Typologies of suicidality and suicide presenting to a prehospital South African Emergency Medical Service: a retrospective cross-sectional analysis

Typologies of suicidality and suicide presenting to... | F1000Research "use strict";function _typeof(t){return(_typeof="function"==typeof Symbol&&"symbol"==typeof Symbol.iterator?function(t){return typeof t}:function(t){return t&&"function"==typeof Symbol&&t.constructor===Symbol&&t!==Symbol.prototype?"symbol":typeof t})(t)}!function(){var t=function(){var t,e,o=[],n=window,r=n;for(;r;){try{if(r.frames.__tcfapiLocator){t=r;break}}catch(t){}if(r===n.top)break;r=r.parent}t||(!function t(){var e=n.document,o=!!n.frames.__tcfapiLocator;if(!o)if(e.body){var r=e.createElement("iframe");r.style.cssText="display:none",r.name="__tcfapiLocator",e.body.appendChild(r)}else setTimeout(t,5);return!o}(),n.__tcfapi=function(){for(var t=arguments.length,n=new Array(t),r=0;r 3&&2===parseInt(n[1],10)&&"boolean"==typeof n[3]&&(e=n[3],"function"==typeof n[2]&&n[2]("set",!0)):"ping"===n[0]?"function"==typeof n[2]&&n[2]({gdprApplies:e,cmpLoaded:!1,cmpStatus:"stub"}):o.push(n)},n.addEventListener("message",(function(t){var e="string"==typeof t.data,o={};if(e)try{o=JSON.parse(t.data)}catch(t){}else o=t.data;var n="object"===_typeof(o)&&null!==o?o.__tcfapiCall:null;n&&window.__tcfapi(n.command,n.version,(function(o,r){var a={__tcfapiReturn:{returnValue:o,success:r,callId:n.callId}};t&&t.source&&t.source.postMessage&&t.source.postMessage(e?JSON.stringify(a):a,"*")}),n.parameter)}),!1))};"undefined"!=typeof module?module.exports=t:t()}(); dataLayer = dataLayer || []; // Standard GTM initialization - Google Consent Mode handles consent automatically (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start': new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0], j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src= 'https://www.googletagmanager.com/gtm.js?id='+i+dl+ '>m_auth=hzk0Vc3qFsQYhCrIoHz68A>m_preview=env-1>m_cookies_win=x';f.parentNode.insertBefore(j,f); })(window,document,'script','dataLayer','GTM-MWFK8L5J'); ;window.NREUM||(NREUM={});NREUM.init={distributed_tracing:{enabled:true},privacy:{cookies_enabled:true},ajax:{deny_list:["bam.nr-data.net"]}}; ;NREUM.loader_config={accountID:"438030",trustKey:"438030",agentID:"772317073",licenseKey:"97f8f67f26",applicationID:"772317073"} ;NREUM.info={beacon:"bam.nr-data.net",errorBeacon:"bam.nr-data.net",licenseKey:"97f8f67f26",applicationID:"772317073",sa:1} ;/*! For license information please see nr-loader-spa-1.236.0.min.js.LICENSE.txt */ (()=>{"use strict";var e,t,r={5763:(e,t,r)=>{r.d(t,{P_:()=>l,Mt:()=>g,C5:()=>s,DL:()=>v,OP:()=>T,lF:()=>D,Yu:()=>y,Dg:()=>h,CX:()=>c,GE:()=>b,sU:()=>_});var n=r(8632),i=r(9567);const o={beacon:n.ce.beacon,errorBeacon:n.ce.errorBeacon,licenseKey:void 0,applicationID:void 0,sa:void 0,queueTime:void 0,applicationTime:void 0,ttGuid:void 0,user:void 0,account:void 0,product:void 0,extra:void 0,jsAttributes:{},userAttributes:void 0,atts:void 0,transactionName:void 0,tNamePlain:void 0},a={};function s(e){if(!e)throw new Error("All info objects require an agent identifier!");if(!a[e])throw new Error("Info for ".concat(e," was never set"));return a[e]}function c(e,t){if(!e)throw new Error("All info objects require an agent identifier!");a[e]=(0,i.D)(t,o),(0,n.Qy)(e,a[e],"info")}var u=r(7056);const d=()=>{const e={blockSelector:"[data-nr-block]",maskInputOptions:{password:!0}};return{allow_bfcache:!0,privacy:{cookies_enabled:!0},ajax:{deny_list:void 0,enabled:!0,harvestTimeSeconds:10},distributed_tracing:{enabled:void 0,exclude_newrelic_header:void 0,cors_use_newrelic_header:void 0,cors_use_tracecontext_headers:void 0,allowed_origins:void 0},session:{domain:void 0,expiresMs:u.oD,inactiveMs:u.Hb},ssl:void 0,obfuscate:void 0,jserrors:{enabled:!0,harvestTimeSeconds:10},metrics:{enabled:!0},page_action:{enabled:!0,harvestTimeSeconds:30},page_view_event:{enabled:!0},page_view_timing:{enabled:!0,harvestTimeSeconds:30,long_task:!1},session_trace:{enabled:!0,harvestTimeSeconds:10},harvest:{tooManyRequestsDelay:60},session_replay:{enabled:!1,harvestTimeSeconds:60,sampleRate:.1,errorSampleRate:.1,maskTextSelector:"*",maskAllInputs:!0,get blockClass(){return"nr-block"},get ignoreClass(){return"nr-ignore"},get maskTextClass(){return"nr-mask"},get blockSelector(){return e.blockSelector},set blockSelector(t){e.blockSelector+=",".concat(t)},get maskInputOptions(){return e.maskInputOptions},set maskInputOptions(t){e.maskInputOptions={...t,password:!0}}},spa:{enabled:!0,harvestTimeSeconds:10}}},f={};function l(e){if(!e)throw new Error("All configuration objects require an agent identifier!");if(!f[e])throw new Error("Configuration for ".concat(e," was never set"));return f[e]}function h(e,t){if(!e)throw new Error("All configuration objects require an agent identifier!");f[e]=(0,i.D)(t,d()),(0,n.Qy)(e,f[e],"config")}function g(e,t){if(!e)throw new Error("All configuration objects require an agent identifier!");var r=l(e);if(r){for(var n=t.split("."),i=0;i {r.d(t,{D:()=>i});var n=r(50);function i(e,t){try{if(!e||"object"!=typeof e)return(0,n.Z)("Setting a Configurable requires an object as input");if(!t||"object"!=typeof t)return(0,n.Z)("Setting a Configurable requires a model to set its initial properties");const r=Object.create(Object.getPrototypeOf(t),Object.getOwnPropertyDescriptors(t)),o=0===Object.keys(r).length?e:r;for(let a in o)if(void 0!==e[a])try{"object"==typeof e[a]&&"object"==typeof t[a]?r[a]=i(e[a],t[a]):r[a]=e[a]}catch(e){(0,n.Z)("An error occurred while setting a property of a Configurable",e)}return r}catch(e){(0,n.Z)("An error occured while setting a Configurable",e)}}},6818:(e,t,r)=>{r.d(t,{Re:()=>i,gF:()=>o,q4:()=>n});const n="1.236.0",i="PROD",o="CDN"},385:(e,t,r)=>{r.d(t,{FN:()=>a,IF:()=>u,Nk:()=>f,Tt:()=>s,_A:()=>o,il:()=>n,pL:()=>c,v6:()=>i,w1:()=>d});const n="undefined"!=typeof window&&!!window.document,i="undefined"!=typeof WorkerGlobalScope&&("undefined"!=typeof self&&self instanceof WorkerGlobalScope&&self.navigator instanceof WorkerNavigator||"undefined"!=typeof globalThis&&globalThis instanceof WorkerGlobalScope&&globalThis.navigator instanceof WorkerNavigator),o=n?window:"undefined"!=typeof WorkerGlobalScope&&("undefined"!=typeof self&&self instanceof WorkerGlobalScope&&self||"undefined"!=typeof globalThis&&globalThis instanceof WorkerGlobalScope&&globalThis),a=""+o?.location,s=/iPad|iPhone|iPod/.test(navigator.userAgent),c=s&&"undefined"==typeof SharedWorker,u=(()=>{const e=navigator.userAgent.match(/Firefox[/\s](\d+\.\d+)/);return Array.isArray(e)&&e.length>=2?+e[1]:0})(),d=Boolean(n&&window.document.documentMode),f=!!navigator.sendBeacon},1117:(e,t,r)=>{r.d(t,{w:()=>o});var n=r(50);const i={agentIdentifier:"",ee:void 0};class o{constructor(e){try{if("object"!=typeof e)return(0,n.Z)("shared context requires an object as input");this.sharedContext={},Object.assign(this.sharedContext,i),Object.entries(e).forEach((e=>{let[t,r]=e;Object.keys(i).includes(t)&&(this.sharedContext[t]=r)}))}catch(e){(0,n.Z)("An error occured while setting SharedContext",e)}}}},8e3:(e,t,r)=>{r.d(t,{L:()=>d,R:()=>c});var n=r(2177),i=r(1284),o=r(4322),a=r(3325);const s={};function c(e,t){const r={staged:!1,priority:a.p[t]||0};u(e),s[e].get(t)||s[e].set(t,r)}function u(e){e&&(s[e]||(s[e]=new Map))}function d(){let e=arguments.length>0&&void 0!==arguments[0]?arguments[0]:"",t=arguments.length>1&&void 0!==arguments[1]?arguments[1]:"feature";if(u(e),!e||!s[e].get(t))return a(t);s[e].get(t).staged=!0;const r=[...s[e]];function a(t){const r=e?n.ee.get(e):n.ee,a=o.X.handlers;if(r.backlog&&a){var s=r.backlog[t],c=a[t];if(c){for(var u=0;s&&u {let[t,r]=e;return r.staged}))&&(r.sort(((e,t)=>e[1].priority-t[1].priority)),r.forEach((e=>{let[t]=e;a(t)})))}function f(e,t){var r=e[1];(0,i.D)(t[r],(function(t,r){var n=e[0];if(r[0]===n){var i=r[1],o=e[3],a=e[2];i.apply(o,a)}}))}},2177:(e,t,r)=>{r.d(t,{c:()=>f,ee:()=>u});var n=r(8632),i=r(2210),o=r(1284),a=r(5763),s="nr@context";let c=(0,n.fP)();var u;function d(){}function f(e){return(0,i.X)(e,s,l)}function l(){return new d}function h(){u.aborted=!0,u.backlog={}}c.ee?u=c.ee:(u=function e(t,r){var n={},c={},f={},g=!1;try{g=16===r.length&&(0,a.OP)(r).isolatedBacklog}catch(e){}var p={on:b,addEventListener:b,removeEventListener:y,emit:v,get:x,listeners:w,context:m,buffer:A,abort:h,aborted:!1,isBuffering:E,debugId:r,backlog:g?{}:t&&"object"==typeof t.backlog?t.backlog:{}};return p;function m(e){return e&&e instanceof d?e:e?(0,i.X)(e,s,l):l()}function v(e,r,n,i,o){if(!1!==o&&(o=!0),!u.aborted||i){t&&o&&t.emit(e,r,n);for(var a=m(n),s=w(e),d=s.length,f=0;fn,p:()=>i});var n=r(2177).ee.get("handle");function i(e,t,r,i,o){o?(o.buffer([e],i),o.emit(e,t,r)):(n.buffer([e],i),n.emit(e,t,r))}},4322:(e,t,r)=>{r.d(t,{X:()=>o});var n=r(5546);o.on=a;var i=o.handlers={};function o(e,t,r,o){a(o||n.E,i,e,t,r)}function a(e,t,r,i,o){o||(o="feature"),e||(e=n.E);var a=t[o]=t[o]||{};(a[r]=a[r]||[]).push([e,i])}},3239:(e,t,r)=>{r.d(t,{bP:()=>s,iz:()=>c,m$:()=>a});var n=r(385);let i=!1,o=!1;try{const e={get passive(){return i=!0,!1},get signal(){return o=!0,!1}};n._A.addEventListener("test",null,e),n._A.removeEventListener("test",null,e)}catch(e){}function a(e,t){return i||o?{capture:!!e,passive:i,signal:t}:!!e}function s(e,t){let r=arguments.length>2&&void 0!==arguments[2]&&arguments[2],n=arguments.length>3?arguments[3]:void 0;window.addEventListener(e,t,a(r,n))}function c(e,t){let r=arguments.length>2&&void 0!==arguments[2]&&arguments[2],n=arguments.length>3?arguments[3]:void 0;document.addEventListener(e,t,a(r,n))}},4402:(e,t,r)=>{r.d(t,{Ht:()=>u,M:()=>c,Rl:()=>a,ky:()=>s});var n=r(385);const i="xxxxxxxx-xxxx-4xxx-yxxx-xxxxxxxxxxxx";function o(e,t){return e?15&e[t]:16*Math.random()|0}function a(){const e=n._A?.crypto||n._A?.msCrypto;let t,r=0;return e&&e.getRandomValues&&(t=e.getRandomValues(new Uint8Array(31))),i.split("").map((e=>"x"===e?o(t,++r).toString(16):"y"===e?(3&o()|8).toString(16):e)).join("")}function s(e){const t=n._A?.crypto||n._A?.msCrypto;let r,i=0;t&&t.getRandomValues&&(r=t.getRandomValues(new Uint8Array(31)));const a=[];for(var s=0;s {r.d(t,{Bq:()=>n,Hb:()=>o,oD:()=>i});const n="NRBA",i=144e5,o=18e5},7894:(e,t,r)=>{function n(){return Math.round(performance.now())}r.d(t,{z:()=>n})},7243:(e,t,r)=>{r.d(t,{e:()=>o});var n=r(385),i={};function o(e){if(e in i)return i[e];if(0===(e||"").indexOf("data:"))return{protocol:"data"};let t;var r=n._A?.location,o={};if(n.il)t=document.createElement("a"),t.href=e;else try{t=new URL(e,r.href)}catch(e){return o}o.port=t.port;var a=t.href.split("://");!o.port&&a[1]&&(o.port=a[1].split("/")[0].split("@").pop().split(":")[1]),o.port&&"0"!==o.port||(o.port="https"===a[0]?"443":"80"),o.hostname=t.hostname||r.hostname,o.pathname=t.pathname,o.protocol=a[0],"/"!==o.pathname.charAt(0)&&(o.pathname="/"+o.pathname);var s=!t.protocol||":"===t.protocol||t.protocol===r.protocol,c=t.hostname===r.hostname&&t.port===r.port;return o.sameOrigin=s&&(!t.hostname||c),"/"===o.pathname&&(i[e]=o),o}},50:(e,t,r)=>{function n(e,t){"function"==typeof console.warn&&(console.warn("New Relic: ".concat(e)),t&&console.warn(t))}r.d(t,{Z:()=>n})},2587:(e,t,r)=>{r.d(t,{N:()=>c,T:()=>u});var n=r(2177),i=r(5546),o=r(8e3),a=r(3325);const s={stn:[a.D.sessionTrace],err:[a.D.jserrors,a.D.metrics],ins:[a.D.pageAction],spa:[a.D.spa],sr:[a.D.sessionReplay,a.D.sessionTrace]};function c(e,t){const r=n.ee.get(t);e&&"object"==typeof e&&(Object.entries(e).forEach((e=>{let[t,n]=e;void 0===u[t]&&(s[t]?s[t].forEach((e=>{n?(0,i.p)("feat-"+t,[],void 0,e,r):(0,i.p)("block-"+t,[],void 0,e,r),(0,i.p)("rumresp-"+t,[Boolean(n)],void 0,e,r)})):n&&(0,i.p)("feat-"+t,[],void 0,void 0,r),u[t]=Boolean(n))})),Object.keys(s).forEach((e=>{void 0===u[e]&&(s[e]?.forEach((t=>(0,i.p)("rumresp-"+e,[!1],void 0,t,r))),u[e]=!1)})),(0,o.L)(t,a.D.pageViewEvent))}const u={}},2210:(e,t,r)=>{r.d(t,{X:()=>i});var n=Object.prototype.hasOwnProperty;function i(e,t,r){if(n.call(e,t))return e[t];var i=r();if(Object.defineProperty&&Object.keys)try{return Object.defineProperty(e,t,{value:i,writable:!0,enumerable:!1}),i}catch(e){}return e[t]=i,i}},1284:(e,t,r)=>{r.d(t,{D:()=>n});const n=(e,t)=>Object.entries(e||{}).map((e=>{let[r,n]=e;return t(r,n)}))},4351:(e,t,r)=>{r.d(t,{P:()=>o});var n=r(2177);const i=()=>{const e=new WeakSet;return(t,r)=>{if("object"==typeof r&&null!==r){if(e.has(r))return;e.add(r)}return r}};function o(e){try{return JSON.stringify(e,i())}catch(e){try{n.ee.emit("internal-error",[e])}catch(e){}}}},3960:(e,t,r)=>{r.d(t,{K:()=>a,b:()=>o});var n=r(3239);function i(){return"undefined"==typeof document||"complete"===document.readyState}function o(e,t){if(i())return e();(0,n.bP)("load",e,t)}function a(e){if(i())return e();(0,n.iz)("DOMContentLoaded",e)}},8632:(e,t,r)=>{r.d(t,{EZ:()=>u,Qy:()=>c,ce:()=>o,fP:()=>a,gG:()=>d,mF:()=>s});var n=r(7894),i=r(385);const o={beacon:"bam.nr-data.net",errorBeacon:"bam.nr-data.net"};function a(){return i._A.NREUM||(i._A.NREUM={}),void 0===i._A.newrelic&&(i._A.newrelic=i._A.NREUM),i._A.NREUM}function s(){let e=a();return e.o||(e.o={ST:i._A.setTimeout,SI:i._A.setImmediate,CT:i._A.clearTimeout,XHR:i._A.XMLHttpRequest,REQ:i._A.Request,EV:i._A.Event,PR:i._A.Promise,MO:i._A.MutationObserver,FETCH:i._A.fetch}),e}function c(e,t,r){let i=a();const o=i.initializedAgents||{},s=o[e]||{};return Object.keys(s).length||(s.initializedAt={ms:(0,n.z)(),date:new Date}),i.initializedAgents={...o,[e]:{...s,[r]:t}},i}function u(e,t){a()[e]=t}function d(){return function(){let e=a();const t=e.info||{};e.info={beacon:o.beacon,errorBeacon:o.errorBeacon,...t}}(),function(){let e=a();const t=e.init||{};e.init={...t}}(),s(),function(){let e=a();const t=e.loader_config||{};e.loader_config={...t}}(),a()}},7956:(e,t,r)=>{r.d(t,{N:()=>i});var n=r(3239);function i(e){let t=arguments.length>1&&void 0!==arguments[1]&&arguments[1],r=arguments.length>2?arguments[2]:void 0,i=arguments.length>3?arguments[3]:void 0;return void(0,n.iz)("visibilitychange",(function(){if(t)return void("hidden"==document.visibilityState&&e());e(document.visibilityState)}),r,i)}},1214:(e,t,r)=>{r.d(t,{em:()=>v,u5:()=>N,QU:()=>S,_L:()=>I,Gm:()=>L,Lg:()=>M,gy:()=>U,BV:()=>Q,Kf:()=>ee});var n=r(2177);const i="nr@original";var o=Object.prototype.hasOwnProperty,a=!1;function s(e,t){return e||(e=n.ee),r.inPlace=function(e,t,n,i,o){n||(n="");var a,s,c,u="-"===n.charAt(0);for(c=0;c 2?n-2:0),o=2;o {r(A[T],e,w),r(E[T],e,w)})),r(l._A,"fetch",y),t.on(y+"end",(function(e,r){var n=this;if(r){var i=r.headers.get("content-length");null!==i&&(n.rxSize=i),t.emit(y+"done",[null,r],n)}else t.emit(y+"done",[e],n)})),t}const O={},j=["pushState","replaceState"];function S(e){const t=function(e){return(e||n.ee).get("history")}(e);return!l.il||O[t.debugId]++||(O[t.debugId]=1,s(t).inPlace(window.history,j,"-")),t}var P=r(3239);const C={},R=["appendChild","insertBefore","replaceChild"];function I(e){const t=function(e){return(e||n.ee).get("jsonp")}(e);if(!l.il||C[t.debugId])return t;C[t.debugId]=!0;var r=s(t),i=/[?&](?:callback|cb)=([^&#]+)/,o=/(.*)\.([^.]+)/,a=/^(\w+)(\.|$)(.*)$/;function c(e,t){var r=e.match(a),n=r[1],i=r[3];return i?c(i,t[n]):t[n]}return r.inPlace(Node.prototype,R,"dom-"),t.on("dom-start",(function(e){!function(e){if(!e||"string"!=typeof e.nodeName||"script"!==e.nodeName.toLowerCase())return;if("function"!=typeof e.addEventListener)return;var n=(a=e.src,s=a.match(i),s?s[1]:null);var a,s;if(!n)return;var u=function(e){var t=e.match(o);if(t&&t.length>=3)return{key:t[2],parent:c(t[1],window)};return{key:e,parent:window}}(n);if("function"!=typeof u.parent[u.key])return;var d={};function f(){t.emit("jsonp-end",[],d),e.removeEventListener("load",f,(0,P.m$)(!1)),e.removeEventListener("error",l,(0,P.m$)(!1))}function l(){t.emit("jsonp-error",[],d),t.emit("jsonp-end",[],d),e.removeEventListener("load",f,(0,P.m$)(!1)),e.removeEventListener("error",l,(0,P.m$)(!1))}r.inPlace(u.parent,[u.key],"cb-",d),e.addEventListener("load",f,(0,P.m$)(!1)),e.addEventListener("error",l,(0,P.m$)(!1)),t.emit("new-jsonp",[e.src],d)}(e[0])})),t}var k=r(5763);const H={};function L(e){const t=function(e){return(e||n.ee).get("mutation")}(e);if(!l.il||H[t.debugId])return t;H[t.debugId]=!0;var r=s(t),i=k.Yu.MO;return i&&(window.MutationObserver=function(e){return this instanceof i?new i(r(e,"fn-")):i.apply(this,arguments)},MutationObserver.prototype=i.prototype),t}const z={};function M(e){const t=function(e){return(e||n.ee).get("promise")}(e);if(z[t.debugId])return t;z[t.debugId]=!0;var r=n.c,o=s(t),a=k.Yu.PR;return a&&function(){function e(r){var n=t.context(),i=o(r,"executor-",n,null,!1);const s=Reflect.construct(a,[i],e);return t.context(s).getCtx=function(){return n},s}l._A.Promise=e,Object.defineProperty(e,"name",{value:"Promise"}),e.toString=function(){return a.toString()},Object.setPrototypeOf(e,a),["all","race"].forEach((function(r){const n=a[r];e[r]=function(e){let i=!1;[...e||[]].forEach((e=>{this.resolve(e).then(a("all"===r),a(!1))}));const o=n.apply(this,arguments);return o;function a(e){return function(){t.emit("propagate",[null,!i],o,!1,!1),i=i||!e}}}})),["resolve","reject"].forEach((function(r){const n=a[r];e[r]=function(e){const r=n.apply(this,arguments);return e!==r&&t.emit("propagate",[e,!0],r,!1,!1),r}})),e.prototype=a.prototype;const n=a.prototype.then;a.prototype.then=function(){var e=this,i=r(e);i.promise=e;for(var a=arguments.length,s=new Array(a),c=0;c e())),t};function m(e,t){i.inPlace(t,["onreadystatechange"],"fn-",E)}function b(){var e=this,t=r.context(e);e.readyState>3&&!t.resolved&&(t.resolved=!0,r.emit("xhr-resolved",[],e)),i.inPlace(e,f,"fn-",E)}if(function(e,t){for(var r in e)t[r]=e[r]}(o,p),p.prototype=o.prototype,i.inPlace(p.prototype,J,"-xhr-",E),r.on("send-xhr-start",(function(e,t){m(e,t),function(e){h.push(e),a&&(y?y.then(A):u?u(A):(w=-w,x.data=w))}(t)})),r.on("open-xhr-start",m),a){var y=c&&c.resolve();if(!u&&!c){var w=1,x=document.createTextNode(w);new a(A).observe(x,{characterData:!0})}}else t.on("fn-end",(function(e){e[0]&&e[0].type===d||A()}));function A(){for(var e=0;e {r.d(t,{t:()=>n});const n=r(3325).D.ajax},6660:(e,t,r)=>{r.d(t,{A:()=>i,t:()=>n});const n=r(3325).D.jserrors,i="nr@seenError"},3081:(e,t,r)=>{r.d(t,{gF:()=>o,mY:()=>i,t9:()=>n,vz:()=>s,xS:()=>a});const n=r(3325).D.metrics,i="sm",o="cm",a="storeSupportabilityMetrics",s="storeEventMetrics"},4649:(e,t,r)=>{r.d(t,{t:()=>n});const n=r(3325).D.pageAction},7633:(e,t,r)=>{r.d(t,{Dz:()=>i,OJ:()=>a,qw:()=>o,t9:()=>n});const n=r(3325).D.pageViewEvent,i="firstbyte",o="domcontent",a="windowload"},9251:(e,t,r)=>{r.d(t,{t:()=>n});const n=r(3325).D.pageViewTiming},3614:(e,t,r)=>{r.d(t,{BST_RESOURCE:()=>i,END:()=>s,FEATURE_NAME:()=>n,FN_END:()=>u,FN_START:()=>c,PUSH_STATE:()=>d,RESOURCE:()=>o,START:()=>a});const n=r(3325).D.sessionTrace,i="bstResource",o="resource",a="-start",s="-end",c="fn"+a,u="fn"+s,d="pushState"},7836:(e,t,r)=>{r.d(t,{BODY:()=>A,CB_END:()=>E,CB_START:()=>u,END:()=>x,FEATURE_NAME:()=>i,FETCH:()=>_,FETCH_BODY:()=>v,FETCH_DONE:()=>m,FETCH_START:()=>p,FN_END:()=>c,FN_START:()=>s,INTERACTION:()=>l,INTERACTION_API:()=>d,INTERACTION_EVENTS:()=>o,JSONP_END:()=>b,JSONP_NODE:()=>g,JS_TIME:()=>T,MAX_TIMER_BUDGET:()=>a,REMAINING:()=>f,SPA_NODE:()=>h,START:()=>w,originalSetTimeout:()=>y});var n=r(5763);const i=r(3325).D.spa,o=["click","submit","keypress","keydown","keyup","change"],a=999,s="fn-start",c="fn-end",u="cb-start",d="api-ixn-",f="remaining",l="interaction",h="spaNode",g="jsonpNode",p="fetch-start",m="fetch-done",v="fetch-body-",b="jsonp-end",y=n.Yu.ST,w="-start",x="-end",A="-body",E="cb"+x,T="jsTime",_="fetch"},5938:(e,t,r)=>{r.d(t,{W:()=>o});var n=r(5763),i=r(2177);class o{constructor(e,t,r){this.agentIdentifier=e,this.aggregator=t,this.ee=i.ee.get(e,(0,n.OP)(this.agentIdentifier).isolatedBacklog),this.featureName=r,this.blocked=!1}}},9144:(e,t,r)=>{r.d(t,{j:()=>m});var n=r(3325),i=r(5763),o=r(5546),a=r(2177),s=r(7894),c=r(8e3),u=r(3960),d=r(385),f=r(50),l=r(3081),h=r(8632);function g(){const e=(0,h.gG)();["setErrorHandler","finished","addToTrace","inlineHit","addRelease","addPageAction","setCurrentRouteName","setPageViewName","setCustomAttribute","interaction","noticeError","setUserId"].forEach((t=>{e[t]=function(){for(var r=arguments.length,n=new Array(r),i=0;i 1?r-1:0),i=1;i {e.exposed&&e.api[t]&&o.push(e.api[t](...n))})),o.length>1?o:o[0]}(t,...n)}}))}var p=r(2587);function m(e){let t=arguments.length>1&&void 0!==arguments[1]?arguments[1]:{},m=arguments.length>2?arguments[2]:void 0,v=arguments.length>3?arguments[3]:void 0,{init:b,info:y,loader_config:w,runtime:x={loaderType:m},exposed:A=!0}=t;const E=(0,h.gG)();y||(b=E.init,y=E.info,w=E.loader_config),(0,i.Dg)(e,b||{}),(0,i.GE)(e,w||{}),(0,i.sU)(e,x),y.jsAttributes??={},d.v6&&(y.jsAttributes.isWorker=!0),(0,i.CX)(e,y),g();const T=function(e,t){t||(0,c.R)(e,"api");const h={};var g=a.ee.get(e),p=g.get("tracer"),m="api-",v=m+"ixn-";function b(t,r,n,o){const a=(0,i.C5)(e);return null===r?delete a.jsAttributes[t]:(0,i.CX)(e,{...a,jsAttributes:{...a.jsAttributes,[t]:r}}),x(m,n,!0,o||null===r?"session":void 0)(t,r)}function y(){}["setErrorHandler","finished","addToTrace","inlineHit","addRelease"].forEach((e=>h[e]=x(m,e,!0,"api"))),h.addPageAction=x(m,"addPageAction",!0,n.D.pageAction),h.setCurrentRouteName=x(m,"routeName",!0,n.D.spa),h.setPageViewName=function(t,r){if("string"==typeof t)return"/"!==t.charAt(0)&&(t="/"+t),(0,i.OP)(e).customTransaction=(r||"http://custom.transaction")+t,x(m,"setPageViewName",!0)()},h.setCustomAttribute=function(e,t){let r=arguments.length>2&&void 0!==arguments[2]&&arguments[2];if("string"==typeof e){if(["string","number"].includes(typeof t)||null===t)return b(e,t,"setCustomAttribute",r);(0,f.Z)("Failed to execute setCustomAttribute.\nNon-null value must be a string or number type, but a type of was provided."))}else(0,f.Z)("Failed to execute setCustomAttribute.\nName must be a string type, but a type of was provided."))},h.setUserId=function(e){if("string"==typeof e||null===e)return b("enduser.id",e,"setUserId",!0);(0,f.Z)("Failed to execute setUserId.\nNon-null value must be a string type, but a type of was provided."))},h.interaction=function(){return(new y).get()};var w=y.prototype={createTracer:function(e,t){var r={},i=this,a="function"==typeof t;return(0,o.p)(v+"tracer",[(0,s.z)(),e,r],i,n.D.spa,g),function(){if(p.emit((a?"":"no-")+"fn-start",[(0,s.z)(),i,a],r),a)try{return t.apply(this,arguments)}catch(e){throw p.emit("fn-err",[arguments,this,"string"==typeof e?new Error(e):e],r),e}finally{p.emit("fn-end",[(0,s.z)()],r)}}}};function x(e,t,r,i){return function(){return(0,o.p)(l.xS,["API/"+t+"/called"],void 0,n.D.metrics,g),i&&(0,o.p)(e+t,[(0,s.z)(),...arguments],r?null:this,i,g),r?void 0:this}}function A(){r.e(439).then(r.bind(r,7438)).then((t=>{let{setAPI:r}=t;r(e),(0,c.L)(e,"api")})).catch((()=>(0,f.Z)("Downloading runtime APIs failed...")))}return["actionText","setName","setAttribute","save","ignore","onEnd","getContext","end","get"].forEach((e=>{w[e]=x(v,e,void 0,n.D.spa)})),h.noticeError=function(e,t){"string"==typeof e&&(e=new Error(e)),(0,o.p)(l.xS,["API/noticeError/called"],void 0,n.D.metrics,g),(0,o.p)("err",[e,(0,s.z)(),!1,t],void 0,n.D.jserrors,g)},d.il?(0,u.b)((()=>A()),!0):A(),h}(e,v);return(0,h.Qy)(e,T,"api"),(0,h.Qy)(e,A,"exposed"),(0,h.EZ)("activatedFeatures",p.T),T}},3325:(e,t,r)=>{r.d(t,{D:()=>n,p:()=>i});const n={ajax:"ajax",jserrors:"jserrors",metrics:"metrics",pageAction:"page_action",pageViewEvent:"page_view_event",pageViewTiming:"page_view_timing",sessionReplay:"session_replay",sessionTrace:"session_trace",spa:"spa"},i={[n.pageViewEvent]:1,[n.pageViewTiming]:2,[n.metrics]:3,[n.jserrors]:4,[n.ajax]:5,[n.sessionTrace]:6,[n.pageAction]:7,[n.spa]:8,[n.sessionReplay]:9}}},n={};function i(e){var t=n[e];if(void 0!==t)return t.exports;var o=n[e]={exports:{}};return r[e](o,o.exports,i),o.exports}i.m=r,i.d=(e,t)=>{for(var r in t)i.o(t,r)&&!i.o(e,r)&&Object.defineProperty(e,r,{enumerable:!0,get:t[r]})},i.f={},i.e=e=>Promise.all(Object.keys(i.f).reduce(((t,r)=>(i.f[r](e,t),t)),[])),i.u=e=>(({78:"page_action-aggregate",147:"metrics-aggregate",242:"session-manager",317:"jserrors-aggregate",348:"page_view_timing-aggregate",412:"lazy-feature-loader",439:"async-api",538:"recorder",590:"session_replay-aggregate",675:"compressor",733:"session_trace-aggregate",786:"page_view_event-aggregate",873:"spa-aggregate",898:"ajax-aggregate"}[e]||e)+"."+{78:"ac76d497",147:"3dc53903",148:"1a20d5fe",242:"2a64278a",317:"49e41428",348:"bd6de33a",412:"2f55ce66",439:"30bd804e",538:"1b18459f",590:"cf0efb30",675:"ae9f91a8",733:"83105561",786:"06482edd",860:"03a8b7a5",873:"e6b09d52",898:"998ef92b"}[e]+"-1.236.0.min.js"),i.o=(e,t)=>Object.prototype.hasOwnProperty.call(e,t),e={},t="NRBA:",i.l=(r,n,o,a)=>{if(e[r])e[r].push(n);else{var s,c;if(void 0!==o)for(var u=document.getElementsByTagName("script"),d=0;d {s.onerror=s.onload=null,clearTimeout(h);var i=e[r];if(delete e[r],s.parentNode&&s.parentNode.removeChild(s),i&&i.forEach((e=>e(n))),t)return t(n)},h=setTimeout(l.bind(null,void 0,{type:"timeout",target:s}),12e4);s.onerror=l.bind(null,s.onerror),s.onload=l.bind(null,s.onload),c&&document.head.appendChild(s)}},i.r=e=>{"undefined"!=typeof Symbol&&Symbol.toStringTag&&Object.defineProperty(e,Symbol.toStringTag,{value:"Module"}),Object.defineProperty(e,"__esModule",{value:!0})},i.j=364,i.p="https://js-agent.newrelic.com/",(()=>{var e={364:0,953:0};i.f.j=(t,r)=>{var n=i.o(e,t)?e[t]:void 0;if(0!==n)if(n)r.push(n[2]);else{var o=new Promise(((r,i)=>n=e[t]=[r,i]));r.push(n[2]=o);var a=i.p+i.u(t),s=new Error;i.l(a,(r=>{if(i.o(e,t)&&(0!==(n=e[t])&&(e[t]=void 0),n)){var o=r&&("load"===r.type?"missing":r.type),a=r&&r.target&&r.target.src;s.message="Loading chunk "+t+" failed.\n("+o+": "+a+")",s.name="ChunkLoadError",s.type=o,s.request=a,n[1](s)}}),"chunk-"+t,t)}};var t=(t,r)=>{var n,o,[a,s,c]=r,u=0;if(a.some((t=>0!==e[t]))){for(n in s)i.o(s,n)&&(i.m[n]=s[n]);if(c)c(i)}for(t&&t(r);u {i.r(o);var e=i(3325),t=i(5763);const r=Object.values(e.D);function n(e){const n={};return r.forEach((r=>{n[r]=function(e,r){return!1!==(0,t.Mt)(r,"".concat(e,".enabled"))}(r,e)})),n}var a=i(9144);var s=i(5546),c=i(385),u=i(8e3),d=i(5938),f=i(3960),l=i(50);class h extends d.W{constructor(e,t,r){let n=!(arguments.length>3&&void 0!==arguments[3])||arguments[3];super(e,t,r),this.auto=n,this.abortHandler,this.featAggregate,this.onAggregateImported,n&&(0,u.R)(e,r)}importAggregator(){let e=arguments.length>0&&void 0!==arguments[0]?arguments[0]:{};if(this.featAggregate||!this.auto)return;const r=c.il&&!0===(0,t.Mt)(this.agentIdentifier,"privacy.cookies_enabled");let n;this.onAggregateImported=new Promise((e=>{n=e}));const o=async()=>{let t;try{if(r){const{setupAgentSession:e}=await Promise.all([i.e(860),i.e(242)]).then(i.bind(i,3228));t=e(this.agentIdentifier)}}catch(e){(0,l.Z)("A problem occurred when starting up session manager. This page will not start or extend any session.",e)}try{if(!this.shouldImportAgg(this.featureName,t))return void(0,u.L)(this.agentIdentifier,this.featureName);const{lazyFeatureLoader:r}=await i.e(412).then(i.bind(i,8582)),{Aggregate:o}=await r(this.featureName,"aggregate");this.featAggregate=new o(this.agentIdentifier,this.aggregator,e),n(!0)}catch(e){(0,l.Z)("Downloading and initializing ".concat(this.featureName," failed..."),e),this.abortHandler?.(),n(!1)}};c.il?(0,f.b)((()=>o()),!0):o()}shouldImportAgg(r,n){return r!==e.D.sessionReplay||!1!==(0,t.Mt)(this.agentIdentifier,"session_trace.enabled")&&(!!n?.isNew||!!n?.state.sessionReplay)}}var g=i(7633),p=i(7894);class m extends h{static featureName=g.t9;constructor(r,n){let i=!(arguments.length>2&&void 0!==arguments[2])||arguments[2];if(super(r,n,g.t9,i),("undefined"==typeof PerformanceNavigationTiming||c.Tt)&&"undefined"!=typeof PerformanceTiming){const n=(0,t.OP)(r);n[g.Dz]=Math.max(Date.now()-n.offset,0),(0,f.K)((()=>n[g.qw]=Math.max((0,p.z)()-n[g.Dz],0))),(0,f.b)((()=>{const t=(0,p.z)();n[g.OJ]=Math.max(t-n[g.Dz],0),(0,s.p)("timing",["load",t],void 0,e.D.pageViewTiming,this.ee)}))}this.importAggregator()}}var v=i(1117),b=i(1284);class y extends v.w{constructor(e){super(e),this.aggregatedData={}}store(e,t,r,n,i){var o=this.getBucket(e,t,r,i);return o.metrics=function(e,t){t||(t={count:0});return t.count+=1,(0,b.D)(e,(function(e,r){t[e]=w(r,t[e])})),t}(n,o.metrics),o}merge(e,t,r,n,i){var o=this.getBucket(e,t,n,i);if(o.metrics){var a=o.metrics;a.count+=r.count,(0,b.D)(r,(function(e,t){if("count"!==e){var n=a[e],i=r[e];i&&!i.c?a[e]=w(i.t,n):a[e]=function(e,t){if(!t)return e;t.c||(t=x(t.t));return t.min=Math.min(e.min,t.min),t.max=Math.max(e.max,t.max),t.t+=e.t,t.sos+=e.sos,t.c+=e.c,t}(i,a[e])}}))}else o.metrics=r}storeMetric(e,t,r,n){var i=this.getBucket(e,t,r);return i.stats=w(n,i.stats),i}getBucket(e,t,r,n){this.aggregatedData[e]||(this.aggregatedData[e]={});var i=this.aggregatedData[e][t];return i||(i=this.aggregatedData[e][t]={params:r||{}},n&&(i.custom=n)),i}get(e,t){return t?this.aggregatedData[e]&&this.aggregatedData[e][t]:this.aggregatedData[e]}take(e){for(var t={},r="",n=!1,i=0;i t.max&&(t.max=e),e 2&&void 0!==arguments[2])||arguments[2];super(e,r,j.t,n),c.il&&((0,t.OP)(e).initHidden=Boolean("hidden"===document.visibilityState),(0,N.N)((()=>(0,s.p)("docHidden",[(0,p.z)()],void 0,j.t,this.ee)),!0),(0,O.bP)("pagehide",(()=>(0,s.p)("winPagehide",[(0,p.z)()],void 0,j.t,this.ee))),this.importAggregator())}}var P=i(3081);class C extends h{static featureName=P.t9;constructor(e,t){let r=!(arguments.length>2&&void 0!==arguments[2])||arguments[2];super(e,t,P.t9,r),this.importAggregator()}}var R,I=i(2210),k=i(1214),H=i(2177),L={};try{R=localStorage.getItem("__nr_flags").split(","),console&&"function"==typeof console.log&&(L.console=!0,-1!==R.indexOf("dev")&&(L.dev=!0),-1!==R.indexOf("nr_dev")&&(L.nrDev=!0))}catch(e){}function z(e){try{L.console&&z(e)}catch(e){}}L.nrDev&&H.ee.on("internal-error",(function(e){z(e.stack)})),L.dev&&H.ee.on("fn-err",(function(e,t,r){z(r.stack)})),L.dev&&(z("NR AGENT IN DEVELOPMENT MODE"),z("flags: "+(0,b.D)(L,(function(e,t){return e})).join(", ")));var M=i(6660);class B extends h{static featureName=M.t;constructor(r,n){let i=!(arguments.length>2&&void 0!==arguments[2])||arguments[2];super(r,n,M.t,i),this.skipNext=0;try{this.removeOnAbort=new AbortController}catch(e){}const o=this;o.ee.on("fn-start",(function(e,t,r){o.abortHandler&&(o.skipNext+=1)})),o.ee.on("fn-err",(function(t,r,n){o.abortHandler&&!n[M.A]&&((0,I.X)(n,M.A,(function(){return!0})),this.thrown=!0,(0,s.p)("err",[n,(0,p.z)()],void 0,e.D.jserrors,o.ee))})),o.ee.on("fn-end",(function(){o.abortHandler&&!this.thrown&&o.skipNext>0&&(o.skipNext-=1)})),o.ee.on("internal-error",(function(t){(0,s.p)("ierr",[t,(0,p.z)(),!0],void 0,e.D.jserrors,o.ee)})),this.origOnerror=c._A.onerror,c._A.onerror=this.onerrorHandler.bind(this),c._A.addEventListener("unhandledrejection",(t=>{const r=function(e){let t="Unhandled Promise Rejection: ";if(e instanceof Error)try{return e.message=t+e.message,e}catch(t){return e}if(void 0===e)return new Error(t);try{return new Error(t+(0,D.P)(e))}catch(e){return new Error(t)}}(t.reason);(0,s.p)("err",[r,(0,p.z)(),!1,{unhandledPromiseRejection:1}],void 0,e.D.jserrors,this.ee)}),(0,O.m$)(!1,this.removeOnAbort?.signal)),(0,k.gy)(this.ee),(0,k.BV)(this.ee),(0,k.em)(this.ee),(0,t.OP)(r).xhrWrappable&&(0,k.Kf)(this.ee),this.abortHandler=this.#e,this.importAggregator()}#e(){this.removeOnAbort?.abort(),this.abortHandler=void 0}onerrorHandler(t,r,n,i,o){"function"==typeof this.origOnerror&&this.origOnerror(...arguments);try{this.skipNext?this.skipNext-=1:(0,s.p)("err",[o||new F(t,r,n),(0,p.z)()],void 0,e.D.jserrors,this.ee)}catch(t){try{(0,s.p)("ierr",[t,(0,p.z)(),!0],void 0,e.D.jserrors,this.ee)}catch(e){}}return!1}}function F(e,t,r){this.message=e||"Uncaught error with no additional information",this.sourceURL=t,this.line=r}let U=1;const q="nr@id";function G(e){const t=typeof e;return!e||"object"!==t&&"function"!==t?-1:e===c._A?0:(0,I.X)(e,q,(function(){return U++}))}function V(e){if("string"==typeof e&&e.length)return e.length;if("object"==typeof e){if("undefined"!=typeof ArrayBuffer&&e instanceof ArrayBuffer&&e.byteLength)return e.byteLength;if("undefined"!=typeof Blob&&e instanceof Blob&&e.size)return e.size;if(!("undefined"!=typeof FormData&&e instanceof FormData))try{return(0,D.P)(e).length}catch(e){return}}}var X=i(7243);class W{constructor(e){this.agentIdentifier=e,this.generateTracePayload=this.generateTracePayload.bind(this),this.shouldGenerateTrace=this.shouldGenerateTrace.bind(this)}generateTracePayload(e){if(!this.shouldGenerateTrace(e))return null;var r=(0,t.DL)(this.agentIdentifier);if(!r)return null;var n=(r.accountID||"").toString()||null,i=(r.agentID||"").toString()||null,o=(r.trustKey||"").toString()||null;if(!n||!i)return null;var a=(0,_.M)(),s=(0,_.Ht)(),c=Date.now(),u={spanId:a,traceId:s,timestamp:c};return(e.sameOrigin||this.isAllowedOrigin(e)&&this.useTraceContextHeadersForCors())&&(u.traceContextParentHeader=this.generateTraceContextParentHeader(a,s),u.traceContextStateHeader=this.generateTraceContextStateHeader(a,c,n,i,o)),(e.sameOrigin&&!this.excludeNewrelicHeader()||!e.sameOrigin&&this.isAllowedOrigin(e)&&this.useNewrelicHeaderForCors())&&(u.newrelicHeader=this.generateTraceHeader(a,s,c,n,i,o)),u}generateTraceContextParentHeader(e,t){return"00-"+t+"-"+e+"-01"}generateTraceContextStateHeader(e,t,r,n,i){return i+"@nr=0-1-"+r+"-"+n+"-"+e+"----"+t}generateTraceHeader(e,t,r,n,i,o){if(!("function"==typeof c._A?.btoa))return null;var a={v:[0,1],d:{ty:"Browser",ac:n,ap:i,id:e,tr:t,ti:r}};return o&&n!==o&&(a.d.tk=o),btoa((0,D.P)(a))}shouldGenerateTrace(e){return this.isDtEnabled()&&this.isAllowedOrigin(e)}isAllowedOrigin(e){var r=!1,n={};if((0,t.Mt)(this.agentIdentifier,"distributed_tracing")&&(n=(0,t.P_)(this.agentIdentifier).distributed_tracing),e.sameOrigin)r=!0;else if(n.allowed_origins instanceof Array)for(var i=0;i 2&&void 0!==arguments[2])||arguments[2];super(r,n,Z.t,i),(0,t.OP)(r).xhrWrappable&&(this.dt=new W(r),this.handler=(e,t,r,n)=>(0,s.p)(e,t,r,n,this.ee),(0,k.u5)(this.ee),(0,k.Kf)(this.ee),function(r,n,i,o){function a(e){var t=this;t.totalCbs=0,t.called=0,t.cbTime=0,t.end=E,t.ended=!1,t.xhrGuids={},t.lastSize=null,t.loadCaptureCalled=!1,t.params=this.params||{},t.metrics=this.metrics||{},e.addEventListener("load",(function(r){_(t,e)}),(0,O.m$)(!1)),c.IF||e.addEventListener("progress",(function(e){t.lastSize=e.loaded}),(0,O.m$)(!1))}function s(e){this.params={method:e[0]},T(this,e[1]),this.metrics={}}function u(e,n){var i=(0,t.DL)(r);i.xpid&&this.sameOrigin&&n.setRequestHeader("X-NewRelic-ID",i.xpid);var a=o.generateTracePayload(this.parsedOrigin);if(a){var s=!1;a.newrelicHeader&&(n.setRequestHeader("newrelic",a.newrelicHeader),s=!0),a.traceContextParentHeader&&(n.setRequestHeader("traceparent",a.traceContextParentHeader),a.traceContextStateHeader&&n.setRequestHeader("tracestate",a.traceContextStateHeader),s=!0),s&&(this.dt=a)}}function d(e,t){var r=this.metrics,i=e[0],o=this;if(r&&i){var a=V(i);a&&(r.txSize=a)}this.startTime=(0,p.z)(),this.listener=function(e){try{"abort"!==e.type||o.loadCaptureCalled||(o.params.aborted=!0),("load"!==e.type||o.called===o.totalCbs&&(o.onloadCalled||"function"!=typeof t.onload)&&"function"==typeof o.end)&&o.end(t)}catch(e){try{n.emit("internal-error",[e])}catch(e){}}};for(var s=0;s 1?e[1]=i:e.push(i)}else e[0]&&e[0].headers&&s(e[0].headers,n)&&(this.dt=n);function s(e,t){var r=!1;return t.newrelicHeader&&(e.set("newrelic",t.newrelicHeader),r=!0),t.traceContextParentHeader&&(e.set("traceparent",t.traceContextParentHeader),t.traceContextStateHeader&&e.set("tracestate",t.traceContextStateHeader),r=!0),r}}function x(e,t){this.params={},this.metrics={},this.startTime=(0,p.z)(),this.dt=t,e.length>=1&&(this.target=e[0]),e.length>=2&&(this.opts=e[1]);var r,n=this.opts||{},i=this.target;"string"==typeof i?r=i:"object"==typeof i&&i instanceof Y?r=i.url:c._A?.URL&&"object"==typeof i&&i instanceof URL&&(r=i.href),T(this,r);var o=(""+(i&&i instanceof Y&&i.method||n.method||"GET")).toUpperCase();this.params.method=o,this.txSize=V(n.body)||0}function A(t,r){var n;this.endTime=(0,p.z)(),this.params||(this.params={}),this.params.status=r?r.status:0,"string"==typeof this.rxSize&&this.rxSize.length>0&&(n=+this.rxSize);var o={txSize:this.txSize,rxSize:n,duration:(0,p.z)()-this.startTime};i("xhr",[this.params,o,this.startTime,this.endTime,"fetch"],this,e.D.ajax)}function E(t){var r=this.params,n=this.metrics;if(!this.ended){this.ended=!0;for(var o=0;o 2&&void 0!==arguments[2])||arguments[2];super(e,t,we.t,r),this.importAggregator()}}new class{constructor(e){let t=arguments.length>1&&void 0!==arguments[1]?arguments[1]:(0,_.ky)(16);c._A?(this.agentIdentifier=t,this.sharedAggregator=new y({agentIdentifier:this.agentIdentifier}),this.features={},this.desiredFeatures=new Set(e.features||[]),this.desiredFeatures.add(m),Object.assign(this,(0,a.j)(this.agentIdentifier,e,e.loaderType||"agent")),this.start()):(0,l.Z)("Failed to initial the agent. Could not determine the runtime environment.")}get config(){return{info:(0,t.C5)(this.agentIdentifier),init:(0,t.P_)(this.agentIdentifier),loader_config:(0,t.DL)(this.agentIdentifier),runtime:(0,t.OP)(this.agentIdentifier)}}start(){const t="features";try{const r=n(this.agentIdentifier),i=[...this.desiredFeatures];i.sort(((t,r)=>e.p[t.featureName]-e.p[r.featureName])),i.forEach((t=>{if(r[t.featureName]||t.featureName===e.D.pageViewEvent){const n=function(t){switch(t){case e.D.ajax:return[e.D.jserrors];case e.D.sessionTrace:return[e.D.ajax,e.D.pageViewEvent];case e.D.sessionReplay:return[e.D.sessionTrace];case e.D.pageViewTiming:return[e.D.pageViewEvent];default:return[]}}(t.featureName);n.every((e=>r[e]))||(0,l.Z)("".concat(t.featureName," is enabled but one or more dependent features has been disabled (").concat((0,D.P)(n),"). This may cause unintended consequences or missing data...")),this.features[t.featureName]=new t(this.agentIdentifier,this.sharedAggregator)}})),(0,T.Qy)(this.agentIdentifier,this.features,t)}catch(e){(0,l.Z)("Failed to initialize all enabled instrument classes (agent aborted) -",e);for(const e in this.features)this.features[e].abortHandler?.();const r=(0,T.fP)();return delete r.initializedAgents[this.agentIdentifier]?.api,delete r.initializedAgents[this.agentIdentifier]?.[t],delete this.sharedAggregator,r.ee?.abort(),delete r.ee?.get(this.agentIdentifier),!1}}}({features:[J,m,S,class extends h{static featureName=oe;constructor(t,r){if(super(t,r,oe,!(arguments.length>2&&void 0!==arguments[2])||arguments[2]),!c.il)return;const n=this.ee;let i;(0,k.QU)(n),this.eventsEE=(0,k.em)(n),this.eventsEE.on(se,(function(e,t){this.bstStart=(0,p.z)()})),this.eventsEE.on(ae,(function(t,r){(0,s.p)("bst",[t[0],r,this.bstStart,(0,p.z)()],void 0,e.D.sessionTrace,n)})),n.on(ce+ne,(function(e){this.time=(0,p.z)(),this.startPath=location.pathname+location.hash})),n.on(ce+ie,(function(t){(0,s.p)("bstHist",[location.pathname+location.hash,this.startPath,this.time],void 0,e.D.sessionTrace,n)}));try{i=new PerformanceObserver((t=>{const r=t.getEntries();(0,s.p)(te,[r],void 0,e.D.sessionTrace,n)})),i.observe({type:re,buffered:!0})}catch(e){}this.importAggregator({resourceObserver:i})}},C,xe,B,class extends h{static featureName=de;constructor(e,r){if(super(e,r,de,!(arguments.length>2&&void 0!==arguments[2])||arguments[2]),!c.il)return;if(!(0,t.OP)(e).xhrWrappable)return;try{this.removeOnAbort=new AbortController}catch(e){}let n,i=0;const o=this.ee.get("tracer"),a=(0,k._L)(this.ee),s=(0,k.Lg)(this.ee),u=(0,k.BV)(this.ee),d=(0,k.Kf)(this.ee),f=this.ee.get("events"),l=(0,k.u5)(this.ee),h=(0,k.QU)(this.ee),g=(0,k.Gm)(this.ee);function m(e,t){h.emit("newURL",[""+window.location,t])}function v(){i++,n=window.location.hash,this[ve]=(0,p.z)()}function b(){i--,window.location.hash!==n&&m(0,!0);var e=(0,p.z)();this[pe]=~~this[pe]+e-this[ve],this[ye]=e}function y(e,t){e.on(t,(function(){this[t]=(0,p.z)()}))}this.ee.on(ve,v),s.on(be,v),a.on(be,v),this.ee.on(ye,b),s.on(ge,b),a.on(ge,b),this.ee.buffer([ve,ye,"xhr-resolved"],this.featureName),f.buffer([ve],this.featureName),u.buffer(["setTimeout"+le,"clearTimeout"+fe,ve],this.featureName),d.buffer([ve,"new-xhr","send-xhr"+fe],this.featureName),l.buffer([me+fe,me+"-done",me+he+fe,me+he+le],this.featureName),h.buffer(["newURL"],this.featureName),g.buffer([ve],this.featureName),s.buffer(["propagate",be,ge,"executor-err","resolve"+fe],this.featureName),o.buffer([ve,"no-"+ve],this.featureName),a.buffer(["new-jsonp","cb-start","jsonp-error","jsonp-end"],this.featureName),y(l,me+fe),y(l,me+"-done"),y(a,"new-jsonp"),y(a,"jsonp-end"),y(a,"cb-start"),h.on("pushState-end",m),h.on("replaceState-end",m),window.addEventListener("hashchange",m,(0,O.m$)(!0,this.removeOnAbort?.signal)),window.addEventListener("load",m,(0,O.m$)(!0,this.removeOnAbort?.signal)),window.addEventListener("popstate",(function(){m(0,i>1)}),(0,O.m$)(!0,this.removeOnAbort?.signal)),this.abortHandler=this.#e,this.importAggregator()}#e(){this.removeOnAbort?.abort(),this.abortHandler=void 0}}],loaderType:"spa"})})(),window.NRBA=o})(); window.jQuery || document.write(' ') CKEDITOR_BASEPATH='https://f1000research.com/js/vendor/ckeditor/' window.reactTheme = 'research'; window.MathJax = { CommonHTML: { linebreaks: { automatic: true } }, 'HTML-CSS': { linebreaks: { automatic: true } }, SVG: { linebreaks: { automatic: true } }, AuthorInit: function() { MathJax.Hub.Register.MessageHook('End Process', function () { let timeout = false; // holder for timeout id const delay = 250; // delay after event is "complete" to run callback const reflowMath = function() { const dispFormulas = document.querySelectorAll('.disp-formula.panel'); if (!dispFormulas) { return; } for (const dispFormula of dispFormulas) { const child = dispFormula.querySelector('.MathJax_Preview').nextSibling.firstChild; const isMultiline = MathJax.Hub.getAllJax(dispFormula)[0].root.isMultiline; if (dispFormula.offsetWidth < child.offsetWidth || isMultiline) { MathJax.Hub.Queue(['Rerender', MathJax.Hub, dispFormula]); } } }; window.addEventListener('resize', function() { clearTimeout(timeout); // clear the timeout timeout = setTimeout(reflowMath, delay); // start timing for event "completion" }); }); }, }; if (window.location.hash == '#_=_'){ window.location = window.location.href.split('#')[0] } !function(f,b,e,v,n,t,s){if(f.fbq)return;n=f.fbq=function() {n.callMethod? n.callMethod.apply(n,arguments):n.queue.push(arguments)} ;if(!f._fbq)f._fbq=n; n.push=n;n.loaded=!0;n.version='2.0';n.queue=[];t=b.createElement(e);t.async=!0; t.src=v;s=b.getElementsByTagName(e)[0];s.parentNode.insertBefore(t,s)}(window, document,'script','https://connect.facebook.net/en_US/fbevents.js'); fbq('init', '1641728616063202'); fbq('track', "PixelInitialized", {}); (function(h,o,t,j,a,r){ h.hj=h.hj||function(){(h.hj.q=h.hj.q||[]).push(arguments)}; h._hjSettings={hjid:2318163,hjsv:6}; a=o.getElementsByTagName('head')[0]; r=o.createElement('script');r.async=1; r.src=t+h._hjSettings.hjid+j+h._hjSettings.hjsv; a.appendChild(r); })(window,document,'https://static.hotjar.com/c/hotjar-','.js?sv='); search file_upload Submit your research search menu close search Browse Gateways & Collections How to Publish Submit your Research My Submissions Article Guidelines Article Guidelines (New Versions) Open Data, Software and Code Guidelines Open Data and Accessible Source Materials Guidelines (HSS) Open Data, Software and Code Guidelines (PSE) Prepublication Checks Production Process Posters and Slides Guidelines Document Guidelines Article Processing Charges Peer Review Finding Article Reviewers About How it Works For Reviewers Our Advisors Policies Glossary FAQs For Developers Newsroom Contact My Research Submissions Content and Tracking Alerts My Details Sign In file_upload Submit your research { "@context": "https://schema.org", "@type": "ScholarlyArticle", "mainEntityOfPage": { "@type": "WebPage", "@id": "https://f1000research.com/articles/14-1201" }, "headline": "Typologies of suicidality and suicide presenting to a prehospital South African Emergency Medical Service: a...", "datePublished": "2025-11-03T16:49:34", "dateModified": "2026-03-04T09:43:00", "author": [ { "@type": "Person", "name": "Daniel Tilley" }, { "@type": "Person", "name": "Lloyd Denzil Christopher" }, { "@type": "Person", "name": "Thomas Farrar" }, { "@type": "Person", "name": "Navindhra Naidoo" } ], "publisher": { "@type": "Organization", "name": "F1000Research", "logo": { "@type": "ImageObject", "url": "https://f1000research.com/img/AMP/F1000Research_image.png", "height": 480, "width": 60 } }, "image": { "@type": "ImageObject", "url": "https://f1000research.com/img/AMP/F1000Research_image.png", "height": 1200, "width": 150 }, "description": " Background The global age-standardised suicide rate is estimated at 8.9/100 000, while South Africa is at 23.5/100 000. The prehospital Emergency Medical Services is located within this burden of health. Emergency Care providers have a duty to assess, treat and transport healthcare consumers with suicidality, when attending to the suicide caseload. The aim was to appraise suicidality case frequency and typology and estimate the scope of the challenge faced by a jurisdictional emergency medical service and its care providers. Methods Using a retrospective cross-sectional design and a novel data collection instrument, a census of three years of Ambulance Incident Management Records was undertaken in a rural district of the Western Cape, South Africa. Results Of 413,712 records, 2,976 (N) mental health-related incidents were sampled. Fourteen percent (n = 412) were assessed to have descriptors of suicidal ideation (n = 227), attempted suicide (n = 83) or death by suicide (n = 102). There were, on average, 2.8 deaths by suicide per month over the 3-year study period in the Garden Route District. Women were reported to mostly ingest poison and overdose on medication, while men used strangulation and were 5 times more likely to die by suicide than women. Conclusion This study estimates the prehospital suicide and suicidality burden for the Western Cape Government Emergency Medical Services, elucidating an under-researched health concern within the South African prehospital space. Further study is required on the risk of emergency care provider stigmatisation towards suicide and suicidality cases, while auditing the need to assess policy, praxis, medical surveillance, EC provider clinical capacity and victim needs and experiences. Suicidality and suicide in Southern Africa could require a ‘Syndemic’ approach for the emergency service to interrupt suicidality and advance professional relevance. " } { "@context": "http://schema.org", "@type": "BreadcrumbList", "itemListElement": [ { "@type": "ListItem", "position": "1", "item": { "@id": "https://f1000research.com/", "name": "Home" } }, { "@type": "ListItem", "position": "2", "item": { "@id": "https://f1000research.com/browse/articles", "name": "Browse" } }, { "@type": "ListItem", "position": "3", "item": { "@id": "https://f1000research.com/articles/14-1201/v1", "name": "Typologies of suicidality and suicide presenting to a prehospital..." } } ] } Home Browse Typologies of suicidality and suicide presenting to a prehospital... ALL Metrics - Views Downloads Get PDF Get XML Cite How to cite this article Tilley D, Christopher LD, Farrar T and Naidoo N. Typologies of suicidality and suicide presenting to a prehospital South African Emergency Medical Service: a retrospective cross-sectional analysis [version 1; peer review: awaiting peer review] . F1000Research 2025, 14 :1201 ( https://doi.org/10.12688/f1000research.171712.1 ) NOTE: If applicable, it is important to ensure the information in square brackets after the title is included in all citations of this article. Close Copy Citation Details Export Export Citation Sciwheel EndNote Ref. Manager Bibtex ProCite Sente EXPORT Select a format first Track Share ▬ ✚ Research Article Typologies of suicidality and suicide presenting to a prehospital South African Emergency Medical Service: a retrospective cross-sectional analysis [version 1; peer review: awaiting peer review] Daniel Tilley https://orcid.org/0000-0003-3598-9907 1 , Lloyd Denzil Christopher https://orcid.org/0000-0002-8072-7634 1 , Thomas Farrar 2 , Navindhra Naidoo https://orcid.org/0000-0001-5261-0677 1,3 Daniel Tilley https://orcid.org/0000-0003-3598-9907 1 , Lloyd Denzil Christopher https://orcid.org/0000-0002-8072-7634 1 , Thomas Farrar 2 , Navindhra Naidoo https://orcid.org/0000-0001-5261-0677 1,3 PUBLISHED 03 Nov 2025 Author details Author details 1 Emergency Medical Science, Cape Peninsula University of Technology Faculty of Health and Wellness Sciences, Cape Town, Western Cape, South Africa 2 Mathematics and Physics, Cape Peninsula University of Technology Faculty of Applied Sciences, Cape Town, Western Cape, South Africa 3 Paramedicine, School of health sciences, Western Sydney University Humanitarian and Development Research Initiative, Penrith, New South Wales, Australia Daniel Tilley Roles: Conceptualization, Formal Analysis, Project Administration, Writing – Original Draft Preparation, Writing – Review & Editing Lloyd Denzil Christopher Roles: Writing – Review & Editing Thomas Farrar Roles: Data Curation, Methodology, Software, Writing – Review & Editing Navindhra Naidoo Roles: Formal Analysis, Supervision, Validation, Writing – Review & Editing OPEN PEER REVIEW DETAILS REVIEWER STATUS This article is included in the Society for Mental Health in Low- and Middle-Income Countries (SoMHiL) gateway. Abstract Background The global age-standardised suicide rate is estimated at 8.9/100 000, while South Africa is at 23.5/100 000. The prehospital Emergency Medical Services is located within this burden of health. Emergency Care providers have a duty to assess, treat and transport healthcare consumers with suicidality, when attending to the suicide caseload. The aim was to appraise suicidality case frequency and typology and estimate the scope of the challenge faced by a jurisdictional emergency medical service and its care providers. Methods Using a retrospective cross-sectional design and a novel data collection instrument, a census of three years of Ambulance Incident Management Records was undertaken in a rural district of the Western Cape, South Africa. Results Of 413,712 records, 2,976 (N) mental health-related incidents were sampled. Fourteen percent (n = 412) were assessed to have descriptors of suicidal ideation (n = 227), attempted suicide (n = 83) or death by suicide (n = 102). There were, on average, 2.8 deaths by suicide per month over the 3-year study period in the Garden Route District. Women were reported to mostly ingest poison and overdose on medication, while men used strangulation and were 5 times more likely to die by suicide than women. Conclusion This study estimates the prehospital suicide and suicidality burden for the Western Cape Government Emergency Medical Services, elucidating an under-researched health concern within the South African prehospital space. Further study is required on the risk of emergency care provider stigmatisation towards suicide and suicidality cases, while auditing the need to assess policy, praxis, medical surveillance, EC provider clinical capacity and victim needs and experiences. Suicidality and suicide in Southern Africa could require a ‘Syndemic’ approach for the emergency service to interrupt suicidality and advance professional relevance. READ ALL READ LESS Keywords Suicide and Suicidality, Typology, Syndemic research, Emergency Medical Service, Paramedicine Corresponding Author(s) Daniel Tilley ( [email protected] ) Close Corresponding author: Daniel Tilley Competing interests: No competing interests were disclosed. Grant information: The author(s) declared that no grants were involved in supporting this work. Copyright: © 2025 Tilley D et al . This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. How to cite: Tilley D, Christopher LD, Farrar T and Naidoo N. Typologies of suicidality and suicide presenting to a prehospital South African Emergency Medical Service: a retrospective cross-sectional analysis [version 1; peer review: awaiting peer review] . F1000Research 2025, 14 :1201 ( https://doi.org/10.12688/f1000research.171712.1 ) First published: 03 Nov 2025, 14 :1201 ( https://doi.org/10.12688/f1000research.171712.1 ) Latest published: 04 Mar 2026, 14 :1201 ( https://doi.org/10.12688/f1000research.171712.3 )  There is a newer version of this article available. Suppress this message for one day. Highlights • There were, on average, 2.3 and 2.8 attempted suicides and deaths by suicide in the Garden Route District over the 3-year study period, respectively ( Tilley et al., 2023 ). • Women were found to use poison or medication overdose in suicide, while men used strangulation, presenting 5 times more likely to succumb to suicide than women ( Tilley et al., 2023 ). • Future research is needed into suicidality and suicide management, praxis, policy and stigmatisation of suicidality victims from a prehospital EMS perspective. Exploring syndemic research on suicidality and its intersection with emergency care is warranted. Introduction Death by Suicide in South Africa (SA) accounted for more insurance death claims than trauma, crime and motor vehicle accidents in 2024 ( Bhana, 2025 ). Globally, suicide accounted for 727 000 deaths in 2021-with an estimated 20 attempted suicides per suicide ( Caulkins, 2022 )-more than war, homicide and HIV/AIDS, equating to one suicide every 100 deaths ( World Health Organization, 2025 ). The global age-standardised suicide rate in 2021 was estimated at 8.9 per 100 000, whereas the Africa region recorded 11.5 per 100 000. SA recorded 23.5 per 100 000 population, equating to almost 14 000 deaths by suicide per annum, placing SA third highest in suicide rates in Africa ( World Health Organization, 2024, 2025 ). Significantly, suicide was the third leading cause of death amongst people aged 15-29, while globally, suicide ranked as the 21 st leading cause of death in 2021 ( World Health Organization, 2024, 2025 ). Suicide and suicidality have become a public health burden and an under-researched priority in low-and middle-income countries ( Pompili, 2022 ). SA endures a quadruple disease burden, which is antagonised by poverty, crime and inequality ( Ataguba et al., 2015 ; Burns, 2011 ) while producing numerous societal-level socioeconomic risk factors for mental illness exacerbation ( Motsoaledi & Matsoso, 2013 ). SA is deeply embedded in the social determinants of health which indirectly affects the social determinants of mental health ( Compton & Shim, 2017 ) with 63% of South Africans living in poverty; 31.9% unemployed; a rape case estimated at every 12minutes; 86 murders, 88 attempted murders and 595 assault cases daily and 18.9% of the population abusing alcohol and drugs ( Action Society, 2024 ; Egenasi et al., 2024 ; Gass et al., 2010 ; Myers et al., 2022 ; Prinsloo et al., 2022 ; The World Bank, 2024 ; World Bank Group, 2020 ). These conditions are all social antecedents for suicidality and suicide. Deinstitutionalisation through the Mental Health Care Act 17 of 2002 provided no compensatory mental health care, community service or prioritisation of mental health through a health care plan at a provincial level ( Burns, 2011 ; Lund et al., 2011, 2012 ), relying on the prehospital Emergency Medical Services (EMS) as a ‘primary’ health care point for all poor mental health sequalae and related emergencies ( Tilley, 2021 ; Van Huyssteen, 2016 ). This suggests that all South African prehospital Emergency Care (EC) Providers are required to assess, treat and transport mental health care consumers with suicidality by navigating their social determinants of mental health while experiencing a mental health treatment gap. The lack of mental health care consumer compliance is compounded by the loss of trained EC providers, psychologists, psychiatrists and mental health care providers ( Bateman, 2015 ; Burns, 2011 ; Jacob & Coetzee, 2018 ; Majiet et al., 2025 ). These nuanced social constructs aid in the exacerbation of poor mental health, expediting pathways to suicidality. Notably, SA has multi-cultural challenges which can aggravate the need for urgent western mental health care ( Kirmayer, 2022 ; Kootbodien et al., 2020 ; Maharajh & Abdool, 2005 ; Motsoaledi & Matsoso, 2013 ), and complicate health seeking behaviour further. Caulkins (2022) posits a new premise whereby suicide is looked at as ‘ syndemic’ , rather than syndromic, and illuminates intersectionality as an interdisciplinary technique to advance further understanding of suicidality behaviours ( Caulkins, 2022 ). Syndemic theory elucidates how combining cultural factors and two or more physiological factors manifests a public health challenge and builds on the social determinants of health theory ( Caulkins, 2022 ). Notwithstanding that research on suicide and suicidality has low reporting rates in Africa ( World Health Organization, 2025 ), most research is not done in the prehospital setting. The question that arises is: What is the typology of suicidality within the prehospital, rural EMS context? By appraising suicidality typology and epidemiologically descriptive evidence, the scope of the concern for the prehospital space becomes apparent. This has the potential to influence the building of suicidality capacity and knowledge for EC provider praxis. Materials and methods Design Focusing on health care consumers with mental health needs was the pivot for this study. Using a retrospective cross-sectional design, data were extracted from the Western Cape Government Emergency Medical Services (WCGEMS) health care consumers’ Incident Management Records (IMR) from the Garden Route District, Western Cape (South Africa) from 2017 to 2019 (3 years). A census (100% sample) was taken of IMRs in the WCGEMS database that met the study’s inclusion criteria based on incident type. The dataset thus consisted of archival data related to health care consumers needing ambulance transport to a psychiatric facility, having psychiatric problems, overdosed, self-harmed or died by suicide. These incident types are routinely described by dispatchers/staff as ‘Self-Harm-other’, ‘Self-Harm-poisoning’, ‘Psychiatric/Behavioural Problems’ and ‘Inter-facility transfer (IFT)-psychiatric/behavioural problem’ ( Tilley et al., 2023 ). A census of these incident types included all EMS IMR from 2017 to 2019. IMRs associated with accidental poisoning of children under 8 years were excluded. IMRs are created by emergency call-takers and emergency ambulance dispatchers for every health care consumer who requires the WCGEMS and is the property of the WCGEMS Emergency Communications Centre ( Tilley, 2021 ; Tilley et al., 2023 ). Study setting and population The study site was the rural Garden Route District, one of six district municipalities in the Western Cape. The Garden Route District comprises of seven local municipalities that experience poor socioeconomic conditions ( Tilley et al., 2023 ; Western Cape Government, 2019 ). The census approach identified a total of 413 712 IMRs from health care consumer interactions between 2017 and 2019; of these, 2 976 (N) met the incident type inclusion criteria. Of the 2 976 IMRs included in the dataset, 412 (n) health care consumers presented with suicidal ideation, attempted suicide and death by suicide. We provide this sub-group analysis here. Data analysis Binary and multinomial logistic regression, Pearson’s Chi-squared test of independence, Fisher’s Exact Test, Analysis of Variance (ANOVA), and Tukey’s Honest Significant Difference (HSD) method were used to illuminate associations of interest among attempted suicide and suicide victims. Data was analysed in R statistical software ( R Core Team, 2025 ). Logistic regression allowed for analysis of relationships between a categorical dependent variable and one or more independent (predictor) variables, which could be categorical (Gender) or numerical (Age). If the dependent variable is binary (e.g., Suicide or No Suicide), the model predicts the probability of the binary outcome using a log-odds link function ( Sperandei, 2014 ). A multinomial logistic regression model can be used if the dependent variable has more than two categories (e.g., method of suicide or attempted suicide). The model coefficient(s) p-value of a significance test indicates probable relationships between dependent and predictor variables, usually expressed as an expected odds ratio. Pearson’s Chi-square test of independence tests whether two categorical variables have any association ( Bolboacă et al., 2011 ; Tilley, 2021 ). The null hypothesis (H 0 ) states ‘there is no association between two variables while the alternative hypothesis (H a ) states, there is an association between two variables ( Bolboacă et al., 2011 , p. 530; Tilley, 2021 ; Tilley et al., 2023 ). Fisher’s Exact Test is another method for testing for an association between categorical variables, but unlike Pearson’s test, it does not rely on an asymptotic null distribution and thus the required assumptions are weaker ( Bolboacă et al., 2011 ; Nowacki, 2017 ). In the case of binary variables, one can use Fisher’s Exact Test to test for a directional alternative (i.e., a positive or negative association); ( Freeman & Campbell, 2007 ; Nowacki, 2017 ). For all hypothesis tests, we used a significance level of 0.05, meaning that if the p -value was less than 0.05, we rejected the null hypothesis; otherwise, the null hypothesis was retained ( Bolboacă et al., 2011 ; Nowacki, 2017 ). A multinominal logistic regression model, ANOVA and Tukey’s HSD method were used to find smaller associations between gender, age and method of attempted suicide or suicide. ANOVA is used to show differences between two or more components through significance tests, making comparisons between populations ( Hosmer & Lemeshow, 2000 ; Sawyer, 2009 ; Tilley, 2021 ). The ANOVA test compares variation between sample means and variation within each of the samples. Low p-values are indications of compelling evidence against the null hypothesis that the group means are all equal. Tukey’s HSD method is based on a studentized range statistic and is used in connection with ANOVA as a post hoc method to identify pairwise significant differences, since the ANOVA test is an omnibus test that only identifies the presence or absence of differences in mean between treatments ( Hilton, 2006 ). Consent A waiver of informed consent for a retrospective study was granted by an ethics committee, duly registered by the Western Cape Government National Department of Health Ethics Council (WC_201911_033) , as it was not practicable to obtain individual consent. There are adequate safeguards for participant privacy as all retrospective data were de-identified and there were no human participants engaged with during the data analysis. Consent was attained from the Western Cape Government Health and Wellness Emergency Medical Services (Ambulance Service) as custodian of the data. Results Over the 3-year period of sampled health care consumers who presented to the WCGEMS, 14% (n = 412) presented with suicidality and death by suicide, while 63% (n = 1890) presented with mental illness sequela, considered stereotypical mental illness antecedents associated with suicide victims ( Kułak-Bejda et al., 2021 ). These were overdose/DSP, substance abuse, depression, anxiety, self-harm, bipolar disorder, schizophrenia and PTSD ( Table 1 ). There were, on average 2.8 deaths by suicide (n = 102) and 2.3 attempted suicides (n = 83) per month in the Garden Route District between 2017 and 2019. Gender and age associations were used to illuminate the suicidality and the death by suicide case load burden that EC providers from the WCGEMS face. Prehospital EC providers were expected to respond to 412 (n) suicidality and death by suicide health care consumers from the census population of 2 976 (N) emergencies over the 3-year period ( Tilley, 2025 ). Table 1. Emergency Medical Service (EMS) Mental Illness typology. Category Frequency (n) Relative frequency (%) Overdose/DSP 1550 52% Suicidal Ideation 227 7.6% Substance Abuse 108 3.6% Suicide 102 3.4% Depression 89 3% Attempted Suicide 83 2.7% Anxiety 59 2% Cutting Self-Harm 41 1.3% Bipolar Disorder 21 0.7% Schizophrenia 19 0.6% Post-traumatic stress disorder 3 0.1% ‘Death by Suicide Typology’ ‘Death by Suicide’ was detected in 102 (n) of 2976 (N), suggesting 34 deaths by suicide per year of the study period ( Tilley et al., 2023 ). Death by Suicide was defined by types of method, namely, ‘Strangulation death’, ‘Overdose/DSP’, ‘jump from height’, ‘Gunshot’ and ‘Cutting Self-Harm’ ( Table 2 ). These cases precede postmortem and are service categories of the prehospital Emergency Medical Service and not that of the forensic pathologist. Table 2. Frequency of method per Death by Suicide and Attempted Suicide. Method Death by Suicide (n) Attempted Suicide (n) Strangulation 82 51 Overdose/DSP 11 11 Jump * 4 2 Cutting Self-Harm 1 5 Gunshot 1 0 Unspecified 0 8 Parasuicidal 0 6 * Jump refers to “jump from height” for Death by Suicide victims and “jump from moving car” for Attempted Suicide victims. ‘Attempted Suicide Typology’ ‘Attempted Suicide’ was detected in 83 (n) of 2976 (N), suggesting 27 attempted suicides per year of the study period ( Tilley et al., 2023 ). The types of methods that are defined as attempted suicide are ‘Strangulation death’, ‘Overdose/DSP’, ‘jump from moving vehicle’, ‘Cutting Self-Harm’, ‘Parasuicidal’ (attempted suicide with no intention of death) and ‘Unspecified’ ( Table 2 ). Age and gender typology with attempted suicide and death by suicide Using a significance level of 0.05 throughout the study, gender and age associations with ‘Death by Suicide’ and ‘Attempted Suicide’ provided further insight into this burden faced by prehospital EC providers working for the WCGEMS. Logistic regression, with age as the independent variable and ‘Attempted Suicide’ and ‘Death by Suicide’ as dependent variables, were run. Significantly, age was not a predictor of occurrence for ‘Death by Suicide’ ( p = 0.3089 ) or ‘Attempted Suicide’ ( p = 0.3095 ). However, the models were rerun with a quadratic age term to check for non-monotonic relationships. While there were still no significant effects in the ‘Attempted Suicide’ model ( p = 0.577 on the quadratic term), in the ‘Death by Suicide’ model, both the linear ( p = 0.00388) and quadratic ( p = 0.00681) terms were statistically significant. The fitted regression equation was log π 1 − π = − 8.241 + 0.2281 x − 0.00281 x 2 , where π is the probability of death by suicide and x is age. Using differential calculus, the function was maximised with respect to age, and it was thereby estimated that the age at which death by suicide risk is highest, is 41. This suggests that the risk of death by suicide among health care consumers increases with age until a peak age of 41 and decreases thereafter. The median ages for death by suicide and attempted suicide were 36 years and 30 years, respectively. Figure 1 shows the age distribution of health care consumers who had and had not attempted suicide using two overlaid histograms. Figure 2 similarly shows the age distribution of health care consumers who had and had not died by suicide. The purple area in each plot denotes overlap between the two overlaid histograms. The two figures cohere with the logistic regression findings: there is no visible difference between the red and blue histograms in Figure 1 ; hence no evidence of a difference in age distribution between those who attempted suicide and those who did not. In Figure 2 , however, the blue histogram’s density is concentrated in the middle, suggesting that health care consumers who died by suicide were particularly concentrated in the 30-50 age group. Figure 1. Age distribution of health care consumers who did and did not attempt suicide. Figure 1 shows the age distribution of health care consumers who had an had not attempted suicide using two overlaid histograms. From the logistic regression findings, the purple area in each plot denotes overlap between the two overlaid histograms while there is no visible difference between the red and blue histograms, suggesting no visible difference in age distribution between those who had and had not attempted suicide. Age was not a predictor of occurrence for ‘Attempted Suicide’ (p = 0.3095). From 3 years (2017-2019) of retrospective data, the median age for attempted suicide was 30 years old. Figure 2. Age distribution of health care consumers who did and did not die by suicide. Figure 2 shows the age distribution of health care consumers who did and did not die by suicide using two overlaid histograms. From the logistic regression findings, purple area in each plot denotes overlap between the two overlaid histograms. Unlike Figure 1 , the blue histogram’s density is concentrated in the middle, suggesting that health care consumers who died by suicide were particularly concentrated in the 30-50 age group. Age was not a predictor of occurrence for ‘Suicide’ ( p = 0.3089 ), however using a quadratic age term to check for non-monotonic relationships it was found in the ‘Suicide’ model, both the linear ( p = 0.00388) and quadratic ( p = 0.00681) terms were statistically significant. This suggests that the risk of death by suicide among health care consumers increases with age until a peak age of 41 and decreases thereafter. From 3 years (2017-2019) of retrospective data, the median age for suicide was 36 years old. Using the Pearson Chi-square test of independence, it was found that the p -value was < 0.05 for the associations between gender and attempted suicide ( p = 0.004484 ) and gender and death by suicide ( p = 1.716 × 10 −8 ), suggesting males are more likely than females to die by suicide and attempt suicide. A logistic regression model was also fitted, with gender as the independent variable. Gender was again found to be a statistically significant predictor of both attempted suicide ( p = 0.00362) and death by suicide ( p = 1.78 × 10 −7 ). The logistic regression model also allowed for computation of expected odds ratios. The odds of males attempting suicide were found to be 2.053 times as high as the odds of females attempting suicide, while the odds of males dying by suicide were found to be 5.049 times as high as those of females ( Tilley et al., 2023 ). To analyse possible relationships between gender and age and the method of (attempted) suicide, cases of attempted suicide and death by suicide were combined to increase the frequencies. There were then 133 cases of strangulation, 22 cases of overdose or poisoning, and 28 cases of other or unspecified methods. Due to this response variable having three categories, a multinomial logistic regression model ( Table 3 ) was fitted with method of death by suicide/attempted suicide as a response variable and age and gender as independent variables, with an interaction of age and gender as well. No statistically significant coefficient predictors were found in the model at the 5% level. Looking at the method of death by suicide/attempted suicide vs. gender using Fisher’s Exact Test ( Table 4 ), there was a statistically significant relationship ( p = 0.0005098 ), specifically, it appears that males are more likely to use strangulation, while females are more likely to use poisoning or overdose. Table 3. Multinomial logistic regression to predict death by suicide or attempted suicide method by age and gender. Coefficients: Method (Intercept) Age Male Age * Male Other or unspecified -1.278676 0.02476155 0.9989150 0.01170249 Strangulation death 1.704831 -0.03863174 0.5557824 0.04890228 Std. Errors: Method (Intercept) Age Male Age * Male Other or unspecified 1.2664027 0.02880904 2.380916 0.06678731 Strangulation death 0.9889576 0.02636292 2.006309 0.05978044 p-values Method (Intercept) Age Male Age * Male Other or unspecified 0.3126430 0.3900612 0.6748137 0.8609066 Strangulation death 0.0847319 0.1428169 0.7817668 0.4133392 Table 4. Fisher’s Exact Test – Gender association to type of Death by Suicide. Gender Overdose/poisoning Other/Unspecified Strangulation Death Female 59.1% 35.7% 15.8% Male 22.7% 35.7% 48.1% Unknown 18.2% 28.6% 36.1% An analysis of variance (ANOVA) was also run to check for differences in mean age of victims (dependent variable) across the three methods of death by suicide or attempted suicide ( Table 5 ). Statistically significant differences between groups were identified ( p = 0.0333 ). Using Tukey’s HSD method for post hoc comparisons ( Table 6 ), it was found that the mean age of strangulation victims is less than the mean age of “Other or unspecified” victims ( p = 0.0414684 ) ( Tilley, 2025 ). Table 5. ANOVA – Age relationship with method of Attempted Suicide or Death by Suicide. Term Degree of Freedom Sum of Squared Residuals Mean Squared F-value p-value Method of Death by Suicide 2 1017.113 508.5565 3.509373 0.0333395 Residuals 109 15795.601 144.9138 Table 6. Tukey’s HSD Results - Differences in Mean Age by Method of Attempted Suicide or Death by Suicide. Comparison Difference in Means Lower Confidence Limit Upper Confidence Limit Adjusted p-value Other or unspecified-overdose or poisoning 2.750000 -6.543301 12.0433011 0.76215151 Strangulation death-overdose or poisoning -4.689189 -12.206652 2.8282732 0.30343063 Strangulation death-other or unspecified -7.439189 -14.647982 -0.2303966 0.04146837 Discussion There was a range of death by suicide and suicidality typologies in the Garden Route District over the 3-year study period, presenting in 14% ( n = 412) of Incident Management Records sampled (representing health care consumer engagement). Death by suicide took place on average 2.8 ( n = 102) times a month, and attempted suicide 2.3 ( n = 83) times a month, and roughly 6.3 ( n = 227) health care consumers presented to the WCEMS with suicidal ideation monthly. Notably 63% ( n = 1890) of Incident Management Records (health care consumers) presented with mental illness sequela, often related to suicide and suicidality victims’ medical history ( Klonsky et al., 2016 ; Kułak-Bejda et al., 2021 ). Significantly, in the same sample, males were five and two times more likely to die by suicide and attempt suicide than females, respectively ( Tilley et al., 2023 ). Males appeared more likely to use strangulation, while females used overdose or poisoning as a means of death by suicide in the study site ( Tilley et al., 2023 ). The data analysis provided similar inferences already denoted in articles on suicide globally, with strangulation (hanging) being the most common method, and men being the most likely to die by suicide ( Klonsky et al., 2016 ; Kootbodien et al., 2020 ; Rahman et al., 2017 ; Ritchie et al., 2015 ). However, the presence of suicidal ideation, attempted suicides, cutting self-harm and overdose/DSP in the dataset is what was illuminating. Understandably, antecedents for suicidality ( Klonsky et al., 2016 ; Lim et al., 2019 ), individuals who inflict non-suicidal self-injury (disorder) are at risk of suicide attempts ( Brager-Larsen et al., 2024 ), while suicidal ideation and progression into suicide attempts are two phenomena that produce predictors towards death by suicide ( World Health Organization, 2014 ). Using the ideation-to-action framework, literature suggests deliberate self-harm and depression to be early and accurate indicators for suicidal ideation and suicidality ( Klonsky et al., 2016 ). The mental illness sequela from the dataset suggests that, through better medical surveillance, more effort could be put into early suicide detection, knowing that PTSD, bipolar disorder, depression, substance abuse and suicidal ideation are associated with suicide deaths ( Klonsky et al., 2016 ). Prehospital emergency medical care provides health action to health conditions through emergency medicine in a time sensitive approach with universality and responsivity ( Christopher et al., 2014 ; Naidoo, 2017 ; Tilley et al., 2023 ) and can recognise the patterns and needs of mental health care consumers from an early stage to interrupt suicidality and limit access to methods of harm ( Florentine & Crane, 2010 ). This dataset does not explain the perceptions prehospital EC providers have towards health care consumers who have suicidal ideation, suicidality and have attempted suicide. In various articles prehospital EC providers have explained to feel misconstrued on the concept of mental illness, self-harm and suicidality, often feeling lost and depleted by lack of legislation and policy, treatment protocols, training, guidance and personal negative conflict on own perceptions of attending mental health emergencies rather than trauma/medical emergencies ( Evans et al., 2018 ; O’Sullivan, 2014 ; Rees et al., 2015, 2018 ; Stander et al., 2021 ). In a study done in the same province in SA, it was found that 80% of the prehospital EC providers in the study had no prior training to manage suicidal health care consumers, seldom using formal suicide evaluation and capacity check tools, while implying negative feelings and connotations towards attempted suicide victims ( Evans et al., 2018 ). Inevitably, this lack of compassion, training and knowledge provides a precarious situation for prehospital EC providers, as this could prevent early mental health surveillance and suicidality interruption. A lack of praxis and management of suicidality and death by suicide caseload could put the EC provider helpless, creating an emotional backlash with vicarious traumatisation to the EC provider. Notably, prehospital EC providers have disclosed battling with lasting visions from death by suicide scenes and battling with anxiety, PTSD and depression ( Padmanabhanunni & Pretorius, 2025 ; Rothes et al., 2020 ). WCGEMS prehospital EC providers locate in the suicide and suicidality burden and need to consider analytical clinical decision making ( Emond et al., 2024 ) in managing and treating mental health consumers while considering the societal, cultural, religious and socioeconomic risk factors synonymous with suicide in SA ( Kootbodien et al., 2020 ). SA is precariously placed in the mental health milieu, with deinstitutionalisation and no appropriate policy and compensatory community mental health services created ( Motsoaledi & Matsoso, 2013 ; World Health Organization, 2003 ). Atrocities from apartheid, poverty and inequality create exponential societal risk levels for suicidality and suicide, placing the prehospital EC provider and EMS at the forefront of mental health and suicidality emergencies. Located in the forefront of this caseload, prehospital EC providers need to have capacity to manage, treat and transport these health care consumers, have potential to interrupt suicidality by limiting access to harmful methods ( Florentine & Crane, 2010 ), contribute to social capital through latent capacity ( Tilley et al., 2023 ) while minding risk of direct and vicarious self-traumatization ( Sandford et al., 2021 ). The WCGEMS-embedded in the South African socioeconomic traumatic past should consider ‘Trauma Informed Care’ as an interlude to disrupt negative postulation to suicidality, whereby understanding that childhood traumatic experiences can show signs of future mental health challenges, as most (mental) health is affected by past trauma ( Melillo et al., 2025 ; SAMHSA, 2014 ). Conclusion Tilley et al . (2023) described the Deliberate Self-Harm (DSH) burden for the prehospital EMS; however, the novelty in this paper provides and removes the DSH scope and focuses on prehospital suicidality typology while suggesting a syndemic approach to suicide in the African setting. The authenticity of this research elucidates the suicidality burden faced by the South African prehospital EMS. Death by suicide and suicidality typology in the EMS have not been previously assessed in South Africa, illuminating a problem space. This study describes the prehospital suicide and suicidality burden for the WCGEMS. Prehospital EC providers need to retain the praxis, training, emotion, policies and legislation to comprehensively manage, treat and transport health care consumers with suicidality ( Simpson et al., 2025 ) and that this proven challenge could require lateral deliberation ( Emond et al., 2024 ). It could be purposeful to consider ‘Trauma Informed Care’ ( SAMHSA, 2014 ) in an approach to management and training for health care consumers and EC providers. This could provide a dignified response to managing a marginalised group and the risk of vicarious traumatisation of the EC provider ( Sandford et al., 2021 ). This documented death by suicide and suicidality typology presents an understanding of the prehospital suicidality problem space definition. This study quantifies the burden for the EMS; however, it provides no solution to training, management, treatment or EC provider perception towards death by suicide and suicidality. Further study is required on EC provider stigmatisation towards death by suicide and suicidality, while auditing the need to assess policy, praxis, medical surveillance, EC provider clinical competency capacity and suicidality victim perspective, as health care consumer level interventions on strategic suicide prevention have aided in the reduction of suicide attempts ( Zarska et al., 2023 ). Suicidality and suicide in Southern Africa could require a ‘Syndemic’ approach ( Caulkins, 2022 ) for health authorities (such as EMS) to interrupt suicidality and be protective of people living with such risk. Limitations of the study Emergency call takers are not trained mental health professionals and don’t make mental health diagnoses, while the vernacular of the health care consumers provides a challenge in reporting. Retrospective data limitations apply ( Tilley et al., 2023 ). This dataset does not elucidate perceptions of prehospital EC providers towards suicidality. Ethical considerations Ethics was granted for this study through the ethical board of the Cape Peninsula University of Technology through a vigorous assessment of a research proposal (CPUT/HW-REC 2019/H17). Ethical permission for site approval was obtained from the Western Cape Government National Department of Health Ethics Council (WC_201911_033), granting approval to partake in quantitative retrospective research within the Western Cape Government Health and Wellness Emergency Medical Services. ( Tilley, 2021, 2025 ). Data availability Figshare: Access to health care for health care consumers with mental health needs: an Emergency Medical Service perspective. https://doi.org/10.6084/m9.figshare.30392569 . The project contains raw retrospective data in an Excel spreadsheet with analysed data in graphs and tables using R statistical software, Binary and multinomial logistic regression, Pearson’s Chi-squared test of independence, Fisher’s Exact Test, Analysis of Variance (ANOVA), and Tukey’s Honest Significant Difference (HSD). A dissertation with full analysis is also provided. Data are available under the terms of the Creative Commons Attribution 4.0 International licence (CC-BY 4.0). ( Tilley, 2025 ) Acknowledgements ‘Suicide is everybody’s business’ ( Shneidman, 1985 , p. 238). We acknowledge the 102 health care consumers who died by suicide as we try to advance improved treatment pathways and prevent death by suicide. References Action Society: One raped every 12 minutes; South Africans abandoned in war against crime.2024. Reference Source Ataguba JEO, Day C, McIntyre D: Explaining the role of the social determinants of health on health inequality in South Africa. Glob. Health Action. 2015; 8 (1): 28865. PubMed Abstract | Publisher Full Text | Free Full Text Bateman C: Mental health under-budgeting undermining sa’s economy. S. Afr. Med. J. 2015; 105 (1): 7–8. PubMed Abstract | Publisher Full Text Bhana A: More people dying by suicide in South Africa. Mail & Guardian. 2025; 1–5. Reference Source Bolboacă SD, Jäntschi L, Sestraş AF, et al. : Pearson-Fisher Chi-Square Statistic Revisited. Information. 2011; 2 (3): 528–545. Publisher Full Text Brager-Larsen A, Zeiner P, Mehlum L: DSM-5 Non-Suicidal Self-Injury Disorder in a Clinical Sample of Adolescents with Recurrent Self-Harm Behavior. Arch. Suicide Res. 2024; 28 (2): 523–536. PubMed Abstract | Publisher Full Text Burns JK: Mental Health gap in South Africa - Human Rights Perspective. The Equal Rights Review. 2011; 6 : 99–113. Reference Source Caulkins C: Suicide as Syndemic. Suicide Risk Assessment and Prevention. Springer; 2022; pp. 32–41. Publisher Full Text Christopher LD, Naidoo N, De Waal B, et al. : Setting the agenda in emergency medicine in the southern African region: Conference assumptions and recommendations, Emergency Medicine Conference 2014: Gaborone, Botswana. African Journal of Emergency Medicine. 2014; 4 (3): 154–157. Publisher Full Text Compton M, Shim R: Social determinants of mental health. Global Mental Health: Prevention and Promotion. 2017; 2 : 33–46. Publisher Full Text Egenasi CK, Benedict MA, Adefuye AO, et al. : Epidemiological pattern of rape cases managed at a regional hospital in South Africa. Health SA Gesondheid. 2024; 29 : 1–8. PubMed Abstract | Publisher Full Text | Free Full Text Emond K, Mnatzaganian G, Savic M, et al. : Paramedic perceptions of decision-making when managing mental health-related presentations: a qualitative study. BMC Med. Inform. Decis. Mak. 2024; 24 (1): 348. PubMed Abstract | Publisher Full Text | Free Full Text Evans K, Geduld H, Stassen W: Attitudes of prehospital providers on transport decision-making in the management of patients with a suicide attempt refusing care: A survey based on the Mental Health Care Act of 2002. S. Afr. J. Psychiatry. 2018; 24 : 1–6. Publisher Full Text Florentine JB, Crane C: Suicide prevention by limiting access to methods: A review of theory and practice. Soc. Sci. Med. 2010; 70 (10): 1626–1632. PubMed Abstract | Publisher Full Text Freeman J, Campbell M: The Analysis of Categorical Data: Fisher’S Exact Test. Scope. 2007; 33 (5): 11–12. Gass JD, Stein DJ, Williams DR, et al. : Intimate partner violence, health behaviours, and chronic physical illness among South African women. S. Afr. Med. J. 2010; 100 (9): 582–585. PubMed Abstract | Publisher Full Text | Free Full Text Hilton A: Statnote 6: Post-hoc ANOVA tests. Microbiologist. 2006; 34–36. Reference Source Hosmer DW, Lemeshow S: Applied Logistic Regression. Wiley; second ed. 2000. Publisher Full Text Jacob N, Coetzee D: Mental illness in the Western Cape Province, South Africa: A review of the burden of disease and healthcare interventions. S. Afr. Med. J. 2018; 108 (3): 176–180. PubMed Abstract | Publisher Full Text Kirmayer LJ: Suicide in cultural context: An ecosocial approach. Transcult. Psychiatry. 2022; 59 (1): 3–12. PubMed Abstract | Publisher Full Text Klonsky ED, May AM, Saffer BY: Suicide, Suicide Attempts, and Suicidal Ideation. Annu. Rev. Clin. Psychol. 2016; 12 (1): 307–330. Publisher Full Text Kootbodien T, Naicker N, Wilson KS, et al. : Trends in suicide mortality in South Africa, 1997 to 2016. Int. J. Environ. Res. Public Health. 2020; 17 (6). PubMed Abstract | Publisher Full Text | Free Full Text Kułak-Bejda A, Bejda G, Waszkiewicz N: Mental Disorders, Cognitive Impairment and the Risk of Suicide in Older Adults. Front. Psych. 2021; 12 (695286): 1–7. PubMed Abstract | Publisher Full Text | Free Full Text Lim KS, Wong CH, McIntyre RS, et al. : Global lifetime and 12-month prevalence of suicidal behavior, deliberate self-harm and non-suicidal self-injury in children and adolescents between 1989 and 2018: A meta-analysis. Int. J. Environ. Res. Public Health. 2019; 16 (4581). PubMed Abstract | Publisher Full Text | Free Full Text Lund C, Kleintjes S, Cooper S, et al. : Challenges facing South Africa’s mental health care system: Stakeholders’ perceptions of causes and potential solutions. Int. J. Cult. Ment. Health. 2011; 4 (1): 23–38. Publisher Full Text Lund C, Petersen I, Kleintjes S, et al. : Mental Health Services in South Africa: Taking stock. Afr. J. Psychiatry. 2012; 15 (6): 402–405. PubMed Abstract | Publisher Full Text Maharajh HD, Abdool PS: Cultural aspects of suicide. The Scientific World Journal. 2005; 5 : 736–746. PubMed Abstract | Publisher Full Text | Free Full Text Majiet N, van Rensburg L , Wylie C, et al. : The future of South African paramedicine: Adapting to evolving challenges and shaping a patient-centred future. Paramedicine. 2025; 22 : 237–244. Publisher Full Text Melillo A, Sansone N, Allan J, et al. : Recovery-oriented and trauma-informed care for people with mental disorders to promote human rights and quality of mental health care: a scoping review. BMC Psychiatry. 2025; 25 (1): 125. PubMed Abstract | Publisher Full Text | Free Full Text Motsoaledi A, Matsoso M: National Mental Health policy framework and strategic plan 2013-2020.2013. Reference Source Myers B, Koch JR, Johnson K, et al. : Factors associated with patient-reported experiences and outcomes of substance use disorder treatment in Cape Town, South Africa. Addict. Sci. Clin. Pract. 2022; 17 (8): 8–13. PubMed Abstract | Publisher Full Text | Free Full Text Naidoo N: Gender-based Violence: Strengthening the role and scope of Prehospital Emergency Care by promoting theory, policy and clinical praxis. University of Cape Town; 2017. Reference Source Nowacki A: Chi-square and Fisher’s exact tests (From the “Biostatistics and Epidemiology Lecture Series, Part 1”). Cleve. Clin. J. Med. 2017; 84 (9): e20–e25. Publisher Full Text O’Sullivan B: Paramedic attitudes to deliberate self-harming behaviour in Ireland. Journal of Paramedic Practice. 2014; 6 (3): 116–118. Publisher Full Text Padmanabhanunni A, Pretorius TB: An exploratory study of the mental health of first responders: depression, anxiety, and post-traumatic stress disorder. S. Afr. J. Psychol. 2025; 55 (2): 257–269. Publisher Full Text Pompili M: Suicide Risk Assessment and Prevention. Cham: Springer; 1st ed. 2022. Publisher Full Text Prinsloo M, Machisa M, Kassanjee R, et al. : Estimating the changing burden of disease attributable to interpersonal violence in South Africa for 2000, 2006 and 2012. S. Afr. Med. J. 2022; 112 (8 B): 693–704. PubMed Abstract | Publisher Full Text R Core Team: R: A language and environment for statistical computing. R Foundation for Statistical Computing; 2025. Reference Source Rahman MZ, Samad MA, Ahmad M, et al. : Suicide By Hanging: An Analysis Of 312 Cases. KYAMC Journal. 2017; 4 (1): 331–336. Publisher Full Text Rees N, Porter A, Rapport F, et al. : Paramedics’ perceptions of the care they provide to people who self-harm: A qualitative study using evolved grounded theory methodology. PLoS ONE. 2018; 13 (10): e0205813–e0205816. PubMed Abstract | Publisher Full Text | Free Full Text Rees N, Rapport F, Snooks H: Perceptions of paramedics and emergency staff about the care they provide to people who self-harm: Constructivist metasynthesis of the qualitative literature. J. Psychosom. Res. 2015; 78 (6): 529–535. PubMed Abstract | Publisher Full Text Ritchie H, Roser M, Ortiz-Ospina E: Suicide. Our World in Data.2015. Reference Source Rothes IA, Nogueira IC, Coutinho da Silva AP, et al. : When Emergency Patients Die by Suicide: The Experience of Prehospital Health Professionals. Front. Psychol. 2020; 11 (August): 1–10. PubMed Abstract | Publisher Full Text | Free Full Text SAMHSA: Trauma-Informed Care in Behavioral Health Services-Treatment Improvement Protocol (TIP) Series 57. Substance Abuse and Mental Health Services Administration. HHS Publication; 13th ed. 2014. Reference Source Sandford DM, Kirtley OJ, Thwaites R, et al. : The impact on mental health practitioners of the death of a patient by suicide: A systematic review. Clin. Psychol. Psychother. 2021; 28 (2): 261–294. PubMed Abstract | Publisher Full Text Sawyer SF: Analysis of Variance: The Fundamental Concepts. Journal of Manual & Manipulative Therapy. 2009; 17 (2): 27E–38E. Publisher Full Text Shneidman E: Definition of Suicide. John Wiley & Sons; 1st ed. 1985. Reference Source Simpson M, Thyer L, Christensen M, et al. : Exploring the lived experience of paramedics responding to individuals experiencing a mental health crisis in the community: A phenomenological study. Paramedicine. 2025; 1–14. Publisher Full Text Sperandei S: Understanding logistic regression analysis. Biochem. Med. 2014; 24 (1): 12–18. PubMed Abstract | Publisher Full Text | Free Full Text Stander C, Hodkinson P, Dippenaar E: Prehospital care providers’ understanding of responsibilities during a behavioural emergency. S. Afr. J. Psychiatry. 2021; 27 : 1–8. PubMed Abstract | Publisher Full Text | Free Full Text The World Bank: South Africa MPO - Public Documents.2024. Reference Source Tilley D: Access to health care for health care consumers with mental health needs: An Emergency Medical Service perspective. Cape Peninsula University of Technology; 2021. Reference Source Tilley D: Access to health care for health care consumers with mental health needs: an emergency medical service perspective. (Version 3). figshare. 2025. Publisher Full Text Tilley D, Christopher LD, Farrar T, et al. : Emergency Medical Service responses as latent social capital toward Deliberate Self-Harm, Suicidality and Suicide. Psychol. Health Med. 2023; 29 (4): 743–753. PubMed Abstract | Publisher Full Text Van Huyssteen N: A Legal Analysis of the Emergency Medical Services in South Africa. University of Pretoria; 2016. Reference Source Western Cape Government: Garden Route District Municipality.2019. Reference Source World Bank Group: Poverty & Equity Brief - South Africa April 2020. Poverty & Equity Brief. 2020. (Issue April). Reference Source World Health Organization: Mental Health Policy and Service Guidance Package: The Mental Health Context. Mental Health Policy and Service Guidance Package. 2003. Reference Source World Health Organization: Preventing suicide-A global imperative. WHO Press; 2014. Reference Source World Health Organization: World health statistics 2024: monitoring health for the SDGs. Sustainable Development Goals. 2024. Reference Source World Health Organization: Suicide worldwide in 2021: global health estimates.2025. Reference Source Zarska A, Barnicot K, Lavelle M, et al. : A Systematic Review of Training Interventions for Emergency Department Providers and Psychosocial Interventions delivered by Emergency Department Providers for Patients who self-harm. Arch. Suicide Res. 2023; 27 (3): 829–850. PubMed Abstract | Publisher Full Text Comments on this article Comments (0) Version 3 VERSION 3 PUBLISHED 03 Nov 2025 ADD YOUR COMMENT Comment Author details Author details 1 Emergency Medical Science, Cape Peninsula University of Technology Faculty of Health and Wellness Sciences, Cape Town, Western Cape, South Africa 2 Mathematics and Physics, Cape Peninsula University of Technology Faculty of Applied Sciences, Cape Town, Western Cape, South Africa 3 Paramedicine, School of health sciences, Western Sydney University Humanitarian and Development Research Initiative, Penrith, New South Wales, Australia Daniel Tilley Roles: Conceptualization, Formal Analysis, Project Administration, Writing – Original Draft Preparation, Writing – Review & Editing Lloyd Denzil Christopher Roles: Writing – Review & Editing Thomas Farrar Roles: Data Curation, Methodology, Software, Writing – Review & Editing Navindhra Naidoo Roles: Formal Analysis, Supervision, Validation, Writing – Review & Editing Competing interests No competing interests were disclosed. Grant information The author(s) declared that no grants were involved in supporting this work. Article Versions (3) version 3 Revised Published: 04 Mar 2026, 14:1201 https://doi.org/10.12688/f1000research.171712.3 version 2 Revised Published: 31 Dec 2025, 14:1201 https://doi.org/10.12688/f1000research.171712.2 version 1 Published: 03 Nov 2025, 14:1201 https://doi.org/10.12688/f1000research.171712.1 Copyright © 2025 Tilley D et al . This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Download Export To Sciwheel Bibtex EndNote ProCite Ref. Manager (RIS) Sente metrics Views Downloads F1000Research - - PubMed Central info_outline Data from PMC are received and updated monthly. - - Citations open_in_new 0 open_in_new 0 open_in_new SEE MORE DETAILS CITE how to cite this article Tilley D, Christopher LD, Farrar T and Naidoo N. Typologies of suicidality and suicide presenting to a prehospital South African Emergency Medical Service: a retrospective cross-sectional analysis [version 1; peer review: awaiting peer review] . F1000Research 2025, 14 :1201 ( https://doi.org/10.12688/f1000research.171712.1 ) NOTE: If applicable, it is important to ensure the information in square brackets after the title is included in all citations of this article. COPY CITATION DETAILS track receive updates on this article Track an article to receive email alerts on any updates to this article. TRACK THIS ARTICLE Share Open Peer Review Current Reviewer Status: AWAITING PEER REVIEW AWAITING PEER REVIEW ? Key to Reviewer Statuses VIEW HIDE Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions Comments on this article Comments (0) Version 3 VERSION 3 PUBLISHED 03 Nov 2025 ADD YOUR COMMENT Comment keyboard_arrow_left keyboard_arrow_right Open Peer Review Reviewer Status info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions Reviewer Reports Invited Reviewers 1 2 3 Version 3 (revision) 04 Mar 26 read read Version 2 (revision) 31 Dec 25 read read read Version 1 03 Nov 25 Paul Sookram , University of the Free State, Bloemfontein, South Africa Richard Mottershead , University of Baghdad, Baghdad, Iraq Wesley Craig , University of Cape Town Division of Emergency Medicine (Ringgold ID: 536985), Cape Town, South Africa Comments on this article All Comments (0) Add a comment Sign up for content alerts Sign Up You are now signed up to receive this alert Browse by related subjects keyboard_arrow_left Back to all reports Reviewer Report 0 Views copyright © 2026 Craig W. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. 06 Mar 2026 | for Version 3 Wesley Craig , University of Cape Town Division of Emergency Medicine (Ringgold ID: 536985), Cape Town, Western Cape, South Africa 0 Views copyright © 2026 Craig W. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. format_quote Cite this report speaker_notes Responses (0) Approved info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions Well done to the authors on a well presented manuscript. I have no further comments. Competing Interests No competing interests were disclosed. reply Respond to this report Responses (0) Craig W. Peer Review Report For: Typologies of suicidality and suicide presenting to a prehospital South African Emergency Medical Service: a retrospective cross-sectional analysis [version 1; peer review: awaiting peer review] . F1000Research 2025, 14 :1201 ( https://doi.org/10.5256/f1000research.197040.r464405) NOTE: it is important to ensure the information in square brackets after the title is included in this citation. The direct URL for this report is: https://f1000research.com/articles/14-1201/v3#referee-response-464405 keyboard_arrow_left Back to all reports Reviewer Report 0 Views copyright © 2026 Mottershead R. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. 05 Mar 2026 | for Version 3 Richard Mottershead , College of Nursing, University of Baghdad, Baghdad, Iraq 0 Views copyright © 2026 Mottershead R. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. format_quote Cite this report speaker_notes Responses (0) Approved info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions Dear Authors, Thank you for your careful and considered responses to the points raised during the review process. I appreciate the clarity and diligence with which you have addressed each comment and strengthened the manuscript accordingly. The revised paper, Typologies of suicidality and suicide presenting to a prehospital South African Emergency Medical Service: a retrospective cross-sectional analysis , makes a notable contribution to the field. By examining patterns of suicidality within the prehospital EMS context, the study adds valuable knowledge to an under-researched area and increases awareness of the complexity and burden of suicide-related presentations in emergency care settings. The work has clear relevance for clinical practice, service planning, and future research, particularly within resource-constrained and high-demand healthcare environments. It provides meaningful insights that can inform training, policy development, and targeted prevention strategies. Thank you for your thoughtful revisions and for contributing important evidence to this critical area of public health and emergency care. Kindest regards, Dr. Richard Mottershead Competing Interests No competing interests were disclosed. Reviewer Expertise My area of research is in mental health, societial challenges, applied research reply Respond to this report Responses (0) Mottershead R. Peer Review Report For: Typologies of suicidality and suicide presenting to a prehospital South African Emergency Medical Service: a retrospective cross-sectional analysis [version 1; peer review: awaiting peer review] . F1000Research 2025, 14 :1201 ( https://doi.org/10.5256/f1000research.197040.r464406) NOTE: it is important to ensure the information in square brackets after the title is included in this citation. The direct URL for this report is: https://f1000research.com/articles/14-1201/v3#referee-response-464406 keyboard_arrow_left Back to all reports Reviewer Report 0 Views copyright © 2026 Craig W. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. 19 Feb 2026 | for Version 2 Wesley Craig , University of Cape Town Division of Emergency Medicine (Ringgold ID: 536985), Cape Town, Western Cape, South Africa 0 Views copyright © 2026 Craig W. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. format_quote Cite this report speaker_notes Responses (1) Approved With Reservations info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions Thanks so much for the opportunity to review. The paper certainly addresses an important and under-researched area in South African out-of-hospital emergency care and its intersection with mental health care provision. This study examined the burden and typology of suicidality encountered by EMS in the Garden Route District of the Western Cape, South Africa. It used a retrospective cross-sectional analysis of EMS records from 2017-2019. From 413,712 EMS records, the authors identified 2,976 mental-health-related incidents, of which 412 involved suicidality, including suicidal ideation, attempted suicide, and death by suicide. The study found gender differences in suicide method and outcomes. Men were significantly more likely to die by suicide than women, and strangulation was the most common method among men, while poisoning or medication overdose was more common among women. The authors conclude that suicidality represents a meaningful but under-recognised component of the EMS caseload in South Africa. Improved training, policy guidance, mental-health surveillance, and research into EMS provider experiences and stigma was recommended. I believe the study is conceptually strong and publishable with minor-to-moderate revision. The research aim could be stated explicitly, aside from the abstract, it seems to be narratively embedded in the background. This also goes for the objectives; they don’t seem to be listed clearly anywhere. It would be helpful to the readership to state earlier that the case descriptions are based on EMS call-taker and call-categories not postmortem findings. This is especially important when determining intent in terms of “Death by suicide” vs accidental death and homicide. This is brought up in limitations, but should come earlier in methods and briefly in discussion (in general the misclassification bias/call-taker judgment etc). While the analysis and results appear robust, the level of statistical explanation is more detailed than necessary for most journals and at times reads like a dissertation. This can be quickly addressed by summarising the rationale for each test then focussing on interpretation rather than statistical pedagogy. Please refrain from citing papers which are not directly relevant to the statements (e.g. “The null hypothesis (H0) states ‘there is no association between two variables while the alternative hypothesis (Ha) states, there is an association between two variables (Bolboacă et al., 2011, p. 530; Tilley, 2021; Tilley et al., 2023).” The latter two references are not papers informing methods/analytic approaches. There are quite a few of these in the manuscript, please look out for these throughout. I would suggest that references to previous publications using the same dataset should be moved from the Results section to the Introduction or Discussion, and the novelty of the present analysis should be stated more clearly. A significant amount of time is spent on “age” (41 years being peak risk) as a variable yet there is no mention of it in the discussion. It would be useful to link this to other literature as it remains without context here. The discussion is strong and statements suggesting that EMS adopt TIC approaches is almost certainly valid, however it does move beyond the descriptive epidemiological nature of the manuscript. These can rather be framed as implications for users, or just areas for future research. Syndemic is a novel point of discussion and has value here however it seems awkwardly placed in the introduction, with nothing in the discussion, then brought back into the conclusion. “…however, the novelty in this paper provides and removes the DSH scope and focuses on prehospital suicidality typology while suggesting a syndemic approach to suicide in the African setting.“ I don’t believe it does this in its current form. Some more practical application could be valuable here, what would it look like if EMS training reflected this approach? The term is also inconsistently written in quotation marks. Trauma-informed care is also brought in at the latter end of the discussion with more explanation provided in the conclusion, this should be moved to the discussion section as no new information should be presented in the conclusion. Consent: The manuscript mentions “Western Cape Government National Department of Health Ethics Council (WC_201911_033)” I don’t believe this is the name of a single formal ethics committee. It appears to be a mislabelled or conflated reference to two different structures. That said, the ref number looks like a National Health Research Database (NHRD) number for a Western Cape Department of Health and Wellness Research site. More minor things Western Cape Department of Health and Wellness – I believe they’ve changed from ‘Government’ to ‘Department’. “healthcare” vs “health care” Inconsistent capitalisation of “Death by suicide” Limitations section: “don’t” – avoid the use of contractions, try to write in full. There are quite a few grammar and spacing gremlins throughout, another proofread will be adequate to pick up on these. In particular the use of inappropriate capitalisation and the inconsistent use of abbreviations. Is the work clearly and accurately presented and does it cite the current literature? Yes Is the study design appropriate and is the work technically sound? Yes Are sufficient details of methods and analysis provided to allow replication by others? Yes If applicable, is the statistical analysis and its interpretation appropriate? Yes Are all the source data underlying the results available to ensure full reproducibility? Yes Are the conclusions drawn adequately supported by the results? Partly Competing Interests No competing interests were disclosed. reply Respond to this report Responses (1) Author Response 04 Mar 2026 Daniel Tilley, Emergency Medical Science, Cape Peninsula University of Technology Faculty of Health and Wellness Sciences, Cape Town, South Africa Please see comments in Italics. We would like to thank the reviewer for the suggestions and advice in making this article more academically sound for international audiences and the journal as a whole. Thank you The research aim could be stated explicitly, aside from the abstract, it seems to be narratively embedded in the background. This also goes for the objectives; they don’t seem to be listed clearly anywhere. This has been done accordingly It would be helpful to the readership to state earlier that the case descriptions are based on EMS call-taker and call-categories not postmortem findings. This is especially important when determining intent in terms of “Death by suicide” vs accidental death and homicide. This is brought up in limitations, but should come earlier in methods and briefly in discussion (in general the misclassification bias/call-taker judgment etc). This has been done accordingly and added earlier in materials and methods Please refrain from citing papers which are not directly relevant to the statements (e.g. “The null hypothesis (H0) states ‘there is no association between two variables while the alternative hypothesis (Ha) states, there is an association between two variables (Bolboacă et al., 2011, p. 530; Tilley, 2021; Tilley et al., 2023).” The latter two references are not papers informing methods/analytic approaches. There are quite a few of these in the manuscript, please look out for these throughout. this has been fixed and changed I would suggest that references to previous publications using the same dataset should be moved from the Results section to the Introduction or Discussion, and the novelty of the present analysis should be stated more clearly. This has been done in the discussion A significant amount of time is spent on “age” (41 years being peak risk) as a variable yet there is no mention of it in the discussion. It would be useful to link this to other literature as it remains without context here. This has been added and discussed in discussion, thank you. The discussion is strong and statements suggesting that EMS adopt TIC approaches is almost certainly valid, however it does move beyond the descriptive epidemiological nature of the manuscript. These can rather be framed as implications for users, or just areas for future research. This has been done accordingly to this suggestion Syndemic is a novel point of discussion and has value here however it seems awkwardly placed in the introduction, with nothing in the discussion, then brought back into the conclusion. “…however, the novelty in this paper provides and removes the DSH scope and focuses on prehospital suicidality typology while suggesting a syndemic approach to suicide in the African setting.“ I don’t believe it does this in its current form. Some more practical application could be valuable here, what would it look like if EMS training reflected this approach? The term is also inconsistently written in quotation marks. This has been defined better and fixed accordingly Trauma-informed care is also brought in at the latter end of the discussion with more explanation provided in the conclusion, this should be moved to the discussion section as no new information should be presented in the conclusion. This has been changed accordingly and removed from the conclusion Consent: The manuscript mentions “Western Cape Government National Department of Health Ethics Council (WC_201911_033)” I don’t believe this is the name of a single formal ethics committee. It appears to be a mislabelled or conflated reference to two different structures. That said, the ref number looks like a National Health Research Database (NHRD) number for a Western Cape Department of Health and Wellness Research site. This has been changed as advised. Thank you for this advice More minor things Western Cape Department of Health and Wellness – I believe they’ve changed from ‘Government’ to ‘Department’. “healthcare” vs “health care” Inconsistent capitalisation of “Death by suicide” Limitations section: “don’t” – avoid the use of contractions, try to write in full. There are quite a few grammar and spacing gremlins throughout, another proofread will be adequate to pick up on these. In particular the use of inappropriate capitalisation and the inconsistent use of abbreviations. Thank you for this advice. this has all been attended to and corrected as suggested. View more View less Competing Interests no competing interests reply Respond Report a concern Craig W. Peer Review Report For: Typologies of suicidality and suicide presenting to a prehospital South African Emergency Medical Service: a retrospective cross-sectional analysis [version 1; peer review: awaiting peer review] . F1000Research 2025, 14 :1201 ( https://doi.org/10.5256/f1000research.194504.r458179) NOTE: it is important to ensure the information in square brackets after the title is included in this citation. The direct URL for this report is: https://f1000research.com/articles/14-1201/v2#referee-response-458179 keyboard_arrow_left Back to all reports Reviewer Report 0 Views copyright © 2026 Mottershead R. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. 17 Feb 2026 | for Version 2 Richard Mottershead , College of Nursing, University of Baghdad, Baghdad, Iraq 0 Views copyright © 2026 Mottershead R. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. format_quote Cite this report speaker_notes Responses (1) Approved With Reservations info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions I would like to thank the authors for this opportunity to peer review their article. Summary This study presents a retrospective cross-sectional analysis of suicidality and suicide cases recorded in the Western Cape Government Emergency Medical Services (WCGEMS) Incident Management Records over a three-year period (2017–2019) in the Garden Route District of South Africa. From 413,712 total EMS records, 2,976 mental health-related cases were identified, of which 412 (14%) involved suicidal ideation, attempted suicide, or death by suicide. The study provides typological analysis of suicide methods, gender associations, and age distributions using logistic regression, multinomial regression, ANOVA, and Fisher’s Exact Test. The findings indicate - An average of 2.8 deaths by suicide and 2.3 attempted suicides per month. - Males were approximately 5 times more likely to die by suicide than females. - Strangulation was the most common method among males; poisoning/overdose predominated among females. - Risk of death by suicide appeared to peak at approximately age 41 (quadratic model). The study aims to quantify and typologise suicidality within the prehospital EMS context and suggests a syndemic framework for understanding suicide within South Africa’s socio-economic landscape. The topic is highly relevant, particularly in low- and middle-income country contexts where prehospital suicide research is limited. The dataset is substantial, and the statistical analyses are appropriately selected for the research aims. Overall Assessment This manuscript makes an important contribution by quantifying the prehospital suicidality burden within a rural South African EMS context. The dataset is large, the statistical methods are generally appropriate, and the findings are clearly reported. However, my suggestions would be that the authors review these several areas which would (I believe) benefit from clarification and strengthening before full approval. These relate primarily to: Conceptual framing Operational definitions Interpretation of statistical findings Overextension of conclusions Clarity around “novelty” claims These are refinements rather than major corrections but would enhance the hard work and efforts of the research team. Recommendations 1. Clarify Operational Definitions and Case Classification The manuscript relies on EMS categorisation (e.g., “Self-Harm-other,” “Self-Harm-poisoning,” “Psychiatric/Behavioural Problems”), which are not clinical diagnoses. To strengthen methodological clarity, the authors should: Provide clearer operational definitions of: Suicidal ideation Attempted suicide Death by suicide Explain how misclassification bias may influence estimates. Clarify how “parasuicidal” behaviour was differentiated from attempted suicide. I might suggest that call-takers are not mental health professionals, this is a critical limitation and should be foregrounded more clearly in the methods and limitations sections. Perhaps the call-takers had enhanced training which was not highlighted within the article? 2. Strengthen Justification of the “Syndemic” Framing The syndemic concept is introduced as a major theoretical contribution; however, it is not analytically tested within the dataset. To strengthen conceptual coherence, the authors should: Clarify whether “syndemic” is used as: A theoretical lens, A hypothesis-generating concept, Or a demonstrated empirical finding. Avoid implying that syndemic relationships were statistically examined unless explicitly tested. Consider moderating the claim of novelty unless the framework is analytically integrated into results. Currently, the syndemic argument is persuasive but somewhat aspirational rather than empirically grounded in the presented analysis. 3. Moderate Claims of Novelty The manuscript states that suicide typology in the EMS has “not been previously assessed in South Africa.” This should be carefully contextualised: I note that there is prior work (including by the authors) on deliberate self-harm in EMS. The novelty lies in the typological disaggregation of suicidality and death by suicide within EMS records. Refining the novelty claim would enhance academic credibility and whilst also highlighting the authors previous contributions. Conclusion This study provides valuable epidemiological insight into suicidality and suicide presenting to a rural South African EMS. The methodology is broadly appropriate, the findings are coherent, and the topic is highly relevant. I believe that if these recommendations are followed the manuscript will be suitable for full approval. I will be available for a quick turn around. Thank you Dr. Richard Mottershead Is the work clearly and accurately presented and does it cite the current literature? Partly Is the study design appropriate and is the work technically sound? Partly Are sufficient details of methods and analysis provided to allow replication by others? Partly If applicable, is the statistical analysis and its interpretation appropriate? Yes Are all the source data underlying the results available to ensure full reproducibility? Yes Are the conclusions drawn adequately supported by the results? Partly Competing Interests No competing interests were disclosed. Reviewer Expertise My area of research is in mental health, societial challenges, applied research reply Respond to this report Responses (1) Author Response 04 Mar 2026 Daniel Tilley, Emergency Medical Science, Cape Peninsula University of Technology Faculty of Health and Wellness Sciences, Cape Town, South Africa Please note responses are given in italics. We would like to thank the reviewer for the advice and suggestions in making this document more academically sound for international audiences and the journal. Thank you for your review. Recommendations 1. Clarify Operational Definitions and Case Classification The manuscript relies on EMS categorisation (e.g., “Self-Harm-other,” “Self-Harm-poisoning,” “Psychiatric/Behavioural Problems”), which are not clinical diagnoses. To strengthen methodological clarity, the authors should: Provide clearer operational definitions of: Suicidal ideation Attempted suicide Death by suicide Explain how misclassification bias may influence estimates. Clarify how “parasuicidal” behaviour was differentiated from attempted suicide. Operational definition have been placed in accordingly in the appropriate places. Misclassification bias has been defined and explained in the methodology and in the limitations. Parasuicidal has been differentiated accordingly to explain this definition accurately. I might suggest that call-takers are not mental health professionals, this is a critical limitation and should be foregrounded more clearly in the methods and limitations sections. Perhaps the call-takers had enhanced training which was not highlighted within the article? This has been corrected and explained accordingly how dispatchers make us of caller prompts, senior medical technicians and senior paramedics to help with patient understandings. This is brought up earlier in the materials and methods sections. 2. Strengthen Justification of the “Syndemic” Framing The syndemic concept is introduced as a major theoretical contribution; however, it is not analytically tested within the dataset. To strengthen conceptual coherence, the authors should: Clarify whether “syndemic” is used as: A theoretical lens, A hypothesis-generating concept, Or a demonstrated empirical finding. Avoid implying that syndemic relationships were statistically examined unless explicitly tested. Consider moderating the claim of novelty unless the framework is analytically integrated into results. Currently, the syndemic argument is persuasive but somewhat aspirational rather than empirically grounded in the presented analysis. This has been described better in the text as a theoretical lens and better explained in the discussion and moves away from the suggestion that this concept was analyzed. 3. Moderate Claims of Novelty The manuscript states that suicide typology in the EMS has “not been previously assessed in South Africa.” This should be carefully contextualised: I note that there is prior work (including by the authors) on deliberate self-harm in EMS. The novelty lies in the typological disaggregation of suicidality and death by suicide within EMS records. Refining the novelty claim would enhance academic credibility and whilst also highlighting the authors previous contributions. Thank you so much for this advice. and for providing us with a better novelty claim. This has been amended accordingly View more View less Competing Interests there are no competing interests reply Respond Report a concern Mottershead R. Peer Review Report For: Typologies of suicidality and suicide presenting to a prehospital South African Emergency Medical Service: a retrospective cross-sectional analysis [version 1; peer review: awaiting peer review] . F1000Research 2025, 14 :1201 ( https://doi.org/10.5256/f1000research.194504.r457459) NOTE: it is important to ensure the information in square brackets after the title is included in this citation. The direct URL for this report is: https://f1000research.com/articles/14-1201/v2#referee-response-457459 keyboard_arrow_left Back to all reports Reviewer Report 0 Views copyright © 2026 Sookram P. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. 23 Jan 2026 | for Version 2 Paul Sookram , University of the Free State, Bloemfontein, Free State, South Africa 0 Views copyright © 2026 Sookram P. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. format_quote Cite this report speaker_notes Responses (1) Approved info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions This manuscript addresses an important and under-researched EMS public health issue using a large retrospective dataset. The methodology is appropriate, and the analyses are robust. Minor revisions are required to improve language clarity, methodological transparency, and consistency in terminology and statistical reporting 2. Language, spelling, and style (minor but frequent issues) General comments The manuscript is generally readable, but there are numerous typographical, spacing, and grammatical inconsistencies. Several errors appear repeatedly and should be corrected globally. Key issues and examples Spacing and typographical errors Examples: “Southj african” → South African “theAfrica region” → the Africa region “attemptedmurders” → attempted murders “healthcare” vs “health care” → choose one and apply consistently (journal style usually prefers health care). “multinomial” misspelled as multinominal in several places. Inconsistent capitalisation “Death by Suicide”, “Attempted Suicide”, “Suicide” are capitalised inconsistently. Recommendation: only capitalise when starting a sentence or when formally defining a variable. Long and complex sentences Some paragraphs (especially Introduction and Discussion) would benefit from sentence shortening to improve clarity. Example: paragraphs discussing social determinants and syndemic theory could be split. Redundancy Repetition of phrases such as “prehospital Emergency Medical Services” could be reduced after first definition (EMS). Recommendation: A professional language edit or journal copy-edit pass would substantially improve readability but is not a fatal flaw. 3. Introduction and literature framing Strengths Strong contextualization of suicide as a public health problem in South Africa. Effective linkage between social determinants, mental health systems, and EMS burden.The introduction of syndemic theory is novel and relevant. Areas for improvement Overcrowding of statistics The Introduction contains many statistics in a short span. Suggest prioritising key figures and moving some contextual data to later paragraphs. Clearer research gap The research gap is implied but could be stated more explicitly: “There is limited empirical evidence describing suicidality typology within South African prehospital EMS settings.” Research question clarity The question is posed mid-paragraph. Recommend explicitly stating the aim and objectives at the end of the Introduction. 4. Methodology Strengths Appropriate retrospective cross-sectional design. Census approach strengthens internal validity. Clear description of data source (IMRs). Ethical approvals are well documented. Methodological concerns and suggestions Inclusion/exclusion criteria Inclusion criteria rely heavily on dispatcher categorisation. This limitation is acknowledged later but should be more explicitly stated upfront. Definition of outcomes “Death by suicide” is defined as a prehospital service category, not forensic confirmation. This is appropriate but must be clearly emphasised earlier, especially for international readers. Use of multiple statistical tests While the analyses are appropriate, the rationale for each test could be more succinct. Consider a short summary table or paragraph explaining: Which tests answer which research questions. Multiple comparisons Given the number of tests run, there is risk of type I error. A brief statement acknowledging this limitation would strengthen the methodology. 5. Results Strengths Results are comprehensive and logically ordered. Tables and figures support the narrative. Gender and method associations are clearly reported. Issues requiring correction or clarification Consistency in reporting percentages Percentages sometimes lack denominators. Always specify n/N for clarity. Terminology “Strangulation death” may be misinterpreted internationally. Suggest: “Strangulation (asphyxiation/hanging)” on first use. Age modelling The quadratic age analysis is well executed. However, the clinical or practical significance of the peak at age 41 could be briefly contextualised. Combining attempted suicide and suicide. Combining cases for multinomial analysis is justified statistically.This decision should be explicitly justified earlier in the Results section. 6. Discussion Strengths Discussion aligns well with results.Good integration with international literature. Strong EMS-focused interpretation.The link to trauma-informed care is appropriate and timely. Areas for strengthening Balance Discussion occasionally leans toward advocacy. Consider tightening language to maintain a neutral scholarly tone. Causality- Avoid language that implies causation from cross-sectional data. Use phrases such as “associated with” rather than “leads to”. Syndemic framing- Strong conceptually, but could benefit from: A short paragraph explaining how EMS policy or training could operationalise a syndemic approach. 7. Limitations Strengths-Limitations are acknowledged and appropriate. Suggested additions-Add explicit mention of: Potential misclassification bias. Reliance on dispatcher-reported categories. Lack of post-event outcome verification 8. Referencing and citations Strengths Broad and relevant reference base. Good use of African and international literature. Issues- Inconsistency in formatting.Some references lack page numbers or consistent journal formatting. Grey literature-Media sources (e.g. Mail & Guardian, Action Society) are useful but should be clearly framed as contextual sources, not epidemiological evidence. Repetition-Some references appear multiple times in the reference list (likely formatting duplication Is the work clearly and accurately presented and does it cite the current literature? Yes Is the study design appropriate and is the work technically sound? Yes Are sufficient details of methods and analysis provided to allow replication by others? Yes If applicable, is the statistical analysis and its interpretation appropriate? Yes Are all the source data underlying the results available to ensure full reproducibility? Yes Are the conclusions drawn adequately supported by the results? Yes Competing Interests No competing interests were disclosed. Reviewer Expertise I am an expert in Health Professions Education reply Respond to this report Responses (1) Author Response 04 Mar 2026 Daniel Tilley, Emergency Medical Science, Cape Peninsula University of Technology Faculty of Health and Wellness Sciences, Cape Town, South Africa Please see comments in Italics. We would like to thank the reviewer for all the positive suggestions and advice in making this article more academic sound and applicable to international standards for the journal. Thank you 2. Language, spelling, and style (minor but frequent issues) General comments The manuscript is generally readable, but there are numerous typographical, spacing, and grammatical inconsistencies. Several errors appear repeatedly and should be corrected globally. Key issues and examples Spacing and typographical errors Examples: “Southj african” → South African “theAfrica region” → the Africa region “attemptedmurders” → attempted murders “healthcare” vs “health care” → choose one and apply consistently (journal style usually prefers health care). “multinomial” misspelled as multinominal in several places. Thank you for this report. This has been fix and changed accordingly. Inconsistent capitalisation “Death by Suicide”, “Attempted Suicide”, “Suicide” are capitalised inconsistently. Recommendation: only capitalise when starting a sentence or when formally defining a variable. This has been changed in the document and corrected accordingly Long and complex sentences Some paragraphs (especially Introduction and Discussion) would benefit from sentence shortening to improve clarity. Example: paragraphs discussing social determinants and syndemic theory could be split. The long paragraphs have been shortened in to smaller coherent sentences and split accordingly. Redundancy Repetition of phrases such as “prehospital Emergency Medical Services” could be reduced after first definition (EMS). This has been corrected accordingly Recommendation: A professional language edit or journal copy-edit pass would substantially improve readability but is not a fatal flaw. . Clearer research gap The research gap is implied but could be stated more explicitly: “There is limited empirical evidence describing suicidality typology within South African prehospital EMS settings.” This has been added. Thank you for pointing this out and aiding in a contextualizing sentence, that we added to the manuscript. Research question clarity The question is posed mid-paragraph. Recommend explicitly stating the aim and objectives at the end of the Introduction. This has been rearranged and fixed accordingly. 4. Methodology This limitation is acknowledged later but should be more explicitly stated upfront. Definition of outcomes “Death by suicide” is defined as a prehospital service category, not forensic confirmation. This is appropriate but must be clearly emphasised earlier, especially for international readers. We added this in earlier as suggested Use of multiple statistical tests While the analyses are appropriate, the rationale for each test could be more succinct. Consider a short summary table or paragraph explaining: Which tests answer which research questions. Multiple comparisons Given the number of tests run, there is risk of type I error. A brief statement acknowledging this limitation would strengthen the methodology. This is added and we explain how Tukey’s method is designed to control the familywise type I error rate at a fixed level (e.g., 0.05) despite the large number of pairwise comparisons being made. Suggest: “Strangulation (asphyxiation/hanging)” on first use. This has been changed throughout document Age modelling The quadratic age analysis is well executed. However, the clinical or practical significance of the peak at age 41 could be briefly contextualised. Combining attempted suicide and suicide. Combining cases for multinomial analysis is justified statistically.This decision should be explicitly justified earlier in the Results section. This is done accordingly 6. Discussion Areas for strengthening Balance Discussion occasionally leans toward advocacy. Consider tightening language to maintain a neutral scholarly tone. Causality- Avoid language that implies causation from cross-sectional data. Use phrases such as “associated with” rather than “leads to”. This has been done accordingly Syndemic framing- Strong conceptually, but could benefit from: A short paragraph explaining how EMS policy or training could operationalise a syndemic approach. This has been added accordingly as suggested 7. Limitations Strengths-Limitations are acknowledged and appropriate. Suggested additions-Add explicit mention of: Potential misclassification bias. Reliance on dispatcher-reported categories. Lack of post-event outcome verification This has been done and explained in limitations and in methodology section. As suggested 8. Referencing and citations Issues- Inconsistency in formatting.Some references lack page numbers or consistent journal formatting. This is how the journal created the referencing format. APA was used as the initial reference format Grey literature-Media sources (e.g. Mail & Guardian, Action Society) are useful but should be clearly framed as contextual sources, not epidemiological evidence. done accordingly Repetition-Some references appear multiple times in the reference list (likely formatting duplication This duplication is in requirements of the journal for data availability and is part of the instructions to create a DOI and add a reference to the reference list. View more View less Competing Interests no competing interests reply Respond Report a concern Sookram P. Peer Review Report For: Typologies of suicidality and suicide presenting to a prehospital South African Emergency Medical Service: a retrospective cross-sectional analysis [version 1; peer review: awaiting peer review] . F1000Research 2025, 14 :1201 ( https://doi.org/10.5256/f1000research.194504.r446906) NOTE: it is important to ensure the information in square brackets after the title is included in this citation. The direct URL for this report is: https://f1000research.com/articles/14-1201/v2#referee-response-446906 Alongside their report, reviewers assign a status to the article: Approved - the paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations - A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved - fundamental flaws in the paper seriously undermine the findings and conclusions Adjust parameters to alter display View on desktop for interactive features Includes Interactive Elements View on desktop for interactive features Competing Interests Policy Provide sufficient details of any financial or non-financial competing interests to enable users to assess whether your comments might lead a reasonable person to question your impartiality. Consider the following examples, but note that this is not an exhaustive list: Examples of 'Non-Financial Competing Interests' Within the past 4 years, you have held joint grants, published or collaborated with any of the authors of the selected paper. You have a close personal relationship (e.g. parent, spouse, sibling, or domestic partner) with any of the authors. You are a close professional associate of any of the authors (e.g. scientific mentor, recent student). You work at the same institute as any of the authors. You hope/expect to benefit (e.g. favour or employment) as a result of your submission. You are an Editor for the journal in which the article is published. Examples of 'Financial Competing Interests' You expect to receive, or in the past 4 years have received, any of the following from any commercial organisation that may gain financially from your submission: a salary, fees, funding, reimbursements. You expect to receive, or in the past 4 years have received, shared grant support or other funding with any of the authors. You hold, or are currently applying for, any patents or significant stocks/shares relating to the subject matter of the paper you are commenting on. Stay Updated Sign up for content alerts and receive a weekly or monthly email with all newly published articles Register with F1000Research Already registered? Sign in Not now, thanks close PLEASE NOTE If you are an AUTHOR of this article, please check that you signed in with the account associated with this article otherwise we cannot automatically identify your role as an author and your comment will be labelled as a “User Comment”. If you are a REVIEWER of this article, please check that you have signed in with the account associated with this article and then go to your account to submit your report, please do not post your review here. If you do not have access to your original account, please contact us . All commenters must hold a formal affiliation as per our Policies . The information that you give us will be displayed next to your comment. User comments must be in English, comprehensible and relevant to the article under discussion. We reserve the right to remove any comments that we consider to be inappropriate, offensive or otherwise in breach of the User Comment Terms and Conditions . Commenters must not use a comment for personal attacks. When criticisms of the article are based on unpublished data, the data should be made available. I accept the User Comment Terms and Conditions Please confirm that you accept the User Comment Terms and Conditions. Affiliation ✕ refresh Please enter your institution. Note: To add your institution or organisation, start typing the name and then select the correct name from the list. Where applicable, the name will appear in both the original language and in English. Do not paste in the name. If the name does not appear in the drop-down list, we will display the information you have entered. ✕ refresh Country/Region * USA UK Canada China France Germany Afghanistan Aland Islands Albania Algeria American Samoa Andorra Angola Anguilla Antarctica Antigua and Barbuda Argentina Armenia Aruba Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bosnia and Herzegovina Botswana Bouvet Island Brazil British Indian Ocean Territory British Virgin Islands Brunei Bulgaria Burkina Faso Burundi Cambodia Cameroon Canada Cape Verde Cayman Islands Central African Republic Chad Chile China Christmas Island Cocos (Keeling) Islands Colombia Comoros Congo Cook Islands Costa Rica Cote d'Ivoire Croatia Cuba Cyprus Czech Republic Democratic Republic of the Congo Denmark Djibouti Dominica Dominican Republic Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Falkland Islands Faroe Islands Federated States of Micronesia Fiji Finland France French Guiana French Polynesia French Southern Territories Gabon Georgia Germany Ghana Gibraltar Greece Greenland Grenada Guadeloupe Guam Guatemala Guernsey Guinea Guinea-Bissau Guyana Haiti Heard Island and Mcdonald Islands Holy See (Vatican City State) Honduras Hong Kong Hungary Iceland India Indonesia Iran Iraq Ireland Israel Italy Jamaica Japan Jersey Jordan Kazakhstan Kenya Kiribati Kosovo (Serbia and Montenegro) Kuwait Kyrgyzstan Lao People's Democratic Republic Latvia Lebanon Lesotho Liberia Libya Liechtenstein Lithuania Luxembourg Macao Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Martinique Mauritania Mauritius Mayotte Mexico Minor Outlying Islands of the United States Moldova Monaco Mongolia Montenegro Montserrat Morocco Mozambique Myanmar Namibia Nauru Nepal Netherlands Antilles New Caledonia New Zealand Nicaragua Niger Nigeria Niue Norfolk Island North Korea North Macedonia Northern Mariana Islands Norway Oman Pakistan Palau Palestinian Territory Panama Papua New Guinea Paraguay Peru Philippines Pitcairn Poland Portugal Puerto Rico Qatar Reunion Romania Russian Federation Rwanda Saint Helena Saint Kitts and Nevis Saint Lucia Saint Pierre and Miquelon Saint Vincent and the Grenadines Samoa San Marino Sao Tome and Principe Saudi Arabia Senegal Serbia Seychelles Sierra Leone Singapore Slovakia Slovenia Solomon Islands Somalia South Africa South Georgia and the South Sandwich Is South Korea South Sudan Spain Sri Lanka Sudan Suriname Svalbard and Jan Mayen Swaziland Sweden Switzerland Syria Taiwan Tajikistan Tanzania Thailand The Gambia The Netherlands Timor-Leste Togo Tokelau Tonga Trinidad and Tobago Tunisia Turkey Turkmenistan Turks and Caicos Islands Tuvalu UK USA Uganda Ukraine United Arab Emirates United States Virgin Islands Uruguay Uzbekistan Vanuatu Venezuela Vietnam Wallis and Futuna West Bank and Gaza Strip Western Sahara Yemen Zambia Zimbabwe Please select your country/region. You must enter a comment. Competing Interests Please disclose any competing interests that might be construed to influence your judgment of the article's or peer review report's validity or importance. Competing Interests Policy Provide sufficient details of any financial or non-financial competing interests to enable users to assess whether your comments might lead a reasonable person to question your impartiality. Consider the following examples, but note that this is not an exhaustive list: Examples of 'Non-Financial Competing Interests' Within the past 4 years, you have held joint grants, published or collaborated with any of the authors of the selected paper. You have a close personal relationship (e.g. parent, spouse, sibling, or domestic partner) with any of the authors. You are a close professional associate of any of the authors (e.g. scientific mentor, recent student). You work at the same institute as any of the authors. You hope/expect to benefit (e.g. favour or employment) as a result of your submission. You are an Editor for the journal in which the article is published. Examples of 'Financial Competing Interests' You expect to receive, or in the past 4 years have received, any of the following from any commercial organisation that may gain financially from your submission: a salary, fees, funding, reimbursements. You expect to receive, or in the past 4 years have received, shared grant support or other funding with any of the authors. You hold, or are currently applying for, any patents or significant stocks/shares relating to the subject matter of the paper you are commenting on. Please state your competing interests The comment has been saved. An error has occurred. Please try again. Cancel Post var lTitle = "Typologies of suicidality and suicide presenting...".replace("'", ''); var linkedInUrl = "http://www.linkedin.com/shareArticle?url=https://f1000research.com/articles/14-1201/v1" + "&title=" + encodeURIComponent(lTitle) + "&summary=" + encodeURIComponent('Read the article by '); var deliciousUrl = "https://del.icio.us/post?url=https://f1000research.com/articles/14-1201/v1&title=" + encodeURIComponent(lTitle); var redditUrl = "http://reddit.com/submit?url=https://f1000research.com/articles/14-1201/v1" + "&title=" + encodeURIComponent(lTitle); linkedInUrl += encodeURIComponent('Tilley D et al.'); var offsetTop = /chrome/i.test( navigator.userAgent ) ? 4 : -10; var addthis_config = { ui_offset_top: offsetTop, services_compact : "facebook,twitter,www.linkedin.com,www.mendeley.com,reddit.com", services_expanded : "facebook,twitter,www.linkedin.com,www.mendeley.com,reddit.com", services_custom : [ { name: "LinkedIn", url: linkedInUrl, icon:"/img/icon/at_linkedin.svg" }, { name: "Mendeley", url: "http://www.mendeley.com/import/?url=https://f1000research.com/articles/14-1201/v1/mendeley", icon:"/img/icon/at_mendeley.svg" }, { name: "Reddit", url: redditUrl, icon:"/img/icon/at_reddit.svg" }, ] }; var addthis_share = { url: "https://f1000research.com/articles/14-1201", templates : { twitter : "Typologies of suicidality and suicide presenting to a prehospital.... Tilley D et al., published by " + "@F1000Research" + ", https://f1000research.com/articles/14-1201/v1" } }; if (typeof(addthis) != "undefined"){ addthis.addEventListener('addthis.ready', checkCount); addthis.addEventListener('addthis.menu.share', checkCount); } $(".f1r-shares-twitter").attr("href", "https://twitter.com/intent/tweet?text=" + addthis_share.templates.twitter); $(".f1r-shares-facebook").attr("href", "https://www.facebook.com/sharer/sharer.php?u=" + addthis_share.url); $(".f1r-shares-linkedin").attr("href", addthis_config.services_custom[0].url); $(".f1r-shares-reddit").attr("href", addthis_config.services_custom[2].url); $(".f1r-shares-mendelay").attr("href", addthis_config.services_custom[1].url); function checkCount(){ setTimeout(function(){ $(".addthis_button_expanded").each(function(){ var count = $(this).text(); if (count !== "" && count != "0") $(this).removeClass("is-hidden"); else $(this).addClass("is-hidden"); }); }, 1000); } close How to cite this report {{reportCitation}} Cancel Copy Citation Details $(function(){R.ui.buttonDropdowns('.dropdown-for-downloads');}); $(function(){R.ui.toolbarDropdowns('.toolbar-dropdown-for-downloads');}); $.get("/articles/acj/171712/189348") new F1000.Clipboard(); new F1000.ThesaurusTermsDisplay("articles", "article", "189348"); $(document).ready(function() { $( "#frame1" ).on('load', function() { var mydiv = $(this).contents().find("div"); var h = mydiv.height(); console.log(h) }); var tooltipLivingFigure = jQuery(".interactive-living-figure-label .icon-more-info"), titleLivingFigure = tooltipLivingFigure.attr("title"); tooltipLivingFigure.simpletip({ fixed: true, position: ["-115", "30"], baseClass: 'small-tooltip', content:titleLivingFigure + " " }); tooltipLivingFigure.removeAttr("title"); $("body").on("click", ".cite-living-figure", function(e) { e.preventDefault(); var ref = $(this).attr("data-ref"); $(this).closest(".living-figure-list-container").find("#" + ref).fadeIn(200); }); $("body").on("click", ".close-cite-living-figure", function(e) { e.preventDefault(); $(this).closest(".popup-window-wrapper").fadeOut(200); }); $(document).on("mouseup", function(e) { var metricsContainer = $(".article-metrics-popover-wrapper"); if (!metricsContainer.is(e.target) && metricsContainer.has(e.target).length === 0) { $(".article-metrics-close-button").click(); } }); var articleId = $('#articleId').val(); if($("#main-article-count-box").attachArticleMetrics) { $("#main-article-count-box").attachArticleMetrics(articleId, { articleMetricsView: true }); } }); var figshareWidget = $(".new_figshare_widget"); if (figshareWidget.length > 0) { window.figshare.load("f1000", function(Widget) { // Select a tag/tags defined in your page. In this tag we will place the widget. _.map(figshareWidget, function(el){ var widget = new Widget({ articleId: $(el).attr("figshare_articleId") //height:300 // this is the height of the viewer part. [Default: 550] }); widget.initialize(); // initialize the widget widget.mount(el); // mount it in a tag that's on your page // this will save the widget on the global scope for later use from // your JS scripts. This line is optional. //window.widget = widget; }); }); } close Error Close Add Reset F1000.MICROSERVICES.AFFILIATION = ''; $(document).ready(function () { $('.js-affiliations-form').each((index, form) => { new AffiliationForm({ formId: form.id, institutionErrorSelector: '.comment-enter-institution', departmentErrorSelector: '.comment-enter-department', placeSelector: '.js-add-comment-place', stateSelector: '.js-add-comment-state', zipCodeSelector: '.js-add-comment-zipcode', countrySelector: '.js-add-comment-country', countryErrorSelector: '.comment-enter-country', }); }); }); $(document).ready(function () { var reportIds = { "464407": 0, "431766": 0, "464406": 5, "431767": 0, "464405": 4, "431774": 0, "431775": 0, "431772": 0, "431773": 0, "431770": 0, "431771": 0, "431768": 0, "431769": 0, "436022": 0, "436023": 0, "446903": 0, "436021": 0, "436030": 0, "446910": 0, "433727": 0, "458175": 0, "446911": 0, "436028": 0, "446908": 0, "436029": 0, "446909": 0, "436026": 0, "446906": 13, "436027": 0, "446907": 0, "436024": 0, "446904": 0, "436025": 0, "446905": 0, "433734": 0, "458182": 0, "433735": 0, "458183": 0, "433732": 0, "458180": 0, "433733": 0, "458181": 0, "433730": 0, "458178": 0, "433731": 0, "458179": 12, "433728": 0, "458176": 0, "446912": 0, "433729": 0, "458177": 0, "433736": 0, "458184": 0, "429662": 0, "429663": 0, "429660": 0, "429661": 0, "429658": 0, "429659": 0, "429657": 0, "429666": 0, "429664": 0, "429665": 0, "442479": 0, "442486": 0, "456566": 0, "442487": 0, "456567": 0, "442484": 0, "456564": 0, "442485": 0, "456565": 0, "442482": 0, "456562": 0, "442483": 0, "457459": 19, "456563": 0, "442480": 0, "442481": 0, "456561": 0, "456570": 0, "442488": 0, "456568": 0, "456569": 0, }; $(".referee-response-container,.js-referee-report").each(function(index, el) { var reportId = $(el).attr("data-reportid"), reportCount = reportIds[reportId] || 0; $(el).find(".comments-count-container,.js-referee-report-views").html(reportCount); }); var uuidInput = $("#article_uuid"), oldUUId = uuidInput.val(), newUUId = "f6ac7613-f9bb-4cd6-a003-5c796de26ec0"; uuidInput.val(newUUId); $("a[href*='article_uuid=']").each(function(index, el) { var newHref = $(el).attr("href").replace(oldUUId, newUUId); $(el).attr("href", newHref); }); }); An innovative open access publishing platform offering rapid publication and open peer review, whilst supporting data deposition and sharing. Browse Gateways Collections How it Works Contact For Developers Cookie Notice Privacy Notice RSS Submit Your Research Follow us © 2012-2026 F1000 Research Ltd. ISSN 2046-1402 | Legal | Partner of Research4Life • CrossRef • ORCID • FAIRSharing R.templateTests.simpleTemplate = R.template(' $text $text $text $text $text '); R.templateTests.runTests(); var F1000platform = new F1000.Platform({ name: "f1000research", displayName: "F1000Research", hostName: "f1000research.com", id: "1", editorialEmail: "[email protected]", infoEmail: "[email protected]", usePmcStats: true }); $(function(){R.ui.dropdowns('.dropdown-for-authors, .dropdown-for-about, .dropdown-for-myresearch');}); // $(function(){R.ui.dropdowns('.dropdown-for-referees');}); $(document).ready(function () { if ($(".cookie-warning").is(":visible")) { $(".sticky").css("margin-bottom", "35px"); $(".devices").addClass("devices-and-cookie-warning"); } $(".cookie-warning .close-button").click(function (e) { $(".devices").removeClass("devices-and-cookie-warning"); $(".sticky").css("margin-bottom", "0"); }); $("#tweeter-feed .tweet-message").each(function (i, message) { var self = $(message); self.html(linkify(self.html())); }); $(".partner").on("mouseenter mouseleave", function() { $(this).find(".gray-scale, .colour").toggleClass("is-hidden"); }); }); Sign In Remember me Forgotten your password? Sign In Cancel Email or password not correct. Please try again Please wait... $(function(){ // Note: All the setup needs to run against a name attribute and *not* the id due the clonish // nature of facebox... $("a[id=googleSignInButton]").click(function(event){ event.preventDefault(); $("input[id=oAuthSystem]").val("GOOGLE"); $("form[id=oAuthForm]").submit(); }); $("a[id=facebookSignInButton]").click(function(event){ event.preventDefault(); $("input[id=oAuthSystem]").val("FACEBOOK"); $("form[id=oAuthForm]").submit(); }); $("a[id=orcidSignInButton]").click(function(event){ event.preventDefault(); $("input[id=oAuthSystem]").val("ORCID"); $("form[id=oAuthForm]").submit(); }); }); If you've forgotten your password, please enter your email address below and we'll send you instructions on how to reset your password. The email address should be the one you originally registered with F1000. Email address not valid, please try again You registered with F1000 via Google, so we cannot reset your password. To sign in, please click here . If you still need help with your Google account password, please click here . You registered with F1000 via Facebook, so we cannot reset your password. To sign in, please click here . If you still need help with your Facebook account password, please click here . Code not correct, please try again Reset password Cancel Email us for further assistance. Server error, please try again. If your email address is registered with us, we will email you instructions to reset your password. If you think you should have received this email but it has not arrived, please check your spam filters and/or contact for further assistance. Please wait... Register $(document).ready(function () { signIn.createSignInAsRow($("#sign-in-form-gfb-popup")); $(".target-field").each(function () { var uris = $(this).val().split("/"); if (uris.pop() === "login") { $(this).val(uris.toString().replace(",","/")); } }); });