Factors Contributing to Suicide Deaths Among Sri Lankan Tamil Men in Toronto, Canada: Perspectives of Family, Friends, and Service Providers.

Approximately 4500 Canadians die by suicide annually, with men at three times the risk of women. Some ethnic and racialized groups face heightened vulnerability due to discrimination, historical trauma, and limited access to mental healthcare. In response to an alarming number of suicide deaths among Sri Lankan Tamil men in the Greater Toronto Area in 2019, this community-engaged study investigated micro-, meso-, and macro-level factors that contribute to suicide deaths in this population. In collaboration with Vasantham Tamil Wellness Centre, we conducted a community-based qualitative interpretive study, which was informed by an ecosystemic framework. Following research ethics board approval, individual semi-structured interviews were conducted with 10 family members and friends, and 12 service providers. The interviews were audio-recorded, (as needed) translated, transcribed, and analysed. We identified contributing factors at micro- (financial burden and upholding social status), meso- (community expectations and pressures, trauma related to the civil war in Sri Lanka, stigma of mental illness, and rigid gender role expectations), and macro-levels (lack of culturally-safe and linguistically-appropriate mental health services and experiences of systemic racism). These factors appeared to intersect and affect numerous domains of life (e.g., education and employment), leading to a cycle of marginalization, social isolation, mental health problems, and loss of hope and life. Multilevel interventions are urgently needed to prevent suicide deaths among Sri Lankan Tamil men in the Greater Toronto Area. Mental health initiatives and suicide prevention programs in Canada should be culturally-safe, linguistically-appropriate, and address historical and intergenerational trauma.