The Impact of the COVID-19 Pandemic and Lockdowns on Self-Poisoning and Suicide in Sri Lanka: An Interrupted Time Series Analysis

Abstract

Evidence from high-income countries suggests that the impact of COVID-19 on suicide and self-harm has been limited, but evidence from low- and middle-income countries is lacking. Using data from a hospital-based self-poisoning register (January 2019–December 2021) and data from national records (2016–2021) of suicide in Sri Lanka, we aimed to assess the impact of the pandemic on both self-poisoning and suicide. We examined changes in admissions for self-poisoning and suicide using interrupted time series (ITS) analysis. For the self-poisoning hospital admission ITS models, we defined the lockdown periods as follows: (i) pre-lockdown: 01/01/2019–19/03/2020; (ii) first lockdown: 20/03/2020–27/06/2020; (iii) post-first lockdown: 28/06/2020–11/05/2021; (iv) second lockdown: 12/05/2021–21/06/2021; and (v) post-second lockdown: 22/06/2021–31/12/2021. For suicide, we defined the intervention according to the pandemic period. We found that during lockdown periods, there was a reduction in hospital admissions for self-poisoning, with evidence that admission following self-poisoning remained lower during the pandemic than would be expected based on pre-pandemic trends. In contrast, there was no evidence that the rate of suicide in the pandemic period differed from that which would be expected. As the long-term socioeconomic impacts of the pandemic are realised, it will be important to track rates of self-harm and suicide in LMICs to inform prevention.

Psychological impact of COVID‐19 pandemic and lockdown among the population involved in tourism sector in Lakeside of Pokhara: A qualitative study

“…Although, some of the studies are inconsistent with our study finding of the connection between financial uncertainty and, suicide and self‐harm 41 . Several study found that in the first year of the pandemic, suicide rates appear not to have risen (and in some cases declined) in most countries for which evidence is available 42–44 . However, there might be a risk of suicide as many countries now are realizing the socioeconomic consequences of the pandemic which belongs to the indicators of poor mental health 35–39 …”

“…41 Several study found that in the first year of the pandemic, suicide rates appear not to have risen (and in some cases declined) in most countries for which evidence is available. [42][43][44] However, there might be a risk of suicide as many countries now are realizing the socioeconomic consequences of the pandemic which belongs to the indicators of poor mental health. [35][36][37][38][39] The findings of the study suggest that, despite some of the participants experienced mental health conditions, they did not receive the necessary mental health services.…”

Reflections on the trends of suicide in Sri Lanka, 1997–2022: The need for continued vigilance

“…Annual suicide counts by sex and age were divided by the mid-year estimates and multiplied by the WHO World Standard Population to calculate the age-standardized suicide rate per 100,000 population. The above listed age groups were collapsed into four broad age categories for ease of interpretation (17–25, 26–35, 36–55 and 55+ years), which have been used in previous analysis of these data [ 1 , 3 ]. To improve statistical power and explore leading methods of suicide, the methods of suicide were classified into four categories, namely suicide by 1) non-pesticide self-poisoning 2) pesticide self-poisoning only 3) hanging and 4) all other methods.…”

“…Since the mid-1990s, Sri Lanka has achieved a 70% reduction in suicide, with an estimated 93,000 suicide deaths prevented mostly by the implementation of bans on identified toxic pesticides [ 1 , 2 ]. Despite this, the suicide rate in Sri Lanka still remains high [ 3 ] and with a current rate well above the global average [ 4 ]. Since the end of the civil war in 2009, Sri Lanka has undergone many changes and challenges, including urbanization [ 5 ], the Easter Sunday bombing attacks in 2019 [ 6 ] and most recently the COVID-19 pandemic and associated intermittent lockdowns during 2020–21 [ 7 ].…”

Self‐harm by single‐ and multi‐agent medication poisoning in a retrospective analysis of a Poison Control Center database from January 2018 to December 2022

“…The available evidence on self‐harm by medication poisoning since 2020 show a decrease in the number of hospital presentations during the initial pandemic wave (March–June 2020, also compared to the corresponding period in 2019) 16,17 . In more longitudinal studies from different countries, some authors failed to show any signs of reprise in the following months 18 and up until mid‐late 2021, 19 while others instead demonstrated a steep re‐rise of cases beginning July 2020 20 . Interestingly, though, two published reports from Poison Control Centers (PCC) database are consistent in showing a decrement in calls concerning self‐harm by poisoning during the first “lockdown” period in Europe in March–June 2020 followed by an increase above pre‐lockdown levels beginning October–November 2020 21,22 …”