# Typologies of suicidality and suicide presenting to a prehospital South African Emergency Medical Service: a retrospective cross-sectional analysis

## TL;DR

This study examines the frequency and types of suicide cases handled by emergency medical services in South Africa, highlighting the burden on healthcare providers and the need for better support.

## Contribution

The study provides a novel analysis of suicidality typologies in a South African prehospital setting, revealing patterns and challenges for emergency care providers.

## Key findings

- Suicide and suicidality cases accounted for 14% of mental health-related incidents in the study area.
- Men were five times more likely to die by suicide compared to women, often using strangulation.
- The study identified a need for policy and practice improvements to address stigmatization and enhance emergency care provider capacity.

## Abstract

The global age-standardised suicide rate is estimated at 8.9/100 000, while South Africa is at 23.5/100 000. The prehospital Emergency Medical Services is located within this burden of health. Emergency Care providers have a duty to assess, treat and transport healthcare consumers with suicidality, when attending to the suicide caseload. The aim was to appraise suicidality case frequency and typology and estimate the scope of the challenge faced by a jurisdictional emergency medical service and its care providers.

Using a retrospective cross-sectional design and a novel data collection instrument, a census of three years of Ambulance Incident Management Records was undertaken in a rural district of the Western Cape, South Africa.

Of 413,712 records, 2,976 (N) mental health-related incidents were sampled. Fourteen percent (n = 412) were assessed to have descriptors of suicidal ideation (n = 227), attempted suicide (n = 83) or death by suicide (n = 102). There were, on average, 2.8 deaths by suicide per month over the 3-year study period in the Garden Route District. Women were reported to mostly ingest poison and overdose on medication, while men used strangulation and were 5 times more likely to die by suicide than women.

This study estimates the prehospital suicide and suicidality burden for the Western Cape Government Emergency Medical Services, elucidating an under-researched health concern within the South African prehospital space. Further study is required on the risk of emergency care provider stigmatisation towards suicide and suicidality cases, while auditing the need to assess policy, praxis, medical surveillance, EC provider clinical capacity and victim needs and experiences. Suicidality and suicide in Southern Africa could require a ‘Syndemic’ approach for the emergency service to interrupt suicidality and advance professional relevance.