Exploring the drivers of suicide among individuals served by a medical university in Southeastern Iran: a qualitative study

BACKGROUND: Suicide remains a leading cause of death worldwide and a critical global public health concern. Although the majority of suicides occur in low- and middle-income countries (LMICs), prevention in these contexts is often hampered by limited mental health infrastructure, entrenched stigma, and systemic barriers. In Iran, although the national suicide mortality rate remains comparatively low, a growing trend in suicide attempts—especially among youth—has raised concern. However, little is known about the sociocultural and structural drivers of suicidal behavior in underserved regions such as southeastern Iran. This study aimed to explore the underlying causes of suicide attempts among individuals served by health services affiliated with Bam University of Medical Sciences. METHODS: This qualitative case study was conducted with 54 individuals who had previously attempted suicide. Participants were recruited through purposive and snowball sampling. Data were collected using semi-structured interviews and analyzed thematically using MAXQDA version 2022. Data saturation was reached during the analysis. RESULTS: Thematic analysis identified four major themes and seventeen subthemes: (1) Limited resilience (family/friend conflict, grief, emotional collapse); (2) Contextual stressors (economic hardship, hopelessness, mandatory military service, gender identity-related stigma, environmental trauma); (3) Distressed marital experiences (forced marriage, divorce, family interference, spousal abuse, fear of social judgment and honor-based pressure); and (4) Psychological problems, including depression, psychological stress, lack of access to mental health services, and spiritual crisis. Many participants described a buildup of diverse stressors—emotional, relational, and contextual—indicating that suicide risk arose from compounding life adversities rather than a singular cause. Cultural norms—such as gender roles, stigma around mental illness, and restricted marital autonomy—exacerbated these vulnerabilities and discouraged help-seeking. These intersecting factors often compounded one another, illustrating that suicidal behavior in this population emerged from a layered accumulation of distress rather than any single cause. CONCLUSION: Suicidal behavior in this population is shaped by a complex interplay of psychological distress, social adversity, and entrenched cultural norms. Culturally informed mental health services are essential, particularly for high-risk groups including youth, women, and gender minorities. Structural reforms—such as improving economic conditions, revising conscription policies, addressing stigma, and expanding access to counseling—are necessary to strengthen suicide prevention in similar sociocultural settings.