Suicide literacy in The Gambia

Abstract

Background

Although suicide literacy affects help-seeking for suicidal behavior, little is known about its status in The Gambia. We aimed to synthesise the existing evidence on suicide literacy in the country.

Methods

We adopted a narrative review approach and made a comprehensive search with various search to identify relevant articles on suicide and suicide literacy in The Gambia. We included all the available article till the search date and synthesized to identify recurring themes, trends, and knowledge gaps.

Results

Despite the thorough search, literature specifically focused on suicide literacy in The Gambia was found to be scarce. There were no published surveys of suicide-specific knowledge and attitudes towards suicide in the country. Accessing help for suicidal behavior has been severely hindered by the limited services, cost, and access to treatments, cultural expectations, stigma, and legal factors.

Conclusion

Suicide literacy in The Gambia is under-researched. There is a pressing need for research to understand the burden of suicide its risk factors and its association with suicide literacy to formulate suicide prevention strategies in the country.

Introduction

Suicide is a global public health concern, being the third leading cause of death among individuals aged 15–29 years [1]. The latest estimate of the World Health Organization (WHO) revealed that over 720,000 people died by suicide globally in 2021, about three quarters died in low- and middle-income countries (LMICs), 519 000 deaths among males and 227 000 among females [1]. Suicide creates a double tragedy: families not only suffer the loss of a loved one but also face abandonment and stigma. While they grieve, they are left without comfort, carrying the pain alone and often being judged by others. The global bodies warrant urgent awareness and prevention efforts [1].

Dealing with suicide depends on the level of information and understanding about it [2]. Suicide literacy refers to the knowledge and beliefs regarding suicide: awareness of warning signs, risk factors, prevention and treatment options, attitudes toward suicide, and help-seeking behaviour [3]. It deals with the understanding of suicide, including risk factors, warning signs, and prevention and it is conceptually narrower than mental health literacy and in the literature [4–6]. Therefore, suicide literacy is a specific knowledge domain within the broader framework of mental health literacy, while stigma represents an attitudinal barrier that literacy interventions often aim to reduce. Research shows that when people understand more about suicide, they’re more likely to seek help and less likely to hold onto stigma, and they will also make efforts to prevent it from happening around them [6, 7].

In sub-Saharan Africa, suicide emerges as an important but understudied component of the health burden. According to Global Burden of Disease (GBD) data, Southern and central Sub-Saharan Africa have among the highest age-standardised suicide mortality rates [8, 9]. While some recent studies in Sub-Saharan Africa and other regions have started looking into these areas, there’s still very little data that directly measures suicide literacy [10].

The Gambia is a small West African nation (area ~ 11,300 km²) with an estimated population of 2.4 million in 2024. About 70% of Gambians are under age 30, and over 95% are Muslim [11]. The Gambia is a low-income country with limited mental health infrastructure and high barriers to care. Sociocultural influences, including religious and traditional beliefs, often stigmatise suicide, viewing it as taboo, leading to under-reporting, and discouraging disclosure of suicidal ideation or attempts [12]. Furthermore, socioeconomic stressors such as poverty, unemployment, and limited access to mental health services exacerbate risk [12]. Barrow and Faerden [13] examined perspectives of patients and family members in The Gambia and revealed that beliefs about the causes of mental illness (often supernatural), family decision-making power, scarcity, and cost of services are significant barriers to access. Additionally, accurate data on suicide in the Gambia are scarce. The WHO estimate indicates lower levels of reporting, and there is no recent peer-reviewed study that reliably estimates suicide prevalence in the general Gambian population [11]. Policy remains under-developed; though a Mental Health Bill was drafted in 2019, full implementation and community awareness remain limited [11, 13].

Given this context, suicide literacy matters in The Gambia because increasing public knowledge and awareness about suicide risk, prevention, and available help could reduce stigma, encourage early help-seeking, and facilitate community support for those at risk. Therefore, we aimed to assess the current status of suicide literacy focusing what is known about public knowledge and beliefs about suicide and related attitudes, the sociocultural, educational, and systemic factors influencing suicide literacy, especially attitudes, stigma, and help-seeking; and highlighting gaps and priority areas for research and public health interventions to enhance suicide prevention through improved literacy and awareness.

Methods

Study type

We conducted this narrative review to synthesise existing evidence on suicide literacy and suicide prevention in The Gambia. We considered the narrative design to summarize the current sporadic evidence as well as to indicate the research gaps on suicide in the country.

Search strategy

We performed a comprehensive search in PubMed, Scopus, Google Scholar, and other independent databases (Google) within the last week of August 2025 to identify relevant articles on suicide literacy in The Gambia. The Search terms included: “suicide”, “suicide literacy,” “suicidality,” “suicide attitudes,” “help-seeking,” and “The Gambia.” These terms and Medical Subject Headings were combined using Boolean operators (AND/OR) to enhance search sensitivity. An example of a search string used was:

• ((“Suicide“[MeSH] OR suicide[tiab] OR suicid[tiab]) OR “Suicide literacy“[tiab]) AND (Gambia[tiab] OR “The Gambia“[tiab]).

• Truncation symbols were the applied to maximize search sensitivity.

• In addition to searching data bases, the reference lists of relevant articles were manually screened to identify articles that may contribute to the review. This strategy ensured that the available literature was comprehensively covered.

Inclusion and exclusion criteria

Included studies were those published in English related to suicide literacy, stigma, awareness, and suicide prevention in The Gambia or in comparable sub-Saharan African contexts. Articles not relevant to the regional or thematic focus were excluded.

Data extraction and synthesis

Data from selected articles were reviewed by the researchers to ensure that they are relevant and extracted and synthesized to identify recurring themes, trends, and knowledge gaps. The data extracted were synthesized using a thematic narrative approach, allowing evidence from the different studies to be integrated into the review.

The findings of the studies were subsequently organised into thematic domains:

1. Epidemiology of suicide in The Gambia.

2. Suicide literacy in The Gambia.

3. Attitudes towards suicide and mental health in The Gambia.

4. Help-seeking behaviours in The Gambia.

5. Facilitators of help-seeking are largely informal and community-based.

6. Methodological trends and gaps.

7. Suicide literacy interventions and prevention efforts in The Gambia.

Ethical aspects

No data were collected from human participants in the course of this study; therefore, ethical clearance was not required.

Results

Search results

Our search did not identify any peer reviewed papers on suicide literacy in The Gambia. We built up the constructs from various reports and articles published on other countries (Table 1).

Table 1.

Documents used in the results section of this review focused on the suicide in The Gambia

SN	Author	Publication year	Type	Focus	Domain
1	WHO [1]	2025	Document	Global suicide	Suicide rates
2	Ministry of Health of The Gambia [11]	2025	Document	The Gambia	Prevention and management of mental health conditions
3	WHO [12]	2020	Document	The Gambia	Mental health
4	Barrow & Faerden [13]	2020	Peer reviewed article (review)	The Gambia	Barriers to accessing mental health services
5	Arafat et al. [14]	2024	Book chapter	Islamic countries	Suicidal behavior in Muslim-majority countries
6	Odejobi [15]	2024	Report	The Gambia	Mental health in the Gambia
7	Drammeh [16]	2023	Report	The Gambia	Mental health services
8	Ali et al. [17]	2024	Book chapter	Islamic countries	Suicidal behavior in Muslim-majority countries
9	Zia et al. [18]	2024	Peer reviewed article (review)	Sunni perspectives	Islam and suicide
10	Atewologun et al. [19]	2025	Peer reviewed article (review)	sub-Saharan Africa	Mental health services
11	Hofstra et al. [23]	2019	Study protocol	Regional	Suicide prevention
12	Doukani et al. [24]	2021	Peer reviewed article (original study)	Kenya	Community intervention for suicide prevention
13	Patena et al. [25]	2025	Systematic review	Zimbabwe	Community intervention for common mental disorders

Epidemiology of suicide in The Gambia

Empirical data on Gambian suicide are scarce. According to the GBD (2021) estimates, The Gambia’s age-standardised suicide mortality was 5.6 per 100,000 (with a much higher rate in males (8.1) than females (3.1)) [11]. The WHO estimate of 2025 mentioned the age-standardised suicide rate was 8.3 (male-11.4, female-5.4) per 100,000 [1]. These two global estimates indicates variations. Nevertheless, all such estimates are provisional because national surveillance is limited. Suicide attempts remain illegal and culturally taboo in The Gambia, so many cases go unreported or misclassified. Thus, the available statistics likely understate the true incidence.

Suicide literacy in The Gambia

There are no published surveys of suicide-specific knowledge in The Gambia. Available information comes from general mental health studies. Research directly addressing suicide literacy in The Gambia is essentially absent from the peer-reviewed literature. National and country-profile reports and Gambian mental-health studies describe constrained services, pervasive stigma, and limited empirical surveillance of mental-health burden; these documents clearly noted that robust epidemiological data and targeted knowledge studies are lacking in the country [11, 13].

For example, one study found that many Gambians hold inaccurate beliefs about mental illness causes. Common misconceptions included attributing mental illness to “bad winds,” evil spirits, poverty, or social factors like an unfulfilled desire to travel [13]. Although this study was not focused on suicide per se, such beliefs are likely to extend to suicidality. In other words, suicide may be viewed through supernatural or moral lenses rather than as a medical phenomenon. This suggests low literacy about suicide risks, warning signs, and prevention in the general population. Formal training is also limited: Gambian health workers and students receive minimal education on mental disorders and suicide. Studies noted that only one psychiatric hospital known as the Tanka Tanka exists for about 2.5 million people and that 90% of those with any mental illness lack care, implying poor public awareness [14, 15].

At this point, three parallel strands that are relevant to any Gambian research agenda. First, measurement development and validation: researchers have created and increasingly validated short and long instruments to quantify suicide literacy (the Literacy of Suicide Scale - LOSS) and suicide stigma (the Stigma of Suicide Scale -SOSS), and short-form derivatives that are used internationally and adapted cross-culturally [3].

Attitudes towards suicide and mental health in The Gambia

Attitudes in The Gambia are heavily influenced by religion and traditional norms. The vast majority of Gambians are Muslim, and Islamic teachings strictly prohibit suicide [16, 17]. Such religious condemnation contributes to intense shame and stigma around self-harm. In practice, suicide is widely seen as morally wrong or spiritually dangerous and discussing it openly is taboo. Traditional cultural attitudes compound this stigma: suicide and mental illness are often associated with dishonor or even witchcraft. These beliefs discourage acknowledgement of mental distress. In Ghana (a culturally similar context), studies find that stigma leads people to hide suicidal behaviour and avoid help-seeking [18].

Barriers of help-seeking behaviours in The Gambia

• Limited services. There is only one psychiatric hospital (Tanka Tanka in Banjul) and a single psychiatric clinic nationwide [14, 15]. About 90% of Gambians with mental disorders receive no professional care [13]. Rural patients must travel long distances to the capital, so many simply forego care.

• Cost and access. Both biomedical and traditional treatments are expensive. Patients reported paying roughly 400 to 500 dalasi (US$9–12) per month for medication and herbal practitioners or healers sometimes charge their own fees as wages monthly and these high costs deter families from seeking or continuing treatment [13].

• Cultural expectations. Families often first consult traditional healers or religious leaders. When symptoms began, relatives suggested clinical care, but other family members may insist on traditional remedies especially, from demons, witchcraft and evil spirits thus delaying psychiatric referral [13]. Such family decision-making, based on belief in supernatural causes, can prevent timely help-seeking [19].

• Stigma and legal factors. The social stigma of suicide means individuals and families often hide problems. Because attempted suicide is illegal, those who survive are at risk of arrest [20] which suppresses disclosure. As a result of this, many suffering individuals suffer in silence.

Facilitators of help-seeking are largely informal and community-based

• Community/traditional support. Engaging local leaders and healers can improve detection. For example, neighboring Uganda and Rwanda have improved early identification by partnering with traditional healers to refer patients to clinics [18]. In Gambian villages, respected elders or imams might similarly serve as gatekeepers [21].

• Peer and Non-governmental organization (NGO) programmes. Community mental health initiatives show promise in the region. Kenya’s Friendship Bench (community lay counselors) and Ethiopia’s health extension workers are examples of grassroots support reducing distress [11, 18] Though not focused on suicide, such models enhance help-seeking attitudes. Moreover, Ghana’s collaboration with national NGOs and its widespread awareness campaigns have successfully mobilised resources and reduced mental health stigma. Similarly, if NGO-led education initiatives in The Gambia are scaled up or expanded, they could play a crucial role in encouraging help-seeking behaviour.

Methodological trends and gaps

The dominant methodological approaches globally include cross-sectional surveys using LOSS and SOSS, instrument validation studies, and qualitative explorations of cultural models [3, 22]. However, intervention studies remain scarce outside high-income settings. For The Gambia, there is no validation of suicide literacy tools in local languages and a lack of nationally representative epidemiological surveys linking literacy and outcomes.

Suicide literacy interventions and prevention efforts in The Gambia

The country does maintain a national mental health policy and strategic plan (2018–2022) aiming to improve access, however, there was no evidence of any formal suicide literacy or anti-stigma campaign specifically implemented. Gambia currently has minimal dedicated suicide prevention programmes. An investment case backed by WHO recommends promoting adolescent mental health through general initiatives, such as school-based social-emotional learning programmes aimed at preventing depression and suicide [11], which has been implemented in Europe [23]. In practice, public education on suicide appears negligible; informal observation suggests Gambian health curricula and media do not address suicide openly. In this sense, Gambia lags behind many neighbours.

Lessons can be drawn from other sub-Saharan countries. For instance, a study carried out by Atewologun et al. [18] showed that Ghana implemented a Mental Health Act and nationwide awareness campaigns, which have helped reduce stigma and improve service coverage; Uganda has engaged NGOs and community groups to reinforce mental health awareness and support. Also, that Kenya pioneered the Friendship Bench (peer-delivered therapy) in primary care which was originally pioneered in Zimbabwe. At its core, the model involves peer-delivered therapy, where specially trained lay health workers or community volunteers which sometimes are often elderly women affectionately referred to as grandmothers. They provide basic talk therapy using a structured, problem-solving approach. These therapy sessions are typically held on a physical bench situated in a quiet corner of a primary health care facility or clinic. This setting makes mental health support more accessible and reduces the stigma often associated with seeking help. Importantly, the intervention is culturally adapted, using local languages and familiar community-based strategies to address prevalent mental health issues, particularly depression and anxiety. Its design is intentionally low-cost and scalable, relying on non-specialist support rather than professional psychologists or psychiatrists, which makes it a practical solution for low-resource settings [24].

In Kenya and elsewhere, adaptations of the Friendship Bench model have been piloted in response to mental health workforce shortages and stigma [24–26], and that Ethiopia trains community health workers to recognise mental distress [18]. South Africa is applying telepsychiatry and mobile health tools to expand rural access, an approach that might benefit Gambia’s dispersed population. These models suggest Gambia could use lay counselors or health workers for early detection and referral. Partnerships with traditional healers have also proven useful elsewhere (Uganda, Rwanda) in bridging cultural divides. Taken together, these examples highlight that Gambia could strengthen suicide prevention by integrating mental health into primary care, launching public education (example via schools or media), engaging community stakeholders, and learning from proven sub-Saharan Africa (SSA) initiatives. However, no published evaluation of such interventions in The Gambia was found, indicating a critical need for pilot programmes and research on what works in this context.

Discussion

Key findings

This review highlights a lack of academic attention assessing the status and impact of suicide literacy in The Gambia where several other challenges like limited population knowledge about suicide as a preventable problem, pervasive misconceptions about causes (spiritual or supernatural explanations), stigmatising attitudes shaped by religion, which plays a dual role in shaping attitudes toward suicide in sub-Saharan Africa, including The Gambia. Religious doctrines in Islam and Christianity often condemn suicide, which can reinforce stigma, discourage open discussion, and hinder help-seeking due to fear of judgment [18, 20]. However, religious involvement can also be protective by providing social support, moral guidance, and a sense of belonging, which are linked to lower suicidal ideation and greater emotional resilience [27]. Therefore, engaging religious leaders and faith-based organizations may help reduce stigma and support culturally sensitive suicide-prevention efforts) and tradition, and very low help-seeking from biomedical services persist [21]. These findings joined together with national service analyses showing extreme scarcity of mental health infrastructure (one psychiatric hospital and few outpatient services) and the high proportion of people with probable mental disorders who receive no care [10, 11]. At the same time, global burden estimates indicate that suicide remains an important and measurable cause of death in low-resource settings, reinforcing the need for better surveillance and prevention [8]. The overall picture is one of an urgent, under-recognised public-health problem in The Gambia compounded by knowledge gaps and structural constraints.

• Data scarcity and underreporting. Criminalisation, stigma, and cultural silence mean many suicides and attempts never enter official statistics; modelled international estimates (example, GBD) are necessary but cannot replace high-quality local surveillance [8].

• Deeply held cultural and religious beliefs. Where suicide is framed as a moral or religious failing, simple awareness campaigns risk backlash or superficial uptake; interventions must be co-designed with community and religious leaders to avoid cultural insensitivity and to be effective [10].

• Human and financial resource constraints. With few specialists and limited health budgets, any programme must be low-cost, scalable, and integrated into existing services, particularly primary care, and schools [17].

• Measurement of literacy and outcomes. There is limited peer-reviewed work validating suicide-literacy measures in West African cultures; research must ensure that instruments are culturally adapted and psychometrically sound before widespread use.

Comparison with other sub-Saharan African and global contexts

Patterns observed in The Gambia mirror regionwide realities but also expose gaps. Across SSA, evidence finds chronic under-resourcing of mental-health services, widespread stigma, reliance on traditional and religious healers, and uneven integration of mental health into primary care [18]. In Ghana, a careful country-level work has documented rising adolescent suicidality and media-reported child suicides; these studies emphasise the role of social determinants (poverty, food insecurity, family conflict) and the frequent absence of formal help-seeking [28, 29]. Likewise, adolescent mental-health reviews for SSA highlight high prevalence of depression and anxiety, gaps in access, and the central role of community norms in shaping response to suicidal behaviour [30]. When compared with better-resourced SSA programmes (for example, countries where Mental Health Gap Action Programme (mhGAP) training could be a great initiative. It is designed to equip nonspecialist health workers with practical skills to assess and manage common mental, neurological, and substance use disorders, especially in low- and middle-income countries where mental health specialists are scarce. It includes modules on depression, psychosis, suicide, epilepsy, and more, using simplified guidelines and decision-making tools), community lay-counsellor models, or telepsychiatry have been piloted or scaled). The Gambia appears to lag in both service availability and in the presence of documented literacy or anti-stigma campaigns [18].

Public health and clinical implications

• Surveillance and measurement. The GBD provides modelled national estimates, but modelled figures require better local data to be actionable [8]. Strengthening routine mortality coding, verbal autopsy procedures, and confidential reporting pathways is a priority so that policymakers can track trends and target resources effectively.

• Integrate suicide literacy into primary care and education. Given the concentration of limited specialist resources, the most pragmatic route is to build suicide literacy into primary-care and school programmes [18, 30]. Training primary-care workers and school staff to recognise warning signs, provide basic psychological first aid, and refer safely could increase early detection without requiring immediate specialist scale-up.

• Address stigma through culturally adapted literacy campaigns. It is critical in The Gambia, where suicide remains highly stigmatised and often framed through moral, religious, or spiritual interpretations. In many SSA contexts, suicide is strongly condemned within dominant religious traditions, which can contribute to silence, shame, and reluctance to seek professional support [18]. Literacy campaigns that engage trusted community actors, such as religious leaders, teachers, and traditional healers, can therefore play an important role in reframing suicide as a preventable public health issue rather than a moral failing. Evidence from mental-health programmess in African settings suggests that culturally grounded community education improves awareness and reduces stigma, thereby increasing openness to discussing mental health concerns and seeking care [30].

  A key structural barrier that such campaigns must address is the criminalisation of suicide attempts, which persists in several African countries and has significant implications for suicide prevention. Criminalisation can discourage individuals experiencing suicidal crises from disclosing their distress or seeking medical help due to fear of legal consequences, social exposure, or arrest [20]. It may also contribute to systematic underreporting of suicide deaths, as families and communities may conceal cases to avoid legal or social repercussions. These dynamics undermine the accuracy of national suicide statistics and hinder the development of effective prevention policies [8]. Consequently, culturally sensitive literacy initiatives should be implemented alongside policy discussions about decriminalisation and rights-based approaches to suicide prevention, helping to create safer environments where individuals can seek support without fear of punishment.

• Leverage community resources and task-sharing. Lay-counsellor and task-sharing approaches used elsewhere in SSA can be adapted to include suicide literacy, gatekeeper training, and referral pathways; this can expand reach rapidly and at low cost [18].

• Policy changes to reduce disincentives for disclosure. Decriminalising suicide attempts and ensuring legal protections for help-seekers would reduce fear of prosecution and facilitate care-seeking which is an essential enabling condition for any literacy strategy.

Policy recommendations

To address suicide in The Gambia meaningfully, policy actions need to unfold in phases, starting now and building momentum over time.

In the short term, it’s essential to bring together key stakeholders, such as the Ministry of Health, education authorities, religious leaders, and NGOs into a dedicated suicide prevention taskforce. This group can help coordinate efforts across sectors. During this period, it would also be wise to develop and pilot suicide literacy modules that can be introduced in schools and primary healthcare settings, while also putting in place confidential pathways for reporting suicidal thoughts or deaths, and improving how deaths are recorded and certified.

Over the medium term, the focus should shift to building on what works. Pilot programmes that show promise should be scaled up using task-sharing approaches that empower community-based workers. Suicide literacy should be woven into the national mental health strategy and integrated into the training of future healthcare professionals. Legal reforms should also begin, especially efforts to decriminalise suicidal behaviour and create laws that protect those seeking help.

Looking further ahead, the aim should be to institutionalise systems for national surveillance of suicide trends, maintain long-term prevention programmes in schools, and secure sustainable funding for community-level mental health services. Each step lays the groundwork for a more informed, compassionate, and responsive approach to suicide prevention.

Strengths and limitations

This review brings together the past and most recent to shed light on the often-overlooked issue of suicide literacy in The Gambia. There are several limitations of this review. Firstly, narrative design could be a potential source of bias. Secondly, unstructured search could fail to identify all the potential articles on the topic. Thirdly, our utlilized search terms may be inadequate to trace all the available evidence. Fourthly, we did not search in Web of Science and PsycINFO that may restrict a portion of evidence on the matter. Fifthly, our search did not identify any peer reviewed papers on suicide literacy in the Gambia. Therefore, we constructed the domains from secondary sources, which warrants careful considerations while generalizing the findings.

Conclusion

Suicide literacy is an under-researched issue in the Gambia evident by a lack of published studies. There is an unmet need for action for conducting research to understand the burden of suicide its risk factors and its association with suicide literacy to formulate suicide prevention strategies in the country. Decriminalisation of suicide attempts to reduce fear, stigma, and underreporting, integration of suicide prevention into The Gambia’s national mental health strategy and strengthen primary care capacity and establishment of a national suicide surveillance and reporting system could be considered as policy-level changes. Training primary healthcare providers, teachers, and community leaders as frontline gatekeepers to identify and support at-risk individuals and partnering with religious leaders and traditional healers to deliver culturally sensitive suicide literacy and anti-stigma messaging. Conducting nationally representative epidemiological studies to determine the true burden of suicide and attempted suicide.

Author contributions

N. I. F. Eneojo: writing original draft, methodology, visualisation writing and editing, formal analysis. V. E. Adamu: validation, review. S. M. Yasir Arafat conceptualization, methodology, review, validation, supervision. All authors approved the final version.

Funding

No funding was received for this paper.

Data availability

No datasets were generated or analysed during the current study.

Declarations

Competing interest

The authors declare no competing interest.

Consent for publication

Not applicable.

Ethical approval

This review used secondary data from publicly available sources and therefore did not require ethical approval.

Consent to participate

Not applicable.