A Retrospective Review of 1018 Suicide Cases From the Capital City of South Africa for the Period 1997–2000

There is a paucity of published data on suicide research in South Africa. According to Burrows et al, suicide accounted for 9.4% of deaths recorded on the NNMS (National Non-Natural Mortality Surveillance) in 2000 for 15 large, urban mortuaries. It would seem from this that South Africa has a very high prevalence of suicide cases. Studies have shown that more suicide victims are male and that male suicide victims are more likely to use violent suicidal methods. It is further commonly believed that there is a seasonal variation in the incidence of suicide. No published studies pertaining to South African populations could be found in the scientific literature. Other factors that are commonly assessed in reviewing suicide in a community are gender, age, and alcohol use prior to the attempt. This study aims to shed some light on successful suicide cases in the Pretoria region. The time frame of the study starts 3 years after the first open, democratic elections held in South Africa. This has been is a time of great sociodemographic and political change. Pretoria is an urban, cosmopolitan city in Gauteng Province (situated approximately 50 km from Johannesburg) with a population of 1,012,145 people, according to the 1996 South African census. The population breakdown according to race was as follows: 469,620 blacks, 53,645 Asians and coloreds, and 479,301whites. The male:female ratio for all groups was 1:1. The Pretoria Medico-Legal Laboratory (MLL) is responsible for the medicolegal investigation and autopsies of all nonnatural deaths in the greater Pretoria region. The MLL conducts 2500 autopsies on average per annum. MATERIALS AND METHODS The Departments of Psychiatry and Forensic Medicine of the University of Pretoria conducted this study jointly. Prior ethical approval was obtained from the University of Pretoria Faculty of Health Sciences Research Ethics Committee. Authorization was also obtained from the provincial health authorities and the South African Police Service. Cases identified as possible or probable suicide by the police investigating officer completing the SAP180 form (the prerequisite form for admission of the body to the medicolegal mortuary), and/or identified as a possible or probable suicide by the pathologist responsible for the autopsy, were included in this study. The SAP180 form provides for completion of the provisional primary medical cause and manner of death, as well as demographic and other detail. Cases where the suicidal intent was unclear, for instance possible suicidal motor vehicle accidents, were excluded. All mortuary case records from January 1997 to December 2000 were retrospectively reviewed, with the anonymity of all cases observed. A research assistant was employed to assist with gathering of data from the identified sources. The data were analyzed according to age, race, gender, method of suicide, month of the year, and toxicology results. The data were analyzed with the assistance of the University of Pretoria’s Department of Statistics, making use of SAS (version 8; SAS Institute, Inc, Cary, NC) and using 2 tests for independence and log linear model analysis.