A reflexive thematic analysis of how South African men make sense of suicidal distress and recovery

Men consistently account for the majority of suicide deaths globally, and South African men are no exception, however the cultural and personal meanings these men attach to their own suicidal experiences remain underexplored. This qualitative study, informed by phenomenological sensibilities and analysed through reflexive thematic analysis, examined how six South African men who had lived through suicidal crises made sense of those experiences. Participants were aged between 24 and 42, identified as men, and were drawn from four racial groups, three sexual orientations and four home languages across three provinces. They were recruited through the South African Depression and Anxiety Group as stable outpatients who had previously received clinical mental health support. Data were generated through individual semi-structured interviews conducted online via video call and were analysed with reference to Chu and colleagues’ Cultural Theory and Model of Suicide and O’Connor’s Integrated Motivational-Volitional model of suicidal behaviour. Four themes were developed: mental health distress and the burden of inadequacy, often linked to untreated conditions and self-medication with substances; adverse childhood experiences shaping long-term psychological vulnerability; stigma and silence around help-seeking, rooted in masculine norms and intersecting with racial, religious and sexual identity; and pathways through distress, in which participants reflected on the supportive relationships, diagnostic clarity and forms of community and clinical care that shaped their recovery. Across these themes, participants described negotiating pain, identity and isolation in contexts where the resources needed to contain distress were unevenly available. The findings argue for gender-attuned, culturally grounded suicide prevention strategies that engage both individual experience and the structural conditions in which men’s distress is silenced.