Suicide Attempts and Reattempts in Cape Town: A Mixed-Methods Study of Lifetime Suicidal Behaviour

Abstract Background Few studies have examined lifetime trajectories of suicidal behaviour in low- and middle-income countries. We characterised suicide attempts and reattempts across the life course and explored contextual and subjective factors shaping suicidal behaviour in socioeconomically disadvantaged South African communities. Methods We analysed baseline data from a cross-sectional study and conducted semi-structured qualitative follow-up interviews with participants who reported a lifetime suicide attempt at baseline. Using event history calendars, interviews reconstructed lifetime history of suicidal behaviour, classified reported events using the Columbia-Suicide Severity Rating Scale, and explored the contexts and meanings of suicidal behaviours from participants’ perspectives. We used descriptive statistics to characterise patterns of suicidal behaviour and calculated reattempt rates between baseline and follow-up. We analysed qualitative data using a hybrid inductive-deductive thematic approach. Results Thirty-two participants completed follow-up qualitative interviews. The median age was 34 years, 81% were female, 88% had a current mental disorder, and socioeconomic disadvantage, stress, and violence exposure were common. Overall, 73 lifetime suicide attempts were reported (median two per person). Over 36.6 person-years of follow-up, six participants reported a repeat suicide attempt (16.39 per 100 person-years) and two reported non-suicidal self-injury (5.46 per 100 person-years). Six themes described drivers of suicidal behaviour, including accumulated stress, self-harm as respite or communication, exposure to self-harm and suicide, degree of social connectedness, and limited care-seeking. Conclusion Suicidal behaviour was recurrent across the life course, reflecting social adversity, psychological distress, mental illness, interpersonal conflict, and unmet professional and social support needs in socioeconomically disadvantaged South African communities.