Attempted suicide in Sri Lanka – An epidemiological study of household and community factors

Knipe, Duleeka; Gunnell, David; Pearson, Melissa; Jayamanne, Shaluka; Pieris, Ravi; Priyadarshana, Chamil; Weerasinghe, Manjula; Hawton, Keith; Konradsen, Flemming; Eddleston, Michael; Metcalfe, Chris

doi:10.1016/j.jad.2018.01.028

Cited by 27 publications

(31 citation statements)

References 38 publications

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“…This is also reflected in the higher rates of informal work in these areas; which added to poverty, and inequality explain the high suicides rates in these regions. Intervention such as improved employment opportunities, welfare and mental health support services, as well as problem-solving skills development, may help farmers and reduce the burden of disease and suicides in poor areas [30,31].…”

Section: Discussionmentioning

confidence: 99%

Social and economic variables related with Paraquat self-poisoning: an ecological study

2020

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Background: Paraquat self-poisonings constitute a significant contributor to the global burden of suicide. Our aim was to evaluate the relationship between social and economic variables with the incidence of self-poisoning with Paraquat in the northeast of Colombia. Methods: Records of 154 cases of self-poisoning with Paraquat and several socioeconomic variables of six regions of northeast of Colombia were analyzed. Results: Most of the cases were mestizos, farmworkers, between 20 and 29 years, with intentional exposure using the oral route. Multivariate analyses revealed significant associations among the incidence of self-poisoning with PQ with the ecological factors such as poverty greater than 30% (IRR 15.9 IC95% 5.56-44.72), land Gini index < 0.7 (IRR 7.11 IC95% 3.58-14.12), private health insurance < 40% (IRR 3.39 IC95% 1.30-8.82) and planted area > 10% (IRR 2.47 IC95% 1.60-3.80). Conclusion: There is a relationship between ecological factors and, as such, this study opens the way to further developments in the field.

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Section: Discussionmentioning

confidence: 99%

Social and economic variables related with Paraquat self-poisoning: an ecological study

2020

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“…We investigated the risk of fatal and non-fatal repeat self-harm in relation to the following: demographic characteristics (sex and age at first presentation, with four age bands [10–25 years; 26–40 years; 41–55 years; and ≥56 years]); medical history or clinical data (data on previous self-harm before the baseline survey obtained via questioning the household respondent; method of self-harm collected from hospital records or by interviewing the patient or accompanying person); and socioeconomic characteristics collected in the baseline survey. Household socioeconomic position was measured on the basis of a household asset score 13 . This score is a composite three-level measure derived by combining data on household construction and motorised vehicle ownership as follows: low (no motorised vehicle and poor quality household construction); middle (either a motorised vehicle or moderate or high quality household construction); or high (motorised vehicle ownership and moderate or high quality household construction).…”

Section: Methodsmentioning

confidence: 99%

Risk of suicide and repeat self-harm after hospital attendance for non-fatal self-harm in Sri Lanka: a cohort study

Knipe

Metcalfe

Hawton

et al. 2019

The Lancet Psychiatry

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Summary Background Evidence from high income countries (HICs) suggests that individuals who present to hospital after self-harm are an important target for suicide prevention, but evidence from low and middle-income countries (LMICs) is lacking. We aimed to investigate the risk of repeat self-harm and suicide, and factors associated with these outcomes, in a large cohort of patients presenting to hospital with self-harm in rural Sri Lanka. Methods In this cohort study, hospital presentations for self-harm at 13 hospitals in a rural area of North Central Province (population 224 000), Sri Lanka, were followed up with a self-harm surveillance system, established as part of a community randomised trial, and based on data from all hospitals, coroners, and police stations in the study area. We estimated the risk of repeat non-fatal and fatal self-harm and risk factors for repetition with Kaplan-Meier methods and Cox proportional hazard models. Sociodemographic (age, sex, and socioeconomic position) and clinical (past self-harm and method of self-harm) characteristics investigated were drawn from a household survey in the study area and data recorded at the time of index hospital presentation. We included all individuals who had complete data for all variables in the study in our primary analysis. Outcomes Between July 29, 2011, and May 12, 2016, we detected 3073 episodes of self-harm (fatal and non-fatal) in our surveillance system, of which 2532 (82·3%) were linked back to an individual in the baseline survey. After exclusion of 145 ineligible episodes, we analysed 2259 index episodes of self-harm. By use of survival models, the estimated risk of repeat self-harm (12 months: 3· 1%, 95% CI 2·4–3·9; 24 months: 5·2%, 4·3–6·4) and suicide (12 months: 0·6%, 0·4–1·1; 24 months: 0·8%, 0·5–1·3) in our study was considerably lower than that in HICs. A higher risk of repeat self-harm was observed in men than in women (fatal and non-fatal; hazard ratio 2·0, 95% CI 1·3–3·2; p=0·0021), in individuals aged 56 years and older compared with those aged 10–25 years (fatal; 16·1, 4·3–59·9; p=0·0027), and those who used methods other than poisoning in their index presentation (fatal and non-fatal; 3·9, 2·0–7·6; p=0·00027). We found no evidence of increased risk of repeat self-harm or suicide in those with a history of self-harm before the index episode. Interpretation Although people who self-harm are an important high-risk group, focusing suicide prevention efforts on those who self-harm might be somewhat less important in LMICs compared with HICs given the low risk of repeat self-harm and subsequent suicide death. Strategies that focus on other risk factors for suicide might be more effective in reducing suicide deaths in LMICs in south Asia. A better understanding of the low incidence of repeat self-harm is also needed, as this could contribute to prevention strategies in nations with a higher incidence of repetition an...

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“…This is also reflected in the higher rates of informal work in these areas; which added to poverty, and inequality explain the high suicides rates in these regions. Intervention such as improved employment opportunities, welfare and mental health support services, as well as problem-solving skills 7 development, may help farmers and reduce the burden of disease and suicides in poor areas [30,31].…”

Section: Discussionmentioning

confidence: 99%

Social and Economic Variables Related with Paraquat Self-Poisoning: an Ecological Study

Rodriguez

Chavarriaga

Zuluaga

2020

Preprint

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BackgroundParaquat self-poisonings constitute a significant contributor to the global burden of suicide.Our aim was to evaluate the relationship between social and economic variables with the incidence of selfpoisoning with Paraquat in the northeast of Colombia. MethodsRecords of 154 cases of self-poisoning with Paraquat and several socio-economic variables of six regions of northeast of Colombia were analyzed. Results Most of the cases were mestizos, farmworkers, between 20 and 29 years, with intentional exposure using the oral route. Multivariate analyses revealed significant associations among the incidence of self-poisoning with PQ with the ecological factors such as poverty greater than 30% (IRR 15.9 IC95% 5.56-44.72), land Gini index <0.7 (IRR 7.11 IC95% 3.58-14.12), private health insurance <40% (IRR 3.39 IC95% 1.30-8.82) andplanted area >10% (IRR 2.47 IC95% 1.60-3.80). ConclusionThere is a relationship between ecological factors and, as such, this study opens the way to further developments in the field.

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Attempted suicide in Sri Lanka – An epidemiological study of household and community factors

Cited by 27 publications

References 38 publications

Social and economic variables related with Paraquat self-poisoning: an ecological study

Social and economic variables related with Paraquat self-poisoning: an ecological study

Risk of suicide and repeat self-harm after hospital attendance for non-fatal self-harm in Sri Lanka: a cohort study

Social and Economic Variables Related with Paraquat Self-Poisoning: an Ecological Study

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