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

Suicide 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.