Associations Between Traumatic Events and Suicidal Behavior in South Africa

Abstract

Research conducted predominantly in the developed world suggests that there is an association between trauma exposure and suicidal behaviour. However, there are limited data available investigating whether specific traumas are uniquely predictive of suicidal behaviour, or the extent to which traumatic events predict the progression from suicide ideation to plans and attempts. A national survey was conducted with 4351 adult South Africans between 2002 and 2004 as part of the WHO World Mental Health Surveys. Data on trauma exposure and subsequent suicidal behaviour were collected. Bivariate and multivariate survival models tested the relationship between the type and number of traumatic events and lifetime suicidal behaviour. A range of traumatic events are associated with lifetime suicide ideation and attempt; however, after controlling for all traumatic events in a multivariate model, only sexual violence (OR=4.7, CI 2.3-9.4) and having witnessed violence (OR=1.8, 1.1-2.9) remained significant predictors of life-time suicide attempts. Disaggregation of the associations between traumatic events and suicide attempts indicates that they are largely due to traumatic events predicting suicide ideation rather than to the progression from suicide ideation to attempt. This paper highlights the importance of traumatic life events in the occurrence of suicidal thoughts and behaviours and provides important information about the nature of this association. Future research is needed to better understand how and why such experiences increase the risk of suicidal outcomes.