Profile of deliberate self-poisoning admissions in KwaZulu-Natal Province, South Africa (2018 - 2023) and the impact of COVID-19

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.