Characteristics of non-fatal self-poisoning in Sri Lanka: a systematic review

Abstract

BackgroundThe rate of non-fatal self-poisoning in Sri Lanka has increased in recent years, with associated morbidity and economic cost to the country. This review examines the published literature for the characteristics and factors associated with non-fatal self-poisoning in Sri Lanka.MethodsElectronic searches were conducted in Psychinfo, Proquest, Medline and Cochrane databases from inception to October 2011.Results26 publications (representing 23 studies) were eligible to be included in the review. A majority of studies reported non-fatal self-poisoning to be more common among males, with a peak age range of 10–30 years. Pesticide ingestion was the most commonly used method of non-fatal self-poisoning. However three studies conducted within the last ten years, in urban areas of the country, reported non-fatal self-poisoning by medicinal overdose to be more common, and also reported non-fatal self-poisoning to be more common among females. Interpersonal conflict was the most commonly reported short-term stressor associated with self-poisoning. Alcohol misuse was reported among males who self-poisoned, and data regarding other psychiatric morbidity was limited.ConclusionsThe findings indicate that pesticide ingestion is the commonest method of non-fatal self-poisoning in Sri Lanka, and it is more common among young males, similar to other Asian countries. However there appears to be an emerging pattern of increasing medicinal overdoses, paralleled by a gender shift towards increased female non-fatal self-poisoning in urban areas.Many non-fatal self-poisoning attempts appear to occur in the context of acute interpersonal stress, with short premeditation, and associated with alcohol misuse in males. Similar to other Asian countries, strategies to reduce non-fatal self-poisoning in Sri Lanka require integrated intervention programs with several key aspects, including culturally appropriate interventions to develop interpersonal skills in young people, community based programs to reduce alcohol misuse, and screening for and specific management of those at high risk of repetition following an attempt of self-poisoning.

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

“…Since the mid-1990s, patterns of non-fatal self-harm have shifted to resemble patterns seen in the West, with increasing medicinal overdoses, and higher rates of nonfatal self-poisoning in young females compared to males (2,22). The high rate of hospital admissions due to non-fatal poisoning by medication and other biological substances has now become an important public health challenge, associated with significant individual distress as well economic cost to the country (23).…”

Overdose of oral contraceptive pills as a means of intentional self-poisoning amongst young women in Sri Lanka: considerations for family planning

“…This could be viewed in the light of Sri Lanka's wider self-harm practices where young women are particularly vulnerable 9. In addition, the epidemiological pattern of intentional self-poisoning seems to be shifting from pesticides to medicinal drugs such as paracetamol, especially in urban areas 3 4 10. A study from Colombo found that this trend of using medicinal drugs was mainly among women aged 15–24 years,11 which matches our findings on overdose of OCPs as a means of self-poisonings.…”

Systematic reviews: significance of search strategy

“…Characteristics of non-fatal self-poisoning in Sri Lanka (Rajapakse, Griffiths & Christensen, 2013). 2.…”

“…Scoping search (electronically) done by the author for articles on systematic reviews carried out in Sri Lanka/by Sri Lankan authors/about Sri Lanka yielded only four articles (Rajapakse, Griffiths & Christensen, 2013, Pearson, Zwi, Rouse, Fernando, Buckley & McDuie-Ra, 2015, Lunyera, Mohottige, Isenburg, Jeuland, Patel & Stanifer, 2015,Ranasinghe, Jayawardena & Katulanda, 2015. All four of these studies have been conducted with foreign collaborations.…”