A prospective study of repetition of self-harm following deliberate self-poisoning in rural Sri Lanka

Pushpakumara, P. H. G. J.; Thennakoon, S. U. B.; Rajapakse, Thilini; Abeysinghe, Ranil; Dawson, Andrew

doi:10.1371/journal.pone.0199486

Cited by 14 publications

(23 citation statements)

References 37 publications

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“…There is, however, a paucity of evidence from LMICs in south Asia regarding the risk of suicide after a self-harm episode 2 . The few south Asian studies on this issue indicate that the risk of repeat self-harm is lower than in HICs,6, 7, 8, 9, 10 but there have been few prospective studies and most studies to date have been small and of low quality. A large prospective study 10 restricted to people who had self-poisoned in a rural region of Sri Lanka reported that the risk of repeat self-poisoning at 12 months was 5·7% (95% CI 5·0–6·4) and of suicide (all methods) at 2 years was 0·7% (0·4–0·9), considerably lower than the risks reported in HICs.…”

Section: Introductionmentioning

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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Section: Introductionmentioning

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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“…THK is the main referral center for the 1.6 million population of the district, [12] and receives more than 53% of the total deliberate self-poisoning cases of the district. [6] Procedure Sample and sampling:…”

Section: Study Design and Study Settingmentioning

confidence: 99%

“…This nding may also partially explain the lower repetition rates of self-harm, observed in Sri Lanka. [6,27] In this Sri Lankan context a greater focus on non-psychiatric and medical interventions many be appropriate. In rural Sri Lanka, self poisoning seems to be the preferred method of dealing with di cult situations [28].…”

Section: Rates Of Psychiatric Morbiditymentioning

confidence: 99%

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Exploration of Associations Between Deliberate Self-Poisoning and Psychiatric Disorders in Rural Sri Lanka: A Case Control Study

et al. 2020

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Background Psychiatric disorders are important predictors of self-harm behaviour. The present study was carried out to determine associations between DSM-IV TR Axis-I & II disorders and deliberate self poisoning (DSP) in a Sri Lankan rural agricultural district. Methods Patients who had attempted DSP, who resided within the district were selected randomly for the study. Both the cases and age, sex and residential area matched controls were assessed for DSM-IV TR Axis-I & II disorders based on the Structured Clinical Interview for DSM-IV-TR Axis I and II Disorders (SCID I & II) conducted by a specialist psychiatrist. Results Cases consisted of 207 (47.3%) males and 231 (52.7%) females. TR axis-I and/or TR axis-II psychiatric diagnoses was found in 89 (25.6%) of cases and 14 (3.2%) controls. Cases with a TR axis-I diagnosis were older (32 and 19 years), p < 0.0001. Having a depressive episode was associated with a 13 time higher risk for DSP. Being a male aged > = 30 years and having an alcohol use disorder carried a 21 time excess risk for DSP. A vefold excess risk for DSP was found among 10-19 years old females with borderline personality traits. Conclusions Depressive disorder and alcohol related disorders were signi cantly associated with older participants who had attempted DSP. The prevalence of psychiatric disorders among DSP in rural Sri Lanka is signi cantly lower than reported rates in western countries. Health and research priorities to reduce self-harm in Sri Lanka will also need to address non-psychiatric issues

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“…In a review article, Carrol et al reported that fewer Asian patients attempted suicide by pesticide at risk of repetition comparing to European patients, 10 nevertheless, a 2019 prospective cohort study in Sri Lanka showed 48.7% of suicide repeaters by pesticide chose pesticide again in repeated attempts. 11 In a study of 39 Fiji patients who attempted suicide mostly by drug and pesticide ingestion, Aghanwa 12 reported that social problems and psychiatric comorbidities were noted in 64.1% of cases. Our previous study 13 of 157 Taiwanese patients who attempted suicide by paraquat ingestion revealed that mood disorders (54.0%) were the most common psychiatric comorbidities.…”

Section: Introductionmentioning

confidence: 99%

<p>Clinical Characteristics of Pesticide Self-Harm as Associated with Suicide Attempt Repetition Status</p>

Huang¹,

Yen²,

Liu³

et al. 2020

NDT

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Purpose: Previous suicide behavior predicts future suicide risk. Studies of suicide repetition are important for suicide prevention. This study examined the clinical characteristics and psychiatric comorbidities of pesticide self-harm as associated with suicide attempt repetition status. Patients and Methods: This retrospective, observational study included patients admitted to a medical center in northern Taiwan between 2000 and 2015 following suicide attempts by pesticide. Diagnoses were made by a consultation-liaison psychiatry team based on the DSM IV-TR criteria. Independent samples t-test was used to analyze the quantitative variables and Pearson's Chi-squared test with a Bonferroni adjustment for categorical variables. Univariate binary logistic regression analysis was conducted to determine the predictors for repeated suicide attempt and multivariate binary logistic regression analysis to identify significant associated factors. Results: Among 151 patients, organophosphate pesticides were the most used (80.8%). The average age was 52.9±17.2 years. Most patients were married males from rural areas, with depressive disorder most often diagnosed (40.4%). Nearly one-third of them were suicide repeaters (n=43, 28.5%); these patients were less likely to be married (53.5%, p=0.001), had previously used psychiatric services (72.1%, p<0.001) and chose complex suicide (46.5%, p=0.014) more often compared to nonrepeaters. No significant differences were found between repeaters and nonrepeaters regarding psychiatric comorbidities. Multivariate logistic regression analysis revealed that marital status (odds ratio: 2.916, 95% confidence interval: 1.234-6.891, p=0.015) and previous psychiatric services usage (odds ratio: 6.897, 95% confidence interval: 3.012-15.625, p<0.001) were significant risk factors associated with suicide repetition. Conclusion: Pesticide suicide repeaters were characterized by less likely to be married and more likely to use psychiatric services before suicide attempts. These features help ensuring that the needs of people who have made a suicide attempt are addressed, and it reduces the likelihood of repetition.

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A prospective study of repetition of self-harm following deliberate self-poisoning in rural Sri Lanka

Cited by 14 publications

References 37 publications

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

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

Exploration of Associations Between Deliberate Self-Poisoning and Psychiatric Disorders in Rural Sri Lanka: A Case Control Study

<p>Clinical Characteristics of Pesticide Self-Harm as Associated with Suicide Attempt Repetition Status</p>

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