An observational study in Mental Illness and Suicidal, sponsored by Yale University. Recruiting at 1 site in Uganda. Open to participants aged 18 Years and older. Per ClinicalTrials.gov, last updated 2026-07-28.
Sponsored by Yale University · Observational
To characterize how disclosure of suicide or severe emotional distress functions socially in rural eastern Uganda: who people have disclosed to, what happened, what harms resulted, who they would want involved in future support, and under what conditions they would want support activated on their behalf.
This study aims to understand how disclosing suicidal thoughts or severe emotional distress leads to either social support or social harm in rural eastern Uganda, and to identify how support can be activated safely and according to individuals' preferences. Using a cross-sectional mixed-methods design, researchers will administer structured surveys to 80-100 adults with lived experience of suicidality or severe distress and conduct 20-30 in-depth interviews with participants representing helpful, harmful or forced, mixed, and non-disclosure experiences. The study will examine disclosure pathways, adverse social consequences, preferred support persons, acceptable conditions for contacting others, and willingness to undergo suicide screening, with safeguarding procedures integrated throughout data collection
The study population consists of adults aged 18 years or older living in rural eastern Uganda who have experienced suicidal thoughts or a suicide attempt, a period of severe depressive distress lasting at least two weeks, or prior disclosure of suicidality or severe emotional distress. Participants will be recruited through outpatient clinic visits, community health worker referrals, and participant-mediated referrals. Individuals who are currently in an acute suicidal crisis with intent or a plan will be referred for immediate support and enrolled only after stabilization, while those unable to consent or complete the survey safely will be excluded or reconsidered later. The study plans to enroll 80-100 participants in the quantitative survey, with 20-30 purposively selected for qualitative interviews representing helpful, harmful or forced, mixed, and non-disclosure experiences
Meets at least one of the following:
Exclusion Criteria:
Participants whose disclosure led to a supportive response. Interviews explore what made it work: who they told, how they told them, what the person did, and what conditions enabled a positive outcome.
Other: Survey Questionnaire
Participants who experienced social harm after disclosure (whether voluntary or involuntary). Interviews reconstruct the harm sequence: what happened, who was involved, what the consequences were, and what could have prevented it.
Other: Survey Questionnaire
Participants who have experienced severe distress but never told anyone. Interviews explore what prevented disclosure, what they feared, and what would have to be different for them to feel safe disclosing.
Other: Survey Questionnaire
Survey capturing disclosure history (who was told, when, why, how), disclosure outcomes (what happened, what harms resulted), disclosure comfort (willingness to tell specific people under specific conditions), social harm inventory (lifetime and recent harms following disclosure), preferred support persons and conditions for activation, and willingness to be screened
Social Harm Inventory
A 10-item inventory of adverse social harms experienced after disclosure: family anger/punishment, community gossip, police involvement, confinement/restraint, forced traditional healing, loss of employment or income, relationship termination, public humiliation, unwanted religious intervention, and other. Each endorsed item rated on a likert scale for severity (mild, moderate, severe) and recency (past month, past year, over a year ago). These likert scales maybe be interpreted numerically (1-mild, 2- moderate, 3- severe and 1-over a year ago, 2- past year, 3- past month) with a higher score indicating higher severity and recency of each of the measured social harms. Scores range from 1 to 3 on each severity and recency scale.
Time frame: Through 60 minute survey and interview
Disclosure Comfort
Willingness to disclose suicidal thoughts or severe distress to each of 9 potential support persons (spouse, parent, sibling, close friend, religious leader, CHW, health worker, traditional healer, employer/teacher) rated on a 4-point scale (1-definitely would, 2- might, 3- probably not, 4- definitely not). Scores on this Likert Scale range from 1-4 with lower scores indicating high comfort disclosing to a sub-group of support persons and higher scores indicating low comfort of disclosure.
Time frame: Through 60 min Interview and survey period
Support Activation Preferences
The core Connection Prescription module. For each potential support person, participants indicate: (a) whether they would want that person contacted if they were in crisis, (b) under what conditions (only with my permission, if I'm in danger, anytime), (c) what they would want that person to do (listen, stay with me, take me to clinic, pray with me, nothing), and (d) who should NEVER be told. This directly parameterizes the Connection Prescription. Question (a) is a discrete choice response with yes scored as '1' and no scored as '0'. TQuestion (b) is rated on a likert scale ranging 1-3 with 1 indicating more consistent comfort with supporter activation and 3 indicating activation in only particular circumstances. Question (c) will allow participants to select mutli-items form the scale and question (d) will allow participants to fill in the blank thus not being scored.
Time frame: Through 60 minute interview and survey period
Plan to share: No
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