Suicide in a poor rural community in the Western Cape, South Africa: Experiences of five suicide attempters and their families.

International studies have documented the association between poverty, low education levels and poor mental health, including suicide attempts. Many farm worker communities in the Western Cape, South Africa, are exposed to poor living and working conditions throughout their lives. They also tend to suffer from chronic illness such as tuberculosis as well as widespread alcohol abuse. Many farm workers are also exposed to pesticides, which have been associated with affective disorders. Through in-depth, semi-structured interviews this qualitative study explored the life experiences of five suicide survivors and their carers to examine the factors that, according to them, predisposed them to and precipitated the suicide attempt. The impact of the suicide attempt on the family was also explored as well as shortcomings in terms of psychological support networks in the community. Contextual factors identified by the study participants that affected them included abject poverty as a result of unemployment and low education levels, childhood within dysfunctional family environments, early alcohol use and current alcohol dependence, previous and current interpersonal conflict and violence, a sense of hopelessness and the absence of coping mechanisms. Easy access to pesticides as a means for self-harm was also a common factor. Further research on the determinants of suicide attempts in this community is needed, as well as on effective and affordable interventions in remote and vulnerable communities such as these. Addressing structural problems would deal with the underlying reasons for suicidal feelings. In the meantime, shorter-term multisectoral interventions are needed by stakeholders such as government, civil society and faith-based organizations. These could include effective legislation and policies that regulate working and living conditions of farm workers, appropriate mental health care interventions, educational workshops, and nutrition schemes that address the unique needs of rural farming communities.