A descriptive analysis of suicides and their interface with healthcare facilities in the Western Cape, South Africa: 2011-2015

Master Thesis


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BACKGROUND: Suicide is a preventable public health problem affecting 800 000 people every year and 79% occurs in low to middle incomes countries. Males are mostly affected, and at-risk age groups are adolescents and young adults. Hanging, firearms and ingestion of pesticides are amongst the most common methods of suicide. Prevention strategies have been applied by various countries to target the use of common methods of suicide however there is little evidence that supports detection of suicide risk in healthcare facilities. This study profiles all suicides that occurred in the Western Cape during the year 2011-2015 and their interface with the healthcare facilities up to one year prior to death. OBJECTIVES: This study assesses the incidence of suicides in the Western Cape. It tests for associations between methods of suicide and demographic characteristics for suicide. Ascertains the characteristics of those suicide cases who made previous contact with a healthcare facility in the past 12 months and proposes context specific interventions for the prevention of suicides. METHODS: A retrospective descriptive study was conducted. All suicides recorded by the forensic pathology service during the years 2011-2015 were linked to patient data held by the provincial health data centre. A total of 3 561 suicides were recorded during the study period. Crude suicide rates were calculated using population denominator from the Statistics South Africa's national census projections. Multiple logistic regression was used to determine associations between the group utilising various methods of suicide and demographic characteristics. FINDINGS: Males were found to be four times more likely to die from suicide compared to females. The age groups most at risk were 20-39 years. Hanging was the method of choice by males and overdose on medication, in females. Two thirds of the 2 367 suicides were positively linked to healthcare facilities. Most cases who sought healthcare up to one year prior to suicide were males that presented with ‘other medical conditions' rather than mental health conditions. CONCLUSION: This study highlights missed opportunities for the detection of suicide risk for those who seek healthcare for all healthcare conditions. Although suicide rates have remained constant over the assessment period, a key focus for prevention should be interventions applied at healthcare facilities as well as other ‘upstream' preventions that reduce the availability of various methods for suicide.