Healthcare Utilization 12 Months Prior to Fatal and Non-fatal Suicidal Behaviour in Cape Town, South Africa

Abstract

The purpose of this study was to characterize healthcare use for general care and mental health one year before suicidal behavior among individuals with fatal and non-fatal suicidal behavior (NFSB) in Cape Town, South Africa. We linked electronic health records of 484 participants from a case series of 93 completed suicides on whom forensic autopsies were performed at a mortuary in Cape Town, between August 2014 and January 2016; and 391 patients admitted to hospital following NFSB between June 2014 and March 2015, and between August 2015 and August 2017. Time from last healthcare visit to date of suicidal behavior (fatal or non-fatal) was calculated, and Kaplan Meier curves were used to compare the differences by psychiatric diagnoses and study group. Overall, 64.5% of completed suicides and 65.9% of NFSB patients sought general healthcare in the year before suicidal behavior. Most of these visits occurred at hospital outpatient clinics (40.8%) and primary healthcare facilities (31.3%). The prevalence of preexisting psychiatric diagnoses and the use of mental healthcare services was lower for individuals who completed suicide compared to NFSB patients. Common reasons for a healthcare visit among individuals who completed suicide were chronic disease and assault; and psychiatric illness (depression, bipolar, and/or substance use disorders), chronic disease and HIV among NFSB patients. A large proportion of individuals with fatal and NFSB interacted with the healthcare system before suicidal behavior. These findings suggest opportunities for suicide prevention at primary healthcare facilities, antiretroviral treatment centers and emergency departments.

HIGHLIGHTS

• Healthcare access is common among individuals with fatal and NFSB in the year before suicidal behavior.

• The prevalence of mental disorder diagnoses is higher among NFSB patients than among individuals who completed suicide.

• A greater proportion of NFSB patients accessed mental healthcare services compared to individuals who completed suicide.

Keywords:

• Access
• completed suicide
• healthcare utilization
• non-fatal suicidal behavior

DISCLOSURE STATEMENT

No potential conflict of interest was reported by the author(s).

DATA AVAILABILITY STATEMENT

The data that support the findings of this study are available from the corresponding author upon reasonable request.

Additional information

Funding

TK is supported by the South African Medical Research Council through its Division of Research Capacity Development under the Clinician Researcher Development PhD Scholarship Programme. The content hereof is the sole responsibility of the author and does not necessarily represent the official views of the SAMRC.

Notes on contributors

Tahira Kootbodien

Tahira Kootbodien, Department of Pathology, University of Cape Town, Cape Town, South Africa.

Jason Bantjes

Jason Bantjes, Alcohol, Tobacco and Other Drug Research Unit, South African Medical Research Council, Tygerberg, South Africa and Department of Global Health, Institute for Life Course Health Research, Stellenbosch University, Stellenbosch, South Africa.

John Joska

John Joska, HIV Mental Health Research Unit, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa.

Laila Asmal

Laila Asmal, Department of Psychiatry, Stellenbosch University, Stellenbosch, South Africa.

Bonginkosi Chiliza

Bonginkosi Chiliza, Department of Psychiatry, University of KwaZulu Natal, Durban, South Africa.

Lorann Stallones

Lorann Stallones, Department of Psychology, Colorado State University, Fort Collins, CO, USA.

Zelda Holtman

Zelda Holtman and Leslie London, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa.

Lorna J. Martin

Lorna J. Martin, Division of Forensic Medicine and Toxicology, Department of Pathology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.

Raj S. Ramesar

Raj S. Ramesar, UCT/MRC Genomic and Precision Medicine Research Unit, Division of Human Genetics, Department of Pathology, Institute for Infectious Diseases and Molecular Medicine, University of Cape Town and Affiliated Hospitals, Cape Town, South Africa.

Leslie London

Zelda Holtman and Leslie London, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa.