Methods of deliberate self-harm in a tertiary hospital in South Africa

Abstract

Background: Little is known about the methods of deliberate self-harm (DSH) in South Africa (SA), despite the importance of means restriction as a public health strategy to reduce the morbidity and mortality associated with self-harm.Aim: The aim of this study was to investigate the range of methods used in DSH and identify the socio-demographic and clinical factors associated with violent and non-violent methods of DSH among patients treated at a tertiary hospital in SA.Setting: The study was conducted at an urban, tertiary level emergency department at Groote Schuur hospital in Cape Town, South Africa.Method: Data were collected from 238 consecutive DSH patients who presented for emergency department treatment at the hospital. Logistic regression models were used to explore the factors associated with violent and non-violent methods of DSH.Results: Self-poisoning was the most common method of self-harm (80.3%). Prescription medication was the most common form of self-poison (57.6%), while a large number of patients used non-prescription paracetamol (40.9%). In the regression analysis, male gender, stating that the reason for DSH was to escape a situation and history of substance use were associated with violent method of DSH.Conclusion: Improved monitoring of prescription medications commonly used in DSH is integral to public health suicide prevention strategies in SA. This study underscores the need for substance use interventions in the healthcare setting.

Over‐the‐counter drug use in suicidal/self‐harm behavior: Scoping review

“…45 Comorbid psychiatric illnesses such as depression, schizophrenia, substance use disorders, generalized anxiety disorder, and bipolar affective disorder were associated with OTC drug use for suicidal behavior. 17,21,28,30,32,33,36,46 Since not all suicidal behaviors are motivated by a desire to die; mental health institutions should educate people with mental illnesses, particularly young people, about OTC usage and toxicity. 47,48 The threat of potential harm is more in countries with poor drug dispensing regulations.…”

“…Twenty‐seven reports were identified in this scoping review, which included OTC medications and suicidal behavior. More than half (15) of the studies examined the use of medications for suicide and attempted suicide 14 , 15 , 16 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 29 , 30 , 34 , 37 , 38 , 39 followed by poisoning and deliberate self‐harm 28 , 33 , 36 Based on this review, analgesics and antihistamine overdoses are the most frequently used for suicide attempts and suicide, and it panned across all age groups. 15 , 35 , 38 , 39 The review found acetaminophen, acetylsalicylic acid, and diphenhydramine as the commonest analgesics and antihistamines used and more common among female adolescents.…”

“…However, because these medications are readily available, they can be taken in large quantities resulting in death. 15 , 16 , 23 , 36 , 38 A study from South Africa reported that OTC analgesics, particularly acetaminophen, are the leading method used in self‐harm. 36 Imposing restrictions on the quantity sold per packet should be considered in all countries.…”

Motives for deliberate self-harm in a South African tertiary hospital

“…This sub-study analysed the data collected as part of a larger study titled An investigation of the epidemiology, psychosocial correlates and cultural context of deliberate self-harm in South Africa. The larger project is a joint study between the Department of Psychology at Stellenbosch University and the Department of Psychiatry and Mental Health at the University of Cape Town and has resulted in publications describing the methods of self-harm 25 and associations between DSH and substance use. 26 The data we present here have, however, not been previously reported.…”

“…(p. 74) 24 The term, as used in this study, includes patients who engaged in self-harm with an intent to die as well as those with no intent to die. 25 and associations between DSH and substance use. 26 The data we present here have, however, not been previously reported.…”