The study recruited participants through the South African Depression and Anxiety Group, a leading mental health organisation that acted as gatekeeper for the research. All six men were stable outpatients who had previously received clinical mental health support, a design choice that balanced ethical sensitivity with the need to speak with people who could reflect on their experiences from a position of relative safety. The participants ranged in age from 24 to 42 and were deliberately diverse: they came from four different racial groups, spoke four different home languages, represented three sexual orientations and lived across three South African provinces. That diversity matters, because the researchers were interested not only in what these men had in common but in how race, religion, sexuality and language intersected with masculine norms to shape each man’s silence or disclosure.

Methodologically, the team adopted a phenomenological sensibility, meaning they were concerned with the lived texture of suicidal experience rather than with counting risk factors. Data were generated through individual semi-structured interviews conducted online via video call, a format that allowed participants to speak from familiar surroundings. The interviews were then analysed using reflexive thematic analysis, an approach in which the researchers actively acknowledge that their own perspectives shape how themes are identified and interpreted, rather than claiming a detached, purely mechanical reading of the data. The analysis was anchored in two established theoretical frameworks: Chu and colleagues’ Cultural Theory and Model of Suicide, which holds that cultural norms determine which stressors men perceive as unbearable and which coping strategies feel legitimate, and O’Connor’s Integrated Motivational-Volitional model, which describes the progression from ideation to action and the factors that can interrupt it.

From this analysis, four themes emerged. The first, mental health distress and the burden of inadequacy, captured how untreated psychological conditions combined with a crushing sense of falling short of what these men believed society expected of them. Several participants had turned to substances in an attempt to medicate themselves, a pattern the researchers link to both the inaccessibility of formal care and the masculine imperative to handle problems privately. The theme suggests that for these men, suicidality was not a sudden aberration but the endpoint of prolonged, unrecognised suffering, in which feelings of failure and emotional pain fed each other in a tightening loop.

The second theme, adverse childhood experiences, traced long-term psychological vulnerability back to early life. Participants reflected on how difficult childhood environments had shaped the adults they became, leaving them with limited emotional vocabulary, fragile self-worth and few models of healthy coping. This finding aligns with a substantial international literature showing that early adversity is a robust predictor of later suicidality, but it adds a culturally specific dimension: in contexts where boys are taught that vulnerability is weakness, childhood wounds are often carried into adulthood without language, support or acknowledgement, only to resurface as crisis in early and middle adulthood.

The third theme, stigma and silence around help-seeking, proved to be the connective tissue binding the others together. The men described how dominant masculine norms, the expectation to be strong, self-reliant and unshakeable, made it feel shameful to admit distress or seek help. Crucially, the researchers found that this stigma did not operate in isolation. It intersected with racial identity, religious expectations and sexual orientation, so that a man’s decision to stay silent was shaped not only by gender but by the overlapping communities to which he belonged and the particular judgements he feared from each. In some cases, religious framings of mental illness deepened the sense of personal failure; in others, fears of rejection related to sexuality compounded the isolation already produced by masculine norms.

The fourth theme, pathways through distress, offered the study’s most hopeful material. Participants reflected on the specific things that had made recovery possible: supportive relationships with family, partners or friends who noticed and stayed; diagnostic clarity, in which finally having a name for their condition transformed an amorphous agony into something treatable; and forms of community and clinical care that met them where they were. Recovery, in these accounts, was not a single dramatic rescue but an accumulation of small, relational and structural openings, moments when the resources needed to contain distress were actually available. The researchers emphasise that such resources were unevenly distributed across the men’s lives, and that where they were absent, isolation deepened.

Across all four themes, the study paints a picture of men negotiating pain, identity and isolation in environments where the tools for containing distress are scarce and the permission to use them is scarcer still. The authors argue that their findings call for gender-attuned and culturally grounded suicide prevention strategies, approaches that do not simply transplant generic mental health messaging but actively engage the meanings of masculinity, race, religion and sexuality that shape how South African men experience and express despair. Prevention, on this view, must work at two levels simultaneously: the individual level of how a man understands his own suffering, and the structural level of the social conditions that silence him.

The study’s practical implications are significant for a country where suicide remains a major public health concern and where men are consistently overrepresented in mortality statistics. By recruiting through an established service organisation and focusing on men already connected to care, the research highlights a critical gap: many men reach clinical attention only after a crisis, and the pathways that could have brought them in earlier, such as community-based support, destigmatised language around male vulnerability and screening that accounts for how men present distress, remain underdeveloped. The finding that diagnostic clarity was itself experienced as relief suggests that public health campaigns should emphasise not only that help exists but that naming a condition can be the first act of recovery.

The researchers are careful about the limits of their work. Six participants cannot represent the full diversity of South African men, and the reliance on men already in contact with mental health services means the voices of those who never sought help remain unheard, arguably the population most at risk. Reflexive thematic analysis, by design, produces interpretations rather than generalisable measurements. Yet it is precisely this depth that gives the study its force. By listening closely to men who have stood at the edge and returned, the research transforms suicide statistics into human narratives and demonstrates that understanding why men die by suicide requires understanding how they live with the pain that precedes it. The authors’ closing argument is direct: effective prevention must be built around men’s actual experiences of distress, not around assumptions about them, and it must confront the social silences that make those experiences so dangerous.

Subject of Research: How South African men make sense of suicidal distress and recovery

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

Article References: Stevens-King, N., Mapaling, C., Mabvurira, V., Quarshie, E. N.-B., & Asante, K. O. (2026). A reflexive thematic analysis of how South African men make sense of suicidal distress and recovery. Discover Psychology. https://doi.org/10.1007/s44202-026-00919-w

Image Credits: AI Generated

DOI: 10.1007/s44202-026-00919-w

Keywords: male suicidality, South Africa, reflexive thematic analysis, masculinity, mental health stigma, suicide prevention, adverse childhood experiences, help-seeking, qualitative research, cultural psychology, recovery, SADAG