“Sometimes I have sleepless nights and sometimes I overthink”: A qualitative study of suicide risk in young Ghanaian women with depression

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Boakye, Winifred Asare-Doku This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7437498/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background Although depression is strongly associated with suicidal behavior among young women, there is limited research in the global south and Africa on the risk of suicide among young females with clinical depression. The study examined the risk of suicide among clinically depressed women and recovery experiences. Methods We conducted interviews with ten ( 10 ) females diagnosed with depression. Interviews were transcribed and analyzed using thematic analysis. Results We identified four major themes: Depressive symptoms broadly categorized into behavior, feelings, thoughts, and physical symptoms; Perceived Causes of Depression reflecting hereditary factors and family dynamics; Depression and Suicide explored factors that influenced the suicide attempt including the feeling of hopelessness and emotional distress; and Coping Strategies. Conclusions The results emphasize the need to integrate suicide screening and early intervention to mitigate the risk of suicide behavior among young women with depression. suicide attempt suicide risk factors depression gender BACKGROUND Suicide is a major global health challenge ( 1 ). The WHO reports that about 703,000 people die by suicide globally each year, with at least one person dying every 40 seconds ( 2 , 3 ). The rate of suicide globally among women is 5.4% per every 100,000 females living in lower and middle-income countries, with Africa recording a rate of 7.1% per every 100,000 females ( 2 ). The suicide mortality rate per every 100,000 population as of 2019 in Ghana was 6.6% with 1.2% representing women ( 4 ). Prevalence studies in Ghana have reported 32% suicide attempts and 30% suicide among females ( 5 ); 29% suicide attempts among adolescent females ( 6 ), and 23.2–23.5% among senior high school females ( 7 ). Several theories have focused on depression as a major factor in suicidal behavior ( 8 , 9 ). The Escape theory proposes that suicidal ideation occurs when there is an intense feeling of failure, disappointment and setback ( 10 ). Suicide appears as the only escape from negative self-awareness ( 11 ). The hopelessness theory asserts that there is a tendency to attribute events to negative causes and consequences which is a risk factor for suicidal ideation ( 9 , 12 ). The Interpersonal theory argues that thwarted belongingness and perceived burdensomeness contribute to the desire to die by suicide ( 8 , 9 ). Beck's ( 12 ) theory remains one of the important explanations for the role of depression in suicidal behavior. For example, Beck's ( 12 ) theory identified three mechanisms for depression: the cognitive triad, negative self-schemas, and errors in logic. Beck ( 12 ) contends that people with depression have a negative view of themselves, the world and the future. The interaction of these components interferes with normal cognitive processes, which leads to impairment in perception, causing the person to become obsessed with negative thoughts ( 13 ). The result is illogical thinking about oneself, causing depression, which may lead to suicidal thoughts. Although some scholars have been critical of many of these theories, including Beck's ( 12 ) theory of depression and suicide, the insight from these theories has been useful in guiding empirical research on suicide. The present study draws on the theoretical and empirical research to understand the risk of suicide among young women with depression in Ghana. The importance of these theories is also linked to the evidence, which shows that severe major depression is the most common psychiatric disorder among people who die by suicide ( 14 ). Depression affects people of all ages and sexes globally, but disproportionately affects 50% more women than men ( 4 , 15 ). Studies in Ghana have reported similarly high levels of depression among females ( 16 ), with some studies reporting rates as high as 62% among women with fertility problems ( 17 ) and females living with HIV in Ghana ( 18 ). Although females are less likely compared to males to die by suicide, studies show that severe depression among females, especially young women strongly increases the risk of suicidal thoughts and attempts ( 19 ). Women are more vulnerable to suicidal behavior due to psychosocial stressors ( 20 ). Evidence shows a correlation between suicide ideation and attempts, and depression among women ( 21 ). Younger-age women with severe depression are more likely to experience both suicidal ideation and suicide attempts ( 19 ). Few studies have investigated depression and suicide in Africa, especially among women. Using pooled data from the Global School-based Student Health Survey (GSHS) for Ghana, Benin, Sierra Leone and Liberia, Diallo ( 22 ) analyzed a sample of 9,726 adolescents which showed that 18.6% had considered suicide while 24.7% had attempted suicide. Azasu ( 23 ) also analyzed data from the GSHS and found prevalence in suicidal ideation (19%), plan (22%) and attempt (25%). Suicidal ideation was found to increase plan, which also increased suicide attempts among middle and high school students in Ghana. These studies show consistent results in suicidal ideation and thoughts, which confirms that suicide is prevalent among young people. Suicide studies in Ghana have reported several risk factors for suicidal behaviors, which include psychological distress ( 24 ); family problems ( 25 ); abandonment, shame, existential struggles, and supernatural reasons ( 26 ). Suicide studies in Ghana have generally focused on self-reported mental health problems and their association with suicidal behavior. To effectively address the growing suicide risk among women in Ghana, an understanding of factors that may increase the risk for suicidal behaviors is essential. The present study focuses on clinical depressive symptoms exhibited by young women, perceived triggering factors of depression and suicidal thoughts, and coping strategies. METHODS Design The study employed a qualitative case study design to explore the experiences of young women with depression. The study was conducted at the largest referral hospital in the northern regional capital. Participants and Procedure Participants of the study comprised young women aged 18–35 years who have been diagnosed with depression and are either receiving or completed treatment at the Tamale Teaching Hospital. The criteria for selection were based on age (alphabets were used to distinguish between participants with similar ages) and clinical diagnosis of depression. Ten participants who met the criteria and were willing to participate were purposively sampled. A semi-structured interview guide was designed. Participants were contacted through the psychiatric units of the hospital. The head nurse called participants over the phone to introduce the study and interviewer (VSL). The interviewer explained the purpose of the study and the details of the consent form to the participants. Participants were informed that they could withdraw from the study at any time without any consequences. They were assured of confidentiality and that the information was only for the study. The interviewer with the help of psychiatric nurses retrieved files of clients diagnosed with depression from the psychiatric unit and with assistance from the head nurse, eligible clients were contacted and introduced to the study and their consent was sought. A mutually convenient time and place were set for those who consented but could not come to the hospital to be interviewed in their homes. The present research was part of a larger project which received ethical approval from the University of Ghana Ethics Committee of Humanities (ECH 216/21–22). In addition to the University ethics approval, also received ethical approval from the Department of Research and Development of the Tamale Teaching Hospital (TTH/R&D/SR/158). The ethical processes were in accordance with the Declaration of Helsinki. Some interviews were conducted over the phone for those who have moved out of the jurisdiction but were willing to participate. Participants were requested to sign a consent form and were reminded of their right to leave the study without any consequences or need to provide reasons for their decision. Some interviews were conducted in English while others were conducted in the local dialect for effective communication through an interpreter who is a psychiatrist nurse. Participants were informed the interview was going to be audio recorded before the start of the interview. The interviews lasted approximately 45 minutes and were transcribed verbatim by the interviewer. Analysis We analyzed the data using thematic analysis. The authors read the transcript and identified patterns in the data to derive themes ( 27 ). The initial list of key ideas was generated after reading and coding the data. We then search for themes from the coded data. This process involved sorting the codes into the broader potential themes. Themes were later reviewed and checked against quotes, refined, and cross-validated by the authors. The final stage was when all themes were defined, and finalized and associations between themes were discussed ( 27 ). RESULTS Participants (n = 10) were between the ages of 18–35 years and identified with the Christian (n = 5) or Islamic religion (n = 5). Participants engaged in petty trading for a living, studied or were involved in occupations such as nursing and administrative roles. Four themes emerged from the analysis of the data: Depressive symptoms, perceived causes of depression, depression and suicide, and coping strategies (see Table 1 ). Table 1 Themes and sub-themes Theme Sub-theme Depressive symptoms - Perceived causes of depression Hereditary factors Family Dynamics Depression and suicide Hopelessness Emotional distress Coping strategies Religion Family Support Prescription Medication Help-seeking behaviors Depressive symptoms In exploring participants' perceptions of depression, it became evident that they experienced a range of clinically recognized symptoms during depressive episodes. These symptoms were categorized into four primary domains: behaviours, feelings, thoughts, and physical signs. Notably, many participants reported that these symptoms often went unnoticed at first, reflecting a lack of awareness about their mental health struggles. One participant said, “ Sometimes when I hear someone make noise then I get startled.” (30 years) Another participant provided an elaborate description of her condition; “... I can’t sleep. I don’t feel myself all the time, I always feel worried…I will just have bad thoughts about myself like killing myself …. I have always been worried. I feel sad all the time, I don’t feel happy.” (27 years) “Sometimes I have sleepless nights and sometimes I overthink. And sometimes I’ll be thinking things are not in order. When somebody does something to me I get annoyed. ” (34 years) Yet others experienced existential struggles, as portrayed in the quote below, often connected with something they might have done that is contrary to their faith; “I begin to feel guilt. I begin to hear something like you are doomed for destruction, you no longer belong to God. You a now a child of the devil. So I begin to feel bad and sad.” (35(b) years). The symptoms experienced by participants were either self-identified or identified by others, including significant others. In some instances, the participants sought help themselves, or their families sought help for them. Perceived causes of depression We explored the perceived causes of depression among participants. Two main sub-themes emerged: hereditary and family dynamics. Each of these factors sheds light on how individuals perceive their mental health challenges, providing valuable insights into their lived experiences. Hereditary factors Some participants, when asked what led to their depression, stated hereditary predisposition as the perceived cause. They were convinced that depression can be passed on from mother to offspring, and this can affect the child later in life. This perception is similar to situations where, for instance, a parent who is diabetic predisposes their child to the illness, which shows itself later in life due to lifestyle choices. In this case, some participant thought a person who is predisposed to depression would start showing symptoms when they experience stressful life events that trigger the condition; “You know, from my small knowledge I know that it can be through childbirth” (33(a) years). Another said, “I inherited it from my mother.” (32 years). However, they could not explain how inheriting depressive symptoms from the mother was possible when probed further. Family Dynamics The events that occur in families are perceived to have triggered or caused depression in several participants. Conflicts among couples and family members, abuse, and death of loved ones were identified as causes of depression among some participants. Misunderstandings among couples in homes can predispose younger children to depression and when it is not resolved, can develop into severe lifelong conditions. “My father was also a soldier and they were from different tribes so they came together to marry. What happened was that most of the time, there was a misunderstanding between them. So I think that was the reason which also contributed to the depression .” (33(a) years) Another participant recounts how displaced aggression from her sister-in-law triggered her condition. When she fell ill and was under the care of her brother and his wife, there were constant arguments between the couple because of her which affected her mental health. The sister-in-law perceived their marital home was being intruded on. Moving from being independent to becoming dependent influenced the depressive symptoms: “I was living alone but when I fell sick, I had to live with my brother. His wife did not relate well with me as a sick person and whenever they fought, she would transfer her agitation on me. ” (32 years) Beliefs in some families can also predispose people to depression as is narrated by a participant whose mother was accused of plotting the husband’s death. The stigma and shame experienced by the mother affected her. One participant said, “When my father died, they accused my mother of killing him and I started having those symptoms.” (30 years) Another participant narrated how her stepmother used abusive words against her while growing up and how that affected her self-esteem and triggered depression. People with low self-esteem are unhappy most of the time, may have a negative view of themselves, and have an increased likelihood of suicidal behaviours. “Because of a lack of confidence in myself and also abusive words from stepmom. Those words made me lose self-confidence and I did not have anyone to talk to so I always kept it to myself, only crying and moving on.” (25 years) Others experienced the loss of a relative which led to the onset of their symptoms. A participant said, “Actually, I lost somebody I thought was supposed to be in my life ” (33(b) years). Another participant who was bereaved attempted suicide due to the significant loss experienced also remarked, “I lost my brother and also when my baby fell seriously ill and I thought I was going to lose her, I tried to kill myself.” (35(b) years) Depression and suicide We explored among participants ways in which depression increased the risk of suicide. Analysis of the themes showed that two depressive symptoms were more salient for suicidal behaviour or increased the risk of suicide among young women. These symptoms were hopelessness and emotional distress: Hopelessness The participant recounts how the relapse of her alcoholic mother caused her to lose hope and attempt suicide. The participant felt they could not depend on their primary caregiver to continue to support and protect them; “... I was so young, around the age of eighteen years when I was in junior high school. So, what happened was that my mother was given some medication from the psychiatric hospital to be given to me. I was happy that my mother was supporting me. But I don’t know what happened and then suddenly she went back to drinking. Which made me feel like all hope was lost and the world has come to an end ” (33(a) years) For another participant, the thought of abandonment from a family member triggered the participant to attempt suicide because the significant support was no more; “I spoke to my sister and told her about how my brother has decided to abandon me and not to take care of me. After speaking to her, I went to buy poison ” (32 years) “ You know depression is such that you feel you have lost everything you own. You can have the whole world to yourself, maybe you just be there and go like I have lost everything what am I living for? What else am I….You see, it can get you to that extent .” (33(b) years) Emotional distress Emotional distress is a symptom of depression that affects a person’s emotional response to present events or memories of occurrences which results in helplessness, feelings of guilt and worrying. The key factors that triggered emotional distress were loneliness, academic struggles and infidelity. A participant noted that, “Because I have no one so sometimes I just feel loneliness and emptiness in my heart. I will just feel that why did I come into the world and why God created me ” (27 years). Another participant attempted suicide when their exam results were not released. Her colleagues were advancing to tertiary institutions, but she could not make progress, and she was made fun of due to the assumption that her results were not released because she failed. She said, “I attempted suicide because of my exam results. After my WASSCE (West African Senior School Certificate Examination), I couldn’t find my results” (25 years). A participant narrates how she tried killing herself because her husband was distrustful. The participant felt betrayed and felt that taking their life would serve as punishment for the husband: “ The children damaged my husband’s phone, so he had to go to town and repair it, and when he went, he was asked to provide identification. So he called me to check his bag and take his passport and I found an opened condom box in his bag. I am quick-tempered, so I got angry and confronted him about his travel for work when he left me to take care of the three children alone .” (34 years). Coping strategies In our exploration of the coping methods employed by participants experiencing depression, three primary strategies emerged: religion, family support, and medication and help-seeking behaviors. Each of these strategies offers valuable insights into how individuals navigate their mental health challenges and seek relief from their depressive symptoms. Religion As almost all the participants identified with either the Christian or Islamic faith, it was not surprising that their religious beliefs and practices impacted their coping approach. A participant narrated how joining a Christian religious group in secondary school helped overcome difficult times. The participant was a member of the Scripture Union that formed a support system to cope by practicing Christian rituals such as praying and reading scripture; “ So when I went to the secondary school too I joined Scripture Union. They normally fast during the week for some days which helped me. ” (33(a) years) Others described how verses from the scripture helped them to renew their faith and redirect their attention to God. “ I read in Ecclesiastes 9:7 that not those who always run that always win the race nor the mighty, but things and time overtake them all. So when I read that verse, I got to know that if God is in control of my life, I should give glory to him ” (25 years) A participant described seeking the help of God through prayer in times of difficulty helped to manage the depression. Even though she sought medical assistance, prayers were still offered because of her faith in God to heal; “ I always cry to God to help me. The only thing I always say is God help me. Even if I am sleeping in the night I am crying. So managing it, I always see myself as whatever is the will of God let it be .“ (35(b) years) Yet still, others spoke to religious leaders who appeared to have some knowledge of the symptoms of mental disorders and were able to refer them to a mental health facility. In Ghana, the first port of call in such situations for some people would be to see a spiritual leader. Hence, it is not surprising that based on their beliefs, some participants confided in religious leaders. “ I am a Muslim and I told my friend’s dad who is a pastor what I have been experiencing and he advised me to attend church with them for prayers but I declined because I’m Muslim. I was having strange dreams so the pastor took me to the mental health facility and they gave me medication .” (27 years) Family Support The support that families give to a person suffering from depression was observed to have helped some participants cope with depression. A participant had support from the sister and husband to facilitate her recovery: “ My sister gave me the needed support. She created a friendly environment for me so I always feel comfortable when I am with her family who are supportive. so I will say they were the people who helped me to regain the happiness I’m having now .” (25 years) Having trusted people to seek support from when going through a suicidal crisis is protective. Some participants had trust in their close family and were able to express their thoughts and feelings without judgment from them. One participant said, “ My mom was there to talk to me and other people were there to also talk to me” (23 years). Another remarked that, “I talk to my siblings and I try to speak to those I can confide in ” (33(b) years) A participant reported opening up about what was happening to her to the stepmother who is a health worker with knowledge about depression. The participant perceived that although the relationship with the stepmother was challenging, she confided in her which ultimately led to receiving help. “ Even though she was my stepmom, and we were not that close, I was struggling so i opened up to her about what I was going through and she was so willing to help me. She arranged for me to get help at the hospital .” (33(a) years) Prescription Medication Some participants coped by relying on the medication prescribed to them by psychiatrists. They reported that when they adhered to the prescription, they felt much better. “ I have been taking the medicine but when I don’t have money to buy more and I remember how my child comes to hug me when she returns from school every day then I consider the troubles she will go through if I am not around .” (32 years) Antidepressants are a key part of treating depression, and the participants reported they helped to improve their mood. A participant noted that, “ The only thing I do is to go and get medication from the psychiatric hospital .” (35(a) years). Another remarked that, “ The support I had from the psychiatric hospital helped. The medications helped. ” (30 years). The medication helped to improve their moods and function which enabled them to go about their activities without interference. Help-seeking behaviors Another participant disclosed that she discussed her symptoms with a doctor and yet, her symptoms were attributed to her fertility problems without exploring other potential causes. The doctor attributed the symptoms to anxiety due to the desire to conceive: “ I complained to many doctors, but they couldn’t understand. Like the doctor I complained to first time said it’s because I am anxious. So when I complained to her, she told me that’s what happens to many women when they are looking to get pregnant and they become anxious about it and they begin to experience that so I should relax .” (35(b) years) Family members and religious leaders sought help for participants after becoming aware of the symptoms they were experiencing. A participant reported opening up about what was happening to her to the stepmother who is a health worker with knowledge about depression and sought help for her. “ Even though she was my stepmom, the relationship wasn’t that close. So, she realized I wasn’t opening up to her. So, one day I couldn’t stand my feelings, I had to voice out to her what I was going through and she was so willing to help me. By then, she was also working at 37 Military Hospital. That’s where she arranged all these for me .”(33(a) years) The participant perceived that although the relationship with the stepmother was challenging, she confided in her which ultimately led to receiving help. Talking to family or trusted friends provides an opportunity to receive support. DISCUSSION The study examined symptoms exhibited by women diagnosed with depression, perceived causes, the intersection between depression and suicide, and coping strategies. Symptoms of depression as described by the participants were similar to known clinical symptoms ( 19 , 28 ). Other studies in Ghana have reported a high prevalence of depression among pregnant women with limited studies on depression among young women ( 29 ). The depressive symptoms identified in this study were self-reported. Most participants lacked the knowledge to identify and relate their symptoms to any mental health condition. The same can be said for family members who sought help for them in medical facilities. The lack of awareness increases the risk of the participant not receiving the appropriate help. Some participants perceived their depression was caused by hereditary factors, partner infidelity, accusations, and abuse. Similar findings have been reported in previous studies ( 25 ). Some studies in Ghana have also reported excessive worrying, anxiety, marital and relational problems, spiritual illness, substance abuse, and punishment for past wrongdoing as causes of mental illness ( 30 ). However, it is interesting that none of the participants attributed depression to spiritual causes reported in some previous studies in Ghana ( 30 ). Psychological distress, abandonment and existential struggles were identified as risk factors for suicide among some participants in this study which has also been reported elsewhere ( 24 , 26 ). In the state of loneliness, hopelessness and negative thoughts about oneself, suicidal ideation was formed in some participants which provides some support for the cognitive theory ( 9 , 12 ). Hopelessness has been identified as an important risk factor for suicide as found in the current study ( 31 ). All participants had been diagnosed with clinical depression, although the majority were unaware of the symptoms of depression at the time. There is a need to create more awareness of mental health among the broader population to allow early help-seeking. In addition to the awareness creation, contextualizing mental health literacy and ensuring education in local dialect to enhance understanding is critical. Others reported they sought help from family and religious leaders which is not surprising in the Ghanaian context. Other studies have reported help-seeking for mental health problems from non-professionals such as family, friends and religious leaders ( 32 , 33 , 34 ). These non-professionals can serve as gatekeepers to identify early symptoms of mental health problems. Three main coping strategies were identified including medication, family support, the use of religion and help-seeking behaviours. In the Ghanaian context, it is not surprising for people to seek help from different sources concurrently with religion being one of the main coping mechanisms, especially if it is believed to be a cause of the problem. The use of hospitals, prayer camps, religious leaders, herbalists and traditional healers has been reported in other studies in Ghana as sources of help to address mental illness ( 30 , 32 , 34 ). Interestingly, participants had a positive view of psychotropic medications and adhered to the medications to improve their mood. Few studies have reported the use of such medications in treating depression ( 35 , 36 , 37 ). Study participants were diagnosed by a psychiatrist, hence not surprising that medication was being used to treat depression. With depression being a risk factor for suicide, young people experiencing/diagnosed with depression must be regularly assessed and monitored for suicide risk for early intervention. It is important to screen for suicidality independently of having a depression diagnosis. There are several limitations to this study. First, participants were selected from a health facility. The findings reported in this study may therefore be specific to this group of patients and unlikely to reflect the experiences of young women with depression and at risk of suicide. Second, the difficulty in recruiting participants and the small number that participated in the study implies caution in interpreting the findings as representing the experiences of young women who have experienced depression and increased risk of suicide. Lastly, there was a language barrier and difficulty in accurately representing concepts such as suicide and depression in the local dialect. Although an effort was made to ensure that participants understood the meanings of these terms and the focus of the research, some participants may have a challenge understanding these requirements. CONCLUSION This study has highlighted the depressive symptoms, perceived causes, risk factors of depression and suicide and coping strategies among young women. Participants experienced a range of depressive symptoms, often unrecognised at onset, with hereditary predisposition and adverse family dynamics identified as key perceived causes. Hopelessness and emotional distress emerged as prominent drivers of suicidal behaviour. Coping strategies centred on religion, family support, medication, and help-seeking, though misattribution of symptoms sometimes delayed care. The findings of this study provide some support for Beck’s Theory that people with depression tend to have a negative view of themselves, the world and the future, and this has contributed to suicidal ideation and attempts, as shown in the study. These findings highlight the need for multi-level prevention strategies. Public education campaigns and routine screening in primary care could improve early recognition and reduce diagnostic delays. Family-based interventions, including psychoeducation and conflict resolution support, may mitigate interpersonal stressors that trigger or worsen depression. Given the influence of religious leaders, mental health literacy training within faith communities could enhance referral to appropriate services. Strengthening suicide prevention efforts, improving access to mental health services, and supporting medication adherence may help reduce the burden of depression in similar contexts. Declarations Ethics approval and consent to participate : Participation in the study was voluntary and informed consent was obtained from each participant upon entry into the study. Consent for publication : Participants who agreed to participate in the study were given informed consent about the details of the research and signed consent forms They were informed that results will be published widely to the public. Availability of data and materials : Access to the data can be made available upon demand from the lead author. Competing interests : The authors declare that they have no competing interests. Funding : This study received no funding. Authors' contributions : VSL and KEB contributed to the study concept and design, analysis, and interpretation. VSL conducted data collection, drafted the introduction and methodology. VSL and WA-D analyzed the data and wrote the discussions. KEB provided critical analyses on the interpretations. All authors read and approved the final manuscript. Acknowledgements : We acknowledge all the participants who made time to share their experiences with us in this study and to the staff of Tamale Teaching Hospital who assisted the study. Authors' information Victoria Sia lebbie https://orcid.org/0009-0009-9387-7242 Kofi E. Boakye https://orcid.org/0000-0002-2715-3301 Winifred Asare-Doku https://orcid.org/0000-0002-9907-3511 “For the purpose of open access, the author has applied a Creative Commons Attribution (CC BY) licence to the Author Accepted Manuscript version arising from this submission.” References WHO, Suicide, World Health Organization. ; 2019 [Available from: https://www.who.int/news-room/factsheets/detail/suicide WHO, Suicide. World Health Organization; 2021 [Available from: World Health Organization. WHO, Preventing Suicide. 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Increases in depression, self-harm, and suicide among US adolescents after 2012 and links to technology use: possible mechanisms. Psychiatric Res Clin Pract. 2020;2(1):19–25. Kugbey N, Ayanore M, Doegah P, Chirwa M, Bartels SA, Davison CM, et al. Prevalence and correlates of prenatal depression, anxiety and suicidal behaviours in the Volta Region of Ghana. Int J Environ Res Public Health. 2021;18(11):5857. Opare-Henaku A, Utsey SO. Culturally prescribed beliefs about mental illness among the Akan of Ghana. Transcult Psychiatry. 2017;54(4):502–22. Young MA, Fogg LF, Scheftner W, Fawcett J, Akiskal H, Maser J. Stable trait components of hopelessness: baseline and sensitivity to depression. J Abnorm Psychol. 1996;105(2):155. Ae-Ngibise K, Cooper S, Adiibokah E, Akpalu B, Lund C, Doku V, et al. Whether you like it or not people with mental problems are going to go to them’: a qualitative exploration into the widespread use of traditional and faith healers in the provision of mental health care in Ghana. Int Rev psychiatry. 2010;22(6):558–67. Asare-Doku W, James C, Rich JL, Amponsah-Tawiah K, Kelly B. Mental health is not our core business: A qualitative study of mental health supports in the Ghanaian mining industry. Saf Sci. 2022;145:105484. Osafo J, Asare-Doku W, Akotia CS. Exploring the role of religion in the recovery experiences of suicide attempt survivors in Ghana. BMC Psychiatry. 2023;23(1):219. Canavan M, Sipsma H, Jack H, Ohene S, Rohrbaugh R, Bradley E, et al. Psychoactive prescription practices for serious mental and neurological illness in Ghana: Data from the Mental Health and Poverty Project (MHaPP). Int J Mental Health. 2016;45(4):223–35. Oppong S, Kretchy IA, Imbeah EP, Afrane BA. Managing mental illness in Ghana: the state of commonly prescribed psychotropic medicines. Int J Mental Health Syst. 2016;10(1):28. Read U. I want the one that will heal me completely so it won’t come back again: the limits of antipsychotic medication in rural Ghana. Transcult Psychiatry. 2012;49(3–4):438–60. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7437498","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":532600451,"identity":"ce144e54-c13a-4855-a3ff-29480d8e1aea","order_by":0,"name":"Victoria Sia Lebbie","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA8UlEQVRIiWNgGAWjYFAC5gZmxgYJBn64wAGgGH4tjBAtkg0wdURqYWAwOECsFoPzBxsfF+6wkDM+f/4AM88vBjm+GwnMrwvwabmR2Gw884yEsdmNZAZm3j4GY8kbCWzWM/BokZzB2CbN2yaRuO0GM1BLD0PiBqAWYx58WvoPtv8Gaqnf3H8YrKWeoBZ+hsQ2ZqCWBAMGoMN4fjAkGAD98hivFonEZmmgXwxn3Eg2ODi3QcJw5pmHbcz4tLDxHz74uXBHnTx//8GHD978sZHnO558+DM+LSjgAGObBJCCkMSCP2CS+QMJWkbBKBgFo2D4AwBloUusPN5adAAAAABJRU5ErkJggg==","orcid":"","institution":"University of Ghana","correspondingAuthor":true,"prefix":"","firstName":"Victoria","middleName":"Sia","lastName":"Lebbie","suffix":""},{"id":532600453,"identity":"f1870d2a-2aaa-4f49-8974-734af8decdbe","order_by":1,"name":"Kofi E. Boakye","email":"","orcid":"","institution":"University of Leicester","correspondingAuthor":false,"prefix":"","firstName":"Kofi","middleName":"E.","lastName":"Boakye","suffix":""},{"id":532600454,"identity":"7798fe8e-2344-464b-b9ac-2e1f3fc0beb8","order_by":2,"name":"Winifred Asare-Doku","email":"","orcid":"","institution":"University of New South Wales","correspondingAuthor":false,"prefix":"","firstName":"Winifred","middleName":"","lastName":"Asare-Doku","suffix":""}],"badges":[],"createdAt":"2025-08-22 21:53:31","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-7437498/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7437498/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":94162638,"identity":"da722c01-96dc-495a-84a3-4c19872547aa","added_by":"auto","created_at":"2025-10-23 05:15:17","extension":"docx","order_by":0,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":5187820,"visible":true,"origin":"","legend":"","description":"","filename":"Manuscript.docx","url":"https://assets-eu.researchsquare.com/files/rs-7437498/v1/7c6488c23ec47b34420be3dc.docx"},{"id":94162634,"identity":"accee0ec-0fdc-4940-9da8-63a2a2d656a4","added_by":"auto","created_at":"2025-10-23 05:15:17","extension":"json","order_by":1,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":4647,"visible":true,"origin":"","legend":"","description":"","filename":"67caa3b9f21b41088817f91632063497.json","url":"https://assets-eu.researchsquare.com/files/rs-7437498/v1/cf435c39078b92eb00fda9c9.json"},{"id":94162637,"identity":"415eea9c-a7ad-4fed-a388-4bd0c5ea15e6","added_by":"auto","created_at":"2025-10-23 05:15:17","extension":"xml","order_by":2,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":90671,"visible":true,"origin":"","legend":"","description":"","filename":"67caa3b9f21b41088817f916320634971enriched.xml","url":"https://assets-eu.researchsquare.com/files/rs-7437498/v1/8eface19906d726885f662f4.xml"},{"id":94162636,"identity":"29677206-f9c2-41d1-ba2f-fc5cfffe82a4","added_by":"auto","created_at":"2025-10-23 05:15:17","extension":"xml","order_by":3,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":87669,"visible":true,"origin":"","legend":"","description":"","filename":"67caa3b9f21b41088817f916320634971structuring.xml","url":"https://assets-eu.researchsquare.com/files/rs-7437498/v1/2ce929fc2ca6a100cced4481.xml"},{"id":94162635,"identity":"d82aefd4-67b2-4d34-9b1d-dac755768c98","added_by":"auto","created_at":"2025-10-23 05:15:17","extension":"html","order_by":4,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":98819,"visible":true,"origin":"","legend":"","description":"","filename":"earlyproof.html","url":"https://assets-eu.researchsquare.com/files/rs-7437498/v1/0c06de8b21dab695a8fde53b.html"},{"id":96605624,"identity":"51a5899f-baed-40bf-9e00-73ec70d36846","added_by":"auto","created_at":"2025-11-24 09:23:42","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":605961,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7437498/v1/f8b38d92-fb6e-40a0-957a-37c5d308e2f9.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"“Sometimes I have sleepless nights and sometimes I overthink”: A qualitative study of suicide risk in young Ghanaian women with depression","fulltext":[{"header":"BACKGROUND","content":"\u003cp\u003eSuicide is a major global health challenge (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e). The WHO reports that about 703,000 people die by suicide globally each year, with at least one person dying every 40 seconds (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e). The rate of suicide globally among women is 5.4% per every 100,000 females living in lower and middle-income countries, with Africa recording a rate of 7.1% per every 100,000 females (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e). The suicide mortality rate per every 100,000 population as of 2019 in Ghana was 6.6% with 1.2% representing women (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e). Prevalence studies in Ghana have reported 32% suicide attempts and 30% suicide among females (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e); 29% suicide attempts among adolescent females (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e), and 23.2\u0026ndash;23.5% among senior high school females (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eSeveral theories have focused on depression as a major factor in suicidal behavior (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e). The Escape theory proposes that suicidal ideation occurs when there is an intense feeling of failure, disappointment and setback (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e). Suicide appears as the only escape from negative self-awareness (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e). The hopelessness theory asserts that there is a tendency to attribute events to negative causes and consequences which is a risk factor for suicidal ideation (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e). The Interpersonal theory argues that thwarted belongingness and perceived burdensomeness contribute to the desire to die by suicide (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e). Beck's (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e) theory remains one of the important explanations for the role of depression in suicidal behavior. For example, Beck's (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e) theory identified three mechanisms for depression: the cognitive triad, negative self-schemas, and errors in logic. Beck (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e) contends that people with depression have a negative view of themselves, the world and the future. The interaction of these components interferes with normal cognitive processes, which leads to impairment in perception, causing the person to become obsessed with negative thoughts (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e). The result is illogical thinking about oneself, causing depression, which may lead to suicidal thoughts. Although some scholars have been critical of many of these theories, including Beck's (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e) theory of depression and suicide, the insight from these theories has been useful in guiding empirical research on suicide. The present study draws on the theoretical and empirical research to understand the risk of suicide among young women with depression in Ghana.\u003c/p\u003e\u003cp\u003eThe importance of these theories is also linked to the evidence, which shows that severe major depression is the most common psychiatric disorder among people who die by suicide (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e). Depression affects people of all ages and sexes globally, but disproportionately affects 50% more women than men (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e). Studies in Ghana have reported similarly high levels of depression among females (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e), with some studies reporting rates as high as 62% among women with fertility problems (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e) and females living with HIV in Ghana (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eAlthough females are less likely compared to males to die by suicide, studies show that severe depression among females, especially young women strongly increases the risk of suicidal thoughts and attempts (\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e). Women are more vulnerable to suicidal behavior due to psychosocial stressors (\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e). Evidence shows a correlation between suicide ideation and attempts, and depression among women (\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e). Younger-age women with severe depression are more likely to experience both suicidal ideation and suicide attempts (\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eFew studies have investigated depression and suicide in Africa, especially among women. Using pooled data from the Global School-based Student Health Survey (GSHS) for Ghana, Benin, Sierra Leone and Liberia, Diallo (\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e) analyzed a sample of 9,726 adolescents which showed that 18.6% had considered suicide while 24.7% had attempted suicide. Azasu (\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e) also analyzed data from the GSHS and found prevalence in suicidal ideation (19%), plan (22%) and attempt (25%). Suicidal ideation was found to increase plan, which also increased suicide attempts among middle and high school students in Ghana. These studies show consistent results in suicidal ideation and thoughts, which confirms that suicide is prevalent among young people.\u003c/p\u003e\u003cp\u003eSuicide studies in Ghana have reported several risk factors for suicidal behaviors, which include psychological distress (\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e); family problems (\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e); abandonment, shame, existential struggles, and supernatural reasons (\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e). Suicide studies in Ghana have generally focused on self-reported mental health problems and their association with suicidal behavior. To effectively address the growing suicide risk among women in Ghana, an understanding of factors that may increase the risk for suicidal behaviors is essential. The present study focuses on clinical depressive symptoms exhibited by young women, perceived triggering factors of depression and suicidal thoughts, and coping strategies.\u003c/p\u003e"},{"header":"METHODS","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003eDesign\u003c/h2\u003e\u003cp\u003eThe study employed a qualitative case study design to explore the experiences of young women with depression. The study was conducted at the largest referral hospital in the northern regional capital.\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eParticipants and Procedure\u003c/h3\u003e\n\u003cp\u003eParticipants of the study comprised young women aged 18\u0026ndash;35 years who have been diagnosed with depression and are either receiving or completed treatment at the Tamale Teaching Hospital. The criteria for selection were based on age (alphabets were used to distinguish between participants with similar ages) and clinical diagnosis of depression. Ten participants who met the criteria and were willing to participate were purposively sampled. A semi-structured interview guide was designed.\u003c/p\u003e\u003cp\u003eParticipants were contacted through the psychiatric units of the hospital. The head nurse called participants over the phone to introduce the study and interviewer (VSL). The interviewer explained the purpose of the study and the details of the consent form to the participants. Participants were informed that they could withdraw from the study at any time without any consequences. They were assured of confidentiality and that the information was only for the study. The interviewer with the help of psychiatric nurses retrieved files of clients diagnosed with depression from the psychiatric unit and with assistance from the head nurse, eligible clients were contacted and introduced to the study and their consent was sought. A mutually convenient time and place were set for those who consented but could not come to the hospital to be interviewed in their homes. The present research was part of a larger project which received ethical approval from the University of Ghana Ethics Committee of Humanities (ECH 216/21\u0026ndash;22). In addition to the University ethics approval, also received ethical approval from the Department of Research and Development of the Tamale Teaching Hospital (TTH/R\u0026amp;D/SR/158). The ethical processes were in accordance with the Declaration of Helsinki. Some interviews were conducted over the phone for those who have moved out of the jurisdiction but were willing to participate. Participants were requested to sign a consent form and were reminded of their right to leave the study without any consequences or need to provide reasons for their decision. Some interviews were conducted in English while others were conducted in the local dialect for effective communication through an interpreter who is a psychiatrist nurse. Participants were informed the interview was going to be audio recorded before the start of the interview. The interviews lasted approximately 45 minutes and were transcribed verbatim by the interviewer.\u003c/p\u003e\n\u003ch3\u003eAnalysis\u003c/h3\u003e\n\u003cp\u003eWe analyzed the data using thematic analysis. The authors read the transcript and identified patterns in the data to derive themes (\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e). The initial list of key ideas was generated after reading and coding the data. We then search for themes from the coded data. This process involved sorting the codes into the broader potential themes. Themes were later reviewed and checked against quotes, refined, and cross-validated by the authors. The final stage was when all themes were defined, and finalized and associations between themes were discussed (\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e).\u003c/p\u003e"},{"header":"RESULTS","content":"\u003cp\u003eParticipants (n\u0026thinsp;=\u0026thinsp;10) were between the ages of 18\u0026ndash;35 years and identified with the Christian (n\u0026thinsp;=\u0026thinsp;5) or Islamic religion (n\u0026thinsp;=\u0026thinsp;5). Participants engaged in petty trading for a living, studied or were involved in occupations such as nursing and administrative roles. Four themes emerged from the analysis of the data: Depressive symptoms, perceived causes of depression, depression and suicide, and coping strategies (see Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eThemes and sub-themes\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"2\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTheme\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSub-theme\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDepressive symptoms\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e-\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePerceived causes of depression\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eHereditary factors\u003c/p\u003e\u003cp\u003eFamily Dynamics\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDepression and suicide\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eHopelessness\u003c/p\u003e\u003cp\u003eEmotional distress\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCoping strategies\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eReligion\u003c/p\u003e\u003cp\u003eFamily Support\u003c/p\u003e\u003cp\u003ePrescription Medication\u003c/p\u003e\u003cp\u003eHelp-seeking behaviors\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\n\u003ch3\u003eDepressive symptoms\u003c/h3\u003e\n\u003cp\u003eIn exploring participants' perceptions of depression, it became evident that they experienced a range of clinically recognized symptoms during depressive episodes. These symptoms were categorized into four primary domains: behaviours, feelings, thoughts, and physical signs. Notably, many participants reported that these symptoms often went unnoticed at first, reflecting a lack of awareness about their mental health struggles. One participant said, \u0026ldquo;\u003cem\u003eSometimes when I hear someone make noise then I get startled.\u0026rdquo;\u003c/em\u003e (30 years)\u003c/p\u003e\u003cp\u003eAnother participant provided an elaborate description of her condition;\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e\u003cem\u003e\u0026ldquo;... I can\u0026rsquo;t sleep. I don\u0026rsquo;t feel myself all the time, I always feel worried\u0026hellip;I will just have bad thoughts about myself like killing myself \u0026hellip;. I have always been worried. I feel sad all the time, I don\u0026rsquo;t feel happy.\u0026rdquo;\u003c/em\u003e (27 years)\u003c/p\u003e\u003cp\u003e\u003cem\u003e\u0026ldquo;Sometimes I have sleepless nights and sometimes I overthink. And sometimes I\u0026rsquo;ll be thinking things are not in order. When somebody does something to me I get annoyed. \u0026rdquo;\u003c/em\u003e (34 years)\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eYet others experienced existential struggles, as portrayed in the quote below, often connected with something they might have done that is contrary to their faith; \u003cem\u003e\u0026ldquo;I begin to feel guilt. I begin to hear something like you are doomed for destruction, you no longer belong to God. You a now a child of the devil. So I begin to feel bad and sad.\u0026rdquo; (35(b) years).\u003c/em\u003e\u003c/p\u003e\u003cp\u003eThe symptoms experienced by participants were either self-identified or identified by others, including significant others. In some instances, the participants sought help themselves, or their families sought help for them.\u003c/p\u003e\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\u003ch2\u003ePerceived causes of depression\u003c/h2\u003e\u003cp\u003eWe explored the perceived causes of depression among participants. Two main sub-themes emerged: hereditary and family dynamics. Each of these factors sheds light on how individuals perceive their mental health challenges, providing valuable insights into their lived experiences.\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eHereditary factors\u003c/h3\u003e\n\u003cp\u003eSome participants, when asked what led to their depression, stated hereditary predisposition as the perceived cause. They were convinced that depression can be passed on from mother to offspring, and this can affect the child later in life. This perception is similar to situations where, for instance, a parent who is diabetic predisposes their child to the illness, which shows itself later in life due to lifestyle choices. In this case, some participant thought a person who is predisposed to depression would start showing symptoms when they experience stressful life events that trigger the condition; \u003cem\u003e\u0026ldquo;You know, from my small knowledge I know that it can be through childbirth\u0026rdquo;\u003c/em\u003e (33(a) years). Another said, \u003cem\u003e\u0026ldquo;I inherited it from my mother.\u0026rdquo;\u003c/em\u003e (32 years). However, they could not explain how inheriting depressive symptoms from the mother was possible when probed further.\u003c/p\u003e\n\u003ch3\u003eFamily Dynamics\u003c/h3\u003e\n\u003cp\u003eThe events that occur in families are perceived to have triggered or caused depression in several participants. Conflicts among couples and family members, abuse, and death of loved ones were identified as causes of depression among some participants. Misunderstandings among couples in homes can predispose younger children to depression and when it is not resolved, can develop into severe lifelong conditions.\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e\u003cem\u003e\u0026ldquo;My father was also a soldier and they were from different tribes so they came together to marry. What happened was that most of the time, there was a misunderstanding between them. So I think that was the reason which also contributed to the depression\u003c/em\u003e.\u0026rdquo; (33(a) years)\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eAnother participant recounts how displaced aggression from her sister-in-law triggered her condition. When she fell ill and was under the care of her brother and his wife, there were constant arguments between the couple because of her which affected her mental health. The sister-in-law perceived their marital home was being intruded on. Moving from being independent to becoming dependent influenced the depressive symptoms:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e\u003cem\u003e\u0026ldquo;I was living alone but when I fell sick, I had to live with my brother. His wife did not relate well with me as a sick person and whenever they fought, she would transfer her agitation on me.\u003c/em\u003e \u0026rdquo; (32 years)\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eBeliefs in some families can also predispose people to depression as is narrated by a participant whose mother was accused of plotting the husband\u0026rsquo;s death. The stigma and shame experienced by the mother affected her. One participant said, \u003cem\u003e\u0026ldquo;When my father died, they accused my mother of killing him and I started having those symptoms.\u0026rdquo;\u003c/em\u003e (30 years)\u003c/p\u003e\u003cp\u003eAnother participant narrated how her stepmother used abusive words against her while growing up and how that affected her self-esteem and triggered depression. People with low self-esteem are unhappy most of the time, may have a negative view of themselves, and have an increased likelihood of suicidal behaviours.\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e\u003cem\u003e\u0026ldquo;Because of a lack of confidence in myself and also abusive words from stepmom. Those words made me lose self-confidence and I did not have anyone to talk to so I always kept it to myself, only crying and moving on.\u0026rdquo;\u003c/em\u003e (25 years)\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eOthers experienced the loss of a relative which led to the onset of their symptoms. A participant said, \u003cem\u003e\u0026ldquo;Actually, I lost somebody I thought was supposed to be in my life\u003c/em\u003e\u0026rdquo; (33(b) years). Another participant who was bereaved attempted suicide due to the significant loss experienced also remarked, \u003cem\u003e\u0026ldquo;I lost my brother and also when my baby fell seriously ill and I thought I was going to lose her, I tried to kill myself.\u0026rdquo;\u003c/em\u003e (35(b) years)\u003c/p\u003e\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e\u003ch2\u003eDepression and suicide\u003c/h2\u003e\u003cp\u003eWe explored among participants ways in which depression increased the risk of suicide. Analysis of the themes showed that two depressive symptoms were more salient for suicidal behaviour or increased the risk of suicide among young women. These symptoms were hopelessness and emotional distress:\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec12\" class=\"Section2\"\u003e\u003ch2\u003eHopelessness\u003c/h2\u003e\u003cp\u003eThe participant recounts how the relapse of her alcoholic mother caused her to lose hope and attempt suicide. The participant felt they could not depend on their primary caregiver to continue to support and protect them;\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e\u0026ldquo;...\u003cem\u003eI was so young, around the age of eighteen years when I was in junior high school. So, what happened was that my mother was given some medication from the psychiatric hospital to be given to me. I was happy that my mother was supporting me. But I don\u0026rsquo;t know what happened and then suddenly she went back to drinking. Which made me feel like all hope was lost and the world has come to an end\u003c/em\u003e\u0026rdquo; (33(a) years)\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eFor another participant, the thought of abandonment from a family member triggered the participant to attempt suicide because the significant support was no more;\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e\u0026ldquo;I spoke to my sister and told her about how my brother has decided to abandon me and not to take care of me. After speaking to her, I went to buy poison \u0026rdquo; (32 years)\u003c/p\u003e\u003cp\u003e\u0026ldquo;\u003cem\u003eYou know depression is such that you feel you have lost everything you own. You can have the whole world to yourself, maybe you just be there and go like I have lost everything what am I living for? What else am I\u0026hellip;.You see, it can get you to that extent\u003c/em\u003e.\u0026rdquo; (33(b) years)\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec13\" class=\"Section2\"\u003e\u003ch2\u003eEmotional distress\u003c/h2\u003e\u003cp\u003eEmotional distress is a symptom of depression that affects a person\u0026rsquo;s emotional response to present events or memories of occurrences which results in helplessness, feelings of guilt and worrying. The key factors that triggered emotional distress were loneliness, academic struggles and infidelity. A participant noted that, \u003cem\u003e\u0026ldquo;Because I have no one so sometimes I just feel loneliness and emptiness in my heart. I will just feel that why did I come into the world and why God created me\u003c/em\u003e\u0026rdquo; (27 years). Another participant attempted suicide when their exam results were not released. Her colleagues were advancing to tertiary institutions, but she could not make progress, and she was made fun of due to the assumption that her results were not released because she failed. She said, \u003cem\u003e\u0026ldquo;I attempted suicide because of my exam results. After my WASSCE (West African Senior School Certificate Examination), I couldn\u0026rsquo;t find my results\u0026rdquo;\u003c/em\u003e (25 years).\u003c/p\u003e\u003cp\u003eA participant narrates how she tried killing herself because her husband was distrustful. The participant felt betrayed and felt that taking their life would serve as punishment for the husband:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e\u0026ldquo;\u003cem\u003eThe children damaged my husband\u0026rsquo;s phone, so he had to go to town and repair it, and when he went, he was asked to provide identification. So he called me to check his bag and take his passport and I found an opened condom box in his bag. I am quick-tempered, so I got angry and confronted him about his travel for work when he left me to take care of the three children alone\u003c/em\u003e.\u0026rdquo; (34 years).\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec14\" class=\"Section2\"\u003e\u003ch2\u003eCoping strategies\u003c/h2\u003e\u003cp\u003eIn our exploration of the coping methods employed by participants experiencing depression, three primary strategies emerged: religion, family support, and medication and help-seeking behaviors. Each of these strategies offers valuable insights into how individuals navigate their mental health challenges and seek relief from their depressive symptoms.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec15\" class=\"Section2\"\u003e\u003ch2\u003eReligion\u003c/h2\u003e\u003cp\u003eAs almost all the participants identified with either the Christian or Islamic faith, it was not surprising that their religious beliefs and practices impacted their coping approach. A participant narrated how joining a Christian religious group in secondary school helped overcome difficult times. The participant was a member of the Scripture Union that formed a support system to cope by practicing Christian rituals such as praying and reading scripture; \u0026ldquo;\u003cem\u003eSo when I went to the secondary school too I joined Scripture Union. They normally fast during the week for some days which helped me.\u003c/em\u003e\u0026rdquo; (33(a) years)\u003c/p\u003e\u003cp\u003eOthers described how verses from the scripture helped them to renew their faith and redirect their attention to God.\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e\u0026ldquo;\u003cem\u003eI read in Ecclesiastes 9:7 that not those who always run that always win the race nor the mighty, but things and time overtake them all. So when I read that verse, I got to know that if God is in control of my life, I should give glory to him\u003c/em\u003e\u0026rdquo; (25 years)\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eA participant described seeking the help of God through prayer in times of difficulty helped to manage the depression. Even though she sought medical assistance, prayers were still offered because of her faith in God to heal;\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e\u0026ldquo;\u003cem\u003eI always cry to God to help me. The only thing I always say is God help me. Even if I am sleeping in the night I am crying. So managing it, I always see myself as whatever is the will of God let it be\u003c/em\u003e.\u0026ldquo; (35(b) years)\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eYet still, others spoke to religious leaders who appeared to have some knowledge of the symptoms of mental disorders and were able to refer them to a mental health facility. In Ghana, the first port of call in such situations for some people would be to see a spiritual leader. Hence, it is not surprising that based on their beliefs, some participants confided in religious leaders.\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e\u0026ldquo;\u003cem\u003eI am a Muslim and I told my friend\u0026rsquo;s dad who is a pastor what I have been experiencing and he advised me to attend church with them for prayers but I declined because I\u0026rsquo;m Muslim. I was having strange dreams so the pastor took me to the mental health facility and they gave me medication\u003c/em\u003e .\u0026rdquo; (27 years)\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec16\" class=\"Section2\"\u003e\u003ch2\u003eFamily Support\u003c/h2\u003e\u003cp\u003eThe support that families give to a person suffering from depression was observed to have helped some participants cope with depression. A participant had support from the sister and husband to facilitate her recovery:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e\u0026ldquo;\u003cem\u003eMy sister gave me the needed support. She created a friendly environment for me so I always feel comfortable when I am with her family who are supportive. so I will say they were the people who helped me to regain the happiness I\u0026rsquo;m having now\u003c/em\u003e.\u0026rdquo; (25 years)\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eHaving trusted people to seek support from when going through a suicidal crisis is protective. Some participants had trust in their close family and were able to express their thoughts and feelings without judgment from them. One participant said, \u0026ldquo;\u003cem\u003eMy mom was there to talk to me and other people were there to also talk to me\u0026rdquo;\u003c/em\u003e (23 years). \u003cem\u003eAnother remarked that, \u0026ldquo;I talk to my siblings and I try to speak to those I can confide in\u003c/em\u003e\u0026rdquo; (33(b) years)\u003c/p\u003e\u003cp\u003eA participant reported opening up about what was happening to her to the stepmother who is a health worker with knowledge about depression. The participant perceived that although the relationship with the stepmother was challenging, she confided in her which ultimately led to receiving help.\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e\u0026ldquo;\u003cem\u003eEven though she was my stepmom, and we were not that close, I was struggling so i opened up to her about what I was going through and she was so willing to help me. She arranged for me to get help at the hospital\u003c/em\u003e.\u0026rdquo; (33(a) years)\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec17\" class=\"Section2\"\u003e\u003ch2\u003ePrescription Medication\u003c/h2\u003e\u003cp\u003eSome participants coped by relying on the medication prescribed to them by psychiatrists. They reported that when they adhered to the prescription, they felt much better.\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e\u0026ldquo;\u003cem\u003eI have been taking the medicine but when I don\u0026rsquo;t have money to buy more and I remember how my child comes to hug me when she returns from school every day then I consider the troubles she will go through if I am not around\u003c/em\u003e.\u0026rdquo; (32 years)\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eAntidepressants are a key part of treating depression, and the participants reported they helped to improve their mood. A participant noted that, \u0026ldquo;\u003cem\u003eThe only thing I do is to go and get medication from the psychiatric hospital\u003c/em\u003e.\u0026rdquo; (35(a) years). Another remarked that, \u0026ldquo;\u003cem\u003eThe support I had from the psychiatric hospital helped. The medications helped.\u003c/em\u003e\u0026rdquo; (30 years).\u003c/p\u003e\u003cp\u003eThe medication helped to improve their moods and function which enabled them to go about their activities without interference.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec18\" class=\"Section2\"\u003e\u003ch2\u003eHelp-seeking behaviors\u003c/h2\u003e\u003cp\u003eAnother participant disclosed that she discussed her symptoms with a doctor and yet, her symptoms were attributed to her fertility problems without exploring other potential causes. The doctor attributed the symptoms to anxiety due to the desire to conceive:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e\u0026ldquo;\u003cem\u003eI complained to many doctors, but they couldn\u0026rsquo;t understand. Like the doctor I complained to first time said it\u0026rsquo;s because I am anxious. So when I complained to her, she told me that\u0026rsquo;s what happens to many women when they are looking to get pregnant and they become anxious about it and they begin to experience that so I should relax\u003c/em\u003e.\u0026rdquo; (35(b) years)\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eFamily members and religious leaders sought help for participants after becoming aware of the symptoms they were experiencing. A participant reported opening up about what was happening to her to the stepmother who is a health worker with knowledge about depression and sought help for her.\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e\u0026ldquo; \u003cem\u003eEven though she was my stepmom, the relationship wasn\u0026rsquo;t that close. So, she realized I wasn\u0026rsquo;t opening up to her. So, one day I couldn\u0026rsquo;t stand my feelings, I had to voice out to her what I was going through and she was so willing to help me. By then, she was also working at 37 Military Hospital. That\u0026rsquo;s where she arranged all these for me\u003c/em\u003e.\u0026rdquo;(33(a) years)\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eThe participant perceived that although the relationship with the stepmother was challenging, she confided in her which ultimately led to receiving help. Talking to family or trusted friends provides an opportunity to receive support.\u003c/p\u003e\u003c/div\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003eThe study examined symptoms exhibited by women diagnosed with depression, perceived causes, the intersection between depression and suicide, and coping strategies. Symptoms of depression as described by the participants were similar to known clinical symptoms (\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e, \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e). Other studies in Ghana have reported a high prevalence of depression among pregnant women with limited studies on depression among young women (\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e). The depressive symptoms identified in this study were self-reported. Most participants lacked the knowledge to identify and relate their symptoms to any mental health condition. The same can be said for family members who sought help for them in medical facilities. The lack of awareness increases the risk of the participant not receiving the appropriate help. Some participants perceived their depression was caused by hereditary factors, partner infidelity, accusations, and abuse. Similar findings have been reported in previous studies (\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e). Some studies in Ghana have also reported excessive worrying, anxiety, marital and relational problems, spiritual illness, substance abuse, and punishment for past wrongdoing as causes of mental illness (\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e). However, it is interesting that none of the participants attributed depression to spiritual causes reported in some previous studies in Ghana (\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e).\u003c/p\u003e\u003cp\u003ePsychological distress, abandonment and existential struggles were identified as risk factors for suicide among some participants in this study which has also been reported elsewhere (\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e). In the state of loneliness, hopelessness and negative thoughts about oneself, suicidal ideation was formed in some participants which provides some support for the cognitive theory (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e). Hopelessness has been identified as an important risk factor for suicide as found in the current study (\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e). All participants had been diagnosed with clinical depression, although the majority were unaware of the symptoms of depression at the time. There is a need to create more awareness of mental health among the broader population to allow early help-seeking. In addition to the awareness creation, contextualizing mental health literacy and ensuring education in local dialect to enhance understanding is critical. Others reported they sought help from family and religious leaders which is not surprising in the Ghanaian context. Other studies have reported help-seeking for mental health problems from non-professionals such as family, friends and religious leaders (\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e, \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e, \u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e). These non-professionals can serve as gatekeepers to identify early symptoms of mental health problems.\u003c/p\u003e\u003cp\u003eThree main coping strategies were identified including medication, family support, the use of religion and help-seeking behaviours. In the Ghanaian context, it is not surprising for people to seek help from different sources concurrently with religion being one of the main coping mechanisms, especially if it is believed to be a cause of the problem. The use of hospitals, prayer camps, religious leaders, herbalists and traditional healers has been reported in other studies in Ghana as sources of help to address mental illness (\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e, \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e, \u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e). Interestingly, participants had a positive view of psychotropic medications and adhered to the medications to improve their mood. Few studies have reported the use of such medications in treating depression (\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e, \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e, \u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e). Study participants were diagnosed by a psychiatrist, hence not surprising that medication was being used to treat depression. With depression being a risk factor for suicide, young people experiencing/diagnosed with depression must be regularly assessed and monitored for suicide risk for early intervention. It is important to screen for suicidality independently of having a depression diagnosis.\u003c/p\u003e\u003cp\u003eThere are several limitations to this study. First, participants were selected from a health facility. The findings reported in this study may therefore be specific to this group of patients and unlikely to reflect the experiences of young women with depression and at risk of suicide. Second, the difficulty in recruiting participants and the small number that participated in the study implies caution in interpreting the findings as representing the experiences of young women who have experienced depression and increased risk of suicide. Lastly, there was a language barrier and difficulty in accurately representing concepts such as suicide and depression in the local dialect. Although an effort was made to ensure that participants understood the meanings of these terms and the focus of the research, some participants may have a challenge understanding these requirements.\u003c/p\u003e"},{"header":"CONCLUSION","content":"\u003cp\u003eThis study has highlighted the depressive symptoms, perceived causes, risk factors of depression and suicide and coping strategies among young women. Participants experienced a range of depressive symptoms, often unrecognised at onset, with hereditary predisposition and adverse family dynamics identified as key perceived causes. Hopelessness and emotional distress emerged as prominent drivers of suicidal behaviour. Coping strategies centred on religion, family support, medication, and help-seeking, though misattribution of symptoms sometimes delayed care. The findings of this study provide some support for Beck\u0026rsquo;s Theory that people with depression tend to have a negative view of themselves, the world and the future, and this has contributed to suicidal ideation and attempts, as shown in the study. These findings highlight the need for multi-level prevention strategies. Public education campaigns and routine screening in primary care could improve early recognition and reduce diagnostic delays. Family-based interventions, including psychoeducation and conflict resolution support, may mitigate interpersonal stressors that trigger or worsen depression. Given the influence of religious leaders, mental health literacy training within faith communities could enhance referral to appropriate services. Strengthening suicide prevention efforts, improving access to mental health services, and supporting medication adherence may help reduce the burden of depression in similar contexts.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e: Participation in the study was voluntary and informed consent was obtained from each participant upon entry into the study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e: Participants who agreed to participate in the study were given informed consent about the details of the research and signed consent forms They were informed that results will be published widely to the public.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e: Access to the data can be made available upon demand from the lead author.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e: The authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e: This study received no funding.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026apos; contributions\u003c/strong\u003e: VSL and KEB contributed to the study concept and design, analysis, and interpretation. VSL conducted data collection, drafted the introduction and methodology. VSL and WA-D analyzed the data and wrote the discussions. KEB provided critical analyses on the interpretations. All authors read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e: We acknowledge all the participants who made time to share their experiences with us in this study and to the staff of\u0026nbsp;Tamale Teaching Hospital who assisted the study.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026apos; information \u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eVictoria Sia lebbie https://orcid.org/0009-0009-9387-7242\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eKofi E. Boakye https://orcid.org/0000-0002-2715-3301\u003c/p\u003e\n\u003cp\u003eWinifred Asare-Doku https://orcid.org/0000-0002-9907-3511\u003c/p\u003e\n\u003cp\u003e\u0026ldquo;For the purpose of open access, the author has applied a Creative Commons Attribution (CC BY) licence to the Author Accepted Manuscript version arising from this submission.\u0026rdquo; \u0026nbsp;\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eWHO, Suicide, World Health Organization. ; 2019 [Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.who.int/news-room/factsheets/detail/suicide\u003c/span\u003e\u003cspan address=\"https://www.who.int/news-room/factsheets/detail/suicide\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eWHO, Suicide. 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Int J Adolescence Youth. 2022;27(1):444\u0026ndash;56.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eAlhassan A, Ziblim AR, Muntaka S. A survey on depression among infertile women in Ghana. BMC Womens Health. 2014;14(1):42.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eOpoku Agyemang S, Ninonni J, Bennin L, Agyare E, Gyimah L, Senya K, et al. Prevalence and associations of depression, anxiety, and stress among people living with HIV: A hospital-based analytical cross‐sectional study. Health Sci Rep. 2022;5(5):e754.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eWeiss SJ, Simeonova DI, Koleva H, Muzik M, Clark KD, Ozerdem A, et al. Potential paths to suicidal ideation and suicide attempts among high-risk women. J Psychiatr Res. 2022;155:493\u0026ndash;500.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eVijayakumar L. Suicide in women. Indian J psychiatry. 2015;57(Suppl 2):S233\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eManalastas EJ. Suicide ideation and suicide attempt among young lesbian and bisexual Filipina women: Evidence for disparities in the Philippines. Asian Women. 2016;32(3).\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eDiallo I, Aldridge LR, Bass J, Adams LB, Spira AP. Factors associated with suicide in four West African countries among adolescent students: an analysis using the global school-based student health survey. J Adolesc Health. 2023;73(3):494\u0026ndash;502.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eAzasu EK, Joe S. Correlates of suicide among middle and high school students in Ghana. J Adolesc Health. 2023;72(5):S59\u0026ndash;63.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eOwusu-Ansah FE, Addae AA, Peasah BO, Oppong Asante K, Osafo J. 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Whether you like it or not people with mental problems are going to go to them\u0026rsquo;: a qualitative exploration into the widespread use of traditional and faith healers in the provision of mental health care in Ghana. Int Rev psychiatry. 2010;22(6):558\u0026ndash;67.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eAsare-Doku W, James C, Rich JL, Amponsah-Tawiah K, Kelly B. Mental health is not our core business: A qualitative study of mental health supports in the Ghanaian mining industry. Saf Sci. 2022;145:105484.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eOsafo J, Asare-Doku W, Akotia CS. Exploring the role of religion in the recovery experiences of suicide attempt survivors in Ghana. BMC Psychiatry. 2023;23(1):219.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eCanavan M, Sipsma H, Jack H, Ohene S, Rohrbaugh R, Bradley E, et al. Psychoactive prescription practices for serious mental and neurological illness in Ghana: Data from the Mental Health and Poverty Project (MHaPP). Int J Mental Health. 2016;45(4):223\u0026ndash;35.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eOppong S, Kretchy IA, Imbeah EP, Afrane BA. Managing mental illness in Ghana: the state of commonly prescribed psychotropic medicines. Int J Mental Health Syst. 2016;10(1):28.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eRead U. I want the one that will heal me completely so it won\u0026rsquo;t come back again: the limits of antipsychotic medication in rural Ghana. Transcult Psychiatry. 2012;49(3\u0026ndash;4):438\u0026ndash;60.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"suicide attempt, suicide, risk factors, depression, gender","lastPublishedDoi":"10.21203/rs.3.rs-7437498/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7437498/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e\u003cp\u003eAlthough depression is strongly associated with suicidal behavior among young women, there is limited research in the global south and Africa on the risk of suicide among young females with clinical depression. The study examined the risk of suicide among clinically depressed women and recovery experiences.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e\u003cp\u003eWe conducted interviews with ten (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e) females diagnosed with depression. Interviews were transcribed and analyzed using thematic analysis.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003eWe identified four major themes: Depressive symptoms broadly categorized into behavior, feelings, thoughts, and physical symptoms; Perceived Causes of Depression reflecting hereditary factors and family dynamics; Depression and Suicide explored factors that influenced the suicide attempt including the feeling of hopelessness and emotional distress; and Coping Strategies.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e\u003cp\u003eThe results emphasize the need to integrate suicide screening and early intervention to mitigate the risk of suicide behavior among young women with depression.\u003c/p\u003e","manuscriptTitle":"“Sometimes I have sleepless nights and sometimes I overthink”: A qualitative study of suicide risk in young Ghanaian women with depression","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-10-23 05:15:13","doi":"10.21203/rs.3.rs-7437498/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"7042d5b7-1290-4764-a27b-a8e9c82b9996","owner":[],"postedDate":"October 23rd, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-11-24T06:09:09+00:00","versionOfRecord":[],"versionCreatedAt":"2025-10-23 05:15:13","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7437498","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7437498","identity":"rs-7437498","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}