Collectivism and Suicide Risk: Reinterpreting Interpersonal Theory Constructs in Southern Belize

Over 70% of global suicides occur in low- and middle-income countries (LMICs), yet cultural mechanisms of suicide risk remain underexplored. Collectivism is often assumed protective, but emerging evidence from vertically collectivist settings suggests a more complex relationship.

Qualitative interviews were conducted with 29 community stakeholders across health, education, religious, and social service sectors in Toledo District, southern Belize. Data were analyzed using reflexive thematic analysis with deductive alignment to the Interpersonal Theory of Suicide (IPTS) and inductive attention to collectivist cultural dynamics.

Findings mapped onto all three IPTS constructs. Acquired capability emerged through repeated lifespan exposure to violence, including corporal punishment, intimate partner violence, alcohol-related harm, and community violence. Thwarted belongingness was shaped by stigma, ethnic exclusion, family conflict, and Toledo's structural marginalization as a "forgotten district." Perceived burdensomeness reflected poverty, unemployment, aging-related dependence, and limited access to care. Across constructs, vertical collectivist norms governing privacy, reputation, and emotional restraint appeared to shape how distress was expressed and managed.

These findings extend IPTS by demonstrating how collectivist norms and structural scarcity intersect to shape suicide risk in an LMIC context, underscoring the need for culturally grounded, structurally informed prevention approaches.