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Psychological autopsy study of suicide in three rural and semi-rural districts of Sri Lanka

Abstract

Background

Knowledge concerning the epidemiology of suicide in Sri Lanka is limited despite its suicide rates being amongst the highest in the world.

Aim

To examine the characteristics of a large sample of Sri Lankan suicides to inform approaches to prevention.

Method

Psychological autopsy study of suicides occurring in three rural districts of Sri Lanka during August–October 1997.

Results

Interviews were conducted with contacts of 372 (74%) of the 499 suicides that occurred over the study period. Males accounted for 79% of the deaths. Twenty-one percent of male and 57% of female suicides were aged <25 years of age. Pesticide self-poisoning accounted for 259 (70%) of the deaths. Almost two-thirds (62%) of the deaths occurred in hospital and 95 (26%) had made previous suicidal gestures. 138 (37%) were moderately or severely depressed and 144 (49%) of male suicides, but only 2 (2.5%) of the females, were alcohol dependent. Illegally brewed alcohol (kasippu) was the main product used by two thirds (62%) of problem drinkers. There was a family history of suicide in 20% of cases.

Conclusion

Pesticide self-poisoning accounts for over two thirds of suicides in rural Sri Lanka. Suicide prevention efforts in Sri Lanka should focus on restricting access to pesticides, improving the medical management of pesticide poisoning, reducing alcohol misuse—particularly targeting the supply of illegal alcohol—and improving the identification and aftercare of people who self-harm.

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References

  1. 1.

    Berger LR (1988) Suicides and pesticides in Sri Lanka. Am J Public Health 78:826–828

  2. 2.

    Buckley NA, Karalliedde L, Dawson A, Senanayake N, Eddleston M (2004) Where is the evidence for treatments used in pesticide poisoning? Is clinical toxicology fiddling while the developing world burns? J Toxicol Clin Toxicol 42:113–116

  3. 3.

    de Silva HJ, Kasturiaratchi N, Seneviratne SL, Senaratne DC, Molagoda A, Ellawala NS (2000) Suicide in Sri Lanka: points to ponder. Ceylon Med J 45:17–24

  4. 4.

    Dissanayake SAW (1974) Suicide and attempted suicide in Sri Lanka. Ceylon J Med Sci 23:10–27

  5. 5.

    Eddleston M, Karunaratne A, Weerakoon M, Kumarasinghe S, Rajapakshe M, Rezvi Sheriff MH, Buckley NA, Gunnell D (2006) Choice of poison for intentional self-poisoning in rural Sri Lanka. Clin Toxicol 44:283–6

  6. 6.

    Eddleston M, Gunnell D, Karunaratne A, de SD, Sheriff MH, Buckley NA (2005) Epidemiology of intentional self-poisoning in rural Sri Lanka. Br J Psychiatry 187:583–584

  7. 7.

    Eddleston M, Buckley NA, Gunnell D, Dawson AH, Konradsen F (2006) Identification of strategies to prevent death after pesticide self-poisoning using a Haddon matrix. Inj Prev 12:333–337

  8. 8.

    Eddleston M, Dissanayake M, Sheriff MH, Warrell DA, Gunnell D (2006) Physical vulnerability and fatal self-harm in the elderly. Br J Psychiatry 189:278–279

  9. 9.

    Fernando PR (1977) Acute poisoning. Ceylon Med J 22:90–93

  10. 10.

    Foster T, Gillespie K, McClelland R, Patterson C (1999) Risk factors for suicide independent of DSM-111-r Axis 1 Disorder. Br J Psychiatry 175:175–179

  11. 11.

    Ganesvaran T, Rajarajeswaran R (1989) Attempted suicide in a Northern town of Sri Lanka. Jaffna Med J 24:3–9

  12. 12.

    Gunnell D, Eddleston M (2003) Suicide by intentional ingestion of pesticides: a continuing tragedy in developing countries. Int J Epidemiol 32:902–909

  13. 13.

    Gunnell D, Ho D, Murray V (2004) Medical management of deliberate drug overdose - a neglected area for suicide prevention? Emerg Med J 21:35–38

  14. 14.

    Gunnell D, Fernando R, Hewagama M, Priyangika WDD, Konradsen F, Eddleston M (2007) The impact of pesticide regulations on suicide in Sri Lanka. Int J Epidemiol 36(6):1235–1242

  15. 15.

    Hettiarachchi J, Kodithuwakku GC, Chandrasiri N (1988) Suicide in southern Sri Lanka. Med Sci Law 28:248–251

  16. 16.

    Hettiarachchi J, Kodituwakku GC (1989) Self poisoning in Sri Lanka: motivational aspects. Int J Soc Psychiatry 35:204–208

  17. 17.

    Konradsen F, van der Hoek W, Cole DC, Hutchinson G, Daisley H, Singh S, Eddleston M (2003) Reducing acute poisoning in developing countries-options for restricting the availability of pesticides. Toxicology 192:249–261

  18. 18.

    Pesonen TM, Hintikka J, Karkola KO, Saarinen PI, Antikainen M, Lehtonen J (2001) Male suicide mortality in eastern Finland -urban- rural changes during a 10-year period between 1988 and 1997. Scand J Public Health 29:189–193

  19. 19.

    Phillips MR, Shen Q, Liu X, Pritzker S, Streiner D, Conner K, Yang G (2007). Assessing depressive symptoms in persons who die of suicide in mainland China. J Affect Disord 98:73–82

  20. 20.

    Qin P, Agerbo E, Mortensen PB (2003) Suicide risk in relation to socioeconomic, demographic, psychiatric, and familial factors: a national register-based study of all suicides in Denmark, 1981–1997. Am J Psychiatry 160:765–772

  21. 21.

    Senewiratne B, Thambipillai S (1974) Pattern of poisoning in a developing agricultural country. Br J Prev Soc Med 28:32–36

  22. 22.

    Somasundaram DJ, Rajadurai S (1995) War and suicide in northern Sri Lanka. Acta Psychiatr Scand 91:1–4

  23. 23.

    Stata Corporation (2001) Intercooled Stata 7.0 for Windows. Stata Corporation, Texas

  24. 24.

    Thalagala NI, Fernando DN (2003) Attempted suicides in Kurunegala District—circumstances and risk factors. Coll Community Physicians Sri Lanka 8:38–45

  25. 25.

    van der Hoek W, Konradsen F, Athukorala K, Wanigadewa T (1998) Pesticide poisoning: a major health problem in Sri Lanka. Soc Sci Med 46:495–504

  26. 26.

    van der Hoek W, Konradsen F (2005) Risk factors for acute pesticide poisoning in Sri Lanka. Trop Med Int Health 10:589–596

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Acknowledgements

The work was funded by a grant from the Presidential Secretariat, Sri Lanka. Dr. Tara de Mel, for supporting this work in many ways. The research team consisted of: S.P.M. Karunaratne, M.G. Hemakumara and Vijitha Bandranayake. Input from the following people was vital: Dr. Priyani Ratnayake; Ms. Indika Bulumulla; Mr. Shelton Gamini; Dr. Amila Hewaratne; Dr. Thushari Wanigaratne and Dr. Thusari Hapuarachchi. Dr Michael Eddleston provided helpful comments on a draft of this paper.

Author information

Correspondence to Dr. Ranil Abeyasinghe.

Appendix A

Appendix A

Four categories of drinking

When interpreting alcohol data, alcohol use was considered under four categories.

  • Those who never used alcohol and those who have stopped drinking completely.

  • Those who drank less than three times a week and only at parties. Their drinking never caused problems. These were categorised as social drinkers.

  • Those who could be categorised as abusing alcohol, according to the DSM 4 criteria.

  • Those who were dependent on alcohol and fulfilled criteria for DSM 4 category of alcohol dependence.

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Abeyasinghe, R., Gunnell, D. Psychological autopsy study of suicide in three rural and semi-rural districts of Sri Lanka. Soc Psychiat Epidemiol 43, 280–285 (2008). https://doi.org/10.1007/s00127-008-0307-3

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Key words

  • suicide
  • Sri Lanka
  • epidemiology