A national forensic study examines recorded suicide mortality trends geographical distribution and methods in Botswana from 2014 to 2025

Abstract Background. National longitudinal evidence on suicide mortality is limited in sub-Saharan Africa, where incomplete death registration and variable medico-legal ascertainment constrain surveillance. We examined temporal trends, demographic and geographical patterns, and methods of recorded suicide mortality in Botswana, 2014-2025. Methods. We conducted a retrospective national forensic mortality study of deaths classified as suicide from Jan 1, 2014, to Dec 31, 2025. Crude annual rates used national population estimates from the 2011 and 2022 censuses. Temporal change was assessed by Poisson regression with population as an offset and post-hoc segmented sensitivity analysis. Results. Among 4,112 unique medico-legal records, 1,150 deaths comprised the primary suicide cohort. Among deaths with known sex, 918/1,035 (88.7%) occurred in males; 881/1,114 (79.1%) deaths with valid age occurred among people aged 15-44 years. Hanging accounted for 970/1,150 (84.3%) deaths. Recorded suicide mortality increased from 3.08 per 100,000 population in 2014 to 6.14 in 2025, corresponding to an average annual increase of 5.2% (95% CI 3.4-7.0; p<0.001). The pattern was non-uniform, with little evidence of change during 2014-2022 followed by a marked increase during 2023-2025. Conclusions. Recorded suicide mortality increased, particularly in the late study period. Concentration of the late increase in the Gaborone forensic-service catchment and contemporaneous increases in recorded homicides suggest that ascertainment or database capture may have contributed. Prospective, integrated national suicide surveillance is needed to support prevention and reliable trend monitoring.