Impact statement
Our study draws attention to an important but underexplored resource for suicide prevention in low- and middle-income countries: faith leaders, who function as highly accessible community leaders. By examining Nigerian clergy’s training experiences, capacity needs and perspectives on suicide prevention, we found strong willingness among clergy to support individuals at risk, despite limited formal training and low awareness of national suicide prevention policies. These findings support the importance of integrating clergy into national- and community-level suicide prevention strategies. Targeted structured training to enhance clergy capacity could strengthen early detection, referral systems and public mental health outreach, while task-sharing models that engage faith leaders may help expand suicide prevention efforts in resource-constrained settings.
Introduction
Every 40 s, one person dies by suicide in the world, and more than three-quarters of these suicides occur in low- and middle-income countries (LMICs) (World Health Organization [WHO], 2025). This incidence may even be underestimated due to stigma, misclassification, and limited suicide surveillance systems in many LMICs (WHO, 2021a). In Africa, 11 people per 100,000 die by suicide annually, exceeding the global average of 9 per 100,000 (WHO African Region, 2022). Nigeria’s suicide death rate, at 6.9 per 100,000 (WHO, 2021b), falls below the continental average but still represents a significant public health concern, particularly given the country’s large population and under-resourced health system. Stigma surrounding suicide and mental health often contributes to delays in help-seeking or complete avoidance of care, while also compounding the limited availability of appropriate resources and treatments (Prikis et al., Reference Prikis, Dandona, Silverman, Khan and Hawton2024). Suicide attempt is also illegal in about 23 under-resourced countries, collectively home to about 820 million people, including Nigeria (WHO, 2024). Although criminalization of suicide remains a major obstacle to suicide prevention efforts (Chan et al., Reference Chan, Ibrahim, Khamal, Panirselvam, Pereira and Khan2024), health care providers in Nigeria are not legally mandated to report suicide attempts, which protects confidentiality in care. When people attempt suicide in public places and it comes to the attention of authorities, the individual may be either incarcerated or ordered to undergo treatment (Oluwabiyi et al., Reference Oluwabiyi, Oduniyi and Odejobi2024).
In 2023, the Nigerian government launched the National Suicide Prevention Strategic Framework (NSPSF) 2023–2030 (Federal Ministry of Health and Social Welfare [FMHSW], 2023). Consistent with WHO’s (2018) call for context-specific multisectoral approaches to suicide prevention, the NSPSF emphasizes a whole-of-society approach to suicide prevention, identifying faith-based organizations as important actors. Within the NSPSF, places of worship are highlighted as key venues for public education and stigma reduction. Faith community leaders (also called faith leaders) are expected to enlighten members, promote mental well-being, and encourage help-seeking behaviors. Faith leader refers to the leader of any religious or spiritual group (e.g., imam, minister, priest, or rabbi) (Suicide Prevention Resource Center, n.d.).
The inclusion of faith leaders and faith-based organizations in suicide prevention is especially important in societies where religion exerts enormous influence on the attitudes, beliefs and behaviors of people (Lehmann et al., Reference Lehmann, Leung, Miller and Girguis2021; U.S. Department of Health and Human Services, 2024). Additionally, for individuals experiencing crisis or suicidal risk – particularly in settings where mental health services are scarce – faith leaders often serve as the initial, and sometimes the only, source of support (Suicide Prevention Resource Center, 2005; Centers for Disease Control and Prevention, 2013; Osafo et al., Reference Osafo, Akotia, Andoh-Arthur and Puplampu2021; Sklar and Goldman, Reference Sklar and Goldman2023). Faith leaders also support grieving families through funeral services and provide emotional care, playing a key role in postvention efforts to promote healing and reduce further risk after a suicide (National Action Alliance for Suicide Prevention, n.d.).
Mbiti’s (Reference Mbiti1969) statement “Wherever the African is, there is his religion” (p. 3) is still relevant today as religion remains an integral part of daily life in many African societies. In Africa, religious worship centers not only significantly outnumber health care institutions but also serve as vital points of contact for health-related support and services (Kagawa et al., Reference Kagawa, Anglemyer and Montagu2012; Oyekan, Reference Oyekan2021). Christianity is growing rapidly in Africa, substantially contributing to the projected global Christian population of nearly three billion by 2050 (Center for the Study of Global Christianity [CSGC], 2013; Pew Research Center, 2015). Nigeria is ranked 3rd worldwide and 1st in Africa in Christian population size (Diamant, Reference Diamant2019; CSGC, 2013). The country also ranks 3rd among countries where almost all individuals raised Christian continue the faith into adulthood (Lesage et al., Reference Lesage, Starr and Miner2025). With more than 30 million members, the Roman Catholic Church is the largest Christian denomination in Nigeria, ranking as the second largest Catholic population in Africa and the 12th largest globally (Catholics & Cultures, n.d.; Center for Applied Research in the Apostolate, 2023). There are approximately 35 million adherents to the Catholic faith in Nigeria (Vatican Central Office of Church Statistics, 2025), accounting for over 25% of the Christian population in the country (U.S. Department of State, 2022). The sheer size of Nigeria’s Christian population underscores the religion’s potential influence and responsibility in shaping national initiatives, including mental health and suicide prevention efforts.
Previous work in Nigeria indicated that women with depression indicated a preference for receiving therapy from trained Catholic clergy (92.9%), with slightly fewer preferring a psychiatrist (89.3%) or a psychologist (85.7%) (Iheanacho et al., Reference Iheanacho, Nduanya, Slinkard, Ogidi, Patel, Itanyi, Naeem, Spiegelman and Ezeanolue2021). Similarly, religion not only plays a key role in the recovery process of suicide attempt survivors in Africa, but they also often report renewed religious commitment (Osafo et al., Reference Osafo, Asare-Doku and Akotia2023). These findings highlight the potential of clergy-led, faith-based therapy in churches to improve mental health care access in low-resource settings. However, use of faith leaders and faith communities in suicide prevention may face challenges. Studies of clergy and religious communities in Western contexts have shown that they view themselves as having a key role in suicide prevention, yet many report substantial skills deficits and being insufficiently trained (Mason et al., Reference Mason, Polischuk, Pendleton, Bousa, Good and Wines2011, Reference Mason, Geist and Clark2019, Reference Mason, Geist, Kuo, Marshall and Wines2016, Reference Mason, Rynbrandt, Capehart, Rando, Dokopoulos and O’Shell2024; Mason et al., Reference Mason, Ji-Young, Taylor, Korver and Hu2021a, Reference Mason, Geist, Kuo, Marshall and Wines2021b; Mason, Reference Mason2021; Lee-Tauler et al., Reference Lee-Tauler, Grammer, Ekman, LaCroix and Ghahramanlou-Holloway2024). In a conceptual review analysis, Nwafor (Reference Nwafor2024) argues that while clergy and other pastoral caregivers in Nigeria often serve as first points of contact for people in crisis, they frequently lack adequate mental health literacy and formal training in suicide prevention. This training gap can hinder effective support, perpetuate stigma or result in missed opportunities for timely intervention.
Most recent studies on suicide prevention stakeholders in LMICs have focused on health professionals, including a recent systematic review of quantitative studies on stakeholders’ experiences of self-harm and suicide in LMICs showing none of the 60 identified studies were conducted among faith leaders (McPhillips et al., Reference McPhillips, Allen, Ramesh, Barnett, Chadwick, Batool, Elahi, Hawton, Huxley, Krayer, Krishna, Nafees and Robinson2025). Bass et al. (Reference Bass, Chibanda, Petersen, Winkler, Sijbrandij and Shidhaye2023) called for increased research attention to populations whose limited representation in global mental health research has resulted in significant gaps in knowledge generation, policy formulation and systems research and evaluation. Faith-based communities and faith leaders in LMICs represent one such group whose perspectives remain underexamined, despite their central role in community mental health support. Past research in Western contexts has highlighted the importance of examining faith community leaders from historically underrepresented populations, who often face greater mental health disparities due to enduring social and health inequities (Mason et al., Reference Mason, Geist and Clark2019; Mason, Reference Mason2021; Boateng et al., Reference Boateng, Britt, Sebu and Oh2024). For instance, cross-cultural evidence (Hirono, Reference Hirono2013) suggests that religious leaders in Western contexts conceptualize their roles in suicide prevention differently from those in non-Western settings. Notably, Japanese clergy frequently cited limited time and resources compared to American clergy (Hirono, Reference Hirono2013). This underscores the need for research on clergy in LMICs, especially Africa, where social and health inequities are more pronounced compared to high-income countries. In these settings, mental health disparities between those with and without access to care are wider, and the burden of suicide is disproportionately high relative to available prevention resources.
Because the NSPSF is designed as a multisectoral implementation framework, clergy training linked to the strategy is what transforms policy from a document into a functioning community-based suicide prevention system. It will help strengthen their buy-in and enhance their utilization of the provisions of the NSPSF. However, the inclusion of religious leaders in Nigeria’s NSPSF presents an opportunity and a challenge. On the one hand, clergy hold a unique position of trust and cultural authority, making them essential partners in suicide prevention. However, we have no empirical data about clergy’s suicide prevention training, skills, and perceptions of their role in suicide prevention, limiting clarity on their preparedness. To address this gap, the current article examines the suicide prevention training needs, experiences, and perceptions of Catholic clergy in Nigeria, who play a central role in Nigerian communities where spiritual guidance often precedes clinical intervention.
Furthermore, data are needed to provide culturally sensitive suicide prevention resources and training for faith leaders in Nigeria. Presently, the Nigeria Suicide Prevention Advocacy Working Group is advancing legislative support for the NSPSF, including suicide decriminalization, through the National Suicide Prevention Bill. Although priests are not legally required to report suicide attempts, the criminalization of suicide still creates a climate of fear and stigma that can inhibit disclosure and complicate pastoral care. This context may undermine help-seeking and constrain clergy’s ability to build trust, assess risk openly and facilitate timely referral to appropriate mental health services. An understanding of the suicide prevention training needs, experiences and perceptions of Catholic Priests in Nigeria will inform initiatives and guide action plans toward effective implementation of the strategic framework within this important professional group and other similar key community partners. Findings from our study will guide both this and other suicide prevention initiatives in other LMICs, particularly in countries with a significant Christian (Roman Catholic) population.
Suicide prevention training has been reported to improve practitioners’ knowledge, confidence and adherence to evidence-based practices, which are core components of national suicide prevention strategies and policy frameworks (e.g., gatekeeper training outcomes) (Liu et al., Reference Liu, Zheng, Cao, Zeng, Chen and Gao2025). Policy frameworks emphasize training as a core strategy (e.g., National Strategy goals include workforce development and training) (U.S. Department of Health and Human Services, 2024) and policy implementation (e.g., training mandates) increases training uptake – highlighting systemic linkages between training experiences and engagement with national policy goals (Rosenblum et al., Reference Rosenblum, Dunphy, Gupta and Wang2025). However, there is a scarcity of studies among the clergy and limited evidence explicitly linking training experience with awareness of national policy frameworks. The noticeable gap in the literature on studies that specifically assess whether suicide prevention training is associated with priests’ awareness of the National Strategy is another important direction in the present study.
The social-ecological model of suicide prevention provides a structural backbone for tailoring current prevention and intervention programs to population-specific needs (Cramer and Kapusta, Reference Cramer and Kapusta2017). Situated within global mental health and community-based suicide prevention, this study conceptualizes clergy as culturally embedded gatekeepers operating within a socio-ecological system. As meso-level actors, clergy operate at interpersonal and community levels, whereby their experience and perceptions regarding suicide have ripple effects beyond individuals. The broader functional framework of gatekeeper theory maintains that non-specialists can be trained to recognize suicide risk, engage empathetically and refer to appropriate care (Burnette et al., Reference Burnette, Ramchand and Ayer2015). Drawing on this theory, the core components of the developmental model of clergy engagement with suicide (Mason et al., Reference Mason, Geist and Clark2019) include recognizing clergy’s pastoral role, active listening, building confidence, conducting risk assessments, making referrals, providing postvention support to survivors and leading memorial services or ceremonies (Mason et al., Reference Mason, Geist and Clark2019, Reference Mason, Kim and Martin2020). Furthermore, consistent with decolonial perspectives, our current analyses foreground local religious epistemologies and community dynamics, recognizing clergy not merely as extensions of formal mental health systems but as co-producers of culturally meaningful prevention strategies, especially in low-resource settings (Kasal et al., Reference Kasal, Táborská, Juríková, Grabenhofer-Eggerth, Pichler, Gruber, Tomášková and Niederkrotenthaler2023; Machado, Reference Machado2025). Guided by the foregoing foundational theories, our study examines how suicide prevention training shapes clergy readiness, attitudes and intervention practices.
Knowledge of Catholic clergy’s perspectives on their preparedness, perceived responsibility and training needs regarding suicide prevention is crucial for designing culturally sensitive and effective suicide prevention initiatives in Nigeria. Due to the descriptive and exploratory nature of the present study, we do not have specific hypotheses. Our research questions are:
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1. What proportion of Catholic priests in Nigeria have: (a) received prior suicide prevention training, (b) perceive such training as necessary, (c) recognize the need for additional skills, (d) affirm their professional duty to assist suicidal persons, (e) are aware of the NSPSF, and (f) support clergy inclusion in national suicide prevention initiatives?
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2. Are suicide prevention training status and perceived need for additional suicide prevention training associated with: (a) perceptions of the necessity for suicide education, (b) duty to assist suicidal persons, and (c) willingness to learn about suicide?
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3. Are suicide prevention training status and perceived need for additional suicide prevention training associated with: (a) awareness of the NSPSF and (b) support for including priests in national suicide prevention efforts?
Method
Participants and procedure
Study participants were 323 Catholic priests (Mean age = 45.33, SD = 10.70, age range 27–78 years) from eight Catholic dioceses in Southeast Nigeria. Roman Catholics constitute the dominant Christian denomination in Southeast Nigeria (U.S. Department of State, 2022). In addition, approximately 20% of the world’s 1.406 billion Catholics are in Africa, where the faith continues to grow rapidly. Catholic priests have significant socio-cultural influence and are frequently regarded as trusted sources of guidance within their communities. Findings from the study may also apply to other Christian faith traditions. Participants in this study were all black men, with the number of years since priestly ordination ranging from 1–46 years (M = 13.59, SD = 10.48). Based on current primary roles, a majority were parish priests (63%), with some working as vicars (18.0%), educators (5.9%), seminary formators (7.1%) or other roles in the church and society (5.9%). By educational status, they have bachelor’s degrees (59.1%), master’s (23.5%), and PhD (17.3%). All Catholic priests in Nigeria must have at least two degrees (Philosophy and Theology) before their ordination, but more than half of the participants (62.2%) proceeded to earn degrees in other academic disciplines, especially in education. Ethical approval for this study was obtained from the psychology research ethics committee of the University of Nigeria, Nsukka.
Permission to conduct the study was obtained from diocesan authorities (either Vicars for priests or Diocesan secretaries/chancellors, or both). The second author personally distributed questionnaires to Catholic priests across dioceses, primarily during monthly recollections (a half-day period of prayer and reflection) or annual retreats (a five-day intensive period of withdrawal from ordinary activities for more profound renewal, discernment, or reorientation of one’s life and ministry) between June and October 2024. At these gatherings, the second author was formally introduced, followed by an explanation of the study purpose and priests were invited to complete the paper-and-pencil survey form. The priests were assured of anonymity, confidentiality, voluntary participation and the right to withdraw at any stage without consequence. No financial incentives were provided. Participants were encouraged to respond honestly to the items on the questionnaire, which contained clear instructions for completion. Completed questionnaires were returned immediately after completion. The overall response rate (86%) reflected a substantial level of engagement from the priests in most dioceses.
Instrument
Instruments were completed in English, as all clergy had English fluency. We assessed the suicide prevention training needs, experiences and perceptions of participants using items from the Professional Suicide Knowledge and Skill Survey (PSKSS) (QPR Institute, n.d.). Some original questions from the PSKSS were retained to explore participants’ formal training in suicide prevention, views on the necessity of such education for clergy, sense of professional duty and legal responsibility in responding to suicidal individuals, willingness to learn more about suicide prevention, the amount of time they could realistically devote to training in a year and preferred educational format (e.g., in-person seminars, online tutorials or print materials).
In line with the QPR Institute’s policy that permits unrestricted use and modification of the PSKSS, we adapted several items to better suit the Nigerian Catholic clergy context (see Supplementary Appendix A). For example, the original item asking, “Do you believe persons in your profession should be included in the national effort to reduce disability and premature death associated with suicide attempts and completions?” was contextualized to ask specifically about priests. In addition, the U.S.-based item regarding the Surgeon General’s publication of the National Strategy for Suicide Prevention was adapted to reflect the Nigerian context by asking about awareness of Nigeria’s Federal Ministry of Health’s NSPSF. We included two additional items to measure clergy experiences with suicidal individuals and their unique pastoral roles. First, the priests were asked: “How many persons who have attempted suicide request your help annually?” Second, to assess pastoral involvement in suicide-related deaths, priests were asked: “Annually, how many suicide-related funerals do you conduct?”
Moreover, before asking about suicide-specific training, participants were first asked to indicate the number of counseling training hours they had received and whether they had any prior training on suicide prevention. These adaptations ensured that the instrument was not only culturally relevant but also capable of capturing clergy’s real-world experiences and pastoral responsibilities related to suicide in Nigeria. The PSKSS demonstrates content and face validity, and its items align with established evidence-based suicide prevention frameworks (Cai et al., Reference Cai, Yin, Tong, Qu, Ding, Ren, Chen, Yin, An and Chen2023; Quinnett, Reference Quinnett2007; Stover et al., Reference Stover, Lavigne and Carpenter2023; Tompkins et al., Reference Tompkins, Witt and Abraibesh2010; WHO, 2021a; Witry and Clayden, Reference Witry and Clayden2020). The adaptation process involved consulting with experts in both suicide prevention and the Nigerian cultural context to ensure that the modified items accurately captured the experiences and responsibilities of Nigerian Catholic priests.
Statistical analyses
Descriptive statistics (mean, SD, frequency and percentages) were conducted for each variable. For each categorical variable, a Chi-square goodness-of-fit test was used to check whether the observed frequencies differ from an expected distribution (e.g., equal distribution of Yes vs. No). Pearson’s correlations and Point-biserial correlation (r_pb) were used in the data analysis for continuous variables and dichotomous (Yes/No) variables, respectively. To address the two research questions in this study, we conducted Chi-square (χ2) tests of independence for the associations between categorical variables. In cases where the categories are larger than 2 × 2, we used the Fisher–Freeman–Halton exact test to check these associations. Significant findings were followed up with effect size estimates to assess the strength of association (Cramer’s V or Phi, depending on table size).
Results
Average lifetime counseling training hours received by the clergy was 44.94 h (SD = 230.49, Mdn = 5; range = 0–3,000). They had few hours of lifetime suicide prevention training (M = 2.15, SD = 11.74, range = 0–200) and were willing to devote an average of 4 h (SD = 2.80, range = 0–9) for suicide prevention training (per year).
Table 1 presents the responses of the clergy to the selected items in the PSKSS. Only about one in four priests (26.3%) had any form of suicide prevention training, but 9 in every 10 priests believed that education in suicide risk skills is necessary/should be required (93.8%), expressed their willingness to learn more about suicide prevention (91.3%), and endorsed the need for additional training of priests in suicide risk detection/referral (92.9%). Similarly, three out of four respondents (75.2%) affirmed the professional responsibility of priests to assist suicidal persons. For the training modality, there was a slightly higher preference for a multimedia online tutorial (38.7%) and an in-person professional seminar or presentation (29.1%). In total, 9 in 10 priests expressed their willingness to learn more about suicide prevention. While only approximately 2 out of 10 (16.7% were aware of Nigeria’s NSPSF, almost all respondents (98.1%) endorsed the inclusion of priests in national suicide prevention efforts.
Descriptive statistics of clergy responses on suicide prevention knowledge and skills survey, including Chi-square goodness-of-fit test for equal distribution of responses on each variable (N = 323)
Table 1. Long description
The table presents descriptive statistics for 323 clergy members across eight survey items. The columns are Item, Response categories, n (percentage), Chi-square (chi super 2), d f, and p.
* Had suicide prevention training: Yes 85 (26.3 percent), No 238 (73.7 percent). Chi-square 72.47, d f 1, p less than .001.
* Education in suicide risk skills necessary: Not necessary 20 (6.2 percent), Necessary 247 (76.5 percent), Should be required 56 (17.3 percent). Chi-square 276.45, d f 2, p less than .001.
* Duty to assist suicidal persons/legal duty: Yes 243 (75.2 percent), No 80 (24.8 percent). Chi-square 82.26, d f 1, p less than .001.
* Willingness to learn more about suicide prevention: Yes 295 (91.3 percent), No 10 (3.1 percent), Uncertain 18 (5.6 percent). Chi-square 489.37, d f 3, p less than .001.
* Preferred training platform: In-person seminar 94 (29.1 percent), Multimedia online tutorial 125 (38.7 percent), Online tutorial with Q and A 62 (19.2 percent), Read-only print 42 (13.0 percent). Chi-square 49.37, d f 3, p less than .001.
* Need for additional training in suicide risk detection/referral: Yes 300 (92.9 percent), No 23 (7.1 percent). Chi-square 92.9, d f 1, p less than .001.
* Aware of Nigeria’s N S P S F: Yes 54 (16.7 percent), No 269 (83.3 percent). Chi-square 143.11, d f 1, p less than .001.
* Should priests be included in national suicide prevention efforts: Yes 317 (98.1 percent), No 6 (1.9 percent). Chi-square 299.45, d f 1, p less than .001.
Note: Items are abbreviated for clarity. Q&A = Question & Answer. NSPSF = National Suicide Prevention Strategic Framework.
The number of counseling training hours was positively correlated with the number of suicide prevention training hours (Table 2). Clergy’s endorsement of duty to assist suicidal persons was associated with need for additional training in suicide prevention. Those with more hours of availability for suicide prevention training endorsed the need for additional training. Endorsement of duty to assist suicidal persons was also associated with endorsing the need for additional training. Older clergy age, more years since ordination, and endorsement of duty to assist suicidal persons were associated with being aware of the NSPSF. Based on Cohen’s criteria, most correlations were small, with a few medium-size associations (e.g., counseling training hours were positively correlated with the number of suicide prevention training hours).
Correlations among study variables
Table 2. Long description
The table presents correlations among ten variables. The variables are: 1. Age, 2. Years since ordination, 3. Additional academic qualification, 4. Counseling training hours, 5. Suicide prevention training hours, 6. Available training hours per year, 7. Duty to assist suicidal persons, 8. Need for training, 9. Awareness of Nigeria’s N S P S F, and 10. Priests’ inclusion in prevention.
Key correlations include:
* A very strong positive correlation between Age and Years since ordination (0.93).
* Moderate positive correlations between Additional academic qualification and both Age (0.36) and Years since ordination (0.38).
* A moderate positive correlation between Counseling training hours and Suicide prevention training hours (0.38).
* A positive correlation between Need for training and Duty to assist suicidal persons (0.20).
* Awareness of Nigeria’s N S P S F shows small positive correlations with Age (0.13), Years since ordination (0.14), and Duty to assist suicidal persons (0.14).
* Priests’ inclusion in prevention shows a small negative correlation with Awareness of Nigeria’s N S P S F (-0.12).
Asterisks indicate statistical significance. Categorical variables (3, 7, 8, 9, and 10) were coded as 0 for No and 1 for Yes for point-biserial correlation analysis.
Note: Categorical variables (additional academic qualification, duty to assist suicidal persons, need for training; awareness of Nigeria’s NSPSF and Priests’ inclusion in prevention) were coded 0 = No and 1 = Yes for the point-biserial correlation. *p < .05; **p < .01; ***p < .001.
Table 3 shows that only a few people who had not received any suicide prevention training (11.3%) were aware of the NSPSF. Among priests who had received suicide prevention training, a higher proportion endorsed priests’ duty to assist suicidal persons (85.3%) and affirmed the inclusion of priests in national suicide prevention initiatives (85.3%) compared to those without training. However, perceived necessity for suicide education and willingness to learn about suicide did not differ significantly by previous suicide prevention training status.
Chi-square analyses of necessity for suicide education, duty to assist suicidal persons, willingness to learn about suicide, awareness of NSPSF, and inclusion of priests in national suicide prevention efforts by training status
Table 3. Long description
The table compares individuals who have not received suicide prevention training (n = 238) versus those who have (n = 85) across five dependent variables.
* Necessity for suicide education: For those without training, 74.4 percent say necessary and 20.2 percent say should be required. For those with training, 82.4 percent say necessary and 9.4 percent say should be required (chi-square 5.48, d f 2, p .065, effect size .13).
* Duty to assist suicidal persons: 71.4 percent of untrained vs 85.3 percent of trained individuals answered Yes (chi-square 7.02, d f 1, p .008, effect size .15).
* Willingness to learn about suicide: 90.8 percent of untrained vs 92.9 percent of trained individuals answered Yes (chi-square 3.14, d f 2, p .208, effect size .10).
* Awareness of N S P S F: 11.3 percent of untrained vs 31.8 percent of trained individuals answered Yes (chi-square 18.76, d f 1, p less than .001).
* Inclusion of priests in suicide prevention: 99.2 percent of untrained vs 95.3 percent of trained individuals answered Yes (chi-square 5.15, d f 1, p .043, effect size .13).
Note: N S P S F stands for National Suicide Prevention Strategic Framework.
Note: Q&A = Question & Answer; NSPSF = National Suicide Prevention Strategic Framework.
Table 4 shows that of the priests who affirmed the necessity for suicide education, 94.3% endorsed the need for additional suicide prevention training compared to those who felt it was unnecessary (5.7%). Similarly, among priests who endorsed that suicide education should be required for their profession, 96.4% supported the need for additional suicide prevention training while 3.6% did not support making it a requirement. Among priests who affirmed their duty to assist suicidal persons, 95.9% endorsed the need for additional suicide prevention training, while 4.1% did not support the need for such training. Of those who expressed willingness to learn about suicide, 95.9% affirmed the need for additional suicide prevention training, while 4.1% did not. The variables demonstrated a substantial association (willingness to learn about suicide), a near-moderate effect size (necessity for suicide education) and a modest association (duty to assist suicidal persons). Awareness of NSPSF and support for priests’ inclusion in national suicide prevention initiatives did not differ by endorsing the need for additional suicide prevention training.
Chi-square analyses of necessity for suicide education, duty to assist suicidal persons, willingness to learn about suicide, awareness of NSPSF and inclusion of priests in national suicide prevention efforts by need for additional suicide prevention training
Table 4. Long description
The table contains eight columns: Dependent variables, Category, Need for additional suicide prevention training (No n percent, Yes n percent), Chi-square (chi super 2), d f, p, and Effect size.
* Necessity for suicide education:
- Not necessary: No 7 (35 percent), Yes 13 (65 percent).
- Necessary: No 14 (5.7 percent), Yes 233 (94.3 percent).
- Should be required: No 2 (3.6 percent), Yes 54 (96.4 percent).
- Statistics: chi super 2 = 25.36, d f = 2, p < .001, Effect size = .28.
* Duty to assist suicidal persons:
- No: No 13 (16.2 percent), Yes 67 (83.8 percent).
- Yes: No 10 (4.1 percent), Yes 233 (95.9 percent).
- Statistics: chi super 2 = 13.40, d f = 1, p < .001, Effect size = .20.
* Willingness to learn about suicide:
- No: No 5 (50 percent), Yes 3 (50 percent).
- Uncertain: No 6 (33.3 percent), Yes 12 (66.7 percent).
- Yes: No 12 (4.1 percent), Yes 283 (95.9 percent).
- Read-only print text: No 1 (2.4 percent), Yes 41 (97.6 percent).
- Statistics: chi super 2 = 50.66, d f = 2, p < .001, Effect size = .40.
* Awareness of N S P S F:
- No: No 19 (7.1 percent), Yes 250 (92.9 percent).
- Yes: No 4 (7.4 percent), Yes 50 (92.6 percent).
- Statistics: chi super 2 = .01, d f = 1, p = .928, Effect size = .01.
* Inclusion of priests in suicide prevention:
- No: No 1 (16.7 percent), Yes 5 (83.3 percent).
- Yes: No 22 (6.9 percent), Yes 295 (93.1 percent).
- Statistics: chi super 2 = .84, d f = 1, p = .359, Effect size = .05.
Note: N S P S F stands for National Suicide Prevention Strategic Framework.
Note: NSPSF = National Suicide Prevention Strategic Framework.
Discussion
The descriptive findings of this study provide insight into Catholic priests’ preparedness, perceived responsibility and training needs regarding suicide prevention within the Nigerian context, providing valuable baseline evidence, especially in LMIC settings which have a disproportionate burden of suicide. We found that only a small proportion of Catholic priests reported having received suicide prevention training, but the respondents widely endorsed the necessity of suicide prevention training as well as the need for additional education and skills training in suicide prevention for priests. This finding is consistent with past research showing significant training deficits and limited skill sets of clergy and leaders in religious communities (Hirono, Reference Hirono2013; Lee-Tauler et al., Reference Lee-Tauler, Grammer, Ekman, LaCroix and Ghahramanlou-Holloway2024; Mason et al., Reference Mason, Polischuk, Pendleton, Bousa, Good and Wines2011, Reference Mason, Geist and Clark2019; Mason, Reference Mason2021; Nwafor, Reference Nwafor2024). The current study’s finding suggests that the existing educational and professional training programs for clergy do not sufficiently address suicide prevention in terms of scope, depth or practical orientation.
Catholic major seminaries in Nigeria are affiliated with universities that oversee their academic curriculum to ensure that it meets the required standards for the award of philosophy and theology degrees. Although courses in psychology and counseling (including pastoral psychology/counseling) are taught in the major seminaries, findings highlight the importance of intentional, targeted and structured suicide prevention training, rather than relying on counseling background alone, in strengthening clergy readiness. From an implementation perspective, identifying priests who endorse a need for additional training may be a strategic approach for targeting advanced suicide prevention programs, given that these individuals acknowledge current skill gaps and demonstrate motivational readiness to engage in further capacity building aligned with their perceived role.
To strengthen implementation, training must move beyond one-off initiatives toward structured, ongoing models embedded within diocesan systems. A key priority in such training programs is the development of clear and functional referral pathways. Clergy are often first points of contact but lack mapped services, defined referral thresholds and feedback mechanisms, weakening continuity of care. Geographic inequities must be addressed through context-sensitive approaches. In under-resourced locations or rural areas, referral options for clergy are often limited to primary health centers, general hospitals, occasional psychiatric facilities and a patchwork of non-profit organizations or informal community supports. While shared religious affiliation may facilitate trust and informal connections with health care providers, referrals are still constrained by systemic challenges such as limited health care service availability, distance, cost and variable quality of care. As a result, clergy may need to act as frontline providers, using a tiered care model while managing cases where formal services are scarce.
Another important result in this study is that despite the competing demands on their time, a large number of priests indicated their willingness to learn more about suicide prevention. This finding agrees with research that supports clergy’s openness to further skills development regarding suicide prevention (Leavey et al., Reference Leavey, Rondon-Sulbaran and McBride2011; Mason et al., Reference Mason, Geist and Clark2019; Martin et al., Reference Martin, Kim and Mason2020). The respondents’ willingness in our study to devote an average of 4 h to suicide prevention training suggests a moderate but potentially realistic engagement which may be compatible with their continuing professional development schedules and job roles. This contrasts with a report of limited time and resources as a barrier to suicide prevention training (Hirono, Reference Hirono2013). Unlike the situation in developed countries, many priests in Nigeria do not get fixed salaries for their pastoral work. Instead, compensation for their services depends on the financial strength of the parish or place of primary assignment. Some of them engage in other secular jobs to also meet their needs. Their willingness to learn more about suicide, therefore, provides a capacity-building opportunity, potentially indicates feasibility of training, and could serve as a foundation for intervention uptake. However, the hours of availability of the priests in time commitment for suicide prevention training were substantially variable, underscoring the need for flexible and modular training formats.
Regarding their preferred training platform, a multimedia online tutorial had the highest endorsement, followed by an in-person professional seminar. Fewer priests preferred multimedia online tutorials and in vivo review/question and answer sessions, and a few preferred read-only print text. While there is no previous study yet reporting clergy’s preferred modality for suicide prevention training, broader medical or public health continuing education literature indicates a preference for multiple modalities and blended formats (combining online content with in-person elements), especially when practical skills are involved (Archer et al., Reference Archer, Berry, Bajwa, Kalda and Di Ruggiero2020; Cassidy et al., Reference Cassidy, Edwards, Bruen, Kelly, Arnett and Illing2023; Mueller et al., Reference Mueller, Croghan, Schroeder, Bhuiyan, Ganesh, Mohabbat, Nanda, Wight, Blomberg and Bonnes2024). The priests’ preferred training platforms in our study highlight practical considerations for effective suicide prevention capacity-building initiatives, suggesting that training delivery methods should align with the priests’ learning preferences and contextual constraints. In other words, the platform preference should inform implementation strategy – brief, modular, flexible delivery modalities and blended technology-supported delivery approaches may enhance accessibility and maximize uptake while accommodating competing professional demands/schedules. Apparently, a hybrid model that integrates most of the training formats may optimally meet the diverse preferences of this population in the Nigerian setting.
Beyond training needs, our findings also speak to how priests perceive their professional and ethical roles in suicide prevention. The respondents’ high endorsement of a duty to assist suicidal persons (and an indication to face legal actions for failing to take reasonable actions to reduce suicide risk) reflects a strong ethical orientation toward suicide prevention among Catholic priests. The current finding is consistent with past research that has reported that the clergy view themselves as having a key role in suicide prevention (Hirono, Reference Hirono2013; Mason et al., Reference Mason, Geist, Kuo, Marshall and Wines2016, Reference Mason, Rynbrandt, Capehart, Rando, Dokopoulos and O’Shell2024; Mason, Reference Mason2021; Nwafor, Reference Nwafor2024). The evident perception of many priests that suicide prevention is consistent with their professional responsibilities is important in the Nigerian context, where legal obligations are currently unclear or inconsistently articulated and pervasive stigma of suicide further complicates professional action. Stigma can reduce help-seeking within their congregations, discourage open disclosure of suicidal distress to faith leaders and create uncertainty among priests about appropriate responses, referral pathways and institutional support. By implication, perceived role legitimacy alone may be insufficient to generate sustained preventive engagement without parallel stigma-reduction and capacity-building efforts – an important area of need. Equally important are safeguards to mitigate risks associated with role overextension. Training should incorporate explicit boundaries, risk escalation protocols and access to supervisory support to ensure ethical and effective responses to suicidal crises. These implementation safeguards are also needed to ensure clergy involvement in suicide prevention does not overburden them in contexts with limited specialist support.
Our findings extend beyond individual preparedness to reveal systemic gaps in suicide prevention, particularly the disconnect between national policy and frontline implementation. Priests showed limited awareness of the National Suicide Prevention Strategic Framework (NSPSF 2023–2030), suggesting that key community-based actors are insufficiently engaged in policy dissemination. Although the NSPSF outlines a comprehensive, multisectoral strategy – including awareness, means restriction and referral systems – it has not been translated into formats that are accessible or actionable for clergy. Similarly, the National Mental Health Act has not been adapted into context-specific guidance for faith leaders. This reflects a broader failure to integrate the faith sector into national mental health strategies. Policies remain largely abstract, with minimal clarity on clergy roles or mechanisms for collaboration with formal health systems. The absence of enabling legislation – particularly the unpassed suicide prevention bill, which would decriminalize suicide and support implementation of the NSPSF – further limits policy effectiveness. As a result, clergy often respond to suicide-related crises without standardized frameworks, relying on personal judgment rather than system-supported protocols. Addressing this policy-to-practice gap requires targeted dissemination, role-specific guidance and stronger integration of clergy into coordinated suicide prevention efforts.
Given the central role of religious institutions in community life in Nigeria and their presence in remote locations where there are limited health care professionals, the low awareness of the NSPSF by priests is a serious systems-level gap that needs to be addressed by the National Technical Working Group that was set up by the government to speed up the implementation of the NSPSF. On pages 2–4 of the NSPSF, government organizations, professional bodies, tertiary institutions, non-governmental organizations and international organizations were listed as contributors to the development of the policy document, but neither a religious group nor their representative(s) was mentioned (FMHSW, 2023). In the build-up to the review of the NSPSF, representatives from the larger umbrella bodies such as the Christian Association of Nigeria, the Nigerian Supreme Council for Islamic Affairs (through the Jama’atu Nasril Islam and traditional religionists should be included.
One of the most contextually rich findings of this study is the substantial endorsement of support for the inclusion of priests in national suicide prevention efforts, mirroring reports of clergy’s desire for collaboration with health professionals in suicide prevention in developed countries (Zoellner & Konieczna, n.d.; Leavey et al., Reference Leavey, Rondon-Sulbaran and McBride2011). Long-term, equitable, trusting relationships and partnerships between faith communities (or faith-based organizations) and public health organizations are required for the maximization of the health of populations, especially in the LMICs (Marshall et al., Reference Marshall, Wilkinson, Jha and Keehan2025). In addition to helping increase access to services, the involvement of priests in suicide prevention helps to combat misinformation and prevent stigma (Ala et al., Reference Ala, Touray, Shafi, Egan, Dar, Essa, Flores, Ocama, Parker, Maeurer and Zumla2025). The present finding could therefore be considered within global mental health and community-based prevention frameworks (Katz et al., Reference Katz, Schuetz-Mueller, Fuerch, Chokroverty and Barrantes2015; Stevens et al., Reference Stevens, Tosatti, Ayer, Barnes-Proby, Belkin, Lieff and Martineau2020). Specifically, the finding reflects the Catholic priests’ recognition of their influential role in Nigerian communities and aligns with task-sharing approaches to mental health care in under-resourced settings (Hoeft et al., Reference Hoeft, Fortney, Patel and Unützer2018; Lange, Reference Lange2021; Kokubun et al., Reference Kokubun, Carlson, Druss, Woods-Jaeger, Kalokhe and Sales2025; Sangraula et al., Reference Sangraula, Chauhan, Best, McEneaney, Shah, Brown and Kohrt2024). Within the broader global mental policy context, the role of faith leaders emerges in this study as a critical yet underutilized component of suicide prevention. However, the very high endorsement of clergy inclusion in suicide prevention in our study may reflect a mix of normative expectations and aspirational beliefs about the role of clergy in addressing distress within a highly religious context. It may also indicate perceived readiness, but this should be interpreted cautiously, as endorsement does not necessarily translate into practical competence or system-supported capacity.
While the descriptive findings outline general trends, additional results provide insight into how suicide prevention training among priests and their perceived need for further training are related to behavioral dispositions and awareness regarding suicide prevention efforts. We found that priests who had received suicide prevention training were more likely to endorse a duty to assist suicidal persons, indicating that training may reinforce their recognition of professional responsibilities in suicide prevention. In addition, priests who endorsed the need for additional suicide prevention training overwhelmingly affirmed the necessity for suicide education, supported making it a requirement for the profession, endorsed their duty to assist suicidal persons and expressed willingness to learn more about suicide. Echoing the results of related research (Terpstra et al., Reference Terpstra, Beekman, Abbing, Jaken, Steendam and Gilissen2018; Mason et al., 2020; Wakai et al., Reference Wakai, Schilling, Aseltine, Blair, Bourbeau, Duarte, Durst, Graham, Hubbard, Hughey, Weidner and Welsh2020; Wortmann et al., Reference Wortmann, Nieuwsma, Cantrell, Fernandez, Smigelsky and Meador2023), this pattern of findings may reflect a self-reinforcing process whereby initial training enhances recognition of professional responsibilities, perceived relevance, and motivation to pursue further training opportunities in suicide prevention. The consistent association between positive attitudes toward suicide education and openness or perceived need for further training supports that targeting individuals who already value suicide prevention may be a strategic approach for implementing advanced or ongoing training programs based on the religious framework for suicide prevention.
Awareness of the NSPSF was limited among priests who had not received suicide prevention training, whereas a higher proportion of trained priests affirmed the inclusion of priests in national suicide prevention initiatives. These findings parallel relevant evidence of association between suicide prevention training experiences and awareness of or engagement with broader policy or national suicide prevention initiatives (U.S. Department of Health and Human Services, 2024; Liu et al., Reference Liu, Zheng, Cao, Zeng, Chen and Gao2025; Rosenblum et al., Reference Rosenblum, Dunphy, Gupta and Wang2025). It implies that participation in training may enhance familiarity with policy frameworks and strengthen support for clergy involvement in national suicide prevention efforts. We found that awareness of the NSPSF and support for priests’ inclusion did not differ based on perceived need for additional suicide prevention training, suggesting that recognition of training gaps does not necessarily translate into awareness of existing national strategic frameworks or policy guidelines. Our findings demonstrate that training could be a pathway to policy engagement and personal motivation (need for training) does not automatically mean policy awareness. These results should be considered against the backdrop of the relatively few priests who have ever received suicide prevention training. It is necessary to integrate policy and advocacy components into training programs, ensuring that priests not only acquire skills but are also informed about and adequately engaged with national suicide prevention initiatives.
Strengths, limitations and future directions
The current study has addressed a key empirical gap by examining suicide prevention training among clergy in an LMIC context, where evidence is limited. Our findings have clear policy relevance, informing diocesan decisions on integrating structured suicide prevention training into clerical formation and continuing professional development. By assessing training experiences and perceived needs, we have offered a refined understanding of both what clergy have received and what they feel is necessary. The present study has also established baseline data to support future longitudinal and comparative research or implementation work across settings and faith traditions.
However, our study has notable limitations. First, the priests’ self-reported responses reflect perceptions and attitudes, and we relied on categorical responses, which limit nuances of the participants’ responses. Hence, the data may be associated with inherent human biases like social desirability bias and recall bias. Second, the design of the study was cross-sectional in nature, and we only obtained information for ‘ever’ received training without consideration for recency of training. There is also a potential for social desirability bias in participants’ responses, particularly given the strong framing of clerical roles in terms of duty, pastoral responsibility and moral obligation. Third, although there is a significant amount of homogeneity across the dioceses in terms of culture, language and church traditions, we did not conduct diocesan-level analyses due to the very small sample size in some of the dioceses. Fourth, our quantitative data offer limited depth, context, and detail regarding clergy’s suicide prevention training experiences, needs and perceptions. Fifth, the effectiveness of clergy interventions in preventing suicide may be limited among demographic groups such as LGBTQ+ and gender-diverse individuals, where doctrinal positions, anticipated moral judgment and concerns about confidentiality may inhibit disclosure and help-seeking. Sixth, the absence of congregant and broader community perspectives limits understanding of how clergy roles in suicide prevention are experienced and perceived by those they serve.
Future research should consider using a longitudinal design, assessing recency/format of training and exploring whether there are significant differences in the responses of priests from the various dioceses. Since the clergy that participated in the current study were Catholic priests from southern Nigeria, researchers should ensure that clergy working in the northern region and Islamic clerics are included in future investigations. The link between training experience and awareness of national policy frameworks also represents a potential area for future research. For instance, researchers may consider using pre- and post-training surveys to measure changes in awareness of national strategy goals or policy components among clergy. An additional avenue for future research is exploring whether preferred training platforms vary on account of clergy’s demographic characteristics and primary roles. Finally, a mixed-methods approach that combines broad generalizable quantitative data with deep, contextual qualitative data is necessary for a richer and more holistic picture of suicide prevention training experiences, needs and perceptions of clergy, thereby enhancing intervention design for diverse needs. Future studies incorporating multi-stakeholder perspectives will help to assess whether reported readiness and inclusion translate into trust, accessibility or actual help-seeking across different demographic groups. This would provide a more comprehensive understanding of clergy-based suicide prevention by capturing both provider perspectives and the lived experiences of congregants.
Conclusion
The current study is the first available empirical study in an LMIC that addresses Catholic clergy’s preparedness, perceived responsibility, and training needs regarding suicide prevention as well as their policy awareness of and endorsement of involvement in national suicide prevention initiatives. Despite the limited number of priests who reported prior suicide prevention training, many affirmed their duty to assist suicidal persons, endorsed the necessity of suicide prevention education, reported that they need additional suicide prevention skills training, and indicated their willingness to learn more about suicide prevention. While only a small proportion were aware of national suicide prevention policy, most of the priests endorsed the inclusion of priests in national suicide prevention initiatives – aligning with task-sharing models increasingly advocated in global mental health. Suicide prevention training and perceived need for further training were also associated with greater perceived responsibility for suicide prevention, awareness regarding suicide prevention policy and support for clergy involvement in suicide prevention initiatives.
Beyond individual and organizational considerations, our study’s findings highlight broader system-level gaps in policy awareness and integration which are amenable to intervention. Implementing a structured suicide prevention training and integrating priests into suicide prevention efforts may strengthen community-level detection and referral pathways, particularly in LMIC settings where faith leaders are highly accessible. This view aligns with calls to leverage trusted community actors to extend the reach of suicide prevention efforts in under-resourced settings. While the cross-sectional design and use of self-report data in this study limit causal explanation, the findings provide a foundation for explanatory, longitudinal and intervention-based studies as well as expanding capacity-building initiatives beyond clinical settings.
Open peer review
To view the open peer review materials for this article, please visit http://doi.org/10.1017/gmh.2026.10285.
Supplementary material
The supplementary material for this article can be found at http://doi.org/10.1017/gmh.2026.10285.
Data availability statement
The data supporting the findings of this study are available from the corresponding author upon reasonable request.
Acknowledgements
The authors are grateful to Reverend Fathers Basil Nweze, Bruno Unamba, Charles Ozioko, Dan Nwokeoma, Desmond Adazie, Donald Chidolue, Oliver Onyebuchi Ugwu, Oluwa Chukwu, Peter Igwe, Princewill Iwummadu and Wilfred Chidi Agubuchie for their assistance with participant coordination and support during data collection. We sincerely appreciate all the priests who participated in the study. We also thank Patrick Hayes of MSU’s CS Mott Department of Public Health for his assistance with creating the Graphical Abstract for this manuscript.
Author contribution
Conceptualization: JohnBosco Chika Chukwuorji, Oluchi Miracle Osondu and Jennifer E. Johnson; Methodology: Oluchi Miracle Osondu, Desmond Uchechukwu Onu and John E. Eze; Formal analysis and interpretation: JohnBosco Chika Chukwuorji and Jennifer E. Johnson; Writing – original draft preparation: JohnBosco Chika Chukwuorji; Writing – review and editing: Jennifer E. Johnson, Echezona E. Ezeanolue, Taiwo Lateef Shiekh, Tunde Masseyferguson Ojo, Victor Ikechukwu Uka, Chidi Julius Lloyd; Resources: Oluchi Miracle Osondu, JohnBosco Chika Chukwuorji, and Jennifer E. Johnson.
Funding statement
This work was partially funded by the National Institute of Mental Health (P50 MH127512, Johnson, Ahmedani and Weinstock). The funders had no role in the design, analysis or interpretation of the study.
Competing interests
The authors declare that there are no competing interests associated with this work.
Ethics and approvals
Ethical approval was obtained from the Psychology Research Ethics Committee of the University of Nigeria Nsukka. All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Informed consent was obtained from all individual participants included in the study.
Open access
Comments
Dear Prof Judy Bass and Dixon Chibanda,
We are pleased to submit our manuscript entitled “Suicide Prevention Training Experiences, Needs and Perceptions among Catholic Clergy in Nigeria” for consideration for publication in Cambridge Prisms: Global Mental Health.
This manuscript examines Nigerian Catholic clergy’s preparedness, training needs and perceived responsibility regarding suicide prevention as well as their awareness of national suicide prevention policy. Clergy often serve as first-line responders to individuals experiencing psychological distress in many low- and middle-income countries, yet empirical evidence on their preparedness for suicide prevention remains limited. By focusing on Nigeria, this study addresses a significant evidence gap in global mental health and contributes data from a context where faith leaders play a critical role in community-based mental health support.
The study employs clearly defined measures and a transparent analytic approach to explore training exposure, perceptions, and policy gaps. Our findings have implications for the development of culturally responsive, faith-sensitive suicide prevention strategies and for strengthening collaboration between mental health services and religious institutions, which is an area of growing relevance to global mental health policy and practice.
This manuscript is original, has not been published previously, and is not under consideration for publication elsewhere. All authors have approved the manuscript and agree with its submission to Cambridge Prisms: Global Mental Health. Any necessary ethical approvals were obtained, and there are no conflicts of interest to declare.
We believe the manuscript aligns well with the journal’s mission to publish high-quality, interdisciplinary research with relevance for global mental health systems, policy, and practice. We would be grateful for the opportunity to have our work considered for publication.
Thank you for your time and consideration.
Yours sincerely,
JohnBosco Chika Chukwuorji
(On behalf of the authors)