Profile of deliberate self-poisoning admissions in KwaZulu-Natal Province, South Africa (2018 - 2023) and the impact of COVID-19
DOI:
https://doi.org/10.7196/SAMJ.2026.v116i1.3710Keywords:
deliberate self-poisoning; suicide attempt; overdose; COVID-19; paracetamol; antiretroviral; South AfricaAbstract
Background. Deliberate self-poisoning (DSP) is a common method of attempted suicide globally, particularly among young adults and women. In South Africa (SA), DSP is the second most frequent method of attempted suicide, after hanging. The COVID-19 pandemic raised concerns about potential increases in suicidal behaviour, but data on its impact on DSP in resource-constrained settings are limited.
Objective. To describe the profile of DSP admissions at a large tertiary hospital in KwaZulu-Natal (KZN) Province, SA, over 2018 - 2023, and to assess whether the COVID-19 pandemic influenced the frequency or outcomes of these cases.
Methods. I conducted a retrospective review of all DSP admissions from 2018 to 2023 at a large tertiary hospital in KZN, SA. All patients aged ≥13 years who intentionally ingested a toxic substance (overdose or poison) were included. Demographic information, substances ingested and clinical outcomes (intensive care unit (ICU) admission, acute medical complications, in-hospital mortality) were recorded. Descriptive statistics were used to characterise the patient cohort, and multivariate logistic regression was used to identify independent predictors of acute medical complications, including an assessment of the COVID-19 pandemic period as a potential risk factor.
Results. A total of 716 DSP cases were analysed over the study period, with a median age of 26 years and a female predominance (64.7%). Medication overdose was the principal mechanism (81%), and the most frequently involved substances were paracetamol (17.6%) and antiretroviral (ARV) medications (16.8%). Acute clinical outcomes were generally favourable: 3.4% of patients required ICU admission, 1.3% developed serious medical complications and the in-hospital mortality rate was 0.7%. A history of psychiatric illness was a strong independent predictor of acute medical complications (odds ratio 9.4, p=0.007). The annual volume of DSP cases showed no significant difference across the pre-pandemic (2018 - 2019), pandemic (2020 - 2021) and post-pandemic (2022 - 2023) periods (p=0.18).
Conclusion. DSP in this setting predominantly affects young adults, especially females, and often involves overdose of readily accessible medications (notably paracetamol and ARV drugs). While acute outcomes were largely favourable, with low rates of severe complications and death, the high involvement of common pharmaceuticals underscores the need for preventive strategies to reduce DSP incidents. Notably, no surge in DSP cases was observed during the COVID-19 pandemic, suggesting that the pandemic’s impact on suicidal behaviour is context-specific.
References
1. World Health Organization. Suicide worldwide in 2019: Global health estimates. Geneva: WHO. 2021. https://www.who.int/publications/i/item/9789240026643 (accessed 17 December 2025).
2. Laher D, Lalla U, Ally M, et al. Deliberate self-poisoning at a tertiary hospital in Johannesburg, South Africa. S Afr Med J 2022;112(5):347-351. https://doi.org/10.7196/SAMJ.2022.v112i5.16439
3. Hawton K, Casey D, Bale L, et al. Self-harm in youth: A prospective cohort study of characteristics, hospital management and repeat presentations. Lancet Child Adolesc Health 2021;5(7):519-528.
4. South African Depression and Anxiety Group. Suicide statistics in South Africa. SADAG, 2018. https:// www.sadag.org/index.php?option=com_content&view=article&id=1687 (accessed 10 October 2025).
5. Onoya ED, Makwakwa NL, Motloba DP. Temporal variation in suicide in peri-urban Pretoria. S Afr
Fam Pract 2021;63(1):e1-e7. https://doi.org/10.4102/safp.v63i1.5227
6. Van Hoving DJ, Hunter LD, Gerber RJ, Lategan HJ, Marks CJ. The burden of intentional self-poisoning on a district-level public hospital in Cape Town, South Africa. Afr J Emerg Med 2018;8(3):79-83. https://doi.org/10.1016/j.afjem.2018.02.001
7. Gabler T, Yudelowitz B, Mahomed A. Overdose with HAART: Are we managing these patients adequately? S Afr Med J 2011;101(8):520-521. https://pubmed.ncbi.nlm.nih.gov/21920122/ (accessed 20 January 2026).
8. Daimari R, Kwape L, Oyekunle AA. Suicidal overdose of dolutegravir: A case report. S Afr J HIV Med 2018;19(1):a799. https://doi.org/10.4102/sajhivmed.v19i1.799
9. Holmes EA, O’Connor RC, Perry VH, et al. Multidisciplinary research priorities for the COVID-19 pandemic: A call for action for mental health science. Lancet Psychiatr 2020;7(6):547-560. https://doi. org/10.1016/S2215-0366(20)30168-1
10. Pirkis J, John A, Shin S, et al. Suicide trends in the early months of the COVID-19 pandemic: An interrupted time-series analysis of 21 countries. Lancet Psychiatr 2021;8(7):579-588. https://doi. org/10.1016/S2215-0366(21)00164-5
11. Els JR, Hendrikse C, Taljaard L. Impact of the COVID-19 pandemic on presentations with suicidal behaviour in an Emergency Centre in Eastern Cape, South Africa: A cross-sectional analysis. Afr J Emerg Med 2024;14(4):268-272. https://doi.org/10.1016/j.afjem.2024.05.003
12. Benedict MOA, van Loggerenberg CJ, Steinberg WJ. The profile of deliberate self-poisoning cases presenting at the emergency department of Pelonomi Regional Hospital, Bloemfontein. S Afr Fam Pract 2019;61(1):11-17. https://doi.org/10.1080/20786190.2018.1547283
13. Pieterse D, Hoare J, Louw K-A, et al. Methods of deliberate self-harm in a tertiary hospital in South Africa. S Afr J Psychiatr 2020;26(1):a1399. https://doi.org/10.4102/sajpsychiatry.v26i0.1399
14. Gunnell D, Appleby L, Arensman E, et al. Suicide risk and prevention during the COVID-19 pandemic. Lancet Psychiatr 2020;7(6):468-471. https://doi.org/10.1016/S2215-0366(20)30171-1
15. Kotzé C, Swanepoel J, Kruger EC, Decloedt E. The management and clinical outcome of paracetamol poisoning in South African adults: A single-centre retrospective review. S Afr Med J 2024;114(12):e1986. https://doi.org/10.7196/SAMJ.2024.v114i12.1986
16. Pilgrim JL, Drummer OH. Self-poisoning and psychiatric disorders: Profile of cases and predictors of fatal outcome. Aust N Z J Psychiatry 2019;53(1):77-86. https://doi.org/10.1177/0004867418792056 17. Lin CL, Lin CC, Chen YH, et al. Depression increases the risk of mortality in patients with
paraquat poisoning: A population-based study. Medicine 2015;94(8):e574. https://doi.org/10.1097/
MD.0000000000000574
18. Hiremath R, Dasar PL, Shankar R, Chidanand S, Ashok NC. Pattern and outcome of acute poisoning cases in a tertiary care hospital in Karnataka, India. Indian J Crit Care Med 2020;24(8):702-707. https:// doi.org/10.5005/jp-journals-10071-23471
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