a complex, yet preventable public health problem resulting from the interaction of psychological, social, biological and environmental factors. Few studies examine local socio-cultural explanatory models of suicide outside the Western milieu, and community studies in Haiti are lacking. This study sought to describe cultural attitudes and models of suicide held by healthcare professionals and community members in rural Haiti. Semi-structured, in-depth interviews were conducted amongst 8 biomedical healthcare professionals and 16 lay community members to determine norms, perceived causal pathways, and attitudes towards suicidal behavior. Qualitative data analysis, drawing on grounded theory, addressed inductive and deductive themes including perceived suicide commonality, veracity of suicidal ideation claims, religious constructs related to suicide, suicide narratives, causal factors, and support resources for suicidality. Compared to community members, healthcare professionals were less likely to consider completed suicide a “common” and important issue. According to community respondents' accounts, pesticide poisoning was used only by women to complete suicide, while men chose sharp objects or hanging as their lethal method. Suicide narratives identified as common causes strained love relationships, public shame, extreme poverty, and “sent spirits” related to Vodou practice. These observed discrepancies between health professionals' and community members' perceptions suggest that the formal health structure may be ill-equipped to respond to suicide-related needs. Prayer and religious practice may be potential protective factors and resources for future prevention programs. Successful interventions should consider the lay contextual understanding and perceived etiology of suicide, address potential provider bias, and incorporate traditional, community-based, and religious resources.