Exploration of associations between deliberate self-poisoning and psychiatric disorders in rural Sri Lanka: A case-control study

Abstract

Psychiatric disorders are important predictors of deliberate self-harm. The present study was carried out to determine the associations between DSM-IV TR Axis- I & II disorders and deliberate self-poisoning (DSP) in a rural agricultural district in Sri Lanka. Patients residing in the district who presented with DSP were randomly selected 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. Cases consisted of 208 (47.4%) males and 231 (52.6%) females. More than one third (37%) of males and more than half (53.7%) of females were aged below 20 years. DSM-IV TR axis-I and/or II psychiatric diagnoses were diagnosed in 89 (20.3%) of cases and 14 (3.2%) controls. Cases with a DSM-IV TR axis-I diagnosis were older than the cases without psychiatric diagnosis (32 and 19 years), p<0.0001. Having a depressive episode was associated with a 19 times higher risk for DSP. Being a male aged > = 30 years and having an alcohol use disorder carried a 21 times excess risk for DSP. A fivefold excess risk for DSP was found among 10–19 year old females with borderline personality traits. Depressive disorder and alcohol-related disorders were significantly associated with the older participants who presented with DSP. The overall prevalence of psychiatric disorders associated with DSP in rural Sri Lanka was significantly lower compared to the rates reported in the West and other countries in the region. Therefore, health and research priorities to reduce self-harm in Sri Lanka should focus both on psychiatric and non-psychiatric factors associated with DSP.

Alcohol use, self-harm and suicide: a scoping review of its portrayal in the Sri Lankan literature

“… Individual-based intervention strategies Hospital-based intervention strategies Community-based intervention strategies Population-based intervention strategies • Psychological treatment programs for heavy alcohol users [ 54 ] • Targeted brief interventions and treatment for alcohol problems [ 30 , [62] , [63] , [64] ] • Education for health staff about ‘red flags’ to identify high risk persons presenting with self-harm i.e. those with alcohol use disorder [ 65 ] • Screening for AUD in individuals who have self-harmed [ 62 ] • Advocacy programs • Waiting times for purchasing pesticides at vendor shops, particularly targeting customers who consumed alcohol [ 66 , 67 ] • Educational programmes about prevention of the harmful use of alcohol and drugs for school-children [ 68 , 69 ] • Community-based interventions to reduce alcohol consumption [ 27 , 40 , 41 , 65 , 68 , [70] , [71] , [72] , [73] ] • Taxes and policies such as ban on alcohol and tobacco advertising • Regulation of access to alcohol, especially through targeting illicit alcohol [ 27 ] • Campaigns against alcohol consumption [ 7 , 69 ] • Recognition of alcoholism as a disease [ 63 ] • Addressing problem alcohol use in national suicide and violence prevention policies [ 47 ] …”

Association of mental health status between self-poisoning suicide patients and their family members: a matched-pair analysis

“…Identification of risk and protective factors is a crucial component of national suicide prevention since it helps to further understand the kind and type of preventive actions needed. Risk factors can occur on a variety of scales, including the individual, sociocultural, and situational, and numerous factors have been linked to increased self-poisoning, including borderline personality disorder or traits [ 9 , 10 ], alcohol use disorder [ 9 ], depressive disorder [ 9 ], substance abuse [ 11 , 12 ], asthma [ 11 ], fewer social connections [ 13 ], living in neighborhoods [ 13 ], being female [ 10 , 14 ], and being young [ 13 ]. However, to the author’s best knowledge, there were few research that looked at the relationship between the mental health state of self-poisoning patients and their family members.…”