Childhood adversity and self-poisoning: A hospital case control study in Sri Lanka

Rajapakse, Thilini; Russell, Abigail Emma; Kidger, Judi; Bandara, Piumee; López-López, José A; Senarathna, Lalith; Metcalfe, Chris; Gunnell, David; Knipe, Duleeka

doi:10.1371/journal.pone.0242437

Cited by 12 publications

(13 citation statements)

References 41 publications

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“…Patient age was calculated using their date of birth (where available) or reported age. On the basis of the recommended cutoff values for defining adolescence and youth, and knowledge of the patient profile of this ward before the pandemic, 15,16 we categorised patients into young (<25 years) and older (≥25 years) individuals. We categorised poisoning into medicinal, agrochemical, and plant or other on the basis of the toxicological agent.…”

Section: Discussionmentioning

confidence: 99%

Hospital presentations for self-poisoning during COVID-19 in Sri Lanka: an interrupted time-series analysis

Knipe¹,

Silva²,

Aroos³

et al. 2021

The Lancet Psychiatry

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Background There is widespread concern over the impact of public health measures, such as lockdowns, associated with COVID-19 on mental health, including suicide. High-quality evidence from low-income and middle-income countries, where the burden of suicide and self-harm is greatest, is scarce. We aimed to determine the effect of the pandemic on hospital presentations for self-poisoning.Methods In this interrupted time-series analysis, we established a new self-poisoning register at the tertiary care Teaching Hospital Peradeniya in Sri Lanka, a lower-middle-income country. Using a standard extraction sheet, data were gathered for all patients admitted to the Toxicology Unit with self-poisoning between Jan 1, 2019, and Aug 31, 2020. Only patients classified by the treating clinician as having intentionally self-poisoned were included. Data on date of admission, age or date of birth, sex, and poisoning method were collected. No data on ethnicity were available. We used interrupted time-series analysis to calculate weekly hospital admissions for self-poisoning before (Jan 1, 2019-March 19, 2020) and during (March 20-Aug 31, 2020) the pandemic, overall and by age (age <25 years vs ≥25 years) and sex. Individuals with missing date of admission were excluded from the main analysis.

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Section: Discussionmentioning

confidence: 99%

Hospital presentations for self-poisoning during COVID-19 in Sri Lanka: an interrupted time-series analysis

Knipe¹,

Silva²,

Aroos³

et al. 2021

The Lancet Psychiatry

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“…33 Trapping women in abusive relationships may lead to increases in self-harming behaviour in both the women and offspring in the household. 6 37–39 In addition to domestic violence, poverty and spousal illness/substance abuse are also significant push factors for emigration. The current study finds evidence that adults who experienced parental emigration during childhood also reported experiencing violence in the home.…”

Section: Discussionmentioning

confidence: 99%

“… 5 The main study findings related to adverse childhood experiences is presented elsewhere. 6 The current study focusses on the impact of parental emigration, an experience that cannot be clearly classed as an adverse experience given the potential beneficial impacts related to this exposure and therefore is investigated separately to other known adverse exposures. Data were collected from the Teaching Hospital Peradeniya (THP) in the Kandy district in the Central Province of Sri Lanka.…”

Section: Methodsmentioning

confidence: 99%

Is being a 'left-behind' child associated with an increased risk of self-poisoning in adulthood? Findings from a case–control study in Sri Lanka

et al. 2021

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PurposeThe long-term consequences of parental emigration on offspring self-harm risk is unknown.MethodsWe investigated the association between experiencing parental emigration in childhood with hospital presentations for self-poisoning in adulthood using a hospital case–control study. Cases were adult self-poisoning patients (≥18 year olds) admitted to the medical toxicology ward Teaching Hospital Peradeniya, Sri Lanka. Sex and age frequency matched controls were recruited from the outpatient department or nearby specialist clinics at the same hospital. Details of parental emigration were collected using a pre-piloted questionnaire. The relationship between parental emigration and self-poisoning in adulthood was estimated using logistic regression models.Results298 cases, and 500 hospital controls were interviewed for the study. We estimate that one in five adults experienced parental emmigration as children (95% CI 17% to 24%). We find limited evidence that children from households with emigrating parents were more likely to experience adverse childhood experiences than those with non-emigrating parents. We found no statistical evidence of an increased risk of self-poisoning in adulthood in individuals who experienced parental emigration (maternal or paternal) during childhood. There was no statistical evidence that the impact differed by the sex of the participant.ConclusionAdults who experienced parental emigration as children were no more likely to self-poison than adults with non-emigrating parents. Further research using longitudinal data are needed to understand whether any adverse outcomes observed in 'left-behind' children are a consequence of parental emigration or due to factors associated but predate the emigration. Prospective data are also important to investigate whether there are any lasting effects on children who experience parental emigration.

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“…This study is nested within a large case-control study examining childhood adversity and deliberate self-poisoning in the semi-urban town of Kandy, Sri Lanka (Rajapakse et al, 2020). Cases were patients ≥18 years admitted to the medical toxicology ward of a tertiary hospital for deliberate self-poisoning between July 18, 2018 and December 31, 2018.…”

Section: Methodsmentioning

confidence: 99%

Domestic violence, mental health, and repeat self-harm in Sri Lanka

Bandara

Page

Rajapakse

et al. 2021

Preprint

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Background: Evidence on the risk factors for repeat self-harm from low- and middle-income countries is scarce and requires urgent attention. Aims: We sought to examine psychosocial correlates of repeat self-harm in Kandy, Sri Lanka. Methods: Logistic regression models (adjusting for age and sex) were used to examine associations between study factors and repeat self-harm among adult patients (N=292) admitted for self-poisoning. Results: Depression (OR 2.8 95% CI 1.7-4.7), prior psychiatric diagnosis (OR 4.8 95% CI 2.2-10.2), past-year exposure to suicidal behaviour (OR 1.9 95% 1.1-3.3), physical/sexual abuse (OR 3.0 95% CI 1.3-6.9), and psychological abuse (OR 2.3 95% CI 1.3-4.2) were strongly associated with repeat self-harm. Conclusions: Identification and management of domestic violence and psychiatric morbidity should be part of routine clinical assessments of patients presenting with self-harm.

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Childhood adversity and self-poisoning: A hospital case control study in Sri Lanka

Cited by 12 publications

References 41 publications

Hospital presentations for self-poisoning during COVID-19 in Sri Lanka: an interrupted time-series analysis

Hospital presentations for self-poisoning during COVID-19 in Sri Lanka: an interrupted time-series analysis

Is being a 'left-behind' child associated with an increased risk of self-poisoning in adulthood? Findings from a case–control study in Sri Lanka

Domestic violence, mental health, and repeat self-harm in Sri Lanka

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