Ayahuasca use and improvements in suicidal behavior: An exploratory qualitative study

Suicidal behaviour is presented as a complex public health problem that includes suicidal ideation and suicide attempts, with substantial global mortality and notable burden in Brazil. The authors note that established risk factors include mental disorders such as depression and substance use disorder, but that access to effective care is uneven. They frame the paper within growing evidence that psychedelics can produce lasting psychological change when used in supportive settings, and they specifically highlight ayahuasca as a substance with emerging therapeutic potential for depression, hopelessness and substance use problems. At the same time, they emphasise that psychedelic clinical research has often lacked ethnoracial diversity, and that high treatment costs and concentration of services in wealthier regions limit access. Against this background, Santos and colleagues set out to explore how people in neoshamanic ayahuasca settings in Brazil describe the relationship between ceremonial ayahuasca use and suicidality. The study aims to understand participants’ motivations for seeking ayahuasca, how they integrated the experience afterwards, and how they perceived its effects on suicidal thoughts and behaviour. The authors present this as a qualitative contribution to suicide prevention research, grounded in community-based psychedelic practices in underrepresented regions and populations.

Santos and colleagues conducted a qualitative, descriptive, exploratory multiple case study. The work formed part of a broader master's research project on ayahuasca as a strategy for self-care in mental health. From a purposive sample of 58 adults who had used ayahuasca in neoshamanic contexts for health-related reasons, the authors selected nine participants for in-depth analysis because they reported a prior history of suicidal ideation or suicide attempts. The final sample included five men and four women, aged 28–59 years, from Rondônia and São Paulo. Recruitment proceeded through three neoshamanic groups. Group leaders first received an explanation of the study and gave formal permission for recruitment. They then nominated people who had sought the group mainly for health-related rather than religious reasons. The researchers contacted nominated individuals by telephone, explained the study, and obtained consent via a Google Forms informed consent form. Participants then completed a self-administered questionnaire on sociodemographic and mental health information. Data were collected through synchronous semi-structured interviews conducted by the first author using Google Meet or WhatsApp video calls. Interviews lasted about 40 minutes, were audio recorded with consent, and were transcribed verbatim. The interview guide covered motivations for ayahuasca use, patterns of use, physical and mental health experiences, ritual context, spirituality, healing, and current mental health and quality of life. Participants also spontaneously discussed suicidality without being directly prompted. The extracted text indicates that the researchers used content analysis with pre-analysis, coding/categorisation, and interpretation to identify factors related to ayahuasca’s perceived benefits. Pseudonyms were used to protect anonymity. The study received ethics approval from the Federal University of Rondônia. The neoshamanic settings themselves were described briefly in the background information: ceremonies involved preparatory orientations, facilitator presence throughout, and time for sharing afterwards. Practices varied somewhat across groups, including differences in screening and support, and one group in São Paulo also offered psychotherapy and other complementary therapies.

The sample comprised nine participants, most of whom were male (5/9; 55%) and from northern Brazil. Mean age was 37 years and mean duration of ayahuasca use was 47 months. Most participants identified as Brown (5/9; 55%), had incomplete higher education, were employed, and were married. All had previously received a psychiatric diagnosis confirmed by a doctor; depression was the most common diagnosis (5/9; 55%), followed by substance use disorder (4/9; 45%). Most were not taking psychiatric medication, and five were in psychotherapy. More than half reported lifetime suicidal ideation that was no longer active, and 45% reported at least one suicide attempt. Content analysis produced three broad themes: motivations for seeking ayahuasca, post-ayahuasca strategies for strengthening psychological well-being, and the psychedelic experience and its health benefits. In the first theme, participants commonly described dissatisfaction with conventional care, including repeated attempts with medication, public services and therapeutic communities that did not bring remission or seemed to worsen symptoms. This dissatisfaction, together with depression or substance use problems, was linked to the decision to seek ayahuasca. Several participants described severe suicidal thinking or attempts before starting ceremonial use. In the second theme, participants stressed the importance of group support and therapeutic integration. Some described the group as a kind of self-help community. They valued the ritual setting, the perceived safety of being monitored by facilitators, practical support during ceremonies, and opportunities to talk afterwards. Participants also said that ayahuasca helped them engage more deeply in psychotherapy or other therapeutic supports offered by the group, which they felt strengthened the benefits of the experience. In the third theme, participants reported self-knowledge, behavioural change, and personal/social transformation. They described greater self-awareness, improved self-image and a better relationship with their bodies. Many reported changes in mood, motivation, lifestyle and health behaviours, including more exercise, improved diet, reduced use of alcohol, marijuana or other drugs, and less suicidal thinking. Participants also described improvements in family relationships, work, finances, home organisation, and a stronger sense of purpose and life satisfaction. The qualitative data therefore consistently portrayed ayahuasca use as associated, in participants’ accounts, with reductions in suicidal ideation and broader improvements in well-being.

The authors interpret the findings as suggesting that participation in naturalistic ayahuasca ceremonies may be linked to reductions in suicidal thoughts and behaviour, especially among people with depression or substance use disorder. They argue that the reported decreases in substance use, improvements in mood and self-esteem, and better functioning in personal and professional life point to a potentially integrative and complementary role for ceremonial ayahuasca in mental health care. They also position the findings alongside previous research indicating that psychedelics can reduce hopelessness and depressive symptoms, and they cite neuroimaging and psychotherapeutic literature to support the idea that acute psychedelic experiences, insight and emotional intensification may contribute to longer-term positive change. The authors further suggest that context matters: preparation, supportive settings, social support, and post-experience integration are presented as important influences on outcomes. They note that the group-based, ritualised and religiously syncretic character of neoshamanic ayahuasca settings in Brazil may lower stigma, facilitate integration into daily life, and potentially broaden access to care for racially marginalised and socioeconomically disadvantaged people. They also mention that five participants used psychotherapy after ayahuasca and perceived this combination as helpful for working through material brought up by the experience. At the same time, the authors are careful to acknowledge limitations. They stress the very small sample size, the exploratory nature of the study, and the possibility of selection bias because group leaders nominated participants, which may have favoured positive accounts. They also note response and recall bias due to retrospective self-report, the absence of validated quantitative measures, and the cross-sectional design. They acknowledge that people who had adverse reactions or left the groups may not have been captured, which could overrepresent benefits. The discussion also notes broader concerns about psychological harms and abuse in some ayahuasca communities, which the authors say future research should be designed to detect. Overall, they call for more diverse and ethically sensitive studies that can capture a wider range of experiences and better understand the role of sociocultural context.

The authors conclude that suicide is a serious and growing public health concern and that their findings raise the possibility that community-based ayahuasca use in Brazil may help expand access to supportive care for diverse populations. They state that, while stronger evidence is still needed, these practices may offer an alternative pathway for mental health support in settings where conventional resources are limited or inaccessible.