Attempted Suicide: Lived Experiences of Refugees in Rhino Camp, West Nile Uganda

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Suicide rates are high among vulnerable groups that experience discrimination, such as refugees and migrants. Purpose This study explored the lived experiences of refugees who attempted suicide in Rhino Camp, West Nile, Uganda, using Thomas Joiner's interpersonal theory of suicide attempts as a theoretical framework. Methods This study employed an Interpretative Phenomenological Research design and purposive sampling techniques to choose 15 participants (seven key informants and eight suicide survivors) to ensure an in-depth analysis of qualitative data. Face-to-face interviews using in-depth interview guides and observations were used to gather data. The study data were collected between June and July 2023. Results After the thirteenth interview, saturation was achieved with no new insights emerging beyond this point. The participants described a broad set of interconnected subjective experiences and triggers shaping suicide attempts among refugees in Rhino Camp which included domestic violence and relationships, mental illness, financial difficulties, inadequate food deliveries, traumatic past, psychological distress, social isolation, and cultural stigma. Participants identified several supportive systems such as community and family support, role of religious, cultural, and opinion or other leaders, and health facilities support. Refugee suicide attempt survivors’ also described personal coping mechanisms, and highlighted the role of psychosocial support providers operating within Rhino camp. Conclusions Complex and intersecting social, economic, and psychological challenges that limit help-seeking and heighten vulnerability shape suicide attempts among refugees in Rhino Camp. Strengthening community-based, culturally responsive mental health services and creating safe spaces for open dialogue and counseling may enhance support for refugee suicide survivors and contribute to reducing suicide risk within refugee settings. Suicide Refugees Lived experiences Mental health Rhino Camp BACKGROUND TO THE STUDY Suicide is among the leading causes of death universally, and every year, more people die as a result of suicide than HIV, malaria, breast cancer, war, and homicide. Globally, 800,000 people are projected to have completed suicide every year, and 75% of global suicides occur in low-income and middle-income nations. Suicide accounts for 1.4% of premature deaths worldwide. Males are predicted to die at rates roughly twice those of females (12.6 per 100000 males compared to 5.4 per 100000 females)[ 1 , 2 , 3 ]. Suicide rates worldwide are a significant public health problem that needs to be addressed urgently. Africa has six of the highest 10 countries for suicide in the world [ 4 ], and suicide kills about 11 individuals per 100,000 individuals in Africa each year, which is higher than the universal average of nine for each 100,000 individuals [ 1 ]. It should be noted that for each suicide in Africa, there are an estimated 20 suicide attempts [ 1 ]. According to UNHCR, about 215 refugees attempted suicide, and 51 refugees completed suicide in Ugandan refugee camps [ 5 ]. In Rhino camp, the cases of those who attempted and completed suicides between 2021- May 2023 were 49 refugees (39 attempted and 10 completed suicides) out of 133,336 refugees majorly South Sudanese hosted [ 6 , 7 ]. Suicide rates are high among vulnerable groups who experience discrimination, such as refugees and migrants, indigenous peoples, lesbians, gays, bisexuals, transgender, intersex (LGBTI) persons, and prisoners [ 8 ]. Suicide refers to intentional death resulting from injuring oneself [ 9 ]. Suicide Attempt refers to the determination of an individual to terminate life by injuring their body, but their deeds do not lead them to death [ 9 ]. Refugees may be extremely pretentious by suicide risk for example: traumatic events [ 10 , 11 , 12 , 13 ], alcohol and other substance use abuse [ 1 , 14 , 15 , 16 ], feelings of isolation [ 17 ], job loss [ 18 , 19 ], chronic pain and illness [ 20 ], relationship conflicts [ 21 , 22 , 23 , 24 ] hopelessness [ 25 ], sense of isolation and lack of social support [ 26 , 27 ], mental pain [ 28 , 29 ] and need for love and belonging [ 30 ] ‘Forfeitures’ identified include family and friends, birthplace, respect, public connection, fiscal properties, salary, and economic stability [ 31 ]. Suicide attempts negatively lead to adverse impacts, such as damage, prolonged sickness, and loss of freedom, and cause financial problems for the family and community [ 32 ]. Despite this, little is known about suicidal behaviors in these highly mobile populations, because collecting timely, relevant, and reliable data is challenging [ 33 ]. There have been more suicide attempts by refugees in recent days, with trauma, social isolation, and services for mental health not widely available [ 34 ] with little attention paid to the lived experiences of refugee suicide survivors [ 35 ] Understanding suicidal thoughts and emotions requires careful attention to the subjective views of individuals who experience suicide, as these insights are fundamental to improving the ability to explain, anticipate, and prevent suicidal behaviour [ 36 ]. Exploring how people interpret and respond to suicidal ideation involves examining the subjective dimensions of these experiences, an approach that has received less emphasis within suicidology in recent decades despite earlier recognition of its importance [ 37 ]. A study conducted in 2019 reported that only a small proportion of participants (10 of 50) experienced relief or happiness immediately after surviving suicide attempts. Most described difficult emotional reactions, including sadness, depression, disappointment, anger, emptiness, embarrassment, and shame. Although many later shifted toward more positive emotions such as gratitude, hope, and a sense of relief, more than 30% continued to view their survival negatively at the time of the study [ 38 ]. Insights from survivors of suicide attempts offer critical experiential knowledge that can strengthen current prevention and intervention strategies. Their lived experiences can help to guide the development of mental health services that are accessible, relevant, and responsive to individual needs during periods of acute psychological distress [ 38 ]. Paying structured attention to personal views of individuals faced by suicide can play an important role in guiding the development of more suitable forms of mental health support, broader societal decisions, and encouraging positive shifts within communities [ 39 ]. This paper reports an interpretive phenomenological qualitative study that explored the lived experiences of refugee suicide attempt survivors. METHODS Study Design This study used an interpretative Phenomenological research design. Interpretative Phenomenology underlines the value of a person's unique view and understanding because they are predicated on the mode of thinking of firsthand knowledge and subjective experience [40]. Researchers have focused on the lived experiences of individuals and how they make sense within the context of their personal and social worlds, with a particular emphasis on personal sense-making [41]. According to prasad (2018), interpretivism involves exploring a person's reality and interpreting them as the foundation for learning about everyday spheres [42]. IInterpretative Phenomenology is clearly idiographic in its commitment to examining the detailed experience of each case, prior to the move to more general claims [43]. Interpretative Phenomenology is a useful methodology for examining topics that are complex, ambiguous and emotionally laden, such as suicide [44]. Study area The study area was Rhino Camp, a refugee camp in West Nile region of Uganda. Rhino camp has geographic coordinates of 2.966°N and 31.395°E. The settlement spans an area of approximately 225 km2 that includes parts of the Terego District, Odupi, Omugo, and Uriama sub-counties, as well as the Madi-Okollo District's Rigbo Sub-County. Although the settlement is not a constant geographic area and has seven zones, the refugees still choose to live there in "wallets" [45]. Host communities and Rhino camp can both be described as rural, with some towns and urban areas included. The primary source of income for both the host community and the refugee population is crop farming. [46]. The choice to concentrate on suicide attempted lived experiences among refugees living in Rhino Camp West Nile, Uganda, was based on several factors. First, Rhino Camp is one of Uganda's largest refugee camps, housing thousands of refugees from nearby nations, such as DRC and South Sudan [47]. There have been more suicide attempts by refugees in the last few days, with trauma, social isolation, and mental health services [34]. Second, there is limited research on the actual experiences of refugee suicide survivors at Rhino Camp and other Ugandan settlements. Refugee suicide studies have largely concentrated on the risk factors, prevalence, and interventions, with little attention paid to the individual experiences of refugee suicide survivors [35]. Thus, by focusing on Rhino Camp, this study aimed to clarify the unique experiences of refugee suicide survivors with regard to displacement, trauma, and limited access to mental health services. Study and target Population Study population The population of the study was refugees’ suicide survivors in Rhino Camp, West Nile, Uganda. The cases of those who attempted and completed suicides in Rhino Camp between 2021-May 2023 were 49 refugees (39 attempted and 10 completed suicides) out of 133,336 refugees [6]. Target population All refugees in Rhino camp, West Nile, Uganda. As of December 2022, Rhino refugee Camp hosted 133,336 refugees majorly South Sudanese [7]. Sample Size The study population comprised 15 participants (seven Key Informants and eight refugee suicide survivors) due to the thoroughness in in-depth analysis of qualitative research information [48] and as this was the number at which “saturation” of the data was reached. After the 13th interview, no new themes were generated. Hence, it was deemed that data collection had reached a saturation point. The researchers continued with data collection for two more interviews to ensure that no new themes emerged. The sample sizes in phenomenological studies vary from 3 to 25 [49] Seven Key Informants and eight refugee suicide survivors could be due to a range of factors, such as trauma, psychological distress, loss of connection, and social support. Participants (Refugee Suicide Survivors) were of different ages, genders, and cultural backgrounds and had attempted suicide for different reasons. The eight refugee suicide survivors were identified and accessed through researchers seeking permission from the OPM Regional Refugee Desk Officer-Arua (RDO), who then directed the researchers to the OPM settlement Commandant Rhino Camp. The OPM settlement commandant allowed researchers to access eight refugee suicide survivors through refugee welfare councils (RWCs) who linked the researcher to the refugees’ suicide survivors and their homes. The 8 refugees’ suicide survivors were obtained from the UNHCR - Mental Health and Psychosocial Support (MHPSS) implementing partner who provided researchers with refugee suicide survivor details through permission from the Regional Project Coordinator. The researcher followed all ethical standards to ensure that the data provided would be kept confidential to avoid violation of suicide survivors’ privacy. The interviews took place at the church or community counseling space to ensure privacy and no social harm. The welfare of eight refugee suicide survivors and seven key informants were 20,000/= Uganda shillings only each. The seven Key Informants included the Office of the Prime Minister with two representatives, two clinicians (1psychologist and one psychiatrist) who are partners in mental health, one police member in the mental health department, and two refugee welfare council members. The sampling of the participants stopped at the point of saturation. Mason, M. 2010, asserted that saturation occurs when gathering fresh data, informed by both interviews and sampling, does not add any new information to our understanding of the problem. A qualitative sample reaches a point known as a diminishing return, which indicates that the data collection is finished or almost finished [50, 51]. Sampling The study utilized Purposive sampling to select the participants. Purposive sampling is a non-probability sample selection in which the researcher chooses respondents based on predetermined standards [52]. Sampling technique where the researcher selects participants based on specific criteria who provide a richness of information that is suitable for the detailed research. In this study, participants were selected based on their history or knowledge of attempted suicide in Rhino Camp as highlighted below: Eligibility criteria Inclusion criteria were · Participants above 18 years old · Participants who attempted suicide in the last three years (2021- March 2023) · Participants who are able and willing to describe their experience with a suicide attempt Exclusion standards • Eligible individuals with mental health issues that could affect the data collection. Methodology Rigor Credibility was achieved by describing the lived experiences of suicide survivors from the perspectives of the participants and using the triangulation of different data collection methods. To ensure credibility and trustworthiness, the researcher’s knowledge of the phenomenon was bracketed to prevent preconceptions regarding refugee suicide survivors’ influence on outcomes and to allow the analysis of lived experiences. The quality of the research results was improved using thick, detailed descriptions and coding processes. Dependability was maintained through in-depth interview guide standards, data audits prior to analysis, and safeguarding the correctness of the data. Verbatim collected from participants was written out by listening to the audio recording and making observations during face-to-face interviews. Confirmability was guaranteed through a review of the supervisor, data checking, and rechecking throughout data collection and analysis. To achieve the criteria of transferability, it tried to explain the process of research exactly so that other researchers could use this technique [53]. Data Collection In-depth (face-to-face) interviews and observations of nonverbal behavior were conducted to collect data. The researchers collected data using an interview guide, as it allowed the researchers to observe the verbal and nonverbal signs (body language and interest) of the participants, enable them to give true information, maintain participants' concentration, and finally capture participants’ emotions and behaviors. The in-depth interview guide had two components: the participant's sociodemographic characteristics and the participant's in-depth interview guide per objective to answer the questions. 45-60 minutes were allotted for each in-depth interview, which arrived at the end of the participants’ answer to the final question. All responses were audio-recorded after obtaining consent from the participants. During the interview, the researcher worked with a translator to help in translating the interview questions to the refugee suicide survivor and one Clinical Psychologist to provide counseling to avoid traumatic recall. The interview took place at the community counseling space/center where a number of activities took place, for example, life skills training, different counseling, and other training of refugees, hence scheduling participants on different appointment days and times to meet them at the counseling center one by one in case participants were two or more in a particular place while maintaining the privacy and confidentiality of the participants, which enabled participants not to identify themselves and other community members to know what a particular participant is doing at the counseling center. This helped manage community stigmatization. In Field editing, the information gathered from the field was reviewed, edited, documented, organized, and coded with participant pseudonyms and dates to identify patterns and related themes. Words, phrases, and open-ended responses in in-depth interviews were coded as they are easier to remember, skim, and organized. The participants’ exact words were used in quotes, and the researcher interpreted and commented on them. In-depth interviews with both key informants and refugee suicide survivors were pilot tested in the Imvepi refugee settlement. Data Management and Analysis There are varying processes by which interpretive phenomenologists analyze data depending on the specific type of phenomenology being used. For this study purposes, we chose the [48] suggested phases, which are as follows: A. Data Management Phase: 1. Data Collection: Qualitative data were collected using various methods such as in-depth interviews, observations, and document reviews. 2. Transcription and Anonymization: The researchers transcribed the collected data, ensured anonymity using anonymous names and removed identifying information. 3. Accuracy: Care was taken during transcriptions and translations to maintain accuracy, including preserving verbal cues like "um," "you know," and silences, which are considered important in understanding women's experiences. 4. Data Storage: The recordings and transcribed data were securely stored in word-processing files on a password-protected laptop and in a lockable room. 5. Data Analysis: The primary data underwent a detailed analysis process to identify themes, and relevant literature from secondary sources was also reviewed to complement the primary data. B. Generative Phase: 1. Qualitative Content Analysis: Qualitative data, specifically from Key Informant and in-depth interviews, were coded using qualitative content analysis. 2. Identifying Keywords and Themes: The researchers read the transcripts multiple times to identify keywords and develop categories and themes based on participants' responses. C. Interpretive Phase: 1. Relating Data to Findings: The researchers related the data to the identified themes, seeking to understand and make sense of the findings. 2. Interpretivism: This study adopts an interpretivist approach, focusing on individual understanding as a starting point for knowledge development. D. Representing and Theorizing Phase: 1. Expression and Guidance: This phase involves expressing the conclusions drawn from the findings, following the guidance of Miles [54]. 2. Scrutinizing Data: The researchers engaged in a continuous process of scrutinizing the data to develop consistent explanations aligned with the study objectives and questions. 3. Enhancing Trustworthiness: By accounting for their knowledge and biases, the researchers aimed to enhance the trustworthiness of the research and the credibility of the findings. Ethical Considerations Approval This study was conducted in accordance with the ethical standards outlined in the Declaration of Helsinki, Lira University Research Ethics Committee (LUREC) no. LUREC-2023-18, and the Uganda National Council for Science and Technology (UNCST) no. HS3046ES before the study was conducted. Written informed consent was obtained from all participants prior to data collection. The researcher sought clearance for data collection from the UNHCR and OPM after receiving approval from LUREC and a letter of introduction from the Faculty of Public Health, Lira University. Informed consent All respondents were requested to provide their consent before the interview. The consent form was written because it provided an auditable record in the case of questions arising from data storage. Informed consent was obtained by describing the purpose of the study and procedures involved. During data collection, one clinical psychologist was able to speak to anyone upset after participating in this study. The interview process was voluntary, and the participants were free to leave the interview process without penalty. Confidentiality Participants were notified that the information from this study would be held and kept strictly private and used only for research purposes. The interviews were conducted in the church or community counseling space/center. To maintain the privacy of the participants, pseudonyms were used to report direct quotes. Furthermore, the participants remained anonymous (nameless) throughout the study. The records were kept electronically with a password, on paper, and behind locked doors. Trustworthiness was achieved through credibility, transferability, dependability, confirmability, audit trails, and reflexivity. RESULTS This study aimed to explore the lived experiences of refugees residing in the Rhino Camp in West Nile Uganda who had attempted suicide. The research involved in-depth interviews with a diverse sample of refugees who had attempted suicide. Socio-Economic Characteristics of attempted suicide participants Distribution of attempted suicide participants by Gender Table 1: Distribution of attempted suicide participants by Gender Sex Suicide survivors’ participants Male 1 Female 7 Total 8 Source: Generated by the researcher The findings in Table 1 show that among the participants who attempted suicide, there were 7 females and 1 male. The data indicate a notable gender disparity, with a significantly higher number of females involved in suicide attempts than males. This finding aligns with existing research that highlights gender differences in suicide attempts and completed suicide. It is well documented that females tend to attempt suicide, whereas males tend to die by suicide [10]. Age distribution of attempted suicide participants Table 2: Age distribution of attempted suicide participants Age Suicide survivors’ participants 18-25 1 25-33 5 33-41 1 41-49 1 49> Total 8 Source: Generated by the researcher The findings in Table 2 show the age distribution of the participants who attempted suicide. The majority of participants (five out of eight) fell within the age group of 25-33 years, indicating that this age range had a higher representation in the study. Each participant was reported in the age groups 18-25, 33-41, and 41-49. Interestingly, no participants were older than 49 years. This distribution suggests that individuals in their mid-to late twenties and early thirties may be more vulnerable to suicide attempts among the refugee population in Rhino Camp. Household Head of attempted suicide participants Table 3: Household Head of attempted suicide participants Female headed/male headed/Both Suicide survivors’ participants Female Headed 6 females Male Headed 1 male Not female headed/male headed 1 female Total 8 Source: Generated by the researcher The findings in Table 3 present the distribution of household heads among the participants who attempted suicide. Among the eight participants, six females were reported as the heads of their households and one male participant was identified as the household head. Additionally, one female participant reported that her household was neither female-headed nor male-headed. The data indicated that the majority of attempted suicide participants (six out of eight) were female-headed households. This finding may suggest that females who are the heads of their households may face unique stressors and challenges that could contribute to their vulnerability to mental health issues and suicide attempts. Marital Status of attempted suicide participants Table 4: Marital Status of attempted suicide participants Married/single/widow/divorced Suicide survivors’ participants Married 5 Single - Widow 2 Divorced/Separated 1 Total 8 Source: Generated by the researcher The findings in Table 4 display the marital status distribution of the participants who attempted suicide. Among the eight participants, the majority (five out of eight) were married. Two participants were identified as widows, and one reported being divorced or separated. The data indicate that married individuals had a higher representation in the study than other marital statuses. Education Level of attempted suicide participants Table 5: Education Level of attempted suicide participants Education Level Suicide survivors’ participants No gone to school 2 Primary 5 Secondary 1 Total 8 Source: Generated by the researcher The findings in Table 5 present the distribution of education levels among participants who attempted suicide. Among the eight participants, five reported having a primary level of education, whereas one participant had a secondary level of education. Additionally, two participants indicated that they had not attended school. The data indicate that the majority of attempted suicide participants (five out of eight) had completed their primary education. This finding suggests that individuals with lower education levels may be more vulnerable to mental health challenges and suicide attempts within the refugee community in Rhino Camp. Number of family members of attempted suicide participants Table 6: Number of family members of attempted suicide participants Number of family members Suicide survivors’ participants 3 2 5 3 4 1 6 1 10 1 Total 8 Source: Generated by the researcher The findings in Table 6 indicate the number of family members among participants who attempted suicide. Among the eight participants, the majority had either three or five family members; two participants reported three family members, and three participants reported five family members. Additionally, there was one participant each for four, six, and ten family members. The data suggest that participants with smaller family sizes (three or five members) were more prevalent in the study. Methods used by attempted suicide participants Table 7: Methods used by attempted suicide participants Methods used Number of attempts Suicide survivors’ participants Drugs 1 2 Rope and Knife 4 1 Drowning 1 1 Poison 1 1 Drugs and Rope 2 2 Rope 2 1 Total 8 Source: Generated by the researcher The findings in Table 7 display the methods used by participants who attempted suicide, along with the number of attempts for each method. Among the eight participants, a variety of methods has been reported, and some individuals have made multiple attempts using different methods. The most frequently reported methods were "Rope and drugs" with 4 participants attempting suicide using rope and 4 participants attempting suicide using drugs. Other methods used included "Knife" (1 participant), "Drowning" (1 participant), and "Poison" (1 participant). Eight attempts have been reported across various methods. The data suggest that the participants employed a range of methods to attempt suicide, with "Rope and drugs" being the most common combination. It is important to recognize that different methods of attempted suicide can have varying levels of lethality and risks. The use of multiple methods by some participants may have indicated the severity and complexity of their emotional distress. Summary of Socio-Economic Characteristics of attempted suicide participants No Sex Age Household Head Marital status Education level Family size Number of attempts Methods used 1 F 33 YES Married P.4 5 1 Drowning 2 F 40 YES Separated - 4 2 Drugs & Rope 3 M 30 YES Married S.2 5 2 Rope & Drugs 4 F 20 NO Married P.4 3 1 Poison 5 F 44 YES Widow P.2 10 1 Drugs 6 F 33 YES Married P.5 6 4 Rope & Knife 7 F 26 YES Married P.6 3 1 Drugs 8 F 33 YES Widow - 5 2 Rope Source: Generated by the researcher Table 8: Generated Qualitative Content Analysis Themes Themes Sub Themes Domestic Violence and relationship Issues of GBV have been ranked the highest as the trigger of suicides in Rhino camp because of the nature of the refugees Domestic violence contributes to women committing suicide because when a man always torture, abuses the wife, it makes the wife to be undermined infront of children and community Unwanted pregnancy, forced marriage, extra marital affairs, fights with the cowife, man concentrating on one family, emotional violences in women. Mental illness There are clients on mental treatment, they stop taking treatment and symptoms comes up for example voices becoming too loughs, tends to relapse… Depression being sad, loss of interest in the activities. trauma in acute form to event, psychological pains with bad dreams, thoughts leading to Post Traumatic Stress Disorder (PTSD). When you over think, the Satan can drive you to one side and you may end up committing suicide Financial difficulties … seeing the little the family is saving is going to their medical bills, they are like instead of letting people suffer and tomorrow they still die, it is better to die and that one left a suicide note The other trigger is unemployment. Inadequate food deliveries Reduction in food ratios has typically increased the suicide. Since then when we were in our own country (home), we use to access our own food by our own self but now accessing food is also very hard, accessing land here is also very hard. All these things are the reasons why refugees attempt suicide. cides rates in Rhino settlement the food given to them are not enough to feed their families and that also bring back the issues of suicidal attempts Traumatic Past I thought of death of my first husband in the war who was so nice to me coupled with camp stressors.. Psychological Distress I found my child who is in primary six (6) was sent home because of money and there was no money and also the children stayed for two days without eating food In Ocea life is very difficult, my family is size 4, food is very little and no land for cultivation, no one to build for me…….. Issue of school fees was a challenge for my child who was in S.4……… There was no money, nobody helped me. That is when that incident started. Social Isolation … I started thinking it is better to kill myself and the government come and take the children, I cried a lot, depressed and traumatized for three days then I just pick the rope…. Organization like TPO provide home visit, counselling, Psychological First Aids through Social Worker and Clinical Psychologist Cultural Stigma There are so many who were even laughing sometimes at me. Stigmatization is there, because at times when I go for some funeral place, people when they see me, they start commenting about my body being thin because by then when I was working as a business woman, I used to have good body Coping Mechanisms Right now, the way I am coping, I managed to secure some land that I am digging and I also constructed my houses alone which has helped to reduced thought of suicide. The first help I got from the family, and Refugee Welfare Council one (RWCI), women representative who came and they counselled me Community and Family Support .. people who have suicide tendencies are best understood at family levels…. Family in totality is the first system that we know can support us in the management of attempted suicide Organizations had established community structures, like CRTs (Crisis Response Teams), VPAs (Volunteer Psychosocial Assistants), Community Based Sociotherapy Facilitators (CBS) Community Development Workers and Village Health Teams, to aid in times of crises and suicide attempts …They receive training in Psychological First Aid and Medical First Aid, and have established reporting mechanisms and referral pathways Role of Religious, Cultural, and Opinion or other Leaders We also have spiritual leaders who help provide counselling or talk to the families We also have African Traditional setting where the elders in the community intervene in case there is suicidal cases in the community We also have police where need be, at times we need enforcement where the situation needs a victim to be kept under safe custody Psychosocial Support Providers Organizations dealing in Psychosocial Support have people who represent them within the community for example psychologists, social workers and psychiatric clinical officers who provides counselling, advanced therapies, and treatment of mental health conditions The MHPSS partners come in to provide MHPSS aspects… Health Facilities Support Health facilities give treatment and follow ups on the clients Some of the services including the health services, community health outreach programs by the health workers, the referrals by the partners where they go out to find out what is ongoing Rescue in terms of ambulance services for example when one attempts to commit suicide and not yet dead, the person is taken to the health centre From the health centre, counselling and treatment of the wounds is done Source: Generated by the researcher The findings in Table 8 indicate the 13 themes which emerged after data analysis and they include: 1) domestic violence and relationships; 2) mental illness; 3) financial difficulties; 4) inadequate food deliveries; 5) traumatic past; 6) psychological distress; 7) social isolation; 8) cultural stigma; 9) coping mechanism; 10) community and family support; 11) role of religious, cultural, and opinion or other leaders; 12) psychosocial support providers; and 13) health facilities support. The themes in this study were the expressive parts of the participants’ experiences that portrayed understanding as a whole. Careful evaluation of the themes that emerged from the participant stories helped to understand refugee suicide survivors’ experiences regarding the phenomenon. The thirteen (13) themes are explained into detail according to the study specific objectives below. Triggers that Prompt Refugee Suicide Survivors to Attempt Suicide This section focuses on objective one, namely: “To find out the triggers that prompt refugee suicide survivors to attempt suicide in Rhino Camp, West Nile, Uganda”. It draws on the views of seven Key Informants that included two (2) representatives from Office of the Prime Minister, 2 clinicians (1psychologist and 1 psychiatrist) who are partners of Mental Health, 1 Police in the Mental Health department and 2 Refugee Welfare Council (RWCs) members. The findings from this study show that suicide triggers can be psychological, social, economic, and demographic. The following key findings emerged from the Study Objective one: 1) domestic violence and relationships, 2) mental illness, 3) financial difficulties, and 4) inadequate food deliveries, as detailed below. Domestic Violence and relationship : A Key Informant explained how domestic violence disproportionately affects women in various forms of violence, such as physical, sexual, emotional, and economic abuse, leading to triggers of suicide, as illustrated below: Issues of GBV have been ranked the highest as the trigger of suicides in Rhino camp because of the nature of the refugees that we have, who have come, they have a lot of trauma, they experience a lot of adversities, so they come in difficult situations psychologically to deal with, so as a reason we find so many cases of GBV more especially inflicted on women because it is the bigger percentage and this the end of GBV leads to suicides because culturally people do not easily open up to GBV. What happens to someone who has been bitten by his closes family where they are supposed to seek solicits to alternate suicides (KII, June 2023) While supporting the above voice, a participant narrated that: Domestic violence contributes to women committing suicide because when a man always torture, abuses the wife, it makes the wife to be undermined infront of children and community and that means it brings about hopelessness in a woman and some of these men end up marrying 2-3 wives and if the relationship with one of the wives is not fine, this wife feels isolated and can reasonably go and commit suicide. Some of the women go through psychological, physical abuse, fighting and harm, and sexual abuse in marriage recorded because sex in homes is done by men without the concern of the wife because the man thinks that he is the head of the family and he can have sex with his wife even when the wife is not prepared. And this practically happens in the refugee camps because here, we have about 64 ethnic groups some of them give out their daughters in marriage even when their daughters do not know (KII, June 2023) . In addition, how relationship can manifest is highlighted by a participant below: Unwanted pregnancy, forced marriage, extra marital affairs, fights with the cowife, man concentrating on one family, emotional violences in women. For example, there are some refugee men who comes and impregnant their women and live them without any support and they go back to their country leaving women to struggle with pregnancy and taking care of children. (KII, June 2023) . The voices of the three Key Informants indicated that domestic violence and suicide are both serious and distressing issues that can be interconnected, especially for victims who are experiencing the devastating effects of abuse. In these situations, relationships can result in exploitation and physical, emotional, and psychological harm, perpetuating inequalities and violating the rights of vulnerable individuals, especially women and children. Addressing exploitation requires awareness, education, and the establishment of protective measures to ensure the safety and well-being of at-risk individuals. The above findings tally with the [22,23,24] that romantic companions or quasi-sexual assaults have encountered by 35 percent of women worldwide. Mental illness: This study indicated that mental illness and attempted suicide are closely related, and individuals with mental health conditions are at an increased risk of attempting suicide, similar to the overall population. A Key Informant made the following assertions. There are clients on mental treatment, they stop taking treatment and symptoms comes up for example voices becoming too loughs, tends to relapse. Mental health clients who are not diagnosed, they are there but unaware, because of pain, sadness, conflict in their thoughts ends up triggered to suicide. Depression being sad, loss of interest in the activities. trauma in acute form to event, psychological pains with bad dreams, thoughts leading to Post Traumatic Stress Disorder (PTSD). Psychosis- thoughts threating to kill them. Autism for instance a family nursing a child who has autism which comes with behavioral management-they don’t know how to manage, no special needs, no therapists, can’t keep in one place, family get confused, can’t work because of keeping this child who destroys people’s properties, fights, and they are aggressive. All the above triggers one’s suicide attempts (KII, June 2023) . The above voice indicates that mental health illnesses and attempted suicide are intertwined, and addressing this complex issue requires a comprehensive approach. By recognizing warning signs, reducing stigma, and promoting mental health awareness, an environment can be created in which individuals feel supported and encouraged to seek help. Therefore, investing in mental healthcare, education, and suicide prevention programs is essential to save lives and foster mental well-being in communities worldwide. Together, we can create a more compassionate and understandable society that prioritizes mental health and supports those who need it most. The above findings are in line with previous studies showing that, during adolescence, intense negative emotions such as guilt, shame, and hopelessness can cause psychological pain, and numerous studies have shown a link between psychological pain and the ability to commit suicide [29]. Financial difficulties: This study found that financial difficulties were a contributing factor in attempted suicide. The stress and strain of financial problems cause individuals to experience feelings of hopelessness, desperation, and helplessness, making them vulnerable to suicidal thoughts and behaviors. For example, one Key Informant explained: Chronic illnesses may leads to financial loss for example there was a client who had been battling with diabetes for so long but the treatment, medical bills, the way he saw how the family are struggling to make him alive, the money they were using to keep his life which he thought they would have been used somewhere else, and they see their cause of disease may not even recover tomorrow or other day, they are refugees, they have small incomes, seeing the little the family is saving is going to their medical bills, they are like instead of letting people suffer and tomorrow they still die, it is better to die and that one left a suicide note (KII, June 2023) . According to another Key Informant, “ the level of poverty is too high in our settlement and because of such reasons, people end up attempting committing suicide ” (KII, June 2023) . While supporting the above statement, a Key Informant argued that: The other trigger is unemployment. We all realize that everybody is yearning to be employed. Even the children who go to school, they go hoping that they will be employed. Where it has happened that one is jobless, one begins thinking in two ways. When you over think, the Satan can drive you to one side and you may end up committing suicide (KII, June 2023) . The three storylines by the Key Informants indicate the need for accessible and affordable healthcare services for all individuals, regardless of their financial status. Inequitable access to proper medical care can lead to adverse outcomes and exacerbate struggles faced by individuals with chronic illnesses. A previous study also asserted that household foreclosure and financial insecurity are thought to be the four triggers that lead to an upsurge in suicide risk due to comorbidity with additional risk factors such as depression [18,19], anxiety, violence and harmful alcohol use. Inadequate food deliveries: This study revealed that inadequate food deliveries can have severe implications for individuals' physical and mental well-being, leading to heightened stress, hopelessness, and desperation. A Key Informant shared how disputes or struggles over access to food or its distribution can create a severe emotional and psychological impact on those affected. Recently we had reduction food ratios and they categorized it into 3 categories 1,2,3. Category 3 which is the worst meaning they will not be receiving any food, but where does a refugee get money to buy this food? No where because they do not have work, no jobs, no employment opportunity in the settlement, they entirely rely on donor handouts and what partners gives. Reduction in food ratios has typically increased the suicides rates in Rhino settlement and partner implementing MHPSS in Rhino camp are finding a peak/rise in suicide cases and the cause are usually around the food (KII, June 2023) . To supplement, another Key Informant stated : One of the reasons could be because of food reduction. the food given to them are not enough to feed their families and that also bring back the issues of suicidal attempts. Since then when we were in our own country (home), we use to access our own food by our own self but now accessing food is also very hard, accessing land here is also very hard. All these things are the reasons why refugees attempt suicide. If we can increase or if the donors can give more support, it will help those who wanted to attempt to commit suicide or these who committed because of food related issues (KII, June 2023) . The above findings suggest that when people are deprived of proper nutrition and face the constant struggle of not having enough food, it can significantly impact their mental health, increasing the risk of suicidal thoughts and attempts. Therefore, addressing food insecurity and providing access to mental health support are essential steps for protecting vulnerable populations and promoting overall well-being. Efforts to alleviate poverty, increase food accessibility, and provide mental health resources can contribute to reducing the risk of suicide related to inadequate food delivery. The findings support previous results that state that through a number of mechanisms, food insecurity may raise the risk of suicidal thoughts and actions. For instance, poor nutrition, stress, and the stigma attached to food insecurity may lead to worsening mental health, which increases the risk of suicide and other related behaviors. Additionally, undernutrition has been linked to food insecurity in older adults [55], and this condition is positively correlated with suicidality [56]. Subjective Experience of Refugees’ Suicide Survivors This section focuses on objective two, namely: “To explore the subjective experience of refugees’ suicide survivors in Rhino Camp, West Nile, Uganda” . It draws on the views of eight suicide survivors. The following key findings emerged from Study Objective two: 1) traumatic past, 2) psychological distress, 3) social isolation, and 4) cultural stigma, as detailed below. Traumatic Past: Many participants shared experiences of violence, persecution, and loss in their home countries, leading to traumatic pasts that affected their mental well-being. They experienced long-lasting effects on their mental well-being which developed into depression, anxiety, and other psychological health issues as narrated by a 40-year-old Female below: I thought of death of my first husband in the war who was so nice to me coupled with camp stressors and I went to drinking and abandoning my children alone. I drunk alcohol for one full month without eating because my only wish was death and even if people advise me to stop drinking, I would not accept. One day I picked the drugs and swallowed and I was unconscious and they rushed me to the health center where I survived death. At the time I took the drug, I felt less breath, eye closed, heart shut down and I had no vision for seeing anything, ( In-depth Interview, June 2023 ) The voice above indicates that memories of violence and loss may continue to haunt them, causing emotional distress and making it challenging to cope with the present and plan for the future. In the context of attempted suicide, the accumulation of trauma can be overwhelming for some individuals. They may feel hopeless, powerless, and unable to envision a better future, increasing their vulnerability to suicidal thoughts and actions. Furthermore, the lack of access to mental health services within refugee camps exacerbates the impact of these traumatic experiences, leaving many refugees without the necessary support and resources to heal and recover. The above findings are in line with previous studies that, as a result, suicidal thoughts and attempts are highly likely to occur among refugees and/or asylum seekers [13]. The probability of psychological illnesses evolving in displaced people is significantly increased due to the large number of traumatic situations that the majority of displaced people experience as a result of having to flee their country. According to [57,58,59,60], depression, anxiety disorders, post-traumatic stress disorder, and somatization illnesses seem to be the most prevalent disorders. Suicide attempts and thoughts are more common in people with mental illnesses and difficult life circumstances. Teenage girls have high rates of emotional disorders and suicidal thoughts. Individual and family initiatives may be beneficial for teenage girls who are at increased risk of suicide and mental trauma [10]. Psychological Distress: Other participants reported high levels of psychological distress due to ongoing uncertainties, worry about the welfare of the kids, household, as well as companions, hopelessness, camp stressors, displacement, and limited access to resources as asserted by the voices below: A 33-year-old female shared her experience: I found my child who is in primary six (6) was sent home because of money and there was no money and also the children stayed for two days without eating food. I felt very disappointed with life, sad, hopeless and angry on myself, my husband rejected me and my children, the world is not worth me living in, so when all these things came into my mind, a plan of drowning into the river together with my children came into my mind (In-depth Interview, June 2023). A related experience was shared by a 40-year-old female The second suicide attempt was now in Ocea C using a rope where I currently staying. In Ocea life is very difficult, my family is size 4, food is very little and no land for cultivation, no one to build for me and when it rain at night we have just to stand the all night because the roof is leaking everywhere, no ways of accessing basic needs like soap, and sanitary facilities and no money for paying children to school, I don’t have a brother he got an accident and I am alone, no one who could support me and right now I am the only one who is taking care of my mother who is old and sick (In-depth Interview, June 2023). Similarly, a 44-year-old female expressed that: Issue of school fees was a challenge for my child who was in S.4. I was having my clan brother who use to paid but he got sick and my child did not go to school. By then, my child was going for the final exams and I was looking for credit from people. There was no money, nobody helped me. That is when that incident started. (In-depth Interview, June 2023). The three voices above indicate that the combination of ongoing uncertainties, displacement, limited resources, traumatic memories, social isolation, and a lack of mental health support contributes to high levels of psychological distress among refugees in Rhino Camp. Addressing these issues requires a comprehensive approach that includes providing basic necessities, fostering a sense of community and support, and offering culturally appropriate mental health services to help refugees cope with distress and rebuild their lives with hope and resilience. The study findings are congruent with those of previous studies, which state that teenage girls have very high rates of both emotional disorders and suicidal thoughts. Individual and family initiatives may be beneficial for teenage girls who are at increased risk of suicide and mental trauma[10]. Overall, the results emphasize earlier findings showing a link between mental distress among displaced people and increased levels of suicidal ideation and suicide attempts [13]. Social Isolation: Findings indicate that the lack of social support systems and feelings of isolation further exacerbate participants' mental health challenges. They expressed the need to create opportunities for social interactions within the camp, as shared by the following statements: A 40-year-old female narrated that: I started thinking it is better to kill myself and the government come and take the children, I cried a lot, depressed and traumatized for three days then I just pick the rope, locked the door, tied it in my house and climb the roof, only to find myself in Ocea health center where I woke up feeling throat pain and wound on my neck, I can’t swallow saliva, I went through severity pain and having shame and guilty of what have done, embarrassed. When I came back Isolated myself from the people. Organization social workers and Psychologists came and counsel me (In-depth Interview, June 2023). Another participant shared how the experience of social isolation was addressed: Organization like TPO provide home visit, counseling, Psychological First Aids through Social Worker and Clinical Psychologist. Psychosocial support provided by the family, friends, and community members. I also got help from the health facility through the treatment and medication I have got. Also, prayers were organized by my church at my home (In-depth Interview, June 2023). The above statements indicate that the consequences of social isolation can be severe, especially for individuals who have already experienced psychological distress. Social support is crucial for mental well-being as it provides emotional comfort, validation, and a sense of belonging. Without such support, individuals may feel overwhelmed by their challenges and lack coping mechanisms, leading to worsened mental health conditions including depression, anxiety, and feelings of hopelessness. To address social isolation among refugees, it is vital to create opportunities for social interaction within the camp. This can include organizing community events, support groups, and cultural exchange programmes. Promoting tolerance and inclusivity, along with providing mental health support services, can play a significant role in mitigating social isolation and improving the overall health of refugees in Rhino Camp. The participants needed to create opportunities for social interaction within the camp, which corresponded with a few researchers. They have emphasized the effectiveness of mutual treatment in suicide prevention owing to the interdisciplinary team’s collaboration having a positive effect on the psychological health of sick people [61,62]. Cultural Stigma: Participants expressed the existence of cultural stigmatization around mental health issues, which prevented them from seeking help and support. A participant shared her bitter experience below: There are so many who were even laughing sometimes at me. Stigmatization is there, because at times when I go for some funeral place, people when they see me, they start commenting about my body being thin because by then when I was working as a business woman, I used to have good body. But nowadays you find people will be like, is she the one or she is not the one? People are just trying to give you hardship, and always those things are there. It even contributed like not visiting people, because always when I go, I think that maybe they are going to talk about me. That is why staying alone could all contribute to this thought that could bring me to again come and attempt suicide (In-depth Interview, June 2023). This voice demonstrates how the consequences of cultural stigma can be significant, particularly for refugees who are already facing numerous challenges in their lives. The fear of being judged or rejected by their community can deter them from seeking professional help or confiding with others about their mental health concerns. Consequently, mental health problems may go untreated, leading to worsening conditions and potential long-term negative effects on well-being. Addressing cultural stigma surrounding mental health requires a multi-faceted approach that includes education, awareness campaigns, and community involvement. It is essential to engage with community leaders, religious figures, and traditional healers to promote a more comprehensive and supportive environment for individuals dealing with mental health challenges. By challenging misconceptions, fostering open dialogue, and offering culturally sensitive mental health services, we can break down the barriers created by cultural stigma and provide necessary support and care for refugees in Rhino Camp. These results are in line with those of a previous study that explained that cross-cultural stress, encounters with discriminatory practices, cultural differences, and environmental exposure factors are some of the factors that impact suicidality among refugees [63]. Support Systems Utilized by Suicide Survivors After Attempting Suicide This section focuses on objective three, namely: “ To explore the support systems in place utilized by refugees’ suicide survivors after attempting suicide in Rhino Camp, West Nile, Uganda. ” . It also draws on the views of seven Key Informants and eight suicide survivors regarding the support systems utilized after attempting suicide. The following key findings emerged from the study objective 3:1) community and family support; 2) role of religious, cultural, and opinion or other leaders; 4) health facilities support; 5) coping mechanisms; and 6) psychosocial support providers, as detailed below. Community and Family Support: This study revealed various community structures put in place by organizations to provide assistance to individuals in need. Participant Information provided a detailed account. You see the individuals who attempted suicide and also those who have completed suicides, they all come from the family. So, I can say that the family is the first support system that we can dwell on. From my experience in the sector is that people who have suicide tendencies are best understood at family levels because you see if somebody starts to lament on issues which are very hard , when you start to behave in a way that they don't even know what they are doing, they are always isolated, they want to stay alone, they can best be addressed at the family level if there are family members for example if there is a wife, husband, children and so on. Family in totality is the first system that we know can support us in the management of attempted suicide (KII, June 2023). Another participant suggested that: Community support systems for mental health vary in awareness, with some known to the community and others not. Organizations had established community structures, like CRTs (Crisis Response Teams), VPAs (Volunteer Psychosocial Assistants), Community Based Sociotherapy Facilitators (CBS) Community Development Workers and Village Health Teams, to aid in times of crises and suicide attempts. Religious, cultural, and opinion leaders serve as trusted first contacts, while mental health professionals, including psychologists, social workers, and psychiatric clinical officers, offer counseling and therapies. Health facilities within and outside the community provide ongoing support, treatment, and follow-ups for individuals dealing with mental health conditions (KII, June 2023). Relatedly, one more participant explained that: Community structures such as Crisis Response Teams, Volunteer Psychosocial Assistants, and Village Health Teams are empowered at the grassroots level. They receive training in Psychological First Aid and Medical First Aid, and have established reporting mechanisms and referral pathways. They work closely with community leaders and ambulances to respond to emergencies like suicide attempts and maternal health needs. Refugee Welfare Councils also play a supportive role. Trained professionals, including social workers, psychiatric clinical officers, and psychologists, provide comprehensive psychosocial support. They conduct mental health assessments, offer counseling and coping therapies to clients and their families. Cases are discussed in sector working groups and settlement coordination meetings to ensure appropriate support is provided (KII, June 2023). These three statements indicate the presence of well-organized and comprehensive mental health support systems within communities, especially in the context of addressing suicide attempts and mental health challenges. These support systems are rooted at the family and grassroots levels and involve various community structures and trained professionals. However, potential gaps include addressing mental health stigma, improving access to remote areas, strengthening crisis response capacity, enhancing coordination and communication among support entities, ensuring long-term follow-up for individuals, promoting cultural sensitivity, establishing data and monitoring systems, integrating mental health with primary healthcare, and enhancing family and community involvement in mental health programs. Addressing these gaps will lead to more effective and inclusive mental health support systems for communities. According to Olatunji et al. (2020), family support is a type of communal support that aids in providing practical, monetary, and affective assistance. Parental involvement results in the lessening of suicide attempts and suicide ideation due to a reduction in depression, according to the latest findings involving 251 South-West Nigerian students from its two universities [64]. Role of Religious, Cultural, and Opinion or other Leaders: A participant had this to say on the support system, “ Religious, cultural, and opinion leaders are first contact/point of entry and community trust them”, (KII, June 2023). In addition, a participant expressed that: We also have spiritual leaders who help provide counseling or talk to the families. We also have African Traditional setting where the elders in the community intervene in case there is suicidal cases in the community. We engage with different partners who intervene in the cases of attempted suicide and suicidal cases and makes follow up with the affected persons to see how they are coping up. We also have police where need be, at times we need enforcement where the situation needs a victim to be kept under safe custody (KII, June 2023). These two accounts indicate that in many communities, religious, cultural, and opinion or other leaders have significant influence and are often the first point of contact for individuals seeking help. These leaders play a crucial role in building trust and facilitating community-related support for those dealing with mental-health challenges. These findings are in line with a previous study that stated that helpful psychological health results with a great deal of happiness are typically associated with religious faith and spirituality [65,66]. Psychosocial support providers : This study revealed that psychosocial support providers play a vital role in helping individuals who have attempted suicide navigate through complex emotional aftermath, providing them with the necessary tools and support to foster healing, resilience, and a renewed sense of hope for the future. To illustrate, a participant highlighted that, “Organizations dealing in Psychosocial Support have people who represent them within the community for example psychologists, social workers and psychiatric clinical officers who provides counseling, advanced therapies, and treatment of mental health conditions etc. ” (KII, June 2023). Similarly, another participant expressed that, The MHPSS partners come in to provide MHPSS aspects. The organization comprised of trained professional social workers, psychiatric clinical officers and psychologists. Their work is to carry out menta health assessment on the clients, profile and clerk cases and take clients through counseling and coping therapies not only individual who attempted suicide but also immediate family members and community because they all suffer this trauma. After profiling and clerking the clients’ case. The cases are forwarded to the sector working group meetings and conference. These cases further go to the settlement coordination meeting after ascertaining the root cause of suicide where all partners come to discuss and provide support according to the need (KII, June 2023). These findings indicate that psychosocial support providers play a vital role in helping individuals who have attempted suicide navigate through complex emotional aftermath, providing them with the necessary tools and support to foster healing, resilience, and a renewed sense of hope for the future. A few researchers have emphasized the effectiveness of mutual treatment in suicide prevention owing to the interdisciplinary team’s collaboration, which has a positive effect on the psychological health of sick people [61,62]. Health Facilities Support: This study revealed that health facilities play an essential role in supporting individuals with mental health issues both within and outside the community. They offer treatment, follow-up, and access to mental health professionals, who can provide support within the community. In support health facilities and community support, a participant had this to say, “ Health facilities within the community and outside communities that keeps on supporting such people or they have mental health professionals that can easily go within the community and support. Health facilities give treatment and follow ups on the clients ”, (KII, June 2023). Like the voice above, another participant added that: Some of the services including the health services, community health outreach programs by the health workers, the referrals by the partners where they go out to find out what is ongoing. Rescue in terms of ambulance services for example when one attempts to commit suicide and not yet dead, the person is taken to the health center. From the health center, counseling and treatment of the wounds is done. Through the VHT system also. There's continuous follow up on how this person is coping up and there is also reporting (KII, June 2023). The above voices point to the significance of a collaborative and supportive approach in dealing with attempted suicide, combining the resources and expertise of health facilities with compassion and understanding of the community to promote mental health and well-being. These findings correspond to those of a previous study that found that the wishes of survivors of suicide attempts include cooperative experts, coordination of care, more follow-up endeavors, and very few transfers throughout the course of treatment [67]. Related favorable and unfavorable opinions on psychotropic drugs have also been documented in previous research [68,69]. Coping Mechanisms: Coping mechanisms among refugees in Rhino Camp, West Nile, Uganda, refer to the strategies and resources that individuals use to navigate the challenges and stressors they face, including those related to their mental health. Given their limited access to formal mental health services, refugees often rely on various coping mechanisms to cope with their emotional struggles. This study found that some participants used coping mechanisms, such as support from family or spiritual practices, to deal with their mental health struggles. To illustrate this, a 33-year-old woman said: Right now, the way I am coping, I managed to secure some land that I am digging and I also constructed my houses alone which has helped to reduced thought of suicide. The organization like CEFORD came and talked to me. Friends helped me to cope up with suicide attempt ( In-depth Interview, June 2023 ). Similarly, another participant explained that: The first help I got from the family, and Refugee Welfare Council one (RWCI), women representative who came and they counseled me. And then there are some phone calls that also called to counsel me. Friends helped me to cope up with suicide attempt (In-depth Interview, June 2023). The above statements indicate the importance of recognizing and appreciating the coping mechanisms used by refugees, as they highlight the resilience and strength of individuals facing overwhelming difficulties. However, it is crucial to note that while some coping strategies could have been effective, they may not be sufficient to address severe mental health challenges, lack professional mental health services, and the stigma surrounding mental health can limit the effectiveness of these coping mechanisms, underscoring the need for comprehensive mental health support within the refugee camp. Addressing mental health issues among refugees requires a holistic approach that combines informal coping mechanisms and formal mental health interventions. By providing accessible and culturally sensitive mental health services, we can better support refugees in dealing with their mental health struggles, and help them build resilience by rebuilding their lives in challenging circumstances. This is in line with previous study results that asserted that individuals with psychiatric illnesses, even those who are unsociable and have little fun, may advance as well as practice helpful coping mechanisms to control psychological pressure as well as to safeguard and improve their health with the help of such assistance [70]. Understanding refugee suicide survivors’subjective experiences is crucial for developing effective interventions. Survivors’ narratives reveal the immense emotional pain they endure, often feeling overwhelmed by their circumstances. Feelings of loneliness, guilt, and shame are common among survivors as they struggle to cope with the aftermath of their suicide attempts. Cultural stigma surrounding mental health issues prevents many refugees from seeking help, as they fear being ostracized or labelled as weak. Consequently, individuals often suffer from silence and a lack of access to proper mental health support. Empowering survivors to openly share their experiences can help reduce stigma and pave the way for destigmatizing mental health discussions within the refugee community. The study corresponds to the study results conducted by [63] who asserts that cross-cultural stress, encounters with discriminatory practices, cultural differences, and environmental exposure factors are some of the factors that have an impact on suicidality among refugees. DISCUSSION Research Question 1. “What are the triggers that prompt refugees suicide survivors to attempt suicide in Rhino Camp, West Nile, Uganda?” Based on the shared views of the volunteers who participated in this study, it was found that domestic violence and suicide are interconnected issues, particularly for victims experiencing abuse. Moreover, exploitation, harm, and inequality perpetuate this link, especially affecting vulnerable individuals, such as women and children. The above findings tally with the [22,23,24], and other sources that romantic companions or quasi-sexual assaults have encountered by 35 percent of women worldwide. To address this, collaboration among various stakeholders, including prevention and early intervention, is necessary. Thomas Joiner's Interpersonal Theory of Suicidal Attempts (2005) provides a valuable lens for understanding the complex relationship between domestic violence and suicide vulnerability among victims. By applying this theory to develop interventions, stakeholders can work together to make the surroundings for those who are abused secure as well as more compassionate to eventually lower suicidality and promote healthier outcomes. Turning to mental illness, this study revealed that mental health issues and suicide are linked, and individuals with mental health conditions are at an increased risk of attempting suicide, similar to the overall population. In a study of 105 cases of main depressive disorder, 31 females and 74 males, revealed a significant relationship between mental pain and suicidality [28]. By showing that suicidal behavior tryers were more likely to provide terrible psychological anguish (odds ratios [ORs] among 1.02, but also 1.17; P. 001) suicide attempt purpose through or lacking a clear proposal (ORs 11.57 11.77; P. 001), extra proof that psychological anguish plays an important part along with suicide risk was offered by [71]. Additionally, they were more likely to suffer from major depressive disorder (ORs between 1.62 and 1.70; P. 05) and personality psychological disorders (ORs between 2.65 and 3.01; P .001; ORs for others between 1.96 and 2.28). A systematic review of 15 studies found that mental pain was a significant predictor of suicidal ideation and attempt vulnerability. During adolescence, intense negative emotions such as guilt, shame, and hopelessness can cause psychological pain, and numerous studies have shown a link between psychological pain and the ability to commit suicide [29]. Thus, a comprehensive approach is needed to recognize warning signs, reduce stigma, promote mental health awareness, invest in mental healthcare, and implement suicide prevention programs. In addition, a compassionate society prioritizing mental well-being can save lives and support those in need. By understanding these factors, stakeholders can develop tailored interventions and create a compassionate society that prioritizes mental well-being, ultimately saving lives and supporting those in need among the refugee population in Rhino Camp. This study found that financial difficulties contributed to attempted suicides. The stress and strain of financial problems cause individuals to experience feelings of hopelessness, desperation, and helplessness, making them vulnerable to suicidal thoughts and behaviors. The results of this study are broadly consistent with previous research on household foreclosure and financial insecurity, which are thought to be triggers that lead to an upsurge in suicide risk due to co-morbidity with additional risk factors such as depression [18,19],anxiety, violence, and harmful alcohol use. Therefore, financial downturns, such as those linked to individual hardships caused by job or asset losses, can be related to individual suicide risk. According to [72], those seeking asylum and refugees might be in danger of suffering poor social conditions upon arrival in another country; they might reside at the bottom of the social scale. [73] asserted that anxiety and depression are linked to living in poverty, which refugees and asylum seekers encounter. Bad monetary situations, including permit limitations that restrict obtaining assistance, social benefits, and medical treatment in the resettlement nation, leave immigrants with precarious situations that affect both mental and physical health [72]. The study suggests that fostering community-based support initiatives, such as provision and integration of livelihood activities into Mental Health and Psychosocial Support, would improve refugee well-being and financial status. In conclusion, this study pointed out that food insecurity significantly impacts mental health, increasing the risk of suicidal thoughts and attempts. The findings support previous results that state that through a number of mechanisms, food insecurity may raise the risk of suicidal thoughts and actions. For instance, poor nutrition, stress, and the stigma attached to food insecurity may lead to worsening mental health, which increases the risk of suicide and other related behaviors. Additionally, undernutrition has been linked to food insecurity in older adults [55], and this condition is positively correlated with suicidality [56]. Thomas Joiner's Interpersonal Theory of Suicidal Attempts (2005) helps us understand how food insecurity affects mental health and increases the risk of suicidal thoughts and attempts. Combining this theory with comprehensive measures and collaborative approaches can effectively address this issue, promote overall well-being, and reduce the risk of suicide in vulnerable populations affected by food insecurity. To effectively address this issue, the findings suggest comprehensive measures to alleviate poverty, increase food accessibility, provide land for agriculture through the Office of the Prime Minister, and rent land from the host communities surrounding refugee camps, mitigating drought. Collaborative approaches involving governments, organizations, and communities are crucial. Early intervention and prevention, along with building social support networks, can help break the cycle of food insecurity and mental health challenges, promote overall well-being, and reduce suicide risk. Research Question 2. “What is the subjective experience of refugees’ suicide survivors in Rhino Camp, West Nile, Uganda?” This study revealed that traumatic experiences have a profound and lasting impact on refugees, making them more vulnerable to suicidal ideation ideas and behaviors. Forfeitures, such as family and friends, birthplace, respect, public connection, fiscal properties, salary, and economic stability [31] lead to a lasting impact of trauma, which eventually prompts refugees to attempt suicide or complete. A study of the protracted mental health of war-affected refugees reported high levels of trauma, mental illnesses such as post-traumatic stress disorder and depression [10] and anxiety disorders in refugees ranging from 20% or more after resettlement. According to data from a national survey, the proportion of depressive disorder among adolescents aged 12 to 17 in the previous year rose from 9% in 2004 to 15.7% in 2019 [74]. As a result, before, during, and/or after flight, suicidal thoughts and attempts are likely to occur among refugees and/or asylum seekers [13]. The probability of psychological illnesses evolving in displaced people is significantly increased due to the large number of traumatic situations that the majority of displaced people experience as a result of having to flee their country. According to [57,58,59,60], depression, anxiety disorders, post-traumatic stress disorder, and somatization seem to be the most prevalent disorders. Suicide attempts and thoughts are more common in people with mental illnesses and difficult life circumstances. Teenage girls have high rates of emotional disorders and suicidal thoughts. Individual and family initiatives may be beneficial for teenage girls who are at increased risk of suicide and mental trauma [10]. Addressing the mental health needs of refugees and providing comprehensive support and trauma-informed care are essential in fostering healing and resilience among those who have endured violence and loss. Recognizing the significance of mental well-being and offering appropriate resources can help refugees cope with their trauma and envision a more hopeful future. Regarding psychological distress as a theme, the shared experiences from participants revealed that the combination of ongoing uncertainties, worry about the welfare of the kids, household as well as companions, limited resources, camp stressors, traumatic memories, social isolation, and inadequate mental health support contributes to high levels of hopelessness brought about by psychological distress among refugees in Rhino Camp. The study findings are congruent with those of previous studies, according to [25], who found that suicide attempts were three times more likely to occur in people who felt extreme hopelessness than in those who did not. According to evidence, those who feel defeated have already forgotten the significance and intent of their lives. can result in several mental illnesses and serious suicide attempts [75]. The findings of this study suggest that it is essential to recognize the indications of discouragement or despair and comprehend the pain that patients experience in therapy, provide basic necessities, foster a sense of community and family support, and offer culturally appropriate mental health services. This approach aims to help refugees cope with distress and rebuild their lives with hope and resilience. Collaboration among governments, humanitarian organizations, and local communities is essential for implementing sustainable solutions for the well-being of refugees. Regarding social isolation as another theme, the study revealed that a lack of social support systems and feelings of isolation further exacerbated participants' mental health challenges. The study findings are in line with the study conducted in 2019, which states that people experience a sense of loneliness and a fear of abandonment when they feel cut off from their closest social group, consisting of spouses, relatives, acquaintances, as well as important nobles [76] Depression, feelings of loneliness and despair, and isolation frequently co-exist. According to a systematic review on the topic, both familial and suicidal loneliness and disconnection are highly associated with one another [26]. However, the results vary slightly by region. Additionally, youth have received the most attention in the most frequent time frame, which is a main problem due to thrifts’ inability to miss youthful generations [26]. Other research on adolescents and young adults found a strong connection between subjective feelings of loneliness and suicidal outcomes, particularly SA and SI [27]. An indirect link between suicide and older age via hopelessness, depression, and unfavorable attitudes toward health has been suggested by the association between older age and social isolation. Physical illness did not increase the risk. According to multivariate analyses, depression, social exclusion, and unfavorable health attitudes had a full mediating effect on the effects of hopelessness on suicide [77]. Joiner et al. (2009) recognized a modest effect of indifference to thoughts of suicide on feelings as well as family social support [78]. Such results were comprehended by the writers in the suicide Interpersonal Psychological Theory context, which establishes that interpersonal concepts, purported distress, and frustrated belonging create the motivation to die as a necessary prerequisite to suicide attempts. This study supports the notion that having more social connections is protective against suicide, even though suicide attempts differ from suicidal thoughts or behaviors and are likely to be relatively common in adolescents. Creating opportunities for social interaction within refugee camps is crucial to improve mental well-being. This can include community events, support groups, and cultural exchange programmes. Promoting tolerance and inclusivity and providing mental health support services are also important in mitigating social isolation and enhancing the overall happiness of refugees in the Rhino Camp. Research and humanitarian organizations support community-based approaches to address mental health challenges and promote resilience among refugees. Another theme is cultural stigma, which found that cultural stigma surrounding mental health among refugees can have significant consequences, hindering their ability to seek help and worsening their condition. The results of this study correspond with those of other studies of cultural stigma. Refugees and asylum seekers have a high chance of being at increased risk when they are cut off from their household members, culture, and religion [17]. The mental health of refugees and asylum seekers can be adversely affected by cultural identity loss and ties during relocation [79]. The Protective Culture Model [63]can be used to explain protective factors against suicide (such as religious convictions, strong family ties, and social support) that may be connected to one's culture of origin. This reduces the stress of acculturation. Even so, as time passes in the host nation, this protection wanes, leading to an increase in suicidal thoughts and actions in the second generation. Cross-cultural stress, encounters with discriminatory practices, cultural differences, and environmental factors are some of the factors that impact suicidality among refugees [63]. Although encounters before relocation powerfully affect psychological health and wellness, findings demonstrate that encounters in life after relocation may also have an impact on the psychological well-being of refugees and asylum seekers [79], with robust resettlement practices showing positive outcomes for mental health [80]. To address this, a multifaceted approach is essential, including education, awareness campaigns, and community involvement. Engaging community leaders and offering culturally sensitive mental health services can break down barriers and create a more supportive environment. Empowering refugees to advocate for their mental health further enhanced their happiness in Rhino Camp. Research Question 3. “What support systems are available to refugees’ suicide survivors to help them in the process of recovering after suicide attempt?” From the shared views of the participants regarding community and family support, this study disclosed that the presence of well-organized and comprehensive mental health support systems within communities is vital for addressing suicide attempts and mental health challenges effectively. These systems involve various community structures, trained professionals, and families. The study results are in line with other studies that state that parental involvement results in the lessening of suicide attempts and suicide ideation due to a reduction in depression, according to the latest findings involving 251 South-West Nigerian students from its two universities [64]. According to Olatunji et al. (2020), family support is a type of communal support that aids in providing practical, monetary, and affective assistance. The person's closest friends and family (couples, households, nobles, and substantial people) have the greatest effect and may be helpful during difficult periods. A significant source may be provided by friends and family, such as communal, affective, and monetary provisions, which lessens the effects of external stressors. Resilience built up from aid reduces the risk of suicide associated with traumatized childhood [81]. Relations are especially protective for young people and the elderly, who have developed levels of dependency. However, potential gaps need attention, including addressing mental health stigma, improving access to remote areas, strengthening crisis response capacity, enhancing coordination and communication among support entities, ensuring long-term follow-up, promoting cultural sensitivity, establishing data and monitoring systems, and integrating mental health with primary healthcare. By addressing these gaps, mental health support systems can become more effective, inclusive, and responsive to communities’ diverse needs. Collaboration among stakeholders is essential for creating comprehensive mental health support systems that prioritize the well-being and resilience of individuals facing mental health challenges. The study results revealed that religious, cultural, and opinion leaders in communities have a significant influence and are often the first point of contact for individuals seeking help for mental health challenges. They play a crucial role in building trust, breaking the stigma, and facilitating community-related support. These leaders provide culturally relevant and accessible mental health assistance, mobilize community resources, and promote a holistic approach to well-being. Refugee Suicide attempt survivors frequently rely on divine principles and observe as opposed to formal clerical membership, according to [82] and [83]. These activities aid in overcoming desperateness, sole greatest reliable dangerous aspect for suicide as well as a symbol in the hearts of individuals who had psychological disorders, and they encourage people to seek personal fulfillment and a sense of belonging outside of the mainstream. Helpful psychological health results in a great deal of happiness and are typically associated with religious faith and spirituality [65, 66]. hese relationships include having access to social support, being resilient to stress, being emotionally stable and calm, having an internal fortitude and enablement, feeling a great deal of happiness, and being less likely to attempt suicide. According to trauma survivors, spirituality helps them to recover in part by transforming their anger and feelings of powerlessness, both of which are risk factors for suicide, into self-agency [84]. Collaboration between these leaders, mental health professionals, and community organizations is essential for creating a comprehensive and effective mental health support system that meets the diverse needs of individuals facing mental health challenges. Based on the shared views from the participants who participated in the research identified that psychosocial support providers are instrumental in helping individuals who have attempted suicide navigate the emotional aftermath, fostering healing, resilience, and hope for the future. They create a safe and non-judgmental space, actively listen to, and validate individuals' experiences. Their roles include offering coping strategies, exploring triggers, and addressing underlying issues. They build hope; provide long-term support; and adopt a holistic approach to address emotional, social, and spiritual aspects. Additionally, they may refer individuals to professional mental health services when needed, and engage in suicide prevention initiatives. Compassionate support plays a crucial role in individuals' healing and contributes to suicide prevention. The study is congruent with other studies that revealed that suicide survivors who have been portraying real upsetting encounters or proactively taking chances to improve are backed by high, lasting, collectively strong partnerships with clinicians [85]. Individuals with psychiatric illnesses, even those who are unsociable and have little fun, may advance as well as practice helpful coping mechanisms to control psychological pressure as well as to safeguard and improve their health with the help of such assistance [70,86]. A few researchers have emphasized the effectiveness of mutual treatment in suicide prevention owing to the interdisciplinary team’s collaboration having a positive effect on the psychological happiness of sick people [61,62] The shared opinions of the participants revealed that collaborative and supportive approaches to dealing with attempted suicide involve combining the resources and expertise of health facilities with compassion and understanding of the community. It integrates professional mental healthcare with community support to effectively promote mental health and well-being. This approach includes providing integrated care, offering compassionate support, raising awareness through education, and implementing suicide-prevention strategies. By working together, stakeholders can create a comprehensive and caring support system that addresses mental health challenges and effectively promotes suicide prevention. Suicidal behavior can be decreased by receiving sufficient, prompt, and available therapeutic interventions to treat mental illness and drug abuse [87,88]. Crucial tactics to broaden structures' and organizations' healthcare facilities availability and policies across all health, especially at community health centers. The use of proper context by healthcare professionals, clear messaging to users about available services, and more streamlined client flow through the system are all examples of practices. Health literacy policies and strategies should pay particular attention to mental health literacy [89,90]. The wishes of survivors of suicide attempts include cooperative expertise, coordination of care, more follow-up endeavors, and very few transfers throughout the course of treatment [67]. According to [69] and [91], service users regularly believe that some experts are ill-equipped to address suicidality and stress the significance of early and regular potential for therapeutic inquiry into relevant subjects and biomedical initiatives to relieve suffering, with neither being seen as a replacement for the other. Related favorable and unfavorable opinions on psychotropic drugs have also been documented in previous research [68,69]. The above voices point to the significance of a collaborative and supportive approach in dealing with attempted suicide, combining the resources and expertise of health facilities with compassion and understanding of the community to promote mental health and well-being. The last major theme under Research Question 3 was coping mechanisms to face overwhelming challenges. Other studies have revealed that connection plays a crucial role in recovery, and social environments are crucial for presenting opportunities for doing and being in daily life [92]. Social structures aid in reducing the aspirations of insistently disadvantaged groups, causing people to internalize constrained or unsuitable favorites, needs, and expectations in order to conform to what is practical. Strong interpersonal skills and self-confidence are nurtured between those with serious psychological disorders by proactive, problem-focused stress management techniques, such as a friendly mindset. These strategies have also been linked to self-help participation. These coping skills can be learned, modeled, and supported using cognitive-behavioral methods, which are helpful in the practice of mental health, particularly in the management of one's health. In order to fight feelings of desperateness, valueless, and loneliness among refugee suicide survivors, supporting networks and healthy coping strategies are therefore helpful in lowering the shame associated with thoughts of suicide. Strengths and limitations of the study Strengths of the study This study is the first to explore the lived experiences of refugees who attempted suicide in Rhino Camp, West Nile, and Uganda. This study adds to the body of scientific knowledge on Mental Health aimed at clarifying the unique experiences of suicide survivors of refugees with regard to displacement, trauma, and limited access to mental health services. Study limitations and delimitations This study was limited by several factors during the field work and included; First, some participants expressed fear during the data-collection process that contributed to incomplete or inaccurate responses. This fear stemmed from concerns about confidentiality, potential repercussions, or the sensitivity of the topic that led certain participants to provide responses that were not fully accurate. To minimize this issue, the researchers clarified and rephrased interview questions when needed to reduce perceived sensitivity and ensure participants felt comfortable, also the researchers ensured that participants fully understood the confidentiality measures in place and by explaining to the participants that participation is volunteer with no implications attached. Second, the study required substantial time for data collection and analysis due to the large volume of data generated. The extensive nature of the data demanded careful and prolonged attention to ensure accuracy, validity, and thorough interpretation. The researchers allocated sufficient time to deal with the large volume of data involved in the research and employed systematic procedures to manage and analyse the data. CONCLUSION The findings from this study provide the following conclusion: Triggers for Suicide Attempts: This research highlights the multiple triggers that prompt suicide attempts among refugee survivors in Rhino Camp. Domestic Violence and relationships, mental illness, financial difficulties, and inadequate food delivery. Subjective Experience of Suicide Survivors: Subjective experiences of suicide survivors reveal a traumatic past, psychological distress, social isolation, and cultural stigma surrounding mental health issues that prevents many refugees from seeking help, leading to silence and lack of access to proper mental health support. Empowering survivors to openly share their experiences can reduce suicide and pave the way for mental health discussions within refugee communities. The lack of adequate mental health services within Rhino Camp exacerbates suicide survivors’ vulnerability. Support Systems for Suicide Survivors: The research highlights community and family support; the role of religious, cultural, and opinion or other leaders; health facilities support; coping mechanisms; and Psychosocial Support Providers as the available support system. Limited support systems are often understaffed and lack cultural sensitivity, which makes them less accessible to the refugee population. Community-based support initiatives hold promise for addressing the mental health needs of refugee suicide survivors. Establishing support groups and engaging community leaders can create safe spaces for survivors to talk about their experiences and receive support from those who have experienced comparable struggles. Recommendations: The research suggests the following recommendations to address the mental health needs of suicide survivors in refugee camps. 1. Enhance mental health services by recruiting and training culturally sensitive professionals who understand the trauma experienced by refugees. Adequate resources should be allocated to establish counseling centers and support groups that provide accessible and stigma-free mental health assistance. 2. Promote mental health awareness within the refugee community to empower refugee suicide survivors to share their experiences openly, break their silence, and foster a supportive environment. 3. Foster community-based support initiatives involving community leaders and volunteers. Establish support groups for suicide survivors, led by trained facilitators, and engage community leaders in mental health discussions. Collaborate with existing community structures, such as Refugee Welfare Councils and Village Health Teams, to build a holistic and sustainable support network for suicide survivors. Provision and integration of livelihood activities into MHPSS to support refugees with food-related distress. 4. Stakeholders should work together to make the surroundings for those who are being abused secure and more compassionate to eventually lower suicidality and promote healthier outcomes through awareness, education, and the establishment of protective measures to ensure the safety and well-being of those at risk. 5. Foster comprehensive measures of alleviating poverty, increasing food accessibility, providing land for agriculture through the Office of Prime Minister, renting land from the host communities surrounding refugee camps, and mitigating drought. Early intervention and prevention, along with building social support networks, can help break the cycle of food insecurity and mental health challenges, promote overall well-being, and reduce suicide risk. Collaborative approaches involving governments, organizations, and communities are crucial. Further research on the problem of study can be undertaken in the areas below This research area aims to deepen the understanding of the challenges faced by suicide survivors in refugee settings and identify effective strategies for providing meaningful and sustainable mental health support. By addressing the gaps in mental health services and acknowledging the importance of cultural sensitivity and community involvement, future research can help improve the well-being and resilience of suicide survivors in Rhino camps and similar refugee communities. Abbreviations CDC Centers for Disease Control and Prevention IASC Inter-Agency Standing Committee ILO International Labour Organization IPT Interpersonal Theory LUREC Lira University Research Ethic Committee OPM Office of the Prime Minister PTSD Post Traumatic Stress Disorder RDO Refugee Desk Officer RWCs Refugee Welfare Councils SA Suicide Attempt SAMHSA Substance Abuse and Mental Health Services Administration SI Suicide Ideation TA Thematic Analysis UNHCR United Nations High Commissioner for refugees WHO World Health Organization Declarations Ethical Considerations Approval This study was conducted in accordance with the ethical standards outlined in the Declaration of Helsinki, Lira University Research Ethics Committee (LUREC) no. LUREC-2023-18, and the Uganda National Council for Science and Technology (UNCST) no. HS3046ES before the study was conducted. Written informed consent was obtained from all participants prior to data collection. The researcher sought clearance for data collection from the UNHCR and OPM after receiving approval from LUREC and a letter of introduction from the Faculty of Public Health, Lira University. Informed consent All respondents were requested to provide their consent before the interview. The consent form was written because it provided an auditable record in the case of questions arising from data storage. Informed consent was obtained by describing the purpose of the study and procedures involved. During data collection, one clinical psychologist was able to speak to anyone upset after participating in this study. The interview process was voluntary, and the participants were free to leave the interview process without penalty. Confidentiality Participants were notified that the information from this study would be held and kept strictly private and used only for research purposes. The interviews were conducted in the church or community counseling space. To maintain the privacy of the participants, pseudonyms were used to report direct quotes. Furthermore, the participants remained anonymous (nameless) throughout the study. The records were kept electronically with a password, on paper, and behind locked doors. Trustworthiness was achieved through credibility, transferability, dependability, confirmability, audit trails, and reflexivity. Consent for publication Not Applicable Availability of data and materials Data will be available from the corresponding author on considerable request. Competing interests The authors declare no competing interests Funding This research was funded by the author with no external form of funding. Authors' contributions Conceptualization: OJWOK ROBINSON Data curation: OJWOK ROBINSON Formal analysis: OJWOK ROBINSON. Project administration: OJWOK ROBINSON & JENIFER ACIO. Supervision: Dr. JUDITH ABAL AKELLO (PhD) Writing – original draft: OJWOK ROBINSON & JENIFER ACIO. Writing – review & editing: OJWOK ROBINSON, ACIO JENIFER & Dr. JUDITH ABAL AKELLO (PhD) Acknowledgements First, I would like to express my gratitude to the Almighty God for providing me with daily existence, vigor, and safeguards through this journey to carry out this research study. Second, I appreciate OPM Arua/Rhino Camp, UNHCR and implementing partner TPO Uganda that allowed me to access participants and offered all necessary support during data collection of this study. I also appreciate participants who boldly provided their written consent and willingly participated into this study. Finally, I sincerely appreciate the spiritual, material, and emotional support my family gave me during this study. Authors' information (optional) References WHO. Reversing suicide, mental health crisis in Africa. 2022. World Health Organization. World health statistics. Monitoring health for the SDGs, sustainable development goals. Geneva: World Health Organization; 2021. Guidance IASCIASC. 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OJWOK","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA1ElEQVRIiWNgGAWjYJACZgYDBjl+9gYg08CCeC3Gkj0HQFokiNXCwJC44UYCiE2EFv72sw8fFxTcYdxw8/nVDT8KJIAi3Ql4tUicSTc2nmHwjFnydk7ZzR6gwyTOnN2A35obbGzSPAaH2fhu56Td4AFqMZDIxa9FHqqFh+HmmbSbf4jRYgDVIiFwg/3YbaJsMTyTxgz0y2EDyZ4cttsyBhI8BP0id/wY4+OCP4fr+9mPP7v55o+NHH97LwHvIwCPAZgkVjkIsD8gRfUoGAWjYBSMIAAAdQ9FMF6ruv4AAAAASUVORK5CYII=","orcid":"","institution":"Lira University","correspondingAuthor":true,"prefix":"","firstName":"ROBINSON","middleName":"","lastName":"OJWOK","suffix":""},{"id":565570473,"identity":"3c2a5e9a-1c82-40b2-8305-eaf806f6fe9e","order_by":1,"name":"JUDITH ABAL","email":"","orcid":"","institution":"Lira University","correspondingAuthor":false,"prefix":"","firstName":"JUDITH","middleName":"","lastName":"ABAL","suffix":""},{"id":565570474,"identity":"1166d928-2b45-4b68-bc1f-a424f8ff12d5","order_by":2,"name":"JENIFER 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16:20:54","extension":"html","order_by":15,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":275350,"visible":true,"origin":"","legend":"","description":"","filename":"earlyproof.html","url":"https://assets-eu.researchsquare.com/files/rs-8228150/v1/45a2f4a0d7749b3873a9cbe5.html"},{"id":100356084,"identity":"f03a0760-d42d-4e9d-825c-761516646e71","added_by":"auto","created_at":"2026-01-16 06:50:38","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":2281423,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8228150/v1/9000d011-1f81-4d33-9804-0d078caceefe.pdf"},{"id":99048200,"identity":"007a7d0f-1934-49de-92aa-550cc994089c","added_by":"auto","created_at":"2025-12-26 14:35:42","extension":"docx","order_by":0,"title":"","display":"","copyAsset":false,"role":"supplement","size":36475,"visible":true,"origin":"","legend":"","description":"","filename":"SupplementaryFile.docx","url":"https://assets-eu.researchsquare.com/files/rs-8228150/v1/0b8e40d8d995ccb795c03e71.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"\u003cp\u003eAttempted Suicide: Lived Experiences of Refugees in Rhino Camp, West Nile Uganda\u003c/p\u003e","fulltext":[{"header":"BACKGROUND TO THE STUDY","content":"\u003cp\u003eSuicide is among the leading causes of death universally, and every year, more people die as a result of suicide than HIV, malaria, breast cancer, war, and homicide. Globally, 800,000 people are projected to have completed suicide every year, and 75% of global suicides occur in low-income and middle-income nations. Suicide accounts for 1.4% of premature deaths worldwide. Males are predicted to die at rates roughly twice those of females (12.6 per 100000 males compared to 5.4 per 100000 females)[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. Suicide rates worldwide are a significant public health problem that needs to be addressed urgently. Africa has six of the highest 10 countries for suicide in the world [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e], and suicide kills about 11 individuals per 100,000 individuals in Africa each year, which is higher than the universal average of nine for each 100,000 individuals [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. It should be noted that for each suicide in Africa, there are an estimated 20 suicide attempts [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. According to UNHCR, about 215 refugees attempted suicide, and 51 refugees completed suicide in Ugandan refugee camps [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. In Rhino camp, the cases of those who attempted and completed suicides between 2021- May 2023 were 49 refugees (39 attempted and 10 completed suicides) out of 133,336 refugees majorly South Sudanese hosted [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eSuicide rates are high among vulnerable groups who experience discrimination, such as refugees and migrants, indigenous peoples, lesbians, gays, bisexuals, transgender, intersex (LGBTI) persons, and prisoners [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. Suicide refers to intentional death resulting from injuring oneself [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. Suicide Attempt refers to the determination of an individual to terminate life by injuring their body, but their deeds do not lead them to death [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eRefugees may be extremely pretentious by suicide risk for example: traumatic events [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e], alcohol and other substance use abuse [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e], feelings of isolation [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e], job loss [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e], chronic pain and illness [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e], relationship conflicts [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e] hopelessness [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e], sense of isolation and lack of social support [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e], mental pain [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e, \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e] and need for love and belonging [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e] \u0026lsquo;Forfeitures\u0026rsquo; identified include family and friends, birthplace, respect, public connection, fiscal properties, salary, and economic stability [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e]. Suicide attempts negatively lead to adverse impacts, such as damage, prolonged sickness, and loss of freedom, and cause financial problems for the family and community [\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eDespite this, little is known about suicidal behaviors in these highly mobile populations, because collecting timely, relevant, and reliable data is challenging [\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e]. There have been more suicide attempts by refugees in recent days, with trauma, social isolation, and services for mental health not widely available [\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e] with little attention paid to the lived experiences of refugee suicide survivors [\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e]\u003c/p\u003e \u003cp\u003eUnderstanding suicidal thoughts and emotions requires careful attention to the subjective views of individuals who experience suicide, as these insights are fundamental to improving the ability to explain, anticipate, and prevent suicidal behaviour [\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e]. Exploring how people interpret and respond to suicidal ideation involves examining the subjective dimensions of these experiences, an approach that has received less emphasis within suicidology in recent decades despite earlier recognition of its importance [\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e]. A study conducted in 2019 reported that only a small proportion of participants (10 of 50) experienced relief or happiness immediately after surviving suicide attempts. Most described difficult emotional reactions, including sadness, depression, disappointment, anger, emptiness, embarrassment, and shame. Although many later shifted toward more positive emotions such as gratitude, hope, and a sense of relief, more than 30% continued to view their survival negatively at the time of the study [\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eInsights from survivors of suicide attempts offer critical experiential knowledge that can strengthen current prevention and intervention strategies. Their lived experiences can help to guide the development of mental health services that are accessible, relevant, and responsive to individual needs during periods of acute psychological distress [\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e]. Paying structured attention to personal views of individuals faced by suicide can play an important role in guiding the development of more suitable forms of mental health support, broader societal decisions, and encouraging positive shifts within communities [\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e]. This paper reports an interpretive phenomenological qualitative study that explored the lived experiences of refugee suicide attempt survivors.\u003c/p\u003e"},{"header":"METHODS","content":"\u003cp\u003e\u003cstrong\u003eStudy Design\u003c/strong\u003e\u003c/p\u003e\n\u003cp id=\"_Toc151593561\"\u003eThis study used an interpretative Phenomenological research design. Interpretative Phenomenology underlines the value of a person\u0026apos;s unique view and understanding because they are predicated on the mode of thinking of firsthand knowledge and subjective experience [40]. Researchers have focused on the lived experiences of individuals and how they make sense within the context of their personal and social worlds, with a particular emphasis on personal sense-making [41]. According to prasad (2018), interpretivism involves exploring a person\u0026apos;s reality and interpreting them as the foundation for learning about everyday spheres [42]. IInterpretative Phenomenology is clearly idiographic in its commitment to examining the detailed experience of each case, prior to the move to more general claims [43]. Interpretative Phenomenology is a useful methodology for examining topics that are complex, ambiguous and emotionally laden, such as suicide [44].\u003c/p\u003e\n\u003ch2\u003e\u003cspan id=\"_Toc151593549\"\u003eStudy area\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/span\u003e\u003c/h2\u003e\n\u003cp\u003eThe study area was Rhino Camp, a refugee camp in West Nile region of Uganda. Rhino camp has geographic coordinates of 2.966\u0026deg;N and 31.395\u0026deg;E. The settlement spans an area of approximately 225 km2 that includes parts of the Terego District, Odupi, Omugo, and Uriama sub-counties, as well as the Madi-Okollo District\u0026apos;s Rigbo Sub-County. Although the settlement is not a constant geographic area and has seven zones, the refugees still choose to live there in \u0026quot;wallets\u0026quot; [45]. Host communities and Rhino camp can both be described as rural, with some towns and urban areas included. The primary source of income for both the host community and the refugee population is crop farming. [46].\u003c/p\u003e\n\u003cp\u003eThe choice to concentrate on suicide attempted lived experiences among refugees living in Rhino Camp West Nile, Uganda, was based on several factors. First, Rhino Camp is one of Uganda\u0026apos;s largest refugee camps, housing thousands of refugees from nearby nations, such as DRC and South Sudan [47]. There have been more suicide attempts by refugees in the last few days, with trauma, social isolation, and mental health services [34]. Second, there is limited research on the actual experiences of refugee suicide survivors at Rhino Camp and other Ugandan settlements. Refugee suicide studies have largely concentrated on the risk factors, prevalence, and interventions, with little attention paid to the individual experiences of refugee suicide survivors [35]. Thus, by focusing on Rhino Camp, this study aimed to clarify the unique experiences of refugee suicide survivors with regard to displacement, trauma, and limited access to mental health services.\u003c/p\u003e\n\u003ch2\u003e\u003cspan id=\"_Toc151593550\"\u003eStudy and target Population\u003c/strong\u003e\u003c/span\u003e\u003c/h2\u003e\n\u003cp\u003e\u003cspan id=\"_Toc151593551\"\u003eStudy population\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/span\u003e\u003c/p\u003e\n\u003cp\u003eThe population of the study was refugees\u0026rsquo; suicide survivors in Rhino Camp, West Nile, Uganda. The cases of those who attempted and completed suicides in Rhino Camp between 2021-May 2023 were 49 refugees (39 attempted and 10 completed suicides) out of 133,336 refugees [6].\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTarget population\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll refugees in Rhino camp, West Nile, Uganda. As of December 2022, Rhino refugee Camp hosted 133,336 refugees majorly South Sudanese [7].\u003c/p\u003e\n\u003ch2\u003e\u003cspan id=\"_Toc151593552\"\u003eSample Size\u003c/strong\u003e\u003c/span\u003e\u003c/h2\u003e\n\u003cp\u003eThe study population comprised 15 participants (seven Key Informants and eight refugee suicide survivors) due to the thoroughness in in-depth analysis of qualitative research information [48] and as this was the number at which \u0026ldquo;saturation\u0026rdquo; of the data was reached. After the 13th interview, no new themes were generated. Hence, it was deemed that data collection had reached a saturation point. The researchers continued with data collection for two more interviews to ensure that no new themes emerged. The sample sizes in phenomenological studies vary from 3 to 25 [49]\u003c/p\u003e\n\u003cp\u003eSeven Key Informants and eight refugee suicide survivors could be due to a range of factors, such as trauma, psychological distress, loss of connection, and social support. Participants (Refugee Suicide Survivors) were of different ages, genders, and cultural backgrounds and had attempted suicide for different reasons. The eight refugee suicide survivors were identified and accessed through researchers seeking permission from the OPM Regional Refugee Desk Officer-Arua (RDO), who then directed the researchers to the OPM settlement Commandant Rhino Camp. \u0026nbsp; The OPM settlement commandant allowed researchers to access eight refugee suicide survivors through refugee welfare councils (RWCs) who linked the researcher to the refugees\u0026rsquo; suicide survivors and their homes. The 8 refugees\u0026rsquo; suicide survivors were obtained from the UNHCR - Mental Health and Psychosocial Support (MHPSS) implementing partner who provided researchers with refugee suicide survivor details through permission from the Regional Project Coordinator. The researcher followed all ethical standards to ensure that the data provided would be kept confidential to avoid violation of suicide survivors\u0026rsquo; privacy. The interviews took place at the church or community counseling space to ensure privacy and no social harm. The welfare of eight refugee suicide survivors and seven key informants were 20,000/= Uganda shillings only each. The seven Key Informants included the Office of the Prime Minister with two representatives, two clinicians (1psychologist and one psychiatrist) who are partners in mental health, one police member in the mental health department, and two refugee welfare council members.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe sampling of the participants stopped at the point of saturation. Mason, M. 2010, asserted that saturation occurs when gathering fresh data, informed by both interviews and sampling, does not add any new information to our understanding of the problem. A qualitative sample reaches a point known as a diminishing return, which indicates that the data collection is finished or almost finished [50, 51].\u003c/p\u003e\n\u003ch2\u003e\u003cspan id=\"_Toc151593553\"\u003e\u003cstrong\u003eSampling\u003c/strong\u003e\u003c/span\u003e\u003c/h2\u003e\n\u003cp\u003eThe study utilized Purposive sampling to select the participants. Purposive sampling is a non-probability sample selection in which the researcher chooses respondents based on predetermined standards [52]. Sampling technique where the researcher selects participants based on specific criteria who provide a richness of information that is suitable for the detailed research. In this study, participants were selected based on their history or knowledge of attempted suicide in Rhino Camp as highlighted below:\u003c/p\u003e\n\u003ch2\u003e\u003cspan id=\"_Toc151593554\"\u003eEligibility criteria\u003c/strong\u003e\u003c/span\u003e\u003c/h2\u003e\n\u003cp\u003e\u003cspan id=\"_Toc151593555\"\u003e\u003cstrong\u003eInclusion\u003c/strong\u003e criteria were\u003c/span\u003e\u003c/p\u003e\n\u003cp\u003e\u0026middot; Participants above 18 years old\u003c/p\u003e\n\u003cp\u003e\u0026middot; Participants who attempted suicide in the last three years (2021- March 2023)\u003c/p\u003e\n\u003cp\u003e\u0026middot; Participants who are able and willing to describe their experience with a suicide attempt\u003c/p\u003e\n\u003cp\u003e\u003cspan id=\"_Toc151593556\"\u003e\u003cstrong\u003eExclusion\u003c/strong\u003e standards\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n\u003cp\u003e\u0026bull; \u0026nbsp; \u0026nbsp;Eligible individuals with mental health issues that could affect the data collection.\u0026nbsp;\u003c/p\u003e\n\u003ch2\u003e\u003cspan id=\"_Toc151593557\"\u003eMethodology Rigor\u003c/strong\u003e\u003c/span\u003e\u003c/h2\u003e\n\u003cp\u003eCredibility was achieved by describing the lived experiences of suicide survivors from the perspectives of the participants and using the triangulation of different data collection methods. To ensure credibility and trustworthiness, the researcher\u0026rsquo;s knowledge of the phenomenon was bracketed to prevent preconceptions regarding refugee suicide survivors\u0026rsquo; influence on outcomes and to allow the analysis of lived experiences. The quality of the research results was improved using thick, detailed descriptions and coding processes. Dependability was maintained through in-depth interview guide standards, data audits prior to analysis, and safeguarding the correctness of the data. Verbatim collected from participants was written out by listening to the audio recording and making observations during face-to-face interviews. Confirmability was guaranteed through a review of the supervisor, data checking, and rechecking throughout data collection and analysis. To achieve the criteria of transferability, it tried to explain the process of research exactly so that other researchers could use this technique [53].\u003c/p\u003e\n\u003ch2\u003e\u003cspan id=\"_Toc151593558\"\u003eData Collection\u003c/strong\u003e\u003c/span\u003e\u003c/h2\u003e\n\u003cp\u003eIn-depth (face-to-face) interviews and observations of nonverbal behavior were conducted to collect data. The researchers collected data using an interview guide, as it allowed the researchers to observe the verbal and nonverbal signs (body language and interest) of the participants, enable them to give true information, maintain participants\u0026apos; concentration, and finally capture participants\u0026rsquo; emotions and behaviors. The in-depth interview guide had two components: the participant\u0026apos;s sociodemographic characteristics and the participant\u0026apos;s in-depth interview guide per objective to answer the questions. 45-60 minutes were allotted for each in-depth interview, which arrived at the end of the participants\u0026rsquo; answer to the final question. All responses were audio-recorded after obtaining consent from the participants. During the interview, the researcher worked with a translator to help in translating the interview questions to the refugee suicide survivor and one Clinical Psychologist to provide counseling to avoid traumatic recall. The interview took place at the community counseling space/center where a number of activities took place, for example, life skills training, different counseling, and other training of refugees, hence scheduling participants on different appointment days and times to meet them at the counseling center one by one in case participants were two or more in a particular place while maintaining the privacy and confidentiality of the participants, which enabled participants not to identify themselves and other community members to know what a particular participant is doing at the counseling center. This helped manage community stigmatization. In Field editing, the information gathered from the field was reviewed, edited, documented, organized, and coded with participant pseudonyms and dates to identify patterns and related themes. Words, phrases, and open-ended responses in in-depth interviews were coded as they are easier to remember, skim, and organized. The participants\u0026rsquo; exact words were used in quotes, and the researcher interpreted and commented on them. In-depth interviews with both key informants and refugee suicide survivors were pilot tested in the Imvepi refugee settlement.\u003c/p\u003e\n\u003ch2\u003e\u003cspan id=\"_Toc151593559\"\u003eData Management and Analysis\u003c/strong\u003e\u003c/span\u003e\u003c/h2\u003e\n\u003cp\u003eThere are varying processes by which interpretive phenomenologists analyze data depending on the specific type of phenomenology being used. For this study purposes, we chose the [48] suggested phases, which are as follows:\u003c/p\u003e\n\u003cp\u003eA. Data Management Phase:\u003c/p\u003e\n\u003cp\u003e1.\u0026nbsp; \u0026nbsp;Data Collection: Qualitative data were collected using various methods such as in-depth interviews, observations, and document reviews.\u003c/p\u003e\n\u003cp\u003e2.\u0026nbsp; \u0026nbsp;Transcription and Anonymization: The researchers transcribed the collected data, ensured anonymity using anonymous names and removed identifying information.\u003c/p\u003e\n\u003cp\u003e3.\u0026nbsp; \u0026nbsp;Accuracy: Care was taken during transcriptions and translations to maintain accuracy, including preserving verbal cues like \u0026quot;um,\u0026quot; \u0026quot;you know,\u0026quot; and silences, which are considered important in understanding women\u0026apos;s experiences.\u003c/p\u003e\n\u003cp\u003e4.\u0026nbsp; \u0026nbsp;Data Storage: The recordings and transcribed data were securely stored in word-processing files on a password-protected laptop and in a lockable room.\u003c/p\u003e\n\u003cp\u003e5.\u0026nbsp; \u0026nbsp;Data Analysis: The primary data underwent a detailed analysis process to identify themes, and relevant literature from secondary sources was also reviewed to complement the primary data.\u003c/p\u003e\n\u003cp\u003eB. Generative Phase:\u003c/p\u003e\n\u003cp\u003e1.\u0026nbsp; \u0026nbsp;Qualitative Content Analysis: Qualitative data, specifically from Key Informant and in-depth interviews, were coded using qualitative content analysis.\u003c/p\u003e\n\u003cp\u003e2.\u0026nbsp; \u0026nbsp;Identifying Keywords and Themes: The researchers read the transcripts multiple times to identify keywords and develop categories and themes based on participants\u0026apos; responses.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eC. Interpretive Phase:\u003c/p\u003e\n\u003cp\u003e1.\u0026nbsp; \u0026nbsp;Relating Data to Findings: The researchers related the data to the identified themes, seeking to understand and make sense of the findings.\u003c/p\u003e\n\u003cp\u003e2.\u0026nbsp; \u0026nbsp;Interpretivism: This study adopts an interpretivist approach, focusing on individual understanding as a starting point for knowledge development.\u003c/p\u003e\n\u003cp\u003eD. Representing and Theorizing Phase:\u003c/p\u003e\n\u003cp\u003e1.\u0026nbsp; \u0026nbsp;Expression and Guidance: This phase involves expressing the conclusions drawn from the findings, following the guidance of Miles [54].\u003c/p\u003e\n\u003cp\u003e2.\u0026nbsp; \u0026nbsp;Scrutinizing Data: The researchers engaged in a continuous process of scrutinizing the data to develop consistent explanations aligned with the study objectives and questions.\u003c/p\u003e\n\u003cp\u003e3.\u0026nbsp; \u0026nbsp;Enhancing Trustworthiness: By accounting for their knowledge and biases, the researchers aimed to enhance the trustworthiness of the research and the credibility of the findings.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthical Considerations\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eApproval\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was conducted in accordance with the ethical standards outlined in the Declaration of Helsinki, Lira University Research Ethics Committee (LUREC) no. LUREC-2023-18, and the Uganda National Council for Science and Technology (UNCST) no. HS3046ES before the study was conducted. Written informed consent was obtained from all participants prior to data collection. The researcher sought clearance for data collection from the UNHCR and OPM after receiving approval from LUREC and a letter of introduction from the Faculty of Public Health, Lira University.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eInformed consent\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll respondents were requested to provide their consent before the interview. The consent form was written because it provided an auditable record in the case of questions arising from data storage. Informed consent was obtained by describing the purpose of the study and procedures involved. During data collection, one clinical psychologist was able to speak to anyone upset after participating in this study. The interview process was voluntary, and the participants were free to leave the interview process without penalty.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConfidentiality\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eParticipants were notified that the information from this study would be held and kept strictly private and used only for research purposes. The interviews were conducted in the church or community counseling space/center. To maintain the privacy of the participants, pseudonyms were used to report direct quotes. Furthermore, the participants remained anonymous (nameless) throughout the study. The records were kept electronically with a password, on paper, and behind locked doors. Trustworthiness was achieved through credibility, transferability, dependability, confirmability, audit trails, and reflexivity.\u003c/p\u003e"},{"header":"RESULTS","content":"\u003cp\u003eThis study aimed to explore the lived experiences of refugees residing in the Rhino Camp in West Nile Uganda who had attempted suicide. The research involved in-depth interviews with a diverse sample of refugees who had attempted suicide.\u0026nbsp;\u003c/p\u003e\n\u003ch2 id=\"_Toc36743651\"\u003eSocio-Economic Characteristics of attempted suicide participants\u0026nbsp;\u003c/h2\u003e\n\u003cp id=\"_Toc151593581\"\u003e\u003cstrong\u003eDistribution\u0026nbsp;of attempted suicide participants by Gender\u003c/strong\u003e\u003c/p\u003e\n\u003ch3\u003e\u003cspan id=\"_Toc141554874\"\u003eTable 1: Distribution of attempted suicide participants by Gender\u003c/span\u003e\u003c/h3\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"463\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 255px;\"\u003e\n \u003cp\u003e\u0026nbsp;Sex\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003eSuicide survivors\u0026rsquo; participants\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 255px;\"\u003e\n \u003cp\u003e\u0026nbsp;Male\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e\u0026nbsp;1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 255px;\"\u003e\n \u003cp\u003e\u0026nbsp;Female\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e\u0026nbsp;7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 255px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eSource: Generated by the researcher\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe findings in Table 1 show that among the participants who attempted suicide, there were 7 females and 1 male. The data indicate a notable gender disparity, with a significantly higher number of females involved in suicide attempts than males.\u003c/p\u003e\n\u003cp\u003eThis finding aligns with existing research that highlights gender differences in suicide attempts and completed suicide. It is well documented that females tend to attempt suicide, whereas males tend to die by suicide [10].\u003c/p\u003e\n\u003ch2\u003e\u003cstrong\u003eAge distribution\u0026nbsp;of attempted suicide participants\u003c/strong\u003e\u003c/h2\u003e\n\u003ch3 id=\"_Toc151593570\"\u003eTable 2: Age distribution of attempted suicide participants\u003c/h3\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"463\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 255px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e\u0026nbsp;Suicide survivors\u0026rsquo; participants\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 255px;\"\u003e\n \u003cp\u003e\u0026nbsp;18-25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e\u0026nbsp;1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 255px;\"\u003e\n \u003cp\u003e\u0026nbsp;25-33\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e\u0026nbsp;5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 255px;\"\u003e\n \u003cp\u003e\u0026nbsp;33-41\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e\u0026nbsp;1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 255px;\"\u003e\n \u003cp\u003e\u0026nbsp;41-49\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e\u0026nbsp;1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 255px;\"\u003e\n \u003cp\u003e\u0026nbsp;49\u0026gt;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 255px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eSource: Generated by the researcher\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe findings in Table 2 show the age distribution of the participants who attempted suicide. The majority of participants (five out of eight) fell within the age group of 25-33 years, indicating that this age range had a higher representation in the study. Each participant was reported in the age groups 18-25, 33-41, and 41-49. Interestingly, no participants were older than 49 years. This distribution suggests that individuals in their mid-to late twenties and early thirties may be more vulnerable to suicide attempts among the refugee population in Rhino Camp.\u0026nbsp;\u003c/p\u003e\n\u003ch2\u003e\u003cspan id=\"_Toc151593573\"\u003e\u003cstrong\u003eHousehold Head of attempted suicide participants\u003c/strong\u003e\u003c/span\u003e\u003c/h2\u003e\n\u003ch3\u003e\u003cspan id=\"_Toc141554866\"\u003eTable 3: Household Head of attempted suicide participants\u003c/span\u003e\u003c/h3\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"463\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 255px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFemale headed/male headed/Both\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e\u0026nbsp;Suicide survivors\u0026rsquo; participants\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 255px;\"\u003e\n \u003cp\u003e\u0026nbsp;Female Headed\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e\u0026nbsp;6 females\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 255px;\"\u003e\n \u003cp\u003e\u0026nbsp;Male Headed\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e\u0026nbsp;1 male\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 255px;\"\u003e\n \u003cp\u003e\u0026nbsp;Not female headed/male headed\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e\u0026nbsp;1 female\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 255px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eSource: Generated by the researcher\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe findings in Table 3 present the distribution of household heads among the participants who attempted suicide. Among the eight participants, six females were reported as the heads of their households and one male participant was identified as the household head. Additionally, one female participant reported that her household was neither female-headed nor male-headed.\u003c/p\u003e\n\u003cp\u003eThe data indicated that the majority of attempted suicide participants (six out of eight) were female-headed households. This finding may suggest that females who are the heads of their households may face unique stressors and challenges that could contribute to their vulnerability to mental health issues and suicide attempts.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMarital Status of attempted suicide participants\u003c/strong\u003e\u003c/p\u003e\n\u003ch3 id=\"_Toc141554388\"\u003eTable 4: Marital Status of attempted suicide participants\u003c/h3\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"463\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 255px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMarried/single/widow/divorced\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e\u0026nbsp;Suicide survivors\u0026rsquo; participants\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 255px;\"\u003e\n \u003cp\u003e\u0026nbsp;Married\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e\u0026nbsp;5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 255px;\"\u003e\n \u003cp\u003e\u0026nbsp;Single\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e\u0026nbsp;-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 255px;\"\u003e\n \u003cp\u003e\u0026nbsp;Widow\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e\u0026nbsp;2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 255px;\"\u003e\n \u003cp\u003e\u0026nbsp;Divorced/Separated\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e\u0026nbsp;1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 255px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eSource: Generated by the researcher\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe findings in Table 4 display the marital status distribution of the participants who attempted suicide. Among the eight participants, the majority (five out of eight) were married. Two participants were identified as widows, and one reported being divorced or separated. The data indicate that married individuals had a higher representation in the study than other marital statuses.\u003c/p\u003e\n\u003ch3 id=\"_Toc151593577\"\u003eEducation Level of attempted suicide participants\u003c/h3\u003e\n\u003ch3\u003e\u003cspan id=\"_Toc141555956\"\u003eTable 5: Education Level of attempted suicide participants\u003c/span\u003e\u003c/h3\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"463\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 255px;\"\u003e\n \u003cp\u003eEducation Level\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003eSuicide survivors\u0026rsquo; participants\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 255px;\"\u003e\n \u003cp\u003e\u0026nbsp;No gone to school\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e\u0026nbsp;2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 255px;\"\u003e\n \u003cp\u003e\u0026nbsp;Primary\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e\u0026nbsp;5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 255px;\"\u003e\n \u003cp\u003e\u0026nbsp;Secondary\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e\u0026nbsp;1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 255px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eSource: Generated by the researcher\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe findings in Table 5 present the distribution of education levels among participants who attempted suicide. Among the eight participants, five reported having a primary level of education, whereas one participant had a secondary level of education. Additionally, two participants indicated that they had not attended school. The data indicate that the majority of attempted suicide participants (five out of eight) had completed their primary education. This finding suggests that individuals with lower education levels may be more vulnerable to mental health challenges and suicide attempts within the refugee community in Rhino Camp.\u003c/p\u003e\n\u003ch3 id=\"_Toc151593575\"\u003eNumber of family members of attempted suicide participants\u003c/h3\u003e\n\u003ch3 id=\"_Toc141554392\"\u003eTable 6: Number of family members of attempted suicide participants\u003c/h3\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"463\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 255px;\"\u003e\n \u003cp\u003e\u0026nbsp;Number of family members\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e\u0026nbsp;Suicide survivors\u0026rsquo; participants\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 255px;\"\u003e\n \u003cp\u003e\u0026nbsp;3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e\u0026nbsp;2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 255px;\"\u003e\n \u003cp\u003e\u0026nbsp;5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e\u0026nbsp;3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 255px;\"\u003e\n \u003cp\u003e\u0026nbsp;4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e\u0026nbsp;1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 255px;\"\u003e\n \u003cp\u003e\u0026nbsp;6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e\u0026nbsp;1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 255px;\"\u003e\n \u003cp\u003e\u0026nbsp;10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e\u0026nbsp;1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 255px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eSource: Generated by the researcher\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe findings in Table 6 indicate the number of family members among participants who attempted suicide. Among the eight participants, the majority had either three or five family members; two participants reported three family members, and three participants reported five family members. Additionally, there was one participant each for four, six, and ten family members. The data suggest that participants with smaller family sizes (three or five members) were more prevalent in the study.\u003c/p\u003e\n\u003ch3\u003eMethods used by attempted suicide participants\u003c/h3\u003e\n\u003ch3 id=\"_Toc141555958\"\u003eTable 7: Methods used by attempted suicide participants\u003c/h3\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"463\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 131px;\"\u003e\n \u003cp\u003e\u0026nbsp;Methods used\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 139px;\"\u003e\n \u003cp\u003e\u0026nbsp;Number of attempts\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 193px;\"\u003e\n \u003cp\u003e\u0026nbsp;Suicide survivors\u0026rsquo; participants\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 131px;\"\u003e\n \u003cp\u003e\u0026nbsp;Drugs\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 139px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; 1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 193px;\"\u003e\n \u003cp\u003e\u0026nbsp;2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 131px;\"\u003e\n \u003cp\u003e\u0026nbsp;Rope and Knife\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 139px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; 4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 193px;\"\u003e\n \u003cp\u003e\u0026nbsp;1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 131px;\"\u003e\n \u003cp\u003e\u0026nbsp;Drowning\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 139px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; 1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 193px;\"\u003e\n \u003cp\u003e\u0026nbsp;1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 131px;\"\u003e\n \u003cp\u003e\u0026nbsp;Poison\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 139px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; 1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 193px;\"\u003e\n \u003cp\u003e\u0026nbsp;1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 131px;\"\u003e\n \u003cp\u003e\u0026nbsp;Drugs and Rope\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 139px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; 2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 193px;\"\u003e\n \u003cp\u003e\u0026nbsp;2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 131px;\"\u003e\n \u003cp\u003eRope\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 139px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; 2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 193px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 270px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 193px;\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eSource: Generated by the researcher\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe findings in Table 7 display the methods used by participants who attempted suicide, along with the number of attempts for each method. Among the eight participants, a variety of methods has been reported, and some individuals have made multiple attempts using different methods. The most frequently reported methods were \u0026quot;Rope and drugs\u0026quot; with 4 participants attempting suicide using rope and 4 participants attempting suicide using drugs. Other methods used included \u0026quot;Knife\u0026quot; (1 participant), \u0026quot;Drowning\u0026quot; (1 participant), and \u0026quot;Poison\u0026quot; (1 participant). Eight attempts have been reported across various methods.\u003c/p\u003e\n\u003cp\u003eThe data suggest that the participants employed a range of methods to attempt suicide, with \u0026quot;Rope and drugs\u0026quot; being the most common combination. It is important to recognize that different methods of attempted suicide can have varying levels of lethality and risks. The use of multiple methods by some participants may have indicated the severity and complexity of their emotional distress.\u003c/p\u003e\n\u003ch3 id=\"_Toc151593583\"\u003eSummary of Socio-Economic Characteristics of attempted suicide participants\u003c/h3\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"633\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 35px;\"\u003e\n \u003cp\u003eNo\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 39px;\"\u003e\n \u003cp\u003eSex\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 41px;\"\u003e\n \u003cp\u003eAge\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003eHousehold Head\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003eMarital status\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 79px;\"\u003e\n \u003cp\u003eEducation level\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003eFamily size\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003eNumber of attempts\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 109px;\"\u003e\n \u003cp\u003eMethods used\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 35px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 39px;\"\u003e\n \u003cp\u003eF\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 41px;\"\u003e\n \u003cp\u003e33\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003eYES\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003eMarried\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 79px;\"\u003e\n \u003cp\u003eP.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 109px;\"\u003e\n \u003cp\u003eDrowning\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 35px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 39px;\"\u003e\n \u003cp\u003eF\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 41px;\"\u003e\n \u003cp\u003e40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003eYES\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003eSeparated\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 79px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 109px;\"\u003e\n \u003cp\u003eDrugs \u0026amp; Rope\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 35px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 39px;\"\u003e\n \u003cp\u003eM\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 41px;\"\u003e\n \u003cp\u003e30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003eYES\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003eMarried\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 79px;\"\u003e\n \u003cp\u003eS.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 109px;\"\u003e\n \u003cp\u003eRope \u0026amp; Drugs\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 35px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 39px;\"\u003e\n \u003cp\u003eF\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 41px;\"\u003e\n \u003cp\u003e20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003eNO\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003eMarried\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 79px;\"\u003e\n \u003cp\u003eP.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 109px;\"\u003e\n \u003cp\u003ePoison\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 35px;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 39px;\"\u003e\n \u003cp\u003eF\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 41px;\"\u003e\n \u003cp\u003e44\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003eYES\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003eWidow\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 79px;\"\u003e\n \u003cp\u003eP.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 109px;\"\u003e\n \u003cp\u003eDrugs\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 35px;\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 39px;\"\u003e\n \u003cp\u003eF\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 41px;\"\u003e\n \u003cp\u003e33\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003eYES\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003eMarried\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 79px;\"\u003e\n \u003cp\u003eP.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 109px;\"\u003e\n \u003cp\u003eRope \u0026amp; Knife\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 35px;\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 39px;\"\u003e\n \u003cp\u003eF\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 41px;\"\u003e\n \u003cp\u003e26\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003eYES\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003eMarried\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 79px;\"\u003e\n \u003cp\u003eP.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 109px;\"\u003e\n \u003cp\u003eDrugs\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 35px;\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 39px;\"\u003e\n \u003cp\u003eF\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 41px;\"\u003e\n \u003cp\u003e33\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003eYES\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003eWidow\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 79px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 109px;\"\u003e\n \u003cp\u003eRope\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eSource: Generated by the researcher\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003ch3 id=\"_Toc151593584\"\u003eTable 8: Generated Qualitative Content Analysis Themes\u003c/h3\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" align=\"\" width=\"691\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eThemes\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 520px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSub Themes\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDomestic Violence and relationship\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 520px;\"\u003e\n \u003cul type=\"disc\"\u003e\n \u003cli\u003eIssues of GBV have been ranked the highest as the trigger of suicides in Rhino camp because of the nature of the refugees\u003c/li\u003e\n \u003cli\u003eDomestic violence contributes to women committing suicide because when a man always torture, abuses the wife, it makes the wife to be undermined infront of children and community\u003c/li\u003e\n \u003cli\u003eUnwanted pregnancy, forced marriage, extra marital affairs, fights with the cowife, man concentrating on one family, emotional violences in women.\u003c/li\u003e\n \u003c/ul\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMental illness\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 520px;\"\u003e\n \u003cul type=\"disc\"\u003e\n \u003cli\u003eThere are clients on mental treatment, they stop taking treatment and symptoms comes up for example voices becoming too loughs, tends to relapse\u0026hellip;\u003c/li\u003e\n \u003cli\u003eDepression being sad, loss of interest in the activities. trauma in acute form to event, psychological pains with bad dreams, thoughts leading to Post Traumatic Stress Disorder (PTSD).\u003c/li\u003e\n \u003cli\u003eWhen you over think, the Satan can drive you to one side and you may end up committing suicide\u003c/li\u003e\n \u003c/ul\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFinancial difficulties\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 520px;\"\u003e\n \u003cul type=\"disc\"\u003e\n \u003cli\u003e\u0026hellip; seeing the little the family is saving is going to their medical bills, they are like instead of letting people suffer and tomorrow they still die, it is better to die and that one left a suicide note\u003c/li\u003e\n \u003cli\u003eThe other trigger is unemployment.\u003c/li\u003e\n \u003c/ul\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eInadequate food deliveries\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 520px;\"\u003e\n \u003cul type=\"disc\"\u003e\n \u003cli\u003eReduction in food ratios has typically increased the suicide.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eSince then when we were in our own country (home), we use to access our own food by our own self but now accessing food is also very hard, accessing land here is also very hard. All these things are the reasons why refugees attempt suicide. cides rates in Rhino settlement\u003c/li\u003e\n \u003cli\u003ethe food given to them are not enough to feed their families and that also bring back the issues of suicidal attempts\u003c/li\u003e\n \u003c/ul\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTraumatic Past\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 520px;\"\u003e\n \u003cul type=\"disc\"\u003e\n \u003cli\u003eI thought of death of my first husband in the war who was so nice to me coupled with camp stressors..\u003c/li\u003e\n \u003c/ul\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePsychological Distress\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 520px;\"\u003e\n \u003cul type=\"disc\"\u003e\n \u003cli\u003eI found my child who is in primary six (6) was sent home because of money and there was no money and also the children stayed for two days without eating food\u003c/li\u003e\n \u003cli\u003eIn Ocea life is very difficult, my family is size 4, food is very little and no land for cultivation, no one to build for me\u0026hellip;\u0026hellip;..\u003c/li\u003e\n \u003cli\u003eIssue of school fees was a challenge for my child who was in S.4\u0026hellip;\u0026hellip;\u0026hellip;\u0026nbsp;There was no money, nobody helped me. That is when that incident started.\u003c/li\u003e\n \u003c/ul\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSocial Isolation\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 520px;\"\u003e\n \u003cul type=\"disc\"\u003e\n \u003cli\u003e\u0026hellip;\u0026nbsp;I started thinking it is better to kill myself and the government come and take the children, I cried a lot, depressed and traumatized for three days then I just pick the rope\u0026hellip;.\u003c/li\u003e\n \u003cli\u003eOrganization like TPO provide home visit, counselling, Psychological First Aids through Social Worker and Clinical Psychologist\u003c/li\u003e\n \u003c/ul\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCultural Stigma\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 520px;\"\u003e\n \u003cul type=\"disc\"\u003e\n \u003cli\u003eThere are so many who were even laughing sometimes at me. Stigmatization is there, because at times when I go for some funeral place, people when they see me, they start commenting about my body being thin because by then when I was working as a business woman, I used to have good body\u003c/li\u003e\n \u003c/ul\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCoping Mechanisms\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 520px;\"\u003e\n \u003cul type=\"disc\"\u003e\n \u003cli\u003eRight now, the way I am coping, I managed to secure some land that I am digging and I also constructed my houses alone which has helped to reduced thought of suicide.\u003c/li\u003e\n \u003cli\u003eThe first help I got from the family, and Refugee Welfare Council one (RWCI), women representative who came and they counselled me\u003c/li\u003e\n \u003c/ul\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCommunity and Family Support\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 520px;\"\u003e\n \u003cul type=\"disc\"\u003e\n \u003cli\u003e.. people who have suicide tendencies are best understood at family levels\u0026hellip;.\u003c/li\u003e\n \u003cli\u003eFamily in totality is the first system that we know can support us in the management of attempted suicide\u003c/li\u003e\n \u003cli\u003eOrganizations had established community structures, like CRTs (Crisis Response Teams), VPAs (Volunteer Psychosocial Assistants), Community Based Sociotherapy Facilitators (CBS) Community Development Workers and Village Health Teams, to aid in times of crises and suicide attempts\u003c/li\u003e\n \u003cli\u003e\u0026hellip;They receive training in Psychological First Aid and Medical First Aid, and have established reporting mechanisms and referral pathways\u003c/li\u003e\n \u003c/ul\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eRole of Religious, Cultural, and Opinion or other Leaders\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 520px;\"\u003e\n \u003cul type=\"disc\"\u003e\n \u003cli\u003eWe also have spiritual leaders who help provide counselling or talk to the families\u003c/li\u003e\n \u003cli\u003eWe also have African Traditional setting where the elders in the community intervene in case there is suicidal cases in the community\u003c/li\u003e\n \u003cli\u003eWe also have police where need be, at times we need enforcement where the situation needs a victim to be kept under safe custody\u003c/li\u003e\n \u003c/ul\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePsychosocial Support Providers\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 520px;\"\u003e\n \u003cul type=\"disc\"\u003e\n \u003cli\u003eOrganizations dealing in Psychosocial Support have people who represent them within the community for example psychologists, social workers and psychiatric clinical officers who provides counselling, advanced therapies, and treatment of mental health conditions\u003c/li\u003e\n \u003cli\u003eThe MHPSS partners come in to provide MHPSS aspects\u0026hellip;\u003c/li\u003e\n \u003c/ul\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eHealth Facilities Support\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 520px;\"\u003e\n \u003cul type=\"disc\"\u003e\n \u003cli\u003eHealth facilities give treatment and follow ups on the clients\u003c/li\u003e\n \u003cli\u003eSome of the services including the health services, community health outreach programs by the health workers, the referrals by the partners where they go out to find out what is ongoing\u003c/li\u003e\n \u003cli\u003eRescue in terms of ambulance services for example when one attempts to commit suicide and not yet dead, the person is taken to the health centre\u003c/li\u003e\n \u003cli\u003eFrom the health centre, counselling and treatment of the wounds is done\u003c/li\u003e\n \u003c/ul\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eSource: Generated by the researcher\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe findings in Table 8 indicate the \u0026nbsp;13 themes which emerged after data analysis and they include: 1) domestic violence and relationships; 2) mental illness; 3) financial difficulties; 4) inadequate food deliveries; 5) traumatic past; 6) psychological distress; 7) social isolation; 8) cultural stigma; 9) coping mechanism; 10) community and family support; 11) role of religious, cultural, and opinion or other leaders; 12) psychosocial support providers; and 13) health facilities support. The themes in this study were the expressive parts of the participants\u0026rsquo; experiences that portrayed understanding as a whole. Careful evaluation of the themes that emerged from the participant stories helped to understand refugee suicide survivors\u0026rsquo; experiences regarding the phenomenon. The thirteen (13) themes are explained into detail according to the study specific objectives below.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTriggers that Prompt Refugee Suicide Survivors to Attempt Suicide\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis section focuses on objective one, namely: \u0026ldquo;To find out the triggers that prompt refugee suicide survivors to attempt suicide in Rhino Camp, West Nile, Uganda\u0026rdquo;. It draws on the views of seven Key Informants that included two (2) representatives from Office of the Prime Minister, 2 clinicians (1psychologist and 1 psychiatrist) who are partners of Mental Health, 1 Police in the Mental Health department and 2 Refugee Welfare Council (RWCs) members. The findings from this study show that suicide triggers can be psychological, social, economic, and demographic. The following key findings emerged from the Study Objective one: 1) domestic violence and relationships, 2) mental illness, 3) financial difficulties, and 4) inadequate food deliveries, as detailed below.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDomestic Violence and relationship\u003c/strong\u003e\u003cstrong\u003e:\u003c/strong\u003e A Key Informant explained how domestic violence disproportionately affects women in various forms of violence, such as physical, sexual, emotional, and economic abuse, leading to triggers of suicide, as illustrated below:\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eIssues of GBV have been ranked the highest as the trigger of suicides in Rhino camp because of the nature of the refugees that we have, who have come, they have a lot of trauma, they experience a lot of adversities, so they come in difficult situations psychologically to deal with, so as a reason we find so many cases of GBV more especially inflicted on women because it is the bigger percentage and this the end of GBV leads to suicides because culturally people do not easily open up to GBV. What happens to someone who has been bitten by his closes family where they are supposed to seek solicits to alternate suicides\u003c/em\u003e (KII, June 2023)\u003c/p\u003e\n\u003cp\u003eWhile supporting the above voice, a participant narrated that:\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eDomestic violence contributes to women committing suicide because when a man always torture, abuses the wife, it makes the wife to be undermined infront of children and community and that means it brings about hopelessness in a woman and some of these men end up marrying 2-3 wives and if the relationship with one of the wives is not fine, this wife feels isolated and can reasonably go and commit suicide. Some of the women go through psychological, physical abuse, fighting and harm, and sexual abuse in marriage recorded because sex in homes is done by men without the concern of the wife because the man thinks that he is the head of the family and he can have sex with his wife even when the wife is not prepared. And this practically happens in the refugee camps because here, we have about 64 ethnic groups some of them give out their daughters in marriage even when their daughters do not know\u0026nbsp;\u003c/em\u003e(KII, June 2023)\u003cem\u003e.\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eIn addition, how relationship can manifest is highlighted by a participant below:\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eUnwanted pregnancy, forced marriage, extra marital affairs, fights with the cowife, man concentrating on one family, emotional violences in women. For example, there are some refugee men who comes and impregnant their women and live them without any support and they go back to their country leaving women to struggle with pregnancy and taking care of children.\u003c/em\u003e (KII, June 2023)\u003cem\u003e.\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThe voices of the three Key Informants indicated that domestic violence and suicide are both serious and distressing issues that can be interconnected, especially for victims who are experiencing the devastating effects of abuse. In these situations, relationships can result in exploitation and physical, emotional, and psychological harm, perpetuating inequalities and violating the rights of vulnerable individuals, especially women and children. Addressing exploitation requires awareness, education, and the establishment of protective measures to ensure the safety and well-being of at-risk individuals. The above findings tally with the [22,23,24] that romantic companions or quasi-sexual assaults have encountered by 35 percent of women worldwide.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;Mental illness:\u0026nbsp;\u003c/strong\u003eThis study indicated that mental illness and attempted suicide are closely related, and individuals with mental health conditions are at an increased risk of attempting suicide, similar to the overall population. A Key Informant made the following assertions.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eThere are clients on mental treatment, they stop taking treatment and symptoms comes up for example voices becoming too loughs, tends to relapse. Mental health clients who are not diagnosed, they are there but unaware, because of pain, sadness, conflict in their thoughts ends up triggered to suicide. Depression being sad, loss of interest in the activities. trauma in acute form to event, psychological pains with bad dreams, thoughts leading to Post Traumatic Stress Disorder (PTSD). Psychosis- thoughts threating to kill them. Autism for instance a family nursing a child who has autism which comes with behavioral management-they don\u0026rsquo;t know how to manage, no special needs, no therapists, can\u0026rsquo;t keep in one place, family get confused, can\u0026rsquo;t work because of keeping this child who destroys people\u0026rsquo;s properties, fights, and they are aggressive. All the above triggers one\u0026rsquo;s suicide attempts\u0026nbsp;\u003c/em\u003e(KII, June 2023)\u003cem\u003e. \u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThe above voice indicates that mental health illnesses and attempted suicide are intertwined, and addressing this complex issue requires a comprehensive approach. By recognizing warning signs, reducing stigma, and promoting mental health awareness, an environment can be created in which individuals feel supported and encouraged to seek help. Therefore, investing in mental healthcare, education, and suicide prevention programs is essential to save lives and foster mental well-being in communities worldwide. Together, we can create a more compassionate and understandable society that prioritizes mental health and supports those who need it most. The above findings are in line with previous studies showing that, during adolescence, intense negative emotions such as guilt, shame, and hopelessness can cause psychological pain, and numerous studies have shown a link between psychological pain and the ability to commit suicide [29].\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFinancial difficulties:\u0026nbsp;\u003c/strong\u003eThis study found that financial difficulties were a contributing factor in attempted suicide. The stress and strain of financial problems cause individuals to experience feelings of hopelessness, desperation, and helplessness, making them vulnerable to suicidal thoughts and behaviors. For example, one Key Informant explained:\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eChronic illnesses may leads to financial loss for example there was a client who had been battling with diabetes for so long but the treatment, medical bills, the way he saw how the family are struggling to make him alive, the money they were using to keep his life which he thought they would have been used somewhere else, and they see their cause of disease may not even recover tomorrow or other day, they are refugees, they have small incomes, seeing the little the family is saving is going to their medical bills, they are like instead of letting people suffer and tomorrow they still die, it is better to die and that one left a suicide note\u0026nbsp;\u003c/em\u003e(KII, June 2023)\u003cem\u003e.\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eAccording to another Key Informant,\u0026nbsp;\u003cem\u003e\u0026ldquo;\u003c/em\u003e\u003cem\u003ethe level of poverty is too high in our settlement and because of such reasons, people end up attempting committing suicide\u003c/em\u003e\u003cem\u003e\u0026rdquo;\u003c/em\u003e (KII, June 2023)\u003cem\u003e. \u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eWhile supporting the above statement, a Key Informant argued that:\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eThe other trigger is unemployment. We all realize that everybody is yearning to be employed. Even the children who go to school, they go hoping that they will be employed. Where it has happened that one is jobless, one begins thinking in two ways. When you over think, the Satan can drive you to one side and you may end up committing suicide\u003c/em\u003e (KII, June 2023)\u003cem\u003e. \u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThe three storylines by the Key Informants indicate the need for accessible and affordable healthcare services for all individuals, regardless of their financial status. Inequitable access to proper medical care can lead to adverse outcomes and exacerbate struggles faced by individuals with chronic illnesses. A previous study also asserted that household foreclosure and financial insecurity are thought to be the four triggers that lead to an upsurge in suicide risk due to comorbidity with additional risk factors such as depression\u0026nbsp;[18,19], anxiety, violence and harmful alcohol use.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eInadequate food deliveries:\u003c/strong\u003e This study revealed that inadequate food deliveries can have severe implications for individuals\u0026apos; physical and mental well-being, leading to heightened stress, hopelessness, and desperation. A Key Informant shared how disputes or struggles over access to food or its distribution can create a severe emotional and psychological impact on those affected.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eRecently we had reduction food ratios and they categorized it into 3 categories 1,2,3. Category 3 which is the worst meaning they will not be receiving any food, but where does a refugee get money to buy this food? No where because they do not have work, no jobs, no employment opportunity in the settlement, they entirely rely on donor handouts and what partners gives. Reduction in food ratios has typically increased the suicides rates in Rhino settlement and partner implementing MHPSS in Rhino camp are finding a peak/rise in suicide cases and the cause are usually around the food\u0026nbsp;\u003c/em\u003e(KII, June 2023)\u003cem\u003e.\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eTo supplement, another Key Informant stated\u003cem\u003e:\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eOne of the reasons could be because of food reduction. the food given to them are not enough to feed their families and that also bring back the issues of suicidal attempts. Since then when we were in our own country (home), we use to access our own food by our own self but now accessing food is also very hard, accessing land here is also very hard. All these things are the reasons why refugees attempt suicide.\u003c/em\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003cem\u003eIf we can increase or if the donors can give more support, it will help those who wanted to attempt to commit suicide or these who committed because of food related issues\u003c/em\u003e (KII, June 2023)\u003cem\u003e.\u003c/em\u003e\u003c/p\u003e\n\u003cp id=\"_Toc151593586\"\u003eThe above findings suggest that when people are deprived of proper nutrition and face the constant struggle of not having enough food, it can significantly impact their mental health, increasing the risk of suicidal thoughts and attempts. Therefore, addressing food insecurity and providing access to mental health support are essential steps for protecting vulnerable populations and promoting overall well-being. Efforts to alleviate poverty, increase food accessibility, and provide mental health resources can contribute to reducing the risk of suicide related to inadequate food delivery. The findings support previous results that state that through a number of mechanisms, food insecurity may raise the risk of suicidal thoughts and actions. For instance, poor nutrition, stress, and the stigma attached to food insecurity may lead to worsening mental health, which increases the risk of suicide and other related behaviors. Additionally, undernutrition has been linked to food insecurity in older adults [55], and this condition is positively correlated with suicidality [56].\u003c/p\u003e\n\u003ch1\u003eSubjective Experience of Refugees\u0026rsquo; Suicide Survivors\u003c/h1\u003e\n\u003cp\u003eThis section focuses on objective two, namely: \u003cem\u003e\u0026ldquo;To explore the subjective experience of refugees\u0026rsquo; suicide survivors in Rhino Camp, West Nile, Uganda\u0026rdquo;\u003c/em\u003e. It draws on the views of eight suicide survivors. The following key findings emerged from Study Objective two: 1) traumatic past, 2) psychological distress, 3) social isolation, and 4) cultural stigma, as detailed below.\u0026nbsp;\u003cstrong\u003eTraumatic Past:\u003c/strong\u003e Many participants shared experiences of violence, persecution, and loss in their home countries, leading to traumatic pasts that affected their mental well-being. They experienced long-lasting effects on their mental well-being which developed into depression, anxiety, and other psychological health issues as narrated by a 40-year-old Female below:\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eI thought of death of my first husband in the war who was so nice to me coupled with camp stressors and I went to drinking and abandoning my children alone. I drunk alcohol for one full month without eating because my only wish was death and even if people advise me to stop drinking, I would not accept. One day I picked the drugs and swallowed and I was unconscious and they rushed me to the health center where I survived death. At the time I took the drug, I felt less breath, eye closed, heart shut down and I had no vision for seeing anything, (\u003c/em\u003e\u003cem\u003eIn-depth Interview, June 2023\u003c/em\u003e\u003cem\u003e)\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThe voice above indicates that memories of violence and loss may continue to haunt them, causing emotional distress and making it challenging to cope with the present and plan for the future. In the context of attempted suicide, the accumulation of trauma can be overwhelming for some individuals. They may feel hopeless, powerless, and unable to envision a better future, increasing their vulnerability to suicidal thoughts and actions. Furthermore, the lack of access to mental health services within refugee camps exacerbates the impact of these traumatic experiences, leaving many refugees without the necessary support and resources to heal and recover. The above findings are in line with previous studies that, as a result, suicidal thoughts and attempts are highly likely to occur among refugees and/or asylum seekers\u0026nbsp;[13]. The probability of psychological illnesses evolving in displaced people is significantly increased due to the large number of traumatic situations that the majority of displaced people experience as a result of having to flee their country. According to [57,58,59,60], depression, anxiety disorders, post-traumatic stress disorder, and somatization illnesses seem to be the most prevalent disorders. Suicide attempts and thoughts are more common in people with mental illnesses and difficult life circumstances. Teenage girls have high rates of emotional disorders and suicidal thoughts. Individual and family initiatives may be beneficial for teenage girls who are at increased risk of suicide and mental trauma [10].\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePsychological Distress:\u003c/strong\u003e Other participants reported high levels of psychological distress due to ongoing uncertainties, worry about the welfare of the kids, household, as well as companions, hopelessness, camp stressors, displacement, and limited access to resources as asserted by the voices below:\u003c/p\u003e\n\u003cp\u003eA 33-year-old female shared her experience:\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eI found my child who is in primary six (6) was sent home because of money and there was no money and also the children stayed for two days without eating food. I felt very disappointed with life, sad, hopeless and angry on myself, my husband rejected me and my children, the world is not worth me living in, so when all these things came into my mind, a plan of drowning into the river together with my children came into my mind\u003c/em\u003e (In-depth Interview, June 2023).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eA related experience was shared by a 40-year-old female\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eThe second suicide attempt was now in Ocea C using a rope where I currently staying. In Ocea life is very difficult, my family is size 4, food is very little and no land for cultivation, no one to build for me and when it rain at night we have just to stand the all night because the roof is leaking everywhere, no ways of accessing basic needs like soap, and sanitary facilities and no money for paying children to school, I don\u0026rsquo;t have a brother he got an accident and I am alone, no one who could support me and right now I am the only one who is taking care of my mother who is old and sick\u003c/em\u003e (In-depth Interview, June 2023).\u003c/p\u003e\n\u003cp\u003eSimilarly, a 44-year-old female expressed that:\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eIssue of school fees was a challenge for my child who was in S.4. I was having my clan brother who use to paid but he got sick and my child did not go to school. By then, my child was going for the final exams and I was looking for credit from people. There was no money, nobody helped me. That is when that incident started.\u0026nbsp;\u003c/em\u003e(In-depth Interview, June 2023).\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThe three voices above indicate that the combination of ongoing uncertainties, displacement, limited resources, traumatic memories, social isolation, and a lack of mental health support contributes to high levels of psychological distress among refugees in Rhino Camp. Addressing these issues requires a comprehensive approach that includes providing basic necessities, fostering a sense of community and support, and offering culturally appropriate mental health services to help refugees cope with distress and rebuild their lives with hope and resilience.\u003c/p\u003e\n\u003cp\u003eThe study findings are congruent with those of previous studies, which state that teenage girls have very high rates of both emotional disorders and suicidal thoughts. Individual and family initiatives may be beneficial for teenage girls who are at increased risk of suicide and mental trauma[10]. Overall, the results emphasize earlier findings showing a link between mental distress among displaced people and increased levels of suicidal ideation and suicide attempts \u0026nbsp;[13].\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSocial Isolation:\u003c/strong\u003e Findings indicate that the lack of social support systems and feelings of isolation further exacerbate participants\u0026apos; mental health challenges. \u0026nbsp;They expressed the need to create opportunities for social interactions within the camp, as shared by the following statements:\u003c/p\u003e\n\u003cp\u003eA 40-year-old female narrated that:\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eI\u0026nbsp;\u003c/em\u003e\u003cem\u003estarted thinking it is better to kill myself and the government come and take the children, I cried a lot, depressed and traumatized for three days then I just pick the rope, locked the door, tied it in my house and climb the roof, only to find myself in Ocea health center where I woke up feeling throat pain and wound on my neck, I can\u0026rsquo;t swallow saliva, I went through severity pain and having shame and guilty of what have done, embarrassed. When I came back Isolated myself from the people. Organization social workers and Psychologists came and counsel me\u003c/em\u003e (In-depth Interview, June 2023).\u003c/p\u003e\n\u003cp\u003eAnother participant shared how the experience of social isolation was addressed:\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eOrganization like TPO provide home visit, counseling, Psychological First Aids through Social Worker and Clinical Psychologist. Psychosocial support provided by the family, friends, and community members. I also got help from the health facility through the treatment and medication I have got. Also, prayers were organized by my church at my home\u003c/em\u003e (In-depth Interview, June 2023).\u003c/p\u003e\n\u003cp\u003eThe above statements indicate that the consequences of social isolation can be severe, especially for individuals who have already experienced psychological distress. Social support is crucial for mental well-being as it provides emotional comfort, validation, and a sense of belonging. Without such support, individuals may feel overwhelmed by their challenges and lack coping mechanisms, leading to worsened mental health conditions including depression, anxiety, and feelings of hopelessness. To address social isolation among refugees, it is vital to create opportunities for social interaction within the camp. This can include organizing community events, support groups, and cultural exchange programmes. Promoting tolerance and inclusivity, along with providing mental health support services, can play a significant role in mitigating social isolation and improving the overall health of refugees in Rhino Camp.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe participants needed to create opportunities for social interaction within the camp, which corresponded with a few researchers. They have emphasized the effectiveness of mutual treatment in suicide prevention owing to the interdisciplinary team\u0026rsquo;s collaboration having a positive effect on the psychological health of sick people \u0026nbsp;[61,62].\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCultural Stigma:\u003c/strong\u003e Participants expressed the existence of cultural stigmatization around mental health issues, which prevented them from seeking help and support.\u003c/p\u003e\n\u003cp\u003eA participant shared her bitter experience below:\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eThere are so many who were even laughing sometimes at me. Stigmatization is there, because at times when I go for some funeral place, people when they see me, they start commenting about my body being thin because by then when I was working as a business woman, I used to have good body. But nowadays you find people will be like, is she the one or she is not the one? People are just trying to give you hardship, and always those things are there. It even contributed like not visiting people, because always when I go, I think that maybe they are going to talk about me. That is why staying alone could all contribute to this thought that could bring me to again come and attempt suicide\u003c/em\u003e (In-depth Interview, June 2023).\u003c/p\u003e\n\u003cp id=\"_Toc151593587\"\u003eThis voice demonstrates how the consequences of cultural stigma can be significant, particularly for refugees who are already facing numerous challenges in their lives. The fear of being judged or rejected by their community can deter them from seeking professional help or confiding with others about their mental health concerns. Consequently, mental health problems may go untreated, leading to worsening conditions and potential long-term negative effects on well-being. Addressing cultural stigma surrounding mental health requires a multi-faceted approach that includes education, awareness campaigns, and community involvement. It is essential to engage with community leaders, religious figures, and traditional healers to promote a more comprehensive and supportive environment for individuals dealing with mental health challenges. By challenging misconceptions, fostering open dialogue, and offering culturally sensitive mental health services, we can break down the barriers created by cultural stigma and provide necessary support and care for refugees in Rhino Camp.\u003c/p\u003e\n\u003cp\u003eThese results are in line with those of a previous study that explained that cross-cultural stress, encounters with discriminatory practices, cultural differences, and environmental exposure factors are some of the factors that impact suicidality among refugees [63]. \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n\u003ch3\u003eSupport Systems Utilized by Suicide Survivors After Attempting Suicide\u003c/h3\u003e\n\u003cp\u003eThis section focuses on objective three, namely: \u0026ldquo;\u003cem\u003eTo explore the support systems in place utilized by refugees\u0026rsquo; suicide survivors after attempting suicide in Rhino Camp, West Nile, Uganda.\u003c/em\u003e\u003cem\u003e\u0026rdquo;\u003c/em\u003e\u003cem\u003e.\u003c/em\u003e It also draws on the views of seven Key Informants and eight suicide survivors regarding the support systems utilized after attempting suicide. The following key findings emerged from the study objective 3:1) community and family support; 2) role of religious, cultural, and opinion or other leaders; 4) health facilities support; 5) coping mechanisms; and 6) psychosocial support providers, as detailed below.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCommunity and Family Support:\u003c/strong\u003e This study revealed various community structures put in place by organizations to provide assistance to individuals in need. Participant Information provided a detailed account.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eYou see the individuals who attempted suicide and also those who have completed suicides, they all come from the family. So, I can say that the family is the first support system that we can dwell on. From my experience in the sector is that people who have suicide tendencies are best understood at family levels because you see if somebody starts to lament on issues which are very hard , when you start to behave in a way that they don\u0026apos;t even know what they are doing, they are always isolated, they want to stay alone, they can best be addressed at the family level if there are family members for example if there is a wife, husband, children and so on. Family in totality is the first system that we know can support us in the management of attempted suicide\u003c/em\u003e (KII, June 2023).\u003c/p\u003e\n\u003cp\u003eAnother participant suggested that:\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eCommunity support systems for mental health vary in awareness, with some known to the community and others not. Organizations had established community structures, like CRTs (Crisis Response Teams), VPAs (Volunteer Psychosocial Assistants), Community Based Sociotherapy Facilitators (CBS) Community Development Workers and Village Health Teams, to aid in times of crises and suicide attempts. Religious, cultural, and opinion leaders serve as trusted first contacts, while mental health professionals, including psychologists, social workers, and psychiatric clinical officers, offer counseling and therapies. Health facilities within and outside the community provide ongoing support, treatment, and follow-ups for individuals dealing with mental health conditions\u003c/em\u003e (KII, June 2023).\u003c/p\u003e\n\u003cp\u003eRelatedly, one more participant explained that:\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eCommunity structures such as Crisis Response Teams, Volunteer Psychosocial Assistants, and Village Health Teams are empowered at the grassroots level. They receive training in Psychological First Aid and Medical First Aid, and have established reporting mechanisms and referral pathways. They work closely with community leaders and ambulances to respond to emergencies like suicide attempts and maternal health needs. Refugee Welfare Councils also play a supportive role. Trained professionals, including social workers, psychiatric clinical officers, and psychologists, provide comprehensive psychosocial support. They conduct mental health assessments, offer counseling and coping therapies to clients and their families. Cases are discussed in sector working groups and settlement coordination meetings to ensure appropriate support is provided\u003c/em\u003e (KII, June 2023).\u003c/p\u003e\n\u003cp\u003eThese three statements indicate the presence of well-organized and comprehensive mental health support systems within communities, especially in the context of addressing suicide attempts and mental health challenges. These support systems are rooted at the family and grassroots levels and involve various community structures and trained professionals. However, potential gaps include addressing mental health stigma, improving access to remote areas, strengthening crisis response capacity, enhancing coordination and communication among support entities, ensuring long-term follow-up for individuals, promoting cultural sensitivity, establishing data and monitoring systems, integrating mental health with primary healthcare, and enhancing family and community involvement in mental health programs. Addressing these gaps will lead to more effective and inclusive mental health support systems for communities.\u003c/p\u003e\n\u003cp\u003eAccording to Olatunji et al. (2020), family support is a type of communal support that aids in providing practical, monetary, and affective assistance. Parental involvement results in the lessening of suicide attempts and suicide ideation due to a reduction in depression, according to the latest findings involving 251 South-West Nigerian students from its two universities \u0026nbsp;[64].\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eRole of Religious, Cultural, and Opinion or other Leaders:\u003c/strong\u003e A participant had this to say on the support system,\u0026nbsp;\u003cem\u003e\u0026ldquo;\u003c/em\u003e\u003cem\u003eReligious, cultural, and opinion leaders are first contact/point of entry and community trust them\u0026rdquo;,\u003c/em\u003e (KII, June 2023).\u003c/p\u003e\n\u003cp\u003eIn addition, a participant expressed that:\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eWe also have spiritual leaders who help provide counseling or talk to the families. We also have African Traditional setting where the elders in the community intervene in case there is suicidal cases in the community. We engage with different partners who intervene in the cases of attempted suicide and suicidal cases and makes follow up with the affected persons to see how they are coping up. We also have police where need be, at times we need enforcement where the situation needs a victim to be kept under safe custody\u003c/em\u003e (KII, June 2023).\u003c/p\u003e\n\u003cp\u003eThese two accounts indicate that in many communities, religious, cultural, and opinion or other leaders have significant influence and are often the first point of contact for individuals seeking help. These leaders play a crucial role in building trust and facilitating community-related support for those dealing with mental-health challenges.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThese findings are in line with a previous study that stated that helpful psychological health results with a great deal of happiness are typically associated with religious faith and spirituality \u0026nbsp;[65,66].\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePsychosocial support providers\u003c/strong\u003e\u003cstrong\u003e:\u003c/strong\u003e This study revealed that psychosocial support providers play a vital role in helping individuals who have attempted suicide navigate through complex emotional aftermath, providing them with the necessary tools and support to foster healing, resilience, and a renewed sense of hope for the future.\u003c/p\u003e\n\u003cp\u003eTo illustrate, a participant highlighted that,\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;Organizations dealing in Psychosocial Support have people who represent them within the community for example psychologists, social workers and psychiatric clinical officers who provides counseling, advanced therapies, and treatment of mental health conditions etc.\u003c/em\u003e\u003cem\u003e\u0026rdquo;\u003c/em\u003e (KII, June 2023).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eSimilarly, another participant expressed that,\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eThe MHPSS partners come in to provide MHPSS aspects. The organization comprised of trained professional social workers, psychiatric clinical officers and psychologists. Their work is to carry out menta health assessment on the clients, profile and clerk cases and take clients through counseling and coping therapies not only individual who attempted suicide but also immediate family members and community because they all suffer this trauma. After profiling and clerking the clients\u0026rsquo; case. The cases are forwarded to the sector working group meetings and conference. These cases further go to the settlement coordination meeting after ascertaining the root cause of suicide where all partners come to discuss and provide support according to the need\u003c/em\u003e (KII, June 2023).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThese findings indicate that psychosocial support providers play a vital role in helping individuals who have attempted suicide navigate through complex emotional aftermath, providing them with the necessary tools and support to foster healing, resilience, and a renewed sense of hope for the future.\u003c/p\u003e\n\u003cp\u003eA few researchers have emphasized the effectiveness of mutual treatment in suicide prevention owing to the interdisciplinary team\u0026rsquo;s collaboration, which has a positive effect on the psychological health of sick people \u0026nbsp;[61,62].\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eHealth Facilities Support:\u003c/strong\u003e This study revealed that health facilities play an essential role in supporting individuals with mental health issues both within and outside the community. They offer treatment, follow-up, and access to mental health professionals, who can provide support within the community.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eIn support health facilities and community support, a participant had this to say,\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;\u003c/em\u003e\u003cem\u003eHealth facilities within the community and outside communities that keeps on supporting such people or they have mental health professionals that can easily go within the community and support. Health facilities give treatment and follow ups on the clients\u003c/em\u003e\u003cem\u003e\u0026rdquo;,\u0026nbsp;\u003c/em\u003e(KII, June 2023).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eLike the voice above, another participant added that:\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eSome of the services including the health services, community health outreach programs by the health workers, the referrals by the partners where they go out to find out what is ongoing. Rescue in terms of ambulance services for example when one attempts to commit suicide and not yet dead, the person is taken to the health center. From the health center, counseling and treatment of the wounds is done. Through the VHT system also. There\u0026apos;s continuous follow up on how this person is coping up and there is also reporting\u003c/em\u003e (KII, June 2023).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe above voices point to the significance of a collaborative and supportive approach in dealing with attempted suicide, combining the resources and expertise of health facilities with compassion and understanding of the community to promote mental health and well-being.\u003c/p\u003e\n\u003cp\u003eThese findings correspond to those of a previous study that found that the wishes of survivors of suicide attempts include cooperative experts, coordination of care, more follow-up endeavors, and very few transfers throughout the course of treatment [67]. Related favorable and unfavorable opinions on psychotropic drugs have also been documented in previous research [68,69].\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCoping Mechanisms:\u003c/strong\u003e Coping mechanisms among refugees in Rhino Camp, West Nile, Uganda, refer to the strategies and resources that individuals use to navigate the challenges and stressors they face, including those related to their mental health. Given their limited access to formal mental health services, refugees often rely on various coping mechanisms to cope with their emotional struggles. This study found that some participants used coping mechanisms, such as support from family or spiritual practices, to deal with their mental health struggles. To illustrate this, a 33-year-old woman said: \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026nbsp;Right now, the way I am coping, I managed to secure some land that I am digging and I also constructed my houses alone which has helped to reduced thought of suicide. The organization like CEFORD came and talked to me. Friends helped me to cope up with suicide attempt\u0026nbsp;(\u003c/em\u003e\u003cem\u003eIn-depth Interview, June 2023\u003c/em\u003e\u003cem\u003e).\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eSimilarly, another participant explained that:\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eThe first help I got from the family, and\u003c/em\u003e\u003cem\u003e\u0026nbsp;Refugee Welfare Council one (RWCI), women representative who came and they counseled me. And then there are some phone calls that also called to counsel me. Friends helped me to cope up with suicide attempt\u003c/em\u003e (In-depth Interview, June 2023).\u003c/p\u003e\n\u003cp\u003eThe above statements indicate the importance of recognizing and appreciating the coping mechanisms used by refugees, as they highlight the resilience and strength of individuals facing overwhelming difficulties. However, it is crucial to note that while some coping strategies could have been effective, they may not be sufficient to address severe mental health challenges, lack professional mental health services, and the stigma surrounding mental health can limit the effectiveness of these coping mechanisms, underscoring the need for comprehensive mental health support within the refugee camp. Addressing mental health issues among refugees requires a holistic approach that combines informal coping mechanisms and formal mental health interventions. By providing accessible and culturally sensitive mental health services, we can better support refugees in dealing with their mental health struggles, and help them build resilience by rebuilding their lives in challenging circumstances.\u003c/p\u003e\n\u003cp\u003eThis is in line with previous study results that asserted that individuals with psychiatric illnesses, even those who are unsociable and have little fun, may advance as well as practice helpful coping mechanisms to control psychological pressure as well as to safeguard and improve their health with the help of such assistance [70].\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eUnderstanding refugee suicide survivors\u0026rsquo;subjective experiences is crucial for developing effective interventions. Survivors\u0026rsquo; narratives reveal the immense emotional pain they endure, often feeling overwhelmed by their circumstances. Feelings of loneliness, guilt, and shame are common among survivors as they struggle to cope with the aftermath of their suicide attempts.\u003c/p\u003e\n\u003cp\u003eCultural stigma surrounding mental health issues prevents many refugees from seeking help, as they fear being ostracized or labelled as weak. Consequently, individuals often suffer from silence and a lack of access to proper mental health support. Empowering survivors to openly share their experiences can help reduce stigma and pave the way for destigmatizing mental health discussions within the refugee community.\u003c/p\u003e\n\u003cp\u003eThe study corresponds to the study results conducted by [63] who asserts that cross-cultural stress, encounters with discriminatory practices, cultural differences, and environmental exposure factors are some of the factors that have an impact on suicidality among refugees.\u0026nbsp;\u003c/p\u003e"},{"header":"DISCUSSION","content":"\u003ch2\u003eResearch Question 1. \u0026ldquo;What are the triggers that prompt refugees suicide survivors to attempt suicide in Rhino Camp, West Nile, Uganda?\u0026rdquo;\u0026nbsp;\u003c/h2\u003e\n\u003cp\u003eBased on the shared views of the volunteers who participated in this study, it was found that domestic violence and suicide are interconnected issues, particularly for victims experiencing abuse. Moreover, exploitation, harm, and inequality perpetuate this link, especially affecting vulnerable individuals, such as women and children. The above findings tally with the [22,23,24], and other sources that romantic companions or quasi-sexual assaults have encountered by 35 percent of women worldwide. \u0026nbsp;To address this, collaboration among various stakeholders, including prevention and early intervention, is necessary. Thomas Joiner\u0026apos;s Interpersonal Theory of Suicidal Attempts (2005) provides a valuable lens for understanding the complex relationship between domestic violence and suicide vulnerability among victims. By applying this theory to develop interventions, stakeholders can work together to make the surroundings for those who are abused secure as well as more compassionate to eventually lower suicidality and promote healthier outcomes.\u003c/p\u003e\n\u003cp\u003eTurning to mental illness, this study revealed that mental health issues and suicide are linked, and individuals with mental health conditions are at an increased risk of attempting suicide, similar to the overall population. In a study of 105 cases of main depressive disorder, 31 females and 74 males, revealed a significant relationship between mental pain and suicidality [28]. \u0026nbsp;By showing that suicidal behavior tryers were more likely to provide terrible psychological anguish (odds ratios [ORs] among 1.02, but also 1.17; P. 001) suicide attempt purpose through or lacking a clear proposal (ORs 11.57 11.77; P. 001), extra proof that psychological anguish plays an important part along with suicide risk was offered by [71]. \u0026nbsp;Additionally, they were more likely to suffer from major depressive disorder (ORs between 1.62 and 1.70; P. 05) and personality psychological disorders (ORs between 2.65 and 3.01; P .001; ORs for others between 1.96 and 2.28). A systematic review of 15 studies found that mental pain was a significant predictor of suicidal ideation and attempt vulnerability. During adolescence, intense negative emotions such as guilt, shame, and hopelessness can cause psychological pain, and numerous studies have shown a link between psychological pain and the ability to commit suicide [29]. Thus, a comprehensive approach is needed to recognize warning signs, reduce stigma, promote mental health awareness, invest in mental healthcare, and implement suicide prevention programs. In addition, a compassionate society prioritizing mental well-being can save lives and support those in need. By understanding these factors, stakeholders can develop tailored interventions and create a compassionate society that prioritizes mental well-being, ultimately saving lives and supporting those in need among the refugee population in Rhino Camp.\u003c/p\u003e\n\u003cp\u003eThis study found that financial difficulties contributed to attempted suicides. The stress and strain of financial problems cause individuals to experience feelings of hopelessness, desperation, and helplessness, making them vulnerable to suicidal thoughts and behaviors. The results of this study are broadly consistent with previous research on household foreclosure and financial insecurity, which are thought to be triggers that lead to an upsurge in suicide risk due to co-morbidity with additional risk factors such as depression [18,19],anxiety, violence, and harmful alcohol use. Therefore, financial downturns, such as those linked to individual hardships caused by job or asset losses, can be related to individual suicide risk. According to [72], those seeking asylum and refugees might be in danger of suffering poor social conditions upon arrival in another country; they might reside at the bottom of the social scale. [73] \u0026nbsp;asserted that anxiety and depression are linked to living in poverty, which refugees and asylum seekers encounter. Bad monetary situations, including permit limitations that restrict obtaining assistance, social benefits, and medical treatment in the resettlement nation, leave immigrants with precarious situations that affect both mental and physical health [72].\u0026nbsp;The study suggests that fostering community-based support initiatives, such as provision and integration of livelihood activities into Mental Health and Psychosocial Support, would improve refugee well-being and financial status. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003eIn conclusion, this study pointed out that food insecurity significantly impacts mental health, increasing the risk of suicidal thoughts and attempts. The findings support previous results that state that through a number of mechanisms, food insecurity may raise the risk of suicidal thoughts and actions. For instance, poor nutrition, stress, and the stigma attached to food insecurity may lead to worsening mental health, which increases the risk of suicide and other related behaviors. Additionally, undernutrition has been linked to food insecurity in older adults [55], and this condition is positively correlated with suicidality [56]. Thomas Joiner\u0026apos;s Interpersonal Theory of Suicidal Attempts (2005) helps us understand how food insecurity affects mental health and increases the risk of suicidal thoughts and attempts. Combining this theory with comprehensive measures and collaborative approaches can effectively address this issue, promote overall well-being, and reduce the risk of suicide in vulnerable populations affected by food insecurity. To effectively address this issue, the findings suggest comprehensive measures to alleviate poverty, increase food accessibility, provide land for agriculture through the Office of the Prime Minister, and rent land from the host communities surrounding refugee camps, mitigating drought. Collaborative approaches involving governments, organizations, and communities are crucial. Early intervention and prevention, along with building social support networks, can help break the cycle of food insecurity and mental health challenges, promote overall well-being, and reduce suicide risk.\u003c/p\u003e\n\u003ch2 id=\"_Toc151593591\"\u003eResearch Question 2. \u0026ldquo;What is the subjective experience of refugees\u0026rsquo; suicide survivors in Rhino Camp, West Nile, Uganda?\u0026rdquo;\u003c/h2\u003e\n\u003cp\u003eThis study revealed that traumatic experiences have a profound and lasting impact on refugees, making them more vulnerable to suicidal ideation ideas and behaviors. Forfeitures, such as family and friends, birthplace, respect, public connection, fiscal properties, salary, and economic stability [31] lead to a lasting impact of trauma, which eventually prompts refugees to attempt suicide or complete. A study of the protracted mental health of war-affected refugees reported high levels of trauma, mental illnesses such as post-traumatic stress disorder and depression [10] and anxiety disorders in refugees ranging from 20% or more after resettlement. According to data from a national survey, the proportion of depressive disorder among adolescents aged 12 to 17 in the previous year rose from 9% in 2004 to 15.7% in 2019 [74]. As a result, before, during, and/or after flight, suicidal thoughts and attempts are likely to occur among refugees and/or asylum seekers [13]. \u0026nbsp;The probability of psychological illnesses evolving in displaced people is significantly increased due to the large number of traumatic situations that the majority of displaced people experience as a result of having to flee their country. \u0026nbsp; According to [57,58,59,60], depression, anxiety disorders, post-traumatic stress disorder, and somatization seem to be the most prevalent disorders. Suicide attempts and thoughts are more common in people with mental illnesses and difficult life circumstances. Teenage girls have high rates of emotional disorders and suicidal thoughts. Individual and family initiatives may be beneficial for teenage girls who are at increased risk of suicide and mental trauma [10]. Addressing the mental health needs of refugees and providing comprehensive support and trauma-informed care are essential in fostering healing and resilience among those who have endured violence and loss. Recognizing the significance of mental well-being and offering appropriate resources can help refugees cope with their trauma and envision a more hopeful future.\u003c/p\u003e\n\u003cp\u003eRegarding psychological distress as a theme, the shared experiences from participants revealed that the combination of ongoing uncertainties, worry about the welfare of the kids, household as well as companions, limited resources, camp stressors, traumatic memories, social isolation, and inadequate mental health support contributes to high levels of hopelessness brought about by psychological distress among refugees in Rhino Camp. The study findings are congruent with those of previous studies, according to [25], who found that suicide attempts were three times more likely to occur in people who felt extreme hopelessness than in those who did not. According to evidence, those who feel defeated have already forgotten the significance and intent of their lives. can result in several mental illnesses and serious suicide attempts \u0026nbsp;[75]. \u0026nbsp;The findings of this study suggest that it is essential to recognize the indications of discouragement or despair and comprehend the pain that patients experience in therapy, provide basic necessities, foster a sense of community and family support, and offer culturally appropriate mental health services. This approach aims to help refugees cope with distress and rebuild their lives with hope and resilience. Collaboration among governments, humanitarian organizations, and local communities is essential for implementing sustainable solutions for the well-being of refugees.\u003c/p\u003e\n\u003cp\u003eRegarding social isolation as another theme, the study revealed that a lack of social support systems and feelings of isolation further exacerbated participants\u0026apos; mental health challenges. The study findings are in line with the study conducted in 2019, which states that people experience a sense of loneliness and a fear of abandonment when they feel cut off from their closest social group, consisting of spouses, relatives, acquaintances, as well as important nobles [76] Depression, feelings of loneliness and despair, and isolation frequently co-exist. According to a systematic review on the topic, both familial and suicidal loneliness and disconnection are highly associated with one another [26]. However, the results vary slightly by region. Additionally, youth have received the most attention in the most frequent time frame, which is a main problem due to thrifts\u0026rsquo; inability to miss youthful generations [26]. Other research on adolescents and young adults found a strong connection between subjective feelings of loneliness and suicidal outcomes, particularly SA and SI [27]. An indirect link between suicide and older age via hopelessness, depression, and unfavorable attitudes toward health has been suggested by the association between older age and social isolation. Physical illness did not increase the risk. According to multivariate analyses, depression, social exclusion, and unfavorable health attitudes had a full mediating effect on the effects of hopelessness on suicide [77]. Joiner et al. (2009) recognized a modest effect of indifference to thoughts of suicide on feelings as well as family social support [78]. Such results were comprehended by the writers in the suicide Interpersonal Psychological Theory context, which establishes that interpersonal concepts, purported distress, and frustrated belonging create the motivation to die as a necessary prerequisite to suicide attempts. This study supports the notion that having more social connections is protective against suicide, even though suicide attempts differ from suicidal thoughts or behaviors and are likely to be relatively common in adolescents. Creating opportunities for social interaction within refugee camps is crucial to improve mental well-being. This can include community events, support groups, and cultural exchange programmes. Promoting tolerance and inclusivity and providing mental health support services are also important in mitigating social isolation and enhancing the overall happiness of refugees in the Rhino Camp. Research and humanitarian organizations support community-based approaches to address mental health challenges and promote resilience among refugees.\u003c/p\u003e\n\u003cp\u003eAnother theme is cultural stigma, which found that cultural stigma surrounding mental health among refugees can have significant consequences, hindering their ability to seek help and worsening their condition. The results of this study correspond with those of other studies of cultural stigma. Refugees and asylum seekers have a high chance of being at increased risk when they are cut off from their household members, culture, and religion [17]. The mental health of refugees and asylum seekers can be adversely affected by cultural identity loss and ties during relocation [79]. The Protective Culture Model [63]can be used to explain protective factors against suicide (such as religious convictions, strong family ties, and social support) that may be connected to one\u0026apos;s culture of origin. This reduces the stress of acculturation. Even so, as time passes in the host nation, this protection wanes, leading to an increase in suicidal thoughts and actions in the second generation. \u0026nbsp;Cross-cultural stress, encounters with discriminatory practices, cultural differences, and environmental factors are some of the factors that impact suicidality among refugees [63]. Although encounters before relocation powerfully affect psychological health and wellness, findings demonstrate that encounters in life after relocation may also have an impact on the psychological well-being of refugees and asylum seekers [79], with robust resettlement practices showing positive outcomes for mental health [80]. To address this, a multifaceted approach is essential, including education, awareness campaigns, and community involvement. Engaging community leaders and offering culturally sensitive mental health services can break down barriers and create a more supportive environment. Empowering refugees to advocate for their mental health further enhanced their happiness in Rhino Camp.\u003c/p\u003e\n\u003ch2 id=\"_Toc151593592\"\u003eResearch Question 3. \u0026ldquo;What support systems are available to refugees\u0026rsquo; suicide survivors to help them in the process of recovering after suicide attempt?\u0026rdquo;\u003c/h2\u003e\n\u003cp\u003eFrom the shared views of the participants regarding community and family support, this study disclosed that the presence of well-organized and comprehensive mental health support systems within communities is vital for addressing suicide attempts and mental health challenges effectively. These systems involve various community structures, trained professionals, and families. The study results are in line with other studies that state that parental involvement results in the lessening of suicide attempts and suicide ideation due to a reduction in depression, according to the latest findings involving 251 South-West Nigerian students from its two universities [64]. According to Olatunji et al. (2020), family support is a type of communal support that aids in providing practical, monetary, and affective assistance. The person\u0026apos;s closest friends and family (couples, households, nobles, and substantial people) have the greatest effect and may be helpful during difficult periods. A significant source may be provided by friends and family, such as communal, affective, and monetary provisions, which lessens the effects of external stressors. Resilience built up from aid reduces the risk of suicide associated with traumatized childhood [81]. Relations are especially protective for young people and the elderly, who have developed levels of dependency. However, potential gaps need attention, including addressing mental health stigma, improving access to remote areas, strengthening crisis response capacity, enhancing coordination and communication among support entities, ensuring long-term follow-up, promoting cultural sensitivity, establishing data and monitoring systems, and integrating mental health with primary healthcare. By addressing these gaps, mental health support systems can become more effective, inclusive, and responsive to communities\u0026rsquo; diverse needs. Collaboration among stakeholders is essential for creating comprehensive mental health support systems that prioritize the well-being and resilience of individuals facing mental health challenges.\u003c/p\u003e\n\u003cp\u003eThe study results revealed that religious, cultural, and opinion leaders in communities have a significant influence and are often the first point of contact for individuals seeking help for mental health challenges. They play a crucial role in building trust, breaking the stigma, and facilitating community-related support. These leaders provide culturally relevant and accessible mental health assistance, mobilize community resources, and promote a holistic approach to well-being. Refugee Suicide attempt survivors frequently rely on divine principles and observe as opposed to formal clerical membership, according to [82] and [83]. These activities aid in overcoming desperateness, sole greatest reliable dangerous aspect for suicide as well as a symbol in the hearts of individuals who had psychological disorders, and they encourage people to seek personal fulfillment and a sense of belonging outside of the mainstream. Helpful psychological health results in a great deal of happiness and are typically associated with religious faith and spirituality [65, 66]. hese relationships include having access to social support, being resilient to stress, being emotionally stable and calm, having an internal fortitude and enablement, feeling a great deal of happiness, and being less likely to attempt suicide. According to trauma survivors, spirituality helps them to recover in part by transforming their anger and feelings of powerlessness, both of which are risk factors for suicide, into self-agency [84]. Collaboration between these leaders, mental health professionals, and community organizations is essential for creating a comprehensive and effective mental health support system that meets the diverse needs of individuals facing mental health challenges.\u003c/p\u003e\n\u003cp\u003eBased on the shared views from the participants who participated in the research identified that psychosocial support providers are instrumental in helping individuals who have attempted suicide navigate the emotional aftermath, fostering healing, resilience, and hope for the future. They create a safe and non-judgmental space, actively listen to, and validate individuals\u0026apos; experiences. Their roles include offering coping strategies, exploring triggers, and addressing underlying issues. They build hope; provide long-term support; and adopt a holistic approach to address emotional, social, and spiritual aspects. Additionally, they may refer individuals to professional mental health services when needed, and engage in suicide prevention initiatives. Compassionate support plays a crucial role in individuals\u0026apos; healing and contributes to suicide prevention. The study is congruent with other studies that revealed that suicide survivors who have been portraying real upsetting encounters or proactively taking chances to improve are backed by high, lasting, collectively strong partnerships with clinicians [85]. Individuals with psychiatric illnesses, even those who are unsociable and have little fun, may advance as well as practice helpful coping mechanisms to control psychological pressure as well as to safeguard and improve their health with the help of such assistance [70,86]. A few researchers have emphasized the effectiveness of mutual treatment in suicide prevention owing to the interdisciplinary team\u0026rsquo;s collaboration having a positive effect on the psychological happiness of sick people [61,62]\u003c/p\u003e\n\u003cp\u003eThe shared opinions of the participants revealed that collaborative and supportive approaches to dealing with attempted suicide involve combining the resources and expertise of health facilities with compassion and understanding of the community. It integrates professional mental healthcare with community support to effectively promote mental health and well-being. This approach includes providing integrated care, offering compassionate support, raising awareness through education, and implementing suicide-prevention strategies. By working together, stakeholders can create a comprehensive and caring support system that addresses mental health challenges and effectively promotes suicide prevention. Suicidal behavior can be decreased by receiving sufficient, prompt, and available therapeutic interventions to treat mental illness and drug abuse [87,88]. Crucial tactics to broaden structures\u0026apos; and organizations\u0026apos; healthcare facilities availability and policies across all health, especially at community health centers. The use of proper context by healthcare professionals, clear messaging to users about available services, and more streamlined client flow through the system are all examples of practices. Health literacy policies and strategies should pay particular attention to mental health literacy [89,90]. The wishes of survivors of suicide attempts include cooperative expertise, coordination of care, more follow-up endeavors, and very few transfers throughout the course of treatment [67]. According to [69] and [91], service users regularly believe that some experts are ill-equipped to address suicidality and stress the significance of early and regular potential for therapeutic inquiry into relevant subjects and biomedical initiatives to relieve suffering, with neither being seen as a replacement for the other. Related favorable and unfavorable opinions on psychotropic drugs have also been documented in previous research [68,69]. The above voices point to the significance of a collaborative and supportive approach in dealing with attempted suicide, combining the resources and expertise of health facilities with compassion and understanding of the community to promote mental health and well-being.\u003c/p\u003e\n\u003cp\u003eThe last major theme under Research Question 3 was coping mechanisms to face overwhelming challenges. Other studies have revealed that connection plays a crucial role in recovery, and social environments are crucial for presenting opportunities for doing and being in daily life [92]. Social structures aid in reducing the aspirations of insistently disadvantaged groups, causing people to internalize constrained or unsuitable favorites, needs, and expectations in order to conform to what is practical. Strong interpersonal skills and self-confidence are nurtured between those with serious psychological disorders by proactive, problem-focused stress management techniques, such as a friendly mindset. These strategies have also been linked to self-help participation. These coping skills can be learned, modeled, and supported using cognitive-behavioral methods, which are helpful in the practice of mental health, particularly in the management of one\u0026apos;s health. In order to fight feelings of desperateness, valueless, and loneliness among refugee suicide survivors, supporting networks and healthy coping strategies are therefore helpful in lowering the shame associated with thoughts of suicide.\u003c/p\u003e\n\u003cp\u003eStrengths and limitations of the study\u003c/p\u003e\n\u003cp\u003eStrengths of the study\u003c/p\u003e\n\u003cp id=\"_Toc211037074\"\u003eThis study is the first to explore the lived experiences of refugees who attempted suicide in Rhino Camp, West Nile, and Uganda. This study adds to the body of scientific knowledge on Mental Health aimed at clarifying the unique experiences of suicide survivors of refugees with regard to displacement, trauma, and limited access to mental health services.\u003c/p\u003e\n\u003ch2 id=\"_Toc151593560\"\u003eStudy limitations and delimitations\u003c/h2\u003e\n\u003cp\u003eThis study was limited by several factors during the field work and included;\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eFirst, some participants expressed fear during the data-collection process that contributed to incomplete or inaccurate responses. This fear stemmed from concerns about confidentiality, potential repercussions, or the sensitivity of the topic that led certain participants to provide responses that were not fully accurate. To minimize this issue, the researchers clarified and rephrased interview questions when needed to reduce perceived sensitivity and ensure participants felt comfortable, also the researchers ensured that participants fully understood the confidentiality measures in place and by explaining to the participants that participation \u0026nbsp;is volunteer with no implications attached.\u003c/p\u003e\n\u003cp\u003eSecond, the study required substantial time for data collection and analysis due to the large volume of data generated. The extensive nature of the data demanded careful and prolonged attention to ensure accuracy, validity, and thorough interpretation. The researchers allocated sufficient time to deal with the large volume of data involved in the research and employed systematic procedures to manage and analyse the data.\u003c/p\u003e"},{"header":"CONCLUSION","content":"\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003eThe findings from this study provide the following conclusion:\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTriggers for Suicide Attempts:\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis research highlights the multiple triggers that prompt suicide attempts among refugee survivors in Rhino Camp. Domestic Violence and relationships, mental illness, financial difficulties, and inadequate food delivery.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003cstrong\u003eSubjective Experience of Suicide Survivors:\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eSubjective experiences of suicide survivors reveal a traumatic past, psychological distress, social isolation, and cultural stigma surrounding mental health issues that prevents many refugees from seeking help, leading to silence and lack of access to proper mental health support. Empowering survivors to openly share their experiences can reduce suicide and pave the way for mental health discussions within refugee communities. The lack of adequate mental health services within Rhino Camp exacerbates suicide survivors\u0026rsquo; vulnerability.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSupport Systems for Suicide Survivors:\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe research highlights community and family support; the role of religious, cultural, and opinion or other leaders; health facilities support; coping mechanisms; and Psychosocial Support Providers as the available support system. Limited support systems are often understaffed and lack cultural sensitivity, which makes them less accessible to the refugee population. Community-based support initiatives hold promise for addressing the mental health needs of refugee suicide survivors. Establishing support groups and engaging community leaders can create safe spaces for survivors to talk about their experiences and receive support from those who have experienced comparable struggles.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eRecommendations:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe research suggests the following recommendations to address the mental health needs of suicide survivors in refugee camps.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e1. Enhance mental health services by recruiting and training culturally sensitive professionals who understand the trauma experienced by refugees. Adequate resources should be allocated to establish counseling centers and support groups that provide accessible and stigma-free mental health assistance.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e2. Promote mental health awareness within the refugee community to empower refugee suicide survivors to share their experiences openly, break their silence, and foster a supportive environment.\u003c/p\u003e\n\u003cp\u003e3. Foster community-based support initiatives involving community leaders and volunteers. Establish support groups for suicide survivors, led by trained facilitators, and engage community leaders in mental health discussions. Collaborate with existing community structures, such as Refugee Welfare Councils and Village Health Teams, to build a holistic and sustainable support network for suicide survivors. Provision and integration of livelihood activities into MHPSS to support refugees with food-related distress.\u003c/p\u003e\n\u003cp\u003e4. Stakeholders should work together to make the surroundings for those who are being abused secure and more compassionate to eventually lower suicidality and promote healthier outcomes through awareness, education, and the establishment of protective measures to ensure the safety and well-being of those at risk.\u003c/p\u003e\n\u003cp\u003e5. Foster comprehensive measures of alleviating poverty, increasing food accessibility, providing land for agriculture through the Office of Prime Minister, renting land from the host communities surrounding refugee camps, and mitigating drought. Early intervention and prevention, along with building social support networks, can help break the cycle of food insecurity and mental health challenges, promote overall well-being, and reduce suicide risk. Collaborative approaches involving governments, organizations, and communities are crucial.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFurther research on the problem of study can be undertaken in the areas below\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis research area aims to deepen the understanding of the challenges faced by suicide survivors in refugee settings and identify effective strategies for providing meaningful and sustainable mental health support. By addressing the gaps in mental health services and acknowledging the importance of cultural sensitivity and community involvement, future research can help improve the well-being and resilience of suicide survivors in Rhino camps and similar refugee communities.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eCDC \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Centers for Disease Control and Prevention\u003c/p\u003e\n\u003cp\u003eIASC \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Inter-Agency Standing Committee\u003c/p\u003e\n\u003cp\u003eILO \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;International Labour Organization\u003c/p\u003e\n\u003cp\u003eIPT \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; Interpersonal Theory\u003c/p\u003e\n\u003cp\u003eLUREC \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; Lira University Research Ethic Committee\u003c/p\u003e\n\u003cp\u003eOPM \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Office of the Prime Minister\u003c/p\u003e\n\u003cp\u003ePTSD \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; Post Traumatic Stress Disorder\u003c/p\u003e\n\u003cp\u003eRDO \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Refugee Desk Officer\u003c/p\u003e\n\u003cp\u003eRWCs \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Refugee Welfare Councils\u003c/p\u003e\n\u003cp\u003eSA \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Suicide Attempt\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eSAMHSA \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; Substance Abuse and Mental Health Services Administration\u003c/p\u003e\n\u003cp\u003eSI \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; Suicide Ideation\u003c/p\u003e\n\u003cp\u003eTA \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; Thematic Analysis\u003c/p\u003e\n\u003cp\u003eUNHCR \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;United Nations High Commissioner for refugees\u003c/p\u003e\n\u003cp\u003eWHO \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; World Health Organization\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthical Considerations\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eApproval\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was conducted in accordance with the ethical standards outlined in the Declaration of Helsinki, Lira University Research Ethics Committee (LUREC) no. LUREC-2023-18, and the Uganda National Council for Science and Technology (UNCST) no. HS3046ES before the study was conducted. Written informed consent was obtained from all participants prior to data collection. The researcher sought clearance for data collection from the UNHCR and OPM after receiving approval from LUREC and a letter of introduction from the Faculty of Public Health, Lira University.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eInformed consent\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll respondents were requested to provide their consent before the interview. The consent form was written because it provided an auditable record in the case of questions arising from data storage. Informed consent was obtained by describing the purpose of the study and procedures involved. During data collection, one clinical psychologist was able to speak to anyone upset after participating in this study. The interview process was voluntary, and the participants were free to leave the interview process without penalty. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConfidentiality\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eParticipants were notified that the information from this study would be held and kept strictly private and used only for research purposes. The interviews were conducted in the church or community counseling space. To maintain the privacy of the participants, pseudonyms were used to report direct quotes. Furthermore, the participants remained anonymous (nameless) throughout the study. The records were kept electronically with a password, on paper, and behind locked doors. Trustworthiness was achieved through credibility, transferability, dependability, confirmability, audit trails, and reflexivity.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot Applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;Data will be available from the corresponding author on considerable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare no competing interests\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis research was funded \u0026nbsp;by the author with no external form of funding.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026apos; contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eConceptualization: OJWOK ROBINSON\u003c/p\u003e\n\u003cp\u003eData curation: OJWOK ROBINSON\u003c/p\u003e\n\u003cp\u003eFormal analysis: OJWOK ROBINSON.\u003c/p\u003e\n\u003cp\u003eProject administration: OJWOK ROBINSON \u0026amp; JENIFER ACIO.\u003c/p\u003e\n\u003cp\u003eSupervision:\u0026nbsp;Dr. JUDITH ABAL AKELLO (PhD)\u003c/p\u003e\n\u003cp\u003eWriting \u0026ndash; original draft: OJWOK ROBINSON \u0026amp; JENIFER ACIO.\u003c/p\u003e\n\u003cp\u003eWriting \u0026ndash; review \u0026amp; editing: OJWOK ROBINSON, ACIO JENIFER \u0026amp; Dr. JUDITH ABAL AKELLO (PhD)\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eFirst, I would like to express my gratitude to the Almighty God for providing me with daily existence, vigor, and safeguards through this journey to carry out this research study. Second, I appreciate OPM Arua/Rhino Camp, UNHCR and implementing partner TPO Uganda that allowed me to access participants and offered all necessary support during data collection of this study. I also appreciate participants who boldly provided their written consent and willingly participated into this study. Finally, I sincerely appreciate the spiritual, material, and emotional support my family gave me during this study.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026apos; information\u0026nbsp;\u003c/strong\u003e(optional)\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eWHO. Reversing suicide, mental health crisis in Africa. 2022.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWorld Health Organization. World health statistics. Monitoring health for the SDGs, sustainable development goals. Geneva: World Health Organization; 2021.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGuidance IASCIASC. Addressing Suicide in Humanitarian Settings. 2022.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWorld population review. Suicide rate by country. 2023.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eUNHCR. UNHCR, Uganda Suicide Dashboard-Quarter 4, December 2022. 2022.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTPO Uganda. Rhino - Suicide Data base 2021-June 2023. Unpublished-primary data; 2023.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eUNHCR. Uganda- Population Dashboard as of December 2022. 2022.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWHO. Suicide. 2023.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCDC. preventing suicide Factsheet. 2022.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBukuluki P, Kisaakye P, Wandiembe SP, Besigwa S. Suicide ideation and psychosocial distress among refugee adolescents in Bidibidi settlement in West Nile. Uganda Epub 2021 Oct. 2021;4(1):3.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eChahine M, Salameh P, Haddad C, Sacre H, Soufia M, Akel M, Obeid S, Hallit R, Hallit S. Suicidal ideation among Lebanese adolescents: scale validation, prevalence and correlates. BMC Psychiatry. 2020;20(304):1\u0026ndash;11.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKoyanagi A, Oh H, Carvalho AF, Smith L, Haro JM, Vancampfort D, Stubbs B, DeVylder JE. Bullying victimization and suicide attempt among adolescents aged 12\u0026ndash;15 years from 48 countries. J Am Acad Child Adolesc Psychiatry. 2019;58(9):907\u0026ndash;e9184.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eIngabire CM, Richters A. Suicidal ideation and behavior among Congolese refugees in Rwanda: contributing factors, consequences, and support mechanisms in the context of culture. 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Povertry, depression, and anxiety: Causal evidence and mechanisms. 2020;370(6522):eaay0214.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSubstance Abuse and Mental Health Services Administration (SAMHSA). Key substance use and mental health indicators in the United States. National Survey on Drug Use and Health; 2020.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMoore A, van Loenhout JAF, de Almeida MM, Smith P, Guha-Sapir D. Measuring mental health burden in humanitarian settings: a critical review of assessment tools. Glob Health Action. 2020;13(1):1783957.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAmerican Foundation for Suicide Prevention. Suicide statistics. Secondary suicide statistics. 2019.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSilvia C, Hernandez JC, Overholser KL, Philips J, Lavacot, Craig A, Stockmeier. Suicide among older adults: Interactions among key risk factors. 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Front Psychol. 2022;13:1036983.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSheehan L, Oexle N, Armas SA, Wan HT, Bushman M, Glover L, et al. Benefits and risks of suicide disclosure. Soc Sci Med. 2019;223:16\u0026ndash;23.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBj\u0026oslash;rlykhaug KI, Karlsson B. Suzie Kim Hesook \u0026amp; Lise C. Kleppe. Social support and recovery from mental health problems: a scoping review. Nordic Social Work Research. 2022;12:5:666\u0026ndash;97. Supplementary File (Interview guides) Interview Guide for Participants who attempted Suicide: PART A: Respondent Characteristics.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-public-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"pubh","sideBox":"Learn more about [BMC Public Health](http://bmcpublichealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/pubh/default.aspx","title":"BMC Public Health","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Suicide, Refugees, Lived experiences, Mental health, Rhino Camp","lastPublishedDoi":"10.21203/rs.3.rs-8228150/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8228150/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eSuicide is among the leading causes of death worldwide, and every year, more people die as a result of suicide than HIV, malaria, breast cancer, war, and homicide. Suicide rates are high among vulnerable groups that experience discrimination, such as refugees and migrants.\u003c/p\u003e\u003ch2\u003ePurpose\u003c/h2\u003e \u003cp\u003eThis study explored the lived experiences of refugees who attempted suicide in Rhino Camp, West Nile, Uganda, using Thomas Joiner's interpersonal theory of suicide attempts as a theoretical framework.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eThis study employed an Interpretative Phenomenological Research design and purposive sampling techniques to choose 15 participants (seven key informants and eight suicide survivors) to ensure an in-depth analysis of qualitative data. Face-to-face interviews using in-depth interview guides and observations were used to gather data. The study data were collected between June and July 2023.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eAfter the thirteenth interview, saturation was achieved with no new insights emerging beyond this point. The participants described a broad set of interconnected subjective experiences and triggers shaping suicide attempts among refugees in Rhino Camp which included domestic violence and relationships, mental illness, financial difficulties, inadequate food deliveries, traumatic past, psychological distress, social isolation, and cultural stigma. Participants identified several supportive systems such as community and family support, role of religious, cultural, and opinion or other leaders, and health facilities support. Refugee suicide attempt survivors\u0026rsquo; also described personal coping mechanisms, and highlighted the role of psychosocial support providers operating within Rhino camp.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003eComplex and intersecting social, economic, and psychological challenges that limit help-seeking and heighten vulnerability shape suicide attempts among refugees in Rhino Camp. Strengthening community-based, culturally responsive mental health services and creating safe spaces for open dialogue and counseling may enhance support for refugee suicide survivors and contribute to reducing suicide risk within refugee settings.\u003c/p\u003e","manuscriptTitle":"Attempted Suicide: Lived Experiences of Refugees in Rhino Camp, West Nile Uganda","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-12-26 14:35:37","doi":"10.21203/rs.3.rs-8228150/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2026-01-16T11:27:34+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-01-10T14:56:11+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-01-08T19:36:08+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-01-08T02:25:34+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-12-29T07:55:12+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"200139295806085922778358188828686493431","date":"2025-12-29T06:12:00+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"167648950807723118995454749722766069095","date":"2025-12-27T22:30:16+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"113352499729775920718395577878603793180","date":"2025-12-27T20:57:45+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"64382843447300155959059194309117798128","date":"2025-12-25T11:23:35+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"142423160897430804754060125053259996658","date":"2025-12-24T11:10:58+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-12-24T09:20:47+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-12-21T11:26:23+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-12-08T05:25:28+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-12-07T19:14:36+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Public Health","date":"2025-12-07T19:07:22+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-public-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"pubh","sideBox":"Learn more about [BMC Public Health](http://bmcpublichealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/pubh/default.aspx","title":"BMC Public Health","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"9d07baee-1e64-4bd2-956b-2afa48d45cd6","owner":[],"postedDate":"December 26th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-05-19T08:25:11+00:00","versionOfRecord":[],"versionCreatedAt":"2025-12-26 14:35:37","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8228150","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8228150","identity":"rs-8228150","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}