Repetition rate after non-fatal self-poisoning in Sri-Lanka: a one year prospective longitudinal study

Rajapakse, Thilini; Griffiths, Kathleen M; Cotton, Sue; Christensen, Helen

doi:10.4038/cmj.v61i4.8380

Cited by 4 publications

(5 citation statements)

References 14 publications

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“…Other possible reasons for the low prevalence of repeat self-harm in Asia are the lower prevalence of mental disorders among those who self-harm compared to levels seen in HICs 22 and longer inpatient stays helping individuals get through the period of greatest risk of repeat self-harm. Our estimates of a lower rate of self-harm repetition are consistent with previous estimates of repetition from south Asia,6, 8, 9, 10 but lower than the 12-month repetition rate from a prospective study from India (14%, 95% CI 10–19) 7 . Possible explanations for these differences might be differing methodology in the Indian study, including collection of data on self-reported self-harm, or differences in the socioeconomic and psychological health of our study population.…”

Section: Discussionsupporting

confidence: 89%

“…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%

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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: Discussionsupporting

confidence: 89%

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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“…A telephone interview based study conducted at Teaching Hospital Peradeniya, Sri Lanka, reported recalled one year repetition rate, 2.7%. [15] Contextual and methodological differences partially explain these difference in rates.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2019

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Introduction Repetition of deliberate self-harm is an important predictor of subsequent suicide. Repetition rates in Asian countries appear to be significantly lower than in western high-income countries. Methodological differences in studies, and the impact of access to means of self-harm with comparatively higher lethality have been suggested as reasons for these reported differences. This prospective study determines the rates and demographic patterns of deliberate self-poisoning (DSP), suicide and repeated deliberate self-harm resulting non-fatal and fatal outcomes in rural Sri Lanka. Methods Details of DSP admission in all hospitals (n = 46) and suicides reported to all police stations (n = 28) in a rural district were collected for the years 2011, 2012 and 2013. Demographic details of the cohort of patients admitted to all hospitals in 2011 due to deliberate self-poisoning (N = 4022), were screened to link with patient records and police reports of the successive two years with high sensitivity using a computer program. Then high specificity manual matching of all screened links was performed to identify repetition within 2 years of initial presentation. Life time repetition was assessed in a randomly selected subset of DSP patients (n = 433). Results There were 15,639 DSP admissions, aged more than 9 years, and 1078 suicides during the study period. The incidence of deliberate self-poisoning and suicide in the population within the study area were 248.3/100,000 and 20.7/100,000 respectively, in 2012. Repetition rates at four weeks, one-year and two-years were 1.9% (95% CI 1.5–2.3%), 5.7% (95% CI 5.0–6.4) and 7.9% (95% CI 7.1–8.8) respectively. The median interval between two attempts were 92 (IQR 10–238) and 191 (IQR 29–419.5) days for the one and two-year repetition groups. The majority of patients used the same poison in the repeat attempt. The age and duration of hospital stay of individuals with repetitive events were not significantly different from those who had no repetitive events. The rate of suicide at two years following DSP was 0.7% (95% CI 0.4–0.9%). The reported life time history of deliberate self-harm attempts was 9.5% (95% CI 6.7–12.2%). Conclusions The comparatively low rates of repetition in rural Sri Lanka was not explained by higher rates of suicide, access to more lethal means or differences in study methodology.

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“…The flow diagram for including studies could be seen in the Figure 1 . Of the included studies, 32 studies reported the associating factors of SH repetition, 7 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 21 studies reported the associating factors of suicide following SH, 11 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 , 68 , 69 , 70 , 71 , 72 , 73 , 74 , 75 and 9 studies both reported the associating factors of suicide and repetition following SH. 8 , 76 , 77 , 78 , 79 , 80 , 81 , 82 , 83...…”

Section: Resultsmentioning

confidence: 99%

Associating factors of suicide and repetition following self-harm: A systematic review and meta-analysis of longitudinal studies

et al. 2022

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Repetition rate after non-fatal self-poisoning in Sri-Lanka: a one year prospective longitudinal study

Cited by 4 publications

References 14 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

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

Associating factors of suicide and repetition following self-harm: A systematic review and meta-analysis of longitudinal studies

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