Suicide in Sri Lanka 1975–2012: age, period and cohort analysis of police and hospital data

Abstract

BackgroundSri Lanka has experienced major changes in its suicide rates since the 1970s, and in 1995 it had one of the highest rates in the world. Subsequent reductions in Sri Lanka’s suicide rates have been attributed to the introduction of restrictions on the availability of highly toxic pesticides. We investigate these changes in suicide rates in relation to age, gender, method specific trends and birth-cohort and period effects, with the aim of informing preventative strategies.MethodsSecular trends of suicide in relation to age, sex, method, birth-cohort and period effects were investigated graphically using police data (1975–2012). Poisoning case-fatality was investigated using national hospital admission data (2004–2010).ResultsThere were marked changes to the age-, gender- and method-specific incidence of suicide over the study period. Year on year declines in rates began in 17–25 year olds in the early 1980s. Reduction in older age groups followed and falls in all age groups occurred after all class I (the most toxic) pesticides were banned. Distinct changes in the age/gender pattern of suicide are observed: in the 1980s suicide rates were highest in 21–35 year old men; by the 2000s, this pattern had reversed with a stepwise increase in male rates with increasing age. Throughout the study period female rates were highest in 17–25 year olds. There has been a rise in suicide by hanging, though this rise is relatively small in relation to the marked decline in self-poisoning deaths. The patterns of suicides are more consistent with a period rather than birth-cohort effect.ConclusionsThe epidemiology of suicide in Sri Lanka has changed noticeably in the last 30 years. The introduction of pesticide regulations in Sri Lanka coincides with a reduction in suicide rates, with evidence of limited method substitution.Electronic supplementary materialThe online version of this article (doi:10.1186/1471-2458-14-839) contains supplementary material, which is available to authorized users.

A review of the changing patterns of suicide and deliberate self-harm in Sri Lanka

“…In keeping with this, the rates of suicide in Sri Lanka by hanging have increased from 13% in 1975-77 to 36% of all suicides in 2010-12 (6). However this increase in rates of hanging over the past decades has been much less than the fall in rates of suicides due to pesticide ingestion (5,6).…”

“…Six studies included in the review commented on the rates of suicides in Sri Lanka since 1995 (2,(4)(5)(6)(7)(8). A common theme reported in all six articles was the decline of overall suicide rates in Sri Lanka during the past two decades.…”

“…Knipe et al examined the rates of suicide in Sri Lanka by age and gender; and reported that similar to the overall patterns of suicide, among males there has been a rapid decline in all age-specific suicide rates since 1995 onwards (6). In the mid-1980s suicide rates among males were higher in the 17-25 year age group than among older males (aged >35 years), but since 1999 this has changed, with the risk of suicide in males increasing with age (6).…”

“…Overall to date, the most common method of suicide in Sri Lanka has been by self-poisoning, most often by pesticide ingestion (6). This despite the fact that from 1995 onwards, rates of suicides by self-poisoning have declined in both genders; the rate of suicide by selfpoisoning fell from 42/100,000 (79% of all suicides) in 1994-96 to 11/100,000 (48% of all suicides) in by 2010-2012 (2,6).…”

Gender differences in suicide in Sri Lanka – what does it tell us?

“…According to police and government statistics, in 2009, a total of 4019 people died by suicide in Sri Lanka, compared to approximately 2457 deaths due to road traffic accidents. Self-poisoning by ingestion of pesticides remains the most common method of suicide, followed by hanging [5]. Thus, suicide remains an important public health problem in this country.…”