Five Years of Suicide in the Governorate of Sidi Bouzid, Tunisia: A Retrospective Medico-Legal and Epidemiological Study

Background/Objectives: The governorate of Sidi Bouzid, an inland region of Tunisia, had not previously been the subject of a medico-legal study of suicide. We described the epidemiological profile of suicide deaths identified through the medico-legal autopsy system during 2019–2023 and identified prevention-relevant hypotheses for future research. Methods: This retrospective descriptive study included 91 suicide deaths undergoing medico-legal autopsy at Sidi Bouzid Hospital. Demographic characteristics, circumstances of death, and autopsy findings were extracted from medico-legal files. Emergency-department suicide-attempt counts from the same region and period provided complementary descriptive context. Results: Suicide accounted for 10.6% of 857 autopsies. Men represented 59.3% of cases and the mean age was 35.5 years. A documented psychiatric history was recorded in 57.1% of victims. Hanging was the leading method (70.3%), followed by poisoning (15.4%). The annual number of forensically identified cases increased from 10 in 2019 to 27 in 2023, but no formal temporal trend was inferred from only five annual observations. The mean annual incidence based on forensic cases was 3.99 per 100,000 person-years (95% CI 3.21–4.90), interpreted as a lower-bound estimate because deaths not referred for forensic investigation could not be captured. Females represented 55.7% of 587 emergency-department suicide attempts recorded over the same period. Conclusions: The study provides a regional medico-legal description of suicide in Sidi Bouzid and identifies patterns that may inform future surveillance and hypothesis-generating prevention research. These findings should not be interpreted as estimates of subgroup-specific suicide risk or as evidence of intervention effectiveness.