{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,29]],"date-time":"2026-10-29T02:32:48Z","timestamp":1793241168642,"version":"4.5.0"},"reference-count":45,"publisher":"SAGE Publications","issue":"4","license":[{"start":{"date-parts":[[2026,8,7]],"date-time":"2026-08-07T00:00:00Z","timestamp":1786060800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"funder":[{"DOI":"10.13039\/501100000155","name":"Social Sciences and Humanities Research Council of Canada","doi-asserted-by":"publisher","award":["The project is funded by the Partnership Engagemen"],"award-info":[{"award-number":["The project is funded by the Partnership Engagemen"]}],"id":[{"id":"10.13039\/501100000155","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Can J Nurs Res"],"published-print":{"date-parts":[[2026,12]]},"abstract":"<jats:p>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.<\/jats:p>","DOI":"10.1177\/08445621261473955","type":"journal-article","created":{"date-parts":[[2026,8,7]],"date-time":"2026-08-07T14:41:54Z","timestamp":1786113714000},"page":"690-700","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Factors Contributing to Suicide Deaths Among Sri Lankan Tamil Men in Toronto, Canada: Perspectives of Family, Friends, and Service Providers"],"prefix":"10.1177","volume":"58","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8459-2319","authenticated-orcid":false,"given":"Sepali","family":"Guruge","sequence":"first","affiliation":[{"name":"Toronto Metropolitan University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Parvathy","family":"Kanthasamy","sequence":"additional","affiliation":[{"name":"Vasantham Health and Wellness Centre"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-7658-7040","authenticated-orcid":false,"given":"Kaveenaa","family":"Chandrasekaran","sequence":"additional","affiliation":[{"name":"Toronto Metropolitan University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vathsala","family":"Illesinghe","sequence":"additional","affiliation":[{"name":"Toronto Metropolitan University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mahesan","family":"Ganesan","sequence":"additional","affiliation":[{"name":"National Institute of Mental Health"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,8,7]]},"reference":[{"key":"e_1_3_3_2_1","doi-asserted-by":"publisher","DOI":"10.1177\/0706743718762388"},{"key":"e_1_3_3_3_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11013-018-9592-9"},{"key":"e_1_3_3_4_1","doi-asserted-by":"publisher","DOI":"10.1080\/07481180701244587"},{"key":"e_1_3_3_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.socscimed.2005.12.002"},{"key":"e_1_3_3_6_1","doi-asserted-by":"publisher","DOI":"10.1177\/070674371105600604"},{"key":"e_1_3_3_7_1","doi-asserted-by":"publisher","DOI":"10.1017\/S003329172200280X"},{"key":"e_1_3_3_8_1","doi-asserted-by":"publisher","DOI":"10.1191\/1478088706qp063oa"},{"key":"e_1_3_3_9_1","doi-asserted-by":"publisher","DOI":"10.1037\/0003-066X.32.7.513"},{"key":"e_1_3_3_10_1","unstructured":"Centre for Suicide Prevention. (2023). *Suicide risk among immigrants and ethnic minorities : A literature review. https:\/\/www.suicideinfo.ca\/wp-content\/uploads\/2023\/01\/Suicide-Risk-among-Immigrants-and-Ethnic-Minorities.pdf"},{"key":"e_1_3_3_11_1","unstructured":"Centres for Disease Control and Prevention. (2023). Disparities in suicide. https:\/\/www.cdc.gov\/suicide\/facts\/disparities-in-suicide.html"},{"key":"e_1_3_3_12_1","doi-asserted-by":"publisher","DOI":"10.1177\/1468017310394240"},{"key":"e_1_3_3_13_1","doi-asserted-by":"publisher","DOI":"10.1027\/0227-5910\/a000334"},{"issue":"6","key":"e_1_3_3_14_1","first-page":"6","article-title":"A closer look substance use and suicide","volume":"13","author":"Esang M.","year":"2018","unstructured":"Esang M., Ahmed S. (2018). A closer look substance use and suicide. The American Journal of Psychiatry Residents\u2019 Journal, 13(6), 6\u20138. https:\/\/doi.org\/10.1176\/appi.ajp-rj.2018.130603","journal-title":"The American Journal of Psychiatry Residents\u2019 Journal"},{"key":"e_1_3_3_15_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0091936"},{"key":"e_1_3_3_16_1","doi-asserted-by":"publisher","DOI":"10.1080\/13674670310001602418"},{"key":"e_1_3_3_17_1","doi-asserted-by":"publisher","DOI":"10.1037\/0003-066X.63.1.14"},{"key":"e_1_3_3_18_1","unstructured":"Government of Canada. (2022). Canada-Sri Lanka relations. Retrieved May 7 2023 from https:\/\/www.international.gc.ca\/country-pays\/sri_lanka\/relations.aspx?lang=eng"},{"key":"e_1_3_3_19_1","unstructured":"Government of Canada. (2023). Suicide in Canada: Key statistics. https:\/\/www.canada.ca\/en\/public-health\/services\/publications\/healthy-living\/suicide-canada-key-statistics-infographic.html"},{"issue":"3","key":"e_1_3_3_20_1","first-page":"32","article-title":"Intersectionalities of influence: Researching the health of immigrant and refugee women","volume":"36","author":"Guruge S.","year":"2004","unstructured":"Guruge S., Khanlou N. (2004). Intersectionalities of influence: Researching the health of immigrant and refugee women. Canadian Journal of Nursing Research, 36(3), 32\u201347.","journal-title":"Canadian Journal of Nursing Research"},{"key":"e_1_3_3_21_1","unstructured":"Health Canada. (n.d.). Stigma around drug use. Government of Canada. https:\/\/www.canada.ca\/en\/health-canada\/services\/opioids\/stigma.html"},{"key":"e_1_3_3_22_1","unstructured":"Help Guide Organization. (2023). Self-medicating depression anxiety and stress. https:\/\/www.helpguide.org\/articles\/addictions\/self-medicating.htm"},{"key":"e_1_3_3_23_1","unstructured":"Immigration and Refugee Board of Canada. (2024). Responses to information requests. https:\/\/www.irb-cisr.gc.ca\/en\/country-information\/rir\/Pages\/index.aspx?doc=456421"},{"key":"e_1_3_3_24_1","doi-asserted-by":"publisher","DOI":"10.1186\/1471-244X-14-154"},{"key":"e_1_3_3_25_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2017-018265"},{"key":"e_1_3_3_26_1","doi-asserted-by":"publisher","DOI":"10.1177\/21582440221140378"},{"key":"e_1_3_3_27_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10903-016-0501-4"},{"key":"e_1_3_3_28_1","doi-asserted-by":"publisher","DOI":"10.1037\/1099-9809.10.1.5"},{"key":"e_1_3_3_29_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12889-022-12842-5"},{"key":"e_1_3_3_30_1","unstructured":"Munasinghe P. A. A. D. (2017). War and Terrorism in Sri Lanka. 1st International Studies Students\u2019 Research Symposium-2017 (ISSRS 2017) Department of International Studies Faculty of Social Sciences University of Kelaniya Sri Lanka. World Health Organization. (2021 June 17). Suicide."},{"key":"e_1_3_3_31_1","doi-asserted-by":"publisher","DOI":"10.1080\/17482631.2020.1744926"},{"key":"e_1_3_3_32_1","volume-title":"Guilt, shame and model minorities: How South Asian youth in Toronto navigate the Canadian educational system","author":"Navaratnam S.","year":"2011","unstructured":"Navaratnam S. (2011). Guilt, shame and model minorities: How South Asian youth in Toronto navigate the Canadian educational system. University of Toronto."},{"key":"e_1_3_3_33_1","unstructured":"Ng E. Gagnon S. (2020). Employment gaps and underemployment for racialized groups and immigrants in Canada: Current findings and future directions (Skills Next Report No. 5). Future Skills Centre. https:\/\/fsc-ccf.ca\/research\/employment-gaps-and-underemployment-for-racialized-groups-and-immigrants-in-canada\/"},{"issue":"1","key":"e_1_3_3_34_1","first-page":"21","article-title":"The impact of south Asian parental involvement behaviors on children\u2019s academic achievement: Instrument development and exploratory factor analysis","volume":"24","author":"Rasool S.","year":"2021","unstructured":"Rasool S., Zhang J., Aydin H., Halpern C. (2021). The impact of south Asian parental involvement behaviors on children\u2019s academic achievement: Instrument development and exploratory factor analysis. New Waves (Rockville, Md.), 24(1), 21\u201352.","journal-title":"New Waves (Rockville, Md.)"},{"key":"e_1_3_3_35_1","unstructured":"Robert A.-M. Gilkinson T. (2012). Mental health and well-being of recent immigrants in Canada: Evidence from the Longitudinal Survey of Immigrants to Canada (LSIC). Immigration Refugees and Citizenship Canada. https:\/\/www.canada.ca\/en\/immigration-refugees-citizenship\/corporate\/reports-statistics\/research\/mental-health-well-being-recent-immigrants-canada-evidence-longitudinal-survey-immigrants-canada-lsic.html"},{"key":"e_1_3_3_36_1","doi-asserted-by":"publisher","DOI":"10.2105\/AJPH.2004.059204"},{"key":"e_1_3_3_37_1","volume-title":"The stigma of mental illness in Sri Lanka: The perspectives of community mental health workers","author":"Samarasekare N.","year":"2018","unstructured":"Samarasekare N., Davies M. L. M., Siribaddana S. (2018). The stigma of mental illness in Sri Lanka: The perspectives of community mental health workers. Institute of Research and Development."},{"key":"e_1_3_3_38_1","doi-asserted-by":"publisher","DOI":"10.1192\/j.eurpsy.2021.2216"},{"key":"e_1_3_3_39_1","doi-asserted-by":"publisher","DOI":"10.1177\/0020764020922881"},{"key":"e_1_3_3_40_1","doi-asserted-by":"crossref","unstructured":"Siddiqui S. M. (2022). Acculturative stress everyday racism and mental health among a community sample of South Asians in Texas.","DOI":"10.3389\/fpubh.2022.954105"},{"key":"e_1_3_3_41_1","unstructured":"Statistics Canada. (2026). Suicide self-harm and suicide-related behaviours in Canada. https:\/\/health-infobase.canada.ca\/mental-health\/suicide-self-harm\/suicide-mortality.html"},{"key":"e_1_3_3_42_1","doi-asserted-by":"publisher","DOI":"10.4324\/9781315426259"},{"key":"e_1_3_3_43_1","doi-asserted-by":"publisher","DOI":"10.1177\/160940690400300101"},{"issue":"1","key":"e_1_3_3_44_1","first-page":"77","article-title":"Sri Lankan Tamil families in Canada: Intergenerational solidarity and conflict","volume":"45","author":"Tyysk\u00e4 V.","year":"2014","unstructured":"Tyysk\u00e4 V. (2014). Sri Lankan Tamil families in Canada: Intergenerational solidarity and conflict. Journal of Comparative Family Studies, 45(1), 77\u201396. https:\/\/doi.org\/10.3138\/jcfs.45.1.77","journal-title":"Journal of Comparative Family Studies"},{"key":"e_1_3_3_45_1","unstructured":"Vasantham Tamil Wellness Centre. (n.d.). About us. https:\/\/www.vasantham.ca\/ta\/about-us\/"},{"key":"e_1_3_3_46_1","volume-title":"Epidemiology: Study of the distribution and determinants of health-related states or events","author":"World Health Organization","year":"2024","unstructured":"World Health Organization. (2024). Epidemiology: Study of the distribution and determinants of health-related states or events. WHO Publications."}],"container-title":["Canadian Journal of Nursing Research"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/08445621261473955","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/08445621261473955","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/08445621261473955","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,29]],"date-time":"2026-10-29T02:16:42Z","timestamp":1793240202000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/08445621261473955"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,7]]},"references-count":45,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2026,12]]}},"alternative-id":["10.1177\/08445621261473955"],"URL":"https:\/\/doi.org\/10.1177\/08445621261473955","relation":{},"ISSN":["0844-5621","1705-7051"],"issn-type":[{"value":"0844-5621","type":"print"},{"value":"1705-7051","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,7]]}}}