This study reviewed 166 articles related to suicidality in South Africa, published between 1952 and 2003. From these, a table of summarized information was created and then coded. Thereafter, a statistical content analysis was conducted. The results suggested that the field of suicidology requires further specific research into suicidal ideation and murder-suicides. Blacks are under-represented and Indians are over-represented in the publications. The representation of Coloureds in South African suicide research is negligible. Increased research efforts could focus on suicidality (especially suicidal ideation) in relation to masculinity and use male-only samples. There is a need for research to focus on prevention and intervention and to increase the use of qualitative methodologies. These suggestions may prevent the duplication of well-researched areas and refine future research agendas. / Thesis (M.A.)-University of KwaZulu-Natal, Pietermaritzburg, 2004.

Homicide suicide (HS) is rare phenomenon where an individual kills one or more people and then commits suicide, normally within a week or less. The suicide must be related to the homicide in order for it to be classified as a HS event. In South Africa, there is no national surveillance system tracking HS events which makes researching this phenomenon difficult. As a result, little research has been conducted in South Africa. This study aimed to determine, through media reports, the annual incident rates, the demographic profiles of the perpetrator and victims involved and the various features of HS in South Africa from 2002 to 2009. The findings of the present study are also compared to other international and national findings. This quantitative study analysed 328 HS events that were reported in nine national newspapers over an eight-year period. The results found that the typical South African HS perpetrator reported in the media is likely to be 37 years of age, male and black African. He would most likely be employed in the security sector and his victim would typically be a 25 year old, would be an intimate partner. Shooting was the most common method for the homicide and the suicide in HS events. The study concluded that the general demographics and patterns were similar to national and international studies. / Thesis (M.A.)-University of KwaZulu-Natal, Pietermaritzburg, 2010.

Master’s thesis submitted to Faculty of Humanities in partial fulfilment of Master of Arts: Applied Ethics for Professionals University of the Witwatersrand Department of Philosophy, 2017 / In this thesis I explore the issue of voluntary assisted suicide in a South African constitutional context through the tri-coloured normative prism of autonomy, dignity and human well-being. I will focus on the way South Africa, as a secular society, ought to engage with this highly emotive issue in light of the socio-legal framework in which we are embedded and which framework carries with it profound normative implications. I divide the discussion into two broad sections. In the first section I articulate, from an ethical standpoint, what I take to be the strongest positive case for South African society to permit voluntary assisted suicide. I argue that by permitting voluntary assisted suicide South African society would be giving proper expression to (i) individual autonomy (ii) human dignity, and (iii) human well-being. In articulating the positive case I also analyse the triumvirate concepts of individual autonomy, dignity and human well-being as well as their relationship to each other. I argue that individual autonomy is an essential component of a good human life, that is to say, a worthwhile life and that to speak of a dignified life is, in turn, to speak of the sort of life that is worthy of respect, reverence and honour. I then turn to an examination of two of the principal ethical arguments against the moral permissibility of voluntary assisted suicide in the literature, namely (i) the Sanctity of Life Argument, and (ii) the Social Harm Argument. I argue that neither argument is sufficiently persuasive to rebut the positive case in favour of voluntary assisted suicide. However, certain critical considerations are raised that do speak to the need for effective oversight and regulation of such a practice in South African society. Accordingly, I advance the view that, in light of the failure of these two principal arguments (and in the absence of any stronger arguments) voluntary assisted suicide ought to be permitted in South Africa subject to uniform, public and specifiable oversight criteria applicable to each individual who wishes to end his life with the assistance of another. In the second section, I describe the South African legal standpoint on voluntary assisted suicide in light of (i) the normative underpinnings of the Constitution of the Republic of South Africa, 1996 (and in particular the Bill of Rights) and (ii) the present legal status of voluntary assisted suicide, taking into account both the common law and the South African Law Commission Report on Euthanasia and Artificial Preservation of Life, 1998. This analysis involves an examination of (i) the recent decision of Stransham-Ford v Minister of Justice and Correctional Services & Others1 handed down on 4 May 2015 in which the North Gauteng High Court granted, for the first time in South African legal history, an application allowing a terminally ill man the right to die and to be actively assisted to do so by a consenting physician; as well as (ii) the subsequent Supreme Court of Appeal decision in The Minister of Justice and Correctional Services & Others v Estate Late Stransham Ford2 that overturned the original decision. I argue that the best way to understand the socio-legal framework in which we find ourselves is as a social contract that ‘instantiates’ or ‘gives expression to’ a rights-based ethic, which in turn protects vital human interests. I argue further that this constitutional legal framework is capable of tracking and incorporating the positive ethical case for voluntary assisted suicide admirably. Finally, I posit that the quickest and most effective way to implement a permissive policy for voluntary assisted suicide is through the development of the common law. In the process, I tentatively suggest what appropriate safeguards and oversight of voluntary assisted suicide might look like, the practical implementation of which would allow South African society – specifically through the judicial branch of government - to more sagaciously and compassionately judge lives. / XL2018

Collection of papers submitted to the Faculty of Medicine, University of Cape Town, in fulfilment of the requirements of Part III of the Degree Master of Medicine in Psychiatry. / The following five papers are included in this collection. Paper 1. Flisher AJ, Joubert G, Yach D. Mortality from external causes in South African adolescents, 1984 - 1986. South African Medical Journal 1992; 81: 77-80. Paper 2. Flisher AJ, Chalton DO. High school dropouts in a working-class South African community: selected characteristics and risk-taking behaviour. Journal of Adolescence (in press). Paper 3. Flisher AJ, Roberts MM, Blignaut RJ. Youth attending Cape Peninsula day hospitals. Sexual behaviour and missed opportunities for contraception counselling. South African Medical Journal 1992; 82: 104-106. Paper 4. Flisher AJ, Parry CDH. Suicide in South Africa. An analysis of nationally registered mortality data for 1984-1986. Acta Psychiatrica Scandinavica (in press). Paper 5. Flisher AJ, Parry CDH, Bradshaw D, Juritz J. Suicide in South Africa - seasonal variation. Acta Psychiatrica Scandinavica (to be submitted) .

This study investigated the seasonal, monthly and weekly variation of fatal suicidal behaviour in Pietermaritzburg, as well as the relationship between fatal suicidal behaviour and climate. Secondary analysis was performed on suicide data collected for two unpublished honours theses. Results indicate that there is significant monthly variation in the distribution of fatal suicidal behaviour in Pietermaritzburg, with the expected spring-summer peak and winter trough . This pattern was more pronounced for adults than for the youth or the elderly. There was no significant variation in the weekly distribution of suicide, and suicides did not reach a peak on Monday as has been evidenced in previous research. Instead, the distribution showed a peak on Sunday with a steady decrease towards the end of the week. An increase in humidity, ambient temperature and minimum temperature was associated with an increase in suicide rates . Overall this relationship was stronger for violent, than non-violent suicide. However, a significant negative relationship was found between hours of sunshine and suicide, but this was only significant for non-violent suicide. This study was largely descriptive, and further research is indicated in order to develop a theoretical framework for understanding the temporal distribution of suicide . / Thesis (M.Soc.Sc.)-University of Natal, Pietermaritzburg, 2000.

Suicide rates have been relatively constant in Australia for over a hundred years, albeit peaking in 1997 and since returning towards historically average levels. Suicide now represents the commonest cause of violent deaths and exceeds deaths from motor vehicle accidents and armed conflict. There have been a number of national programs following the lead of Finland in the 1980s. Modern research has clearly demonstrated many of the risk factors, but they lack specificity in terms of prediction, and therefore the numbers needed to demonstrate the effectiveness of any intervention are particularly daunting. This makes research problematic and it is probably impossible to ever get Level 1 evidence because of the large numbers and expense required. Therefore many research studies are either epidemiologically oriented or directed to crisis care and treatment algorithms. Rural suicide presents particular challenges because of the increasing numbers of young and elderly men who take their lives, the lack of services available locally and the paucity of research in rural societies, with it usually being confined to examining risk factors and comparing them with urban populations. This thesis describes an approach to rural suicide which, whilst cognisant of the broad range of risk factors, was more directed to tackling poor mental health on a community basis, utilising local resources. It used four main approaches: educating the community to enhance mental health literacy by appreciating the causes of poor mental health; building the social capital or community capacity of existing resources; emphasising early identification and intervention of problems; and the establishment of a community child and adolescent program based in the local school, but with close liaison with the local medical practitioners. The educative approach to mental health literacy was to engage the whole community as widely as possible with special programs for general practitioners, nurses, and teachers; community capacity and social capital were increased by teaching the community warning signs, techniques to engage and refer to known entry points into the system; early identification was undertaken by screening for poor mental health within the doctors’ office, the hospital and the school; and a child and adolescent program was devised to detect dysfunctional students, formulate an assessment and management plan, and then evaluate the outcome. The most important results were a statistically significant reduction of suicides from twelve in ten years to one in the following decade, as well as a statistically significant reduction in the number of suicide attempts. In addition there was the establishment of a primary mental health service within the community which was independent of specific government finance and resources. / http://proxy.library.adelaide.edu.au/login?url= http://library.adelaide.edu.au/cgi-bin/Pwebrecon.cgi?BBID=1292809 / Thesis(M.D.)-- School of Medicine, 2007.

This pilot study aimed to contribute to the development of a methodology for researching various aspects of the relationship between HIV/AIDS and suicide in South Africa. To date, few systematic studies into this relationship have been conducted in South Africa. Specifically this study investigated the aspect of suicidal ideation in relation to HIV seroposivity, CD4 cell counts and social support. Although this study did not find increased suicidality in this sample of people living with HIV, the findings highlighted variables that may need to be studied in greater depth and outlined suggestions for further research methodology. Further research could indicate the extent to which suicide assessment and counselling is needed for people living with HIV/AIDS. This in turn could inform policy makers as to the inclusion of suicide assessment into the protocol for Voluntary Counselling and Testing (VCT). / Thesis (M.A.)-University of KwaZulu-Natal, Pietermaritzburg, 2007.

Considering the high incidence of suicide in the South African context, the fact that suicide is considered an occupational hazard for psychologists, with more than half experiencing the suicide of a patient in their career and the dearth of post-suicide qualitative research among psychologists, the purpose of this study is to explore and describe the experience of psychologists after the suicide of their patient, and to develop guidelines as a framework of reference to assist psychologists in dealing with the suicide of their patient. In keeping with a social constructionist ontological and ecosystemic epistemological theoretical framework, data was collected by means of meaning-making conversations with six purposively selected psychologists, with a minimum of five years‟ experience and at least one year having passed after the suicide of their patient. The data was analysed independently by the researcher and an independent coder using Tesch‟s open and descriptive method. The present study found that, following the suicide of their patient, the participants were propelled into a myriad of acutely distressing emotions. They often described a suffocating sense of responsibility for the suicide and the lingering presence of their patient. The participants experienced feelings of guilt and self-doubt, often questioning their own professional competence. The post-suicide process was described as being both a personally and professionally isolating event, due to the sense of having to carry the burden of the suicide alone for ethical reasons and fear of social stigmatisation. The participants appeared to grapple with the paradoxical dance between their personal emotional realities and what they perceived to be “clinically” or “professionally” acceptable. Having gone through the traumatic experience of losing a patient to suicide, most of the participants eventually found new wisdom, which helped them become wounded healers. Based on these findings, post-vention guidelines with practical actions were developed to assist psychologists in dealing with the suicide of their patient. Recommendations are made with regard to suicidology research, suicide education and psychologists‟ practice. / Psychology / M.A. (Clinical Psychology)

Thesis (MA (Psychology))--Stellenbosch University, 2008. / South Africa’s violence and injury death rates pandemic are steadily growing. Global estimates reported by the World Health Organisation (2000) have revealed that there is an increase in worldwide deaths. Approximately 5 million people die as a result of injuries each year and hundreds of thousands more are left physically or psychologically scarred (World Health Organisation, 2000). There are alarmingly high incidences of violence, crime and injury deaths in South Africa and the impact of these injury fatalities is imposing an immense burden on government, communities, families and even individuals. The burden of fatal injury mortalities has not fallen evenly. In South Africa, low socio-economic communities have borne the brunt of this epidemic. This study presents a focus on mortality and injury patterns and emerging problem areas for children and youth in a peri-urban setting. The aim of this study was to provide an overview of the fatal injury mortality and suicide data of children and youth in the Stellenbosch district, in order to develop a comprehensive understanding of the problem areas of injury deaths such as the main causes and consequences and age, sex, race and other pertinent comparisons. The study also aimed to consider the impact and relationship between alcohol abuse and youth injury deaths. Mortuary data were compiled from 591 children and youth cases for the period 2001-2005 in the Stellenbosch district using the National Injury Mortality Surveillance System data form. The present study highlighted several key findings. Transport-related deaths were indicated as a serious cause for concern among both children and youth in peri-urban settings. The importance of specific road safety awareness initiatives within peri-urban areas and among specific age groups were also indicated. Violence-related deaths were determined to be a leading cause of death among the older age groups in the youth category, with sharp force objects being the leading external cause of violent deaths. This highlighted an additional key finding reporting that sharp force objects death are a more serious cause for concern than firearm deaths in peri-urban areas, which challenges previous urban data. vi Burns and drowning were indicated as pertinent cause of unintentional deaths among both children and youth within peri-urban areas. This was suggested to be due to the high use of paraffin enabled heating systems in house in peri-urban areas and the lack of safety surrounding materials such as matches in the home. In addition, suffocation deaths among infants were also identified as a concern. Furthermore, the link between alcohol abuse among the youth age group was indicated by a key finding that alcohol is a prominent risk factor for fatal injury mortalities among youth. However more studies are needed to explore the effects and risks of other substances on youth fatal injury deaths. Several implications of the research findings are identified for health care professionals, policy developers, government departments and non-government organisations to consider in reducing the mortality rates of children and youth. These implications are critical in informing preventative interventions and initiatives aimed at enhancing safety to children and youth living in peri-urban areas within South Africa. vii

Considering the high incidence of suicide in the South African context, the fact that suicide is considered an occupational hazard for psychologists, with more than half experiencing the suicide of a patient in their career and the dearth of post-suicide qualitative research among psychologists, the purpose of this study is to explore and describe the experience of psychologists after the suicide of their patient, and to develop guidelines as a framework of reference to assist psychologists in dealing with the suicide of their patient. In keeping with a social constructionist ontological and ecosystemic epistemological theoretical framework, data was collected by means of meaning-making conversations with six purposively selected psychologists, with a minimum of five years‟ experience and at least one year having passed after the suicide of their patient. The data was analysed independently by the researcher and an independent coder using Tesch‟s open and descriptive method. The present study found that, following the suicide of their patient, the participants were propelled into a myriad of acutely distressing emotions. They often described a suffocating sense of responsibility for the suicide and the lingering presence of their patient. The participants experienced feelings of guilt and self-doubt, often questioning their own professional competence. The post-suicide process was described as being both a personally and professionally isolating event, due to the sense of having to carry the burden of the suicide alone for ethical reasons and fear of social stigmatisation. The participants appeared to grapple with the paradoxical dance between their personal emotional realities and what they perceived to be “clinically” or “professionally” acceptable. Having gone through the traumatic experience of losing a patient to suicide, most of the participants eventually found new wisdom, which helped them become wounded healers. Based on these findings, post-vention guidelines with practical actions were developed to assist psychologists in dealing with the suicide of their patient. Recommendations are made with regard to suicidology research, suicide education and psychologists‟ practice. / Psychology / M.A. (Clinical Psychology)