The impact of COVID-19 and public health measures on homicide and suicide trends in Botswana using an interrupted time series analysis

Abstract

Introduction: The effects of the COVID-19 pandemic and subsequent public health measures on trends of homicide and suicide in various settings remain unclear. There has been little attention paid to the effects of the COVID-19 pandemic on trends of homicide and suicide in African countries. Methods: We conducted an interrupted time-series analysis (ITSA) to evaluate the impact of the COVID-19 pandemic on monthly homicide and suicide trends in Botswana. Using forensic registers from the Forensic Pathology Unit of the Botswana Police Service, we compared mean incidence and trends before, during, and after the State of Emergency (SoE), stratifying by age and sex. Results: Our study analyzed 2,225 autopsies from January 1, 2018, to September 30, 2022, comprising of 1,479 homicides and 746 suicides. Monthly autopsy rates were lower during the SoE (median 32, IQR: 11.5) compared to pre-SoE (40, IQR: 15.8) and post-SoE (46, IQR: 11.5) periods. Homicide rates were 28 (IQR: 7.5), 19 (IQR: 7), and 29.5 (IQR: 10) for pre-SoE, SoE, and post-SoE, respectively, while suicide rates were 12.5 (IQR: 4), 13 (IQR: 6), and 16.5 (IQR: 4.75). Conclusions: Our findings indicate a reduction in homicide and suicide incidence during the SoE, with a return to pre-pandemic levels thereafter. Public health professionals can leverage these insights to identify actionable factors for reducing suicide and homicide risks in future crises.