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Eizadi-Mood N, Sanjari H, Feizi A, Yazdi R, Dorostkar A, Mahvari R, Mirmoghtadaee P, Meamar R. Clinico-epidemiological evaluation of pharmaceutical/non-pharmaceutical poisoning in a referral poisoning emergency in the Central part of Iran. Sci Rep 2024; 14:10493. [PMID: 38714819 PMCID: PMC11076496 DOI: 10.1038/s41598-024-61411-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2023] [Accepted: 05/06/2024] [Indexed: 05/10/2024] Open
Abstract
The pattern of poisoning varies in different societies. In this study, we investigated the clinical-epidemiological features and outcomes of poisoned patients based on the substances involved, whether pharmaceutical or non- pharmaceutical toxins. This cross-sectional study involved a retrospective chart review of all poisoned patients who presented to the poisoning emergency hospital in the center of Iran between January 2015 and December 2019. We collected data on socio-demographics, the nature of the poisoning, and the outcomes. Backward stepwise binary regression analysis was conducted to predict the mortality. Throughout the study period, 5777 patients with acute poisoning met the inclusion criteria. Of these, 3524 cases (61%) were attributed to pharmaceutical, and 2253 cases (39%) were due to non-pharmaceutical poisoning. The majority of pharmaceutical poisonings (82.9%) were intentional, whereas non-pharmaceutical poisonings accounted for 46.2% of intentional exposures (P < 0.001). Patients with non-pharmaceutical poisoning were predominantly men, older in age, and had a history of addiction compared to those with pharmaceutical poisoning (P < 0.001). In binary logistic regression analysis, patients poisoned by non-pharmaceutical substances had a significantly higher risk of mortality [Odds ratio, 3.14; (95% CI 1.39-7.10); P = 0.006] compared to those poisoned by pharmaceutical substances (P < 0.001). The pattern of poisoning differs in terms of age and gender when comparing pharmaceutical to non-pharmaceutical poisoning. Patients poisoned by non-pharmaceutical may have a worse outcome compared to those poisoned by pharmaceutical substances.
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Affiliation(s)
- Nastaran Eizadi-Mood
- Department of Clinical Toxicology, Khorshid hospital, School of Medicine, Isfahan Clinical Toxicology Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Hamed Sanjari
- Isfahan Clinical Toxicology Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Awat Feizi
- Department of Epidemiology & Biostatistics, School of Public Health, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Razieh Yazdi
- Department of Clinical Toxicology, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Amin Dorostkar
- Department of Clinical Toxicology, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Razieh Mahvari
- Isfahan Clinical Toxicology Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Parisa Mirmoghtadaee
- Deputy of Research and Technology, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Rokhsareh Meamar
- Isfahan Clinical Toxicology Research Center, Khorshid hospital, Isfahan University of Medical Sciences, Ostandari Street, Hasht Behest Avenue, Isfahan, 81458-31451, Iran.
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Bandara P, Page A, Rajapakse T, Knipe D. Intimate partner violence, suicide and self-harm in Sri Lanka: Analysis of national data. PLoS One 2024; 19:e0298413. [PMID: 38512911 PMCID: PMC10956877 DOI: 10.1371/journal.pone.0298413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2021] [Accepted: 01/25/2024] [Indexed: 03/23/2024] Open
Abstract
There is increasing evidence from South Asia and internationally that intimate partner violence (IPV) is strongly associated with self-harm, however its association with suicide and self-harm has not been extensively examined, nor has this relationship been explored at a national level. Using national datasets, area-level variation in IPV, suicide and self-harm in Sri Lanka were examined. In addition, the association between individual level exposure to past-year IPV and non-fatal self-harm by any household member were explored in a series of multi-level logistic regression models, adjusting for age. Similar patterns in the distribution of suicide and IPV were found, with higher rates evident in post-conflict districts, specifically Batticaloa, Kilinochchi, and Mullaitivu. Experience of past year IPV and its various forms were strongly associated with household-level self-harm in the past year (adjusted odds ratio [AOR] = 3.83 95% CI 2.27-6.46). A similar magnitude was found for physical/sexual abuse (AOR 5.17 95% CI 2.95-9.05) and psychological abuse (AOR 4.64 95% CI 2.50-7.00). A dose-response association was also evident for frequency of abuse, with an increasing risk of household-level self-harm for women reporting abuse 'less often' (AOR 2.95 95% CI 1.46-5.92), and abuse experienced 'daily, weekly, or monthly' (AOR 4.83 95% CI 2.59-9.00), compared to no abuse. This study contributes to a growing body of evidence on the relationship between IPV and suicidal behaviour in South Asia. Addressing IPV and its various forms should be a priority for suicide prevention in Sri Lanka, alongside trauma-informed approaches in post-conflict settings.
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Affiliation(s)
- Piumee Bandara
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
- South Asian Clinical Toxicology Research Collaboration, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
- Translational Health Research Institute, Western Sydney University, New South Wales, Australia
| | - Andrew Page
- Translational Health Research Institute, Western Sydney University, New South Wales, Australia
| | - Thilini Rajapakse
- South Asian Clinical Toxicology Research Collaboration, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
- Department of Psychiatry, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
| | - Duleeka Knipe
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
- South Asian Clinical Toxicology Research Collaboration, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
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Sørensen JB, Lee KSK, Dawson A, Dawson A, Senarathna L, Pushpakumara PHGJ, Rajapakse T, Konradsen F, Glozier N, Conigrave KM, Siriwardhana P, Hansen D, Buhl A, Priyadhasana C, Senawirathna K, Herath M, Mantillake S, Fonseka P, Pearson M. Evaluating the programme and behavior change theories of a community alcohol education intervention in rural Sri Lanka: a study protocol. Glob Health Action 2023; 16:2273625. [PMID: 37971492 PMCID: PMC10795635 DOI: 10.1080/16549716.2023.2273625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 10/17/2023] [Indexed: 11/19/2023] Open
Abstract
Risky alcohol use is a major public health problem globally and in Sri Lanka. While a reduction in alcohol consumption can result in physical, mental, and social benefits, behaviour change is difficult to achieve. Effective, context-adapted interventions are required to minimise alcohol-related harm at a community level. THEATRE is a complex, community-based intervention evaluating whether a promising Sri Lankan pilot study that utilised arts-based research to moderate alcohol use can be scaled up. While the scaled-up pilot study protocol is presented elsewhere, the aim of this protocol paper is to describe the intervention programme theory and evaluation design, and modifications made to the study resulting from COVID-19 and the financial crisis. Drawing on the Behaviour Change Wheel (BCW) and Theoretical Domains Framework, behaviour change theories are presented with potential pathways to guide implementation and evaluation. Alcohol consumption patterns and context of drinking is detailed. The multifaceted intervention targets individuals and communities using arts-based interventions. Four of nine BCW functions are employed in the design of the intervention: education, persuasion, modelling and enablement, and training. Modifications made to the study due to COVID-19 and the financial crisis are described. Ethical approval was obtained from the Ethics Review Committee, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka (ERC/2018/21-July 2018 and Feb 2022) and the University of Sydney (2019/006). Findings will be disseminated locally to community members and key stakeholders and via international peer-reviewed publications.
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Affiliation(s)
| | - K. S. Kylie Lee
- NHMRC Centre of Research Excellence in Indigenous Health and Alcohol, Discipline of Addiction Medicine, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, Australia
- The Edith Collins Centre (Translational Research in Alcohol Drugs and Toxicology), Royal Price Alfred Hospital, Camperdown, NSW, Australia
- Centre for Alcohol Policy Research, La Trobe University, Bundoora, VIC, Australia
- National Drug Research Institute, Faculty of Health Sciences, Curtin University, Perth, WA, Australia
- Burnet Institute, Melbourne, Victoria, Australia
| | - Andrew Dawson
- The Edith Collins Centre (Translational Research in Alcohol Drugs and Toxicology), Royal Price Alfred Hospital, Camperdown, NSW, Australia
- Faculty of Medicine, South Asian Clinical Toxicology Collaboration, University of Peradeniya, Peradeniya, Sri Lanka
| | - Angela Dawson
- School of Public Health, University of Technology Sydney, Sydney, Australia
| | - Lalith Senarathna
- Faculty of Medicine, South Asian Clinical Toxicology Collaboration, University of Peradeniya, Peradeniya, Sri Lanka
- Faculty of Applied Sciences, Rajarata University of Sri Lanka, Mihintale, Sri Lanka
| | - P. H. G. Janaka Pushpakumara
- Faculty of Medicine, South Asian Clinical Toxicology Collaboration, University of Peradeniya, Peradeniya, Sri Lanka
- Department of Family Medicine, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Saliyapura, Sri Lanka
| | - Thilini Rajapakse
- Faculty of Medicine, South Asian Clinical Toxicology Collaboration, University of Peradeniya, Peradeniya, Sri Lanka
- Department of Psychiatry, University of Peradeniya, Peradeniya, Sri Lanka
| | - Flemming Konradsen
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Nick Glozier
- Central Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
- ARC Centre of Excellence for Children and Families over the Life Course, Sydney, Australia
| | - Katherine M. Conigrave
- The Edith Collins Centre (Translational Research in Alcohol Drugs and Toxicology), Royal Price Alfred Hospital, Camperdown, NSW, Australia
- Royal Prince Alfred Hospital, Drug Health Services, Sydney, NSW, Australia
- Faculty of Medicine and Health, Central Clinical School, Camperdown, NSW, Australia
| | - Prabash Siriwardhana
- Faculty of Medicine, South Asian Clinical Toxicology Collaboration, University of Peradeniya, Peradeniya, Sri Lanka
- Department of Sociology, Rajarata University of Sri Lanka, Mihintale, Sri Lanka
| | | | - Alexandra Buhl
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Chamill Priyadhasana
- Faculty of Medicine, South Asian Clinical Toxicology Collaboration, University of Peradeniya, Peradeniya, Sri Lanka
| | - Kamal Senawirathna
- Faculty of Medicine, South Asian Clinical Toxicology Collaboration, University of Peradeniya, Peradeniya, Sri Lanka
| | - Malith Herath
- Faculty of Medicine, South Asian Clinical Toxicology Collaboration, University of Peradeniya, Peradeniya, Sri Lanka
| | | | | | - Melissa Pearson
- Faculty of Medicine, South Asian Clinical Toxicology Collaboration, University of Peradeniya, Peradeniya, Sri Lanka
- Central Clinical School, University of Sydney, Sydney, Australia
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Weerasinghe M, Jobe L, Konradsen F, Eddleston M, Pearson M, Jayamanne S, Hawton K, Gunnell D, Agampodi S. Differences in the characteristics of people who purchase pesticides from shops for self-harm versus those who use pesticides available in the domestic environment in Sri Lanka. Trop Med Int Health 2023; 28:901-911. [PMID: 37871998 DOI: 10.1111/tmi.13941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2023]
Abstract
OBJECTIVE Data from South Asia indicate that for 15%-20% of suicide attempts, pesticides are purchased from shops; otherwise, pesticides are obtained from an individual's house or nearby environment. We aimed to investigate the difference between individuals who directly purchase pesticides from shops for suicide attempts and suicide deaths versus those related to accessing the pesticides from an individual's house or nearby environment. METHODS We conducted two comparative studies in rural Sri Lanka: (1) non-fatal shop cases (n = 50) were survivors of self-poisoning with pesticides who ingested the pesticides after purchasing them from a shop; non-fatal domestic cases (n = 192) were survivors who accessed pesticides from their house or nearby environment. (2) fatal shop cases (n = 50) were individuals who died after ingesting pesticides they purchased for the act; fatal domestic cases (n = 102) were patients who died after ingesting pesticides they accessed at house or nearby environment. Logistic regression analysis was used to assess the characteristics which distinguished between the shop and domestic cases. RESULTS Data indicate that 20.7% and 32.9% of individuals who used pesticides for suicide attempts and suicide deaths had purchased them from shops, respectively. Being a non-farmer was the main distinguishing characteristic of shop cases: adjusted odds ratios (AOR) 8.9, 95% confidence intervals (CI) 3.2-24.4 for non-fatal shop cases, and AOR 4.0, 95% CI 1.5-10.6 for fatal shop cases. Non-fatal shop cases also had higher suicide intent (AOR 3.0, CI 1.0-8.9), and ingesting an insecticide (AOR 4.8, CI 1.8-1.0-8.9) than non-fatal domestic cases. CONCLUSION A high suicide intent of individuals who purchase pesticides for the event explains the high proportion of such fatal cases. Such high suicide intent makes the prevention implications difficult to spell out for those individuals who purchase pesticides for self-poisoning. However, our findings are valuable for clinicians to assess pesticide poisoning cases in hospitals.
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Affiliation(s)
- Manjula Weerasinghe
- Department of Community Medicine, Faculty of Medicine & Allied Sciences, Rajarata University of Sri Lanka, Anuradhapura, Sri Lanka
- South Asian Clinical Toxicology Research Collaboration, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
- Centre for Pesticide Suicide Prevention, and Pharmacology, Toxicology and Therapeutics, Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
| | - Lei Jobe
- Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Flemming Konradsen
- Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Michael Eddleston
- South Asian Clinical Toxicology Research Collaboration, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
- Centre for Pesticide Suicide Prevention, and Pharmacology, Toxicology and Therapeutics, Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
- Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Melissa Pearson
- South Asian Clinical Toxicology Research Collaboration, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
- Centre for Pesticide Suicide Prevention, and Pharmacology, Toxicology and Therapeutics, Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
| | - Shaluka Jayamanne
- South Asian Clinical Toxicology Research Collaboration, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
- Department of Medicine, Faculty of Medicine, University of Kelaniya, Ragama, Sri Lanka
| | - Keith Hawton
- Centre for Suicide Research, Department of Psychiatry, University of Oxford, Oxford, UK
| | - David Gunnell
- Population Health Sciences, University of Bristol, Bristol, UK
| | - Suneth Agampodi
- International Vaccine Institute, Seoul, South Korea
- Center for Public Health, Anuradhapura, Sri Lanka
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Schölin L, Sørensen JB, Eddleston M. A lethal cocktail - shining a light on the relationship between alcohol use and pesticide self-poisoning. Clin Toxicol (Phila) 2023; 61:581-583. [PMID: 37815248 DOI: 10.1080/15563650.2023.2259599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 09/12/2023] [Indexed: 10/11/2023]
Abstract
INTRODUCTION Alcohol and pesticides are toxic substances that each cause acute and chronic harm to humans. Alcohol plays an important and complex role in pesticide self-poisoning, involving toxicological, public health, and social aspects important for research, prevention, and interventions. ALCOHOL USE DISORDER AND SOCIAL HARMS While the evidence on alcohol co-ingestion in the context of pesticide self-poisoning is limited, it appears that alcohol use increases complications. Even fewer studies address alcohol use disorder and dependence among pesticide self-poisoning patients. The harmful use of alcohol also impacts social life, families, and communities in several ways, including pesticide self-poisoning among individuals around the alcohol user. This, however, is vastly understudied. OUTSIDE INFLUENCES Agrochemicals and alcohol are produced by industries with financial interests, and the outcome of individual acts of pesticide self-poisoning depends on the lethality of the pesticide purchased and ingested. The promotion of acutely toxic pesticides by companies must be acknowledged within this issue. CONCLUSION The relationship between alcohol and pesticide self-poisoning is increasingly clear, but more studies are needed to guide management. We cannot ignore that pesticide self-poisoning and harmful use of alcohol occur within the context of wider, often structural, stressors and are influenced by commercial entities.
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Affiliation(s)
- Lisa Schölin
- Centre for Pesticide Suicide Prevention, University of Edinburgh, Edinburgh, UK
| | | | - Michael Eddleston
- Centre for Pesticide Suicide Prevention, University of Edinburgh, Edinburgh, UK
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Sørensen JB, Pearson M, Pushpakumara J, Leth-Sørensen D, Buhl A, Konradsen F, Senarathna L. Alcohol use, self-harm and suicide: a scoping review of its portrayal in the Sri Lankan literature. Heliyon 2023; 9:e17566. [PMID: 37449166 PMCID: PMC10336444 DOI: 10.1016/j.heliyon.2023.e17566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 06/16/2023] [Accepted: 06/21/2023] [Indexed: 07/18/2023] Open
Abstract
Background Suicide is a global public health problem. Compared to other middle-income countries, much literature has been generated on the topic of self-harm and suicide in Sri Lanka. Harmful use of alcohol is a well-known risk factor to self-harm and suicide, however the connection needed further exploration. Aim The aim was to investigate alcohol's role in self-harm and suicide in Sri Lanka to inform policy and prevention programs and future research priorities. Methods We performed a scoping review exploring how the association between alcohol use, self-harm and suicide in Sri Lanka is presented in scientific literature from August 1, 2008 to December 31, 2022. Thematic analysis was used to explore emerging themes. Results Altogether 116 peer-reviewed articles were included. Three themes emerged: (i) gendered, inter-relational explanations of alcohol's role in self-harm, (ii) hospital management of patients who co-ingested alcohol and pesticides, and (iii) proposed research and interventions targeting alcohol, self-harm and suicide. The articles' recommendations for policy, prevention and research priorities included: Family- and community-based alcohol, self-harm and suicide reduction interventions; viewing self-harm as a window of opportunity for health personnel to intervene in families affected by harmful alcohol consumption; and introduction of and increased access to treatment of alcohol use disorder at the individual level. Conclusion Suggestions for alcohol, self-harm, and suicide prevention interventions were primarily targeted at the community, though this might also reflect the limited treatment, mental health, and alcohol support available in the country. Future research should explore and test context-appropriate interventions integrating alcohol and self-harm prevention and treatment.
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Affiliation(s)
- Jane Brandt Sørensen
- Department of Public Health, University of Copenhagen, Øster Farimagsgade 5, Building 9, 1014, Copenhagen K, Denmark
| | - Melissa Pearson
- Central Clinical School, Faculty of Medicine and Health, The University of Sydney, Australia
| | - Janaka Pushpakumara
- Department of Family Medicine, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Sri Lanka
| | | | - Alexandra Buhl
- Department of Public Health, University of Copenhagen, Denmark
| | | | - Lalith Senarathna
- Department of Health Promotion, Faculty of Applied Sciences, Rajarata University of Sri Lanka, Sri Lanka
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Zheng W, Han L, Fan Y, Yi M, Lu X, Yang J, Peng X, Yang Y. Association of mental health status between self-poisoning suicide patients and their family members: a matched-pair analysis. BMC Psychiatry 2023; 23:294. [PMID: 37118663 PMCID: PMC10144897 DOI: 10.1186/s12888-023-04779-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 04/12/2023] [Indexed: 04/30/2023] Open
Abstract
BACKGROUND The objective of this study was to examine the relationship of mental health status between self-poisoning suicide patients and their family members, and it also sought to identify potential patient's risk and parental factors for the prediction of suicide attempt, anxiety, and depression. METHODS In this study, 151 poisoned patients were prospectively included, and they were matched 1:1 with 151 family members. We gathered information on patient's and their matched family member's demographics, lifestyle choices, mental health status, level of intimacy, and history of psychiatry disease. The relationship of patient's and their family member's mental health state was investigated using a correlation matrix. Multivariable analyses (multiple logistic regression) were conducted among patients and their matched family members, to identify potential risk factors for self-poisoning suicide, anxiety, and depression. RESULTS Of the total patients, 67.55% (102/151) attempted self-poisoning suicide. Poisoned patients had more severe anxiety and depression symptoms than their matched family members, and this difference was even more pronounced among patients with self-poisoning suicide. Generalized anxiety disorder-7 (GAD-7) score for family members was significantly and favorably correlated with patient's GAD-7 score after eliminating non-suicide patients and their matched family members. The patient health questionnaire-9 (PHQ-9) score showed a similar pattern, and the family member's PHQ-9 score was strongly and favorably associated with patient's PHQ-9 and Beck hopelessness scale-20 (BHS-20) score. Multivariable analysis showed that married marital status (P = 0.038), quitting smoking (P = 0.003), sedentary time of 1 to 6 h (P = 0.013), and participation in a sports more than five times per week (P = 0.046) were all significantly associated with a lower risk of suicide by self-poisoning, while a more serious anxiety state (P = 0.001) was significantly associated with a higher risk of self-poisoning suicide. Multivariable analysis demonstrated that, specifically among self-poisoning suicide patients, married marital status (P = 0.011) and no history of psychiatry disease (P < 0.001) were protective factors for anxiety, while divorced or widowed marital status (P = 0.004), a sedentary time of 1 to 3 h (P = 0.022), and a higher monthly income (P = 0.027) were significant contributors to anxiety. The propensity of additional family-matched characteristics to predict patient's suicidality, anxiety, and depression was also examined. CONCLUSIONS Self-poisoning suicide patients have severe mental health issues. Patients who self-poison have a close connection to their family member's mental health, particularly their levels of anxiety and depression. According to the findings, being married and adopting healthy lifestyle habits, such as quitting smoking and drinking, increasing their physical activity levels, and managing their idle time, are able to help patients with mental health concerns and even suicidal thoughts.
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Affiliation(s)
- Wenjing Zheng
- Department of Chemical Poisoning Treatment, Senior Department of Hematology, Fifth Medical Center of PLA General Hospital, Beijing, China
| | - Limei Han
- Department of Chemical Poisoning Treatment, Senior Department of Hematology, Fifth Medical Center of PLA General Hospital, Beijing, China
| | - Yanna Fan
- Department of Radiotherapy, Senior Department of Oncology, Fifth Medical Center of PLA General Hospital, Beijing, China
| | - Min Yi
- Institute of Medical Information and Library, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xiaoxia Lu
- Department of Chemical Poisoning Treatment, Senior Department of Hematology, Fifth Medical Center of PLA General Hospital, Beijing, China
| | - Juan Yang
- Department of Emergency, Fifth Medical Center of PLA General Hospital, Beijing, China
| | - Xiaobo Peng
- Department of Chemical Poisoning Treatment, Senior Department of Hematology, Fifth Medical Center of PLA General Hospital, Beijing, China.
| | - Ying Yang
- Nursing Department, Fifth Medical Center of PLA General Hospital, Beijing, China.
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Dhanarisi J, Perera S, Wijerathna T, Gawarammana I, Shihana F, Pathiraja V, Eddleston M, Mohamed F. Relationship Between Alcohol Co-Ingestion and Clinical Outcome in Pesticide Self-Poisoning: A Systematic Review and Meta-Analysis. Alcohol Alcohol 2023; 58:4-12. [PMID: 36172715 DOI: 10.1093/alcalc/agac045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Revised: 08/12/2022] [Accepted: 08/13/2022] [Indexed: 01/12/2023] Open
Abstract
AIM Alcohol is a commonly co-ingested compound during self-poisoning with pesticides. Clinical experiences suggest alcohol co-ingestion (or withdrawal) makes patient management more difficult after self-poisoning and may contribute to poor clinical outcomes. We aimed to systematically review the world literature to explore the relationship between alcohol co-ingestion and outcome in pesticide self-poisoning. METHODS We searched 13 electronic databases and Google scholar, conducted citation searching and a review of reference lists to find studies which investigated the relationship of alcohol with clinical outcome of pesticide self-poisoning in different countries. Thirteen studies, including 11 case series/reports and two cohort studies were considered for inclusion. RESULTS Meta-analysis showed that alcohol co-ingestion in pesticide self-poisoning was associated with increased risk of death [odds ratio (OR) 4.9, 95% confidence interval (CI) 2.9-8.2 P<0.0001] and that alcohol co-ingested group required intubation eight times more often than non-co-ingested group in organophosphorus insecticide self-poisoning (OR 8.0, 95% CI 4.9-13.0 P<0.0001). Cases who co-ingested alcohol were older than non-alcohol group in two studies. One cohort study demonstrated that alcohol co-ingestion was associated with larger pesticide ingestions but did not itself affect the outcome. CONCLUSIONS This systematic review indicates that alcohol co-ingestion may worsen clinical outcome in pesticide self-poisoning.
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Affiliation(s)
- Jeevan Dhanarisi
- South Asian Clinical Toxicology Research Collaboration, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
| | - Sriyani Perera
- Medical Library, University of Peradeniya, Peradeniya, Sri Lanka
| | - Thilini Wijerathna
- South Asian Clinical Toxicology Research Collaboration, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka.,Department of Biosystems Technology, Faculty of Technology, General Sir John Kotelawala Defence University, Rathmalana, Sri Lanka
| | - Indika Gawarammana
- South Asian Clinical Toxicology Research Collaboration, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka.,Department of Medicine, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
| | - Fathima Shihana
- Biomedical informatics and Digital Health, Clinical Pharmacology and Toxicology Research Group, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia.,The Centenary Institute of Cancer Medicine & Cell Biology, The University of Sydney, NSW, Australia
| | - Vindya Pathiraja
- Department of Pharmacy, Faculty of Allied Health Sciences, University of Ruhuna, Galle, Sri Lanka
| | - Michael Eddleston
- South Asian Clinical Toxicology Research Collaboration, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka.,Pharmacology, Toxicology, & Therapeutics, University/BHF Centre for Cardiovascular Science, and Centre for Pesticide Suicide Prevention, University of Edinburgh, Edinburgh, UK
| | - Fahim Mohamed
- South Asian Clinical Toxicology Research Collaboration, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka.,Department of Pharmacology, Sydney Pharmacy School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia.,National Poison Centre, Universiti Sains Malaysia, Penang Malaysia.,Department of Pharmacy, Faculty of Allied Health Sciences, University of Peradeniya, Peradeniya, Sri Lanka
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9
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Investigation of acute organophosphate poisoning in humans based on sociodemographic and role of neurotransmitters with survival study in South India. Sci Rep 2022; 12:16513. [PMID: 36192626 PMCID: PMC9530162 DOI: 10.1038/s41598-022-21054-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 09/22/2022] [Indexed: 11/11/2022] Open
Abstract
The aim of this study was to investigate the sociodemographic characteristics of patients based on the poison chosen and different types of organophosphorus compounds. The data were collected to explore the sociodemographic characteristics of organophosphate (OP)-poisoned patients based on the source, site, and route of poisoning, education level, occupational status, and the purpose of poisoning. Furthermore, we estimated the serotonin and dopamine levels in the plasma samples of patients, and survival plots were also described. During the study of OP pesticide poisoning in 116 human subjects and 5 healthy volunteers, we observed, based on the survival plot, that75.9% of the patients were discharged, and the remaining patients died (24.1% of the patients) due to respiratory failure followed by cardiac arrest. Our findings suggest that the serotonin levels significantly (p < 0.01 and p < 0.001) decreased from 12 to 36 h, whereas the dopamine levels slightly increased from 12 to 36 h in the group with OP poisoning compared to the control group. Based on these findings, this study may aid in deciphering the precise mechanism by which pesticides cause behavioural changes that influence serotonin and dopamine levels in OP-poisoned patients. The purpose of this work was to serve as a small reminder of the risk to public health associated with organophosphate pesticides.
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Silva T, Agampodi T, Evans M, Knipe D, Rathnayake A, Rajapakse T. Barriers to help-seeking from healthcare professionals amongst women who experience domestic violence - a qualitative study in Sri Lanka. BMC Public Health 2022; 22:721. [PMID: 35410170 PMCID: PMC9004164 DOI: 10.1186/s12889-022-13116-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 03/30/2022] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Domestic violence (DV) is a major global public health problem which is associated with significant adverse consequences. Although Sri Lankan women who experience DV receive treatment from healthcare professionals (HCPs) for DV related physical and psychological problems, disclosure of DV within health services is quite low. This study explored barriers to disclosure of DV to HCPs among Sri Lankan women who experience DV. METHOD This qualitative study took place in the Central Province of Sri Lanka. Twenty women who had experienced DV were recruited from Gender Based Violence Centers (Mithuru Piyasa Centers) and a toxicology unit of the two selected hospitals. Participants were purposefully selected using maximum variation sampling technique. In-depth interviews were conducted until data saturation was reached. Interviews were recorded, and analyzed using thematic analysis. RESULTS Survivor related barriers to help seeking included women's lack of knowledge and perceptions about the role of HCPs, lack of confidence in HCPs, fear of repercussions, personal attitudes towards DV, and their love and loyalty towards the perpetrator. Women preferred it if HCPs initiated discussions about DV, and they valued it when HCPs could be confidential and protect their privacy, and give enough time for DV related issues during consultations. A perpetrator related barrier was the controlling behavior of the perpetrator. Social stigma and social and cultural norms about the role of women emerged as the socio-cultural constraints to disclosure. CONCLUSIONS Barriers to help seeking for DV from HCPs exist at individual, healthcare level, and societal level. Community programs are needed to increase women's access to healthcare services and interventions should be implemented to develop effective, preventive, and supportive strategies at the healthcare system level.
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Affiliation(s)
- Tharuka Silva
- grid.11139.3b0000 0000 9816 8637South Asian Clinical Toxicology Research Collaboration, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
- grid.11139.3b0000 0000 9816 8637Department of Psychiatry, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
| | - Thilini Agampodi
- grid.430357.60000 0004 0433 2651Department of Community Medicine, Faculty of Medicine and Allied Sciences, Rajarata University, Anuradhapura, Sri Lanka
| | - Maggie Evans
- grid.5337.20000 0004 1936 7603Centre for Academic Primary Care, Population Health Science Institute, University of Bristol, Bristol, UK
| | - Duleeka Knipe
- grid.11139.3b0000 0000 9816 8637South Asian Clinical Toxicology Research Collaboration, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
- grid.5337.20000 0004 1936 7603Bristol Medical School, Population Health Sciences, University of Bristol, Bristol, UK
| | - Abey Rathnayake
- grid.11139.3b0000 0000 9816 8637Department of Sociology, Faculty of Arts, University of Peradeniya, Peradeniya, Sri Lanka
| | - Thilini Rajapakse
- grid.11139.3b0000 0000 9816 8637South Asian Clinical Toxicology Research Collaboration, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
- grid.11139.3b0000 0000 9816 8637Department of Psychiatry, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
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11
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Bandara P, Page A, Senarathna L, Kidger J, Feder G, Gunnell D, Rajapakse T, Knipe D. Domestic violence and self-poisoning in Sri Lanka. Psychol Med 2022; 52:1183-1191. [PMID: 32912344 PMCID: PMC7612699 DOI: 10.1017/s0033291720002986] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND There is increasing evidence that domestic violence (DV) is an important risk factor for suicidal behaviour. The level of risk and its contribution to the overall burden of suicidal behaviour among men and women has not been quantified in South Asia. We carried out a large case-control study to examine the association between DV and self-poisoning in Sri Lanka. METHODS Cases (N = 291) were patients aged ⩾18 years, admitted to a tertiary hospital in Kandy Sri Lanka for self-poisoning. Sex and age frequency matched controls were recruited from the hospital's outpatient department (N = 490) and local population (N = 450). Exposure to DV was collected through the Humiliation, Afraid, Rape, Kick questionnaire. Multivariable logistic regression models were conducted to estimate the association between DV and self-poisoning, and population attributable fractions were calculated. RESULTS Exposure to at least one type of DV within the previous 12 months was strongly associated with self-poisoning for women [adjusted OR (AOR) 4.08, 95% CI 1.60-4.78] and men (AOR 2.52, 95% CI 1.51-4.21), compared to those reporting no abuse. Among women, the association was strongest for physical violence (AOR 14.07, 95% CI 5.87-33.72), whereas among men, emotional abuse showed the highest risk (AOR 2.75, 95% CI 1.57-4.82). PAF% for exposure to at least one type of DV was 38% (95% CI 32-43) in women and 22% (95% CI 14-29) in men. CONCLUSIONS Multi-sectoral interventions to address DV including enhanced identification in health care settings, community-based strategies, and integration of DV support and psychological services may substantially reduce suicidal behaviour in Sri Lanka.
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Affiliation(s)
- Piumee Bandara
- Translational Health Research Institute, Western Sydney University, New South Wales, Australia
- South Asian Clinical Toxicology Research Collaboration, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
| | - Andrew Page
- Translational Health Research Institute, Western Sydney University, New South Wales, Australia
| | - Lalith Senarathna
- South Asian Clinical Toxicology Research Collaboration, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
- Department of Health Promotion, Faculty of Applied Sciences, Rajarata University of Sri Lanka, Mihintale, Sri Lanka
| | - Judi Kidger
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Gene Feder
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- National Institute of Health Research Biomedical Research Centre, University Hospitals Bristol and Weston NHS Foundation Trust
| | - David Gunnell
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- National Institute of Health Research Biomedical Research Centre, University Hospitals Bristol and Weston NHS Foundation Trust
| | - Thilini Rajapakse
- South Asian Clinical Toxicology Research Collaboration, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
- Department of Psychiatry, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
| | - Duleeka Knipe
- South Asian Clinical Toxicology Research Collaboration, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
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12
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Tu CY, Yen TH, Chang CM, Chen HY, Yen YC, Guo MC, Lu TH, Wu CS, Chen IM, Cheng HC, Huang WL, Chen CC, Eddleston M, Chang SS. Characteristics and psychopathology of 1,086 patients who self-poisoned using pesticides in Taiwan (2012-2019): A comparison across pesticide groups. J Affect Disord 2022; 300:17-26. [PMID: 34952117 DOI: 10.1016/j.jad.2021.12.058] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Revised: 11/09/2021] [Accepted: 12/18/2021] [Indexed: 10/19/2022]
Abstract
Background Previous studies, mainly from low- and middle-income settings, showed that pesticide self-poisonings were mostly impulsive with low levels of psychopathology. We aimed to investigate whether pesticide self-poisoning in a high-income country showed similar profiles, and whether those with certain characteristics and psychopathology were more likely to use specific pesticides. Methods Data were extracted from hospital records of pesticide self-poisoning patients treated at eight major hospitals in Taiwan between 2012 and 2019. Multinomial logistic regression was used to investigate the association of interpersonal conflicts, triggers of self-poisoning, and psychopathology with the groups of pesticides ingested. Results A total of 1,086 patients who self-poisoned using pesticides were identified; 67.0% were male and 39.8% aged 65+ years. Approximately three quarters (75.7%) of patients who received psychiatric assessment had at least one psychiatric diagnosis, and the prevalence was 48.3% in all patients. No association was found between the pesticide groups ingested and interpersonal conflicts, most of the triggers, past psychiatric service use, or having psychiatric diagnoses. Limitations Data were collected from hospital records retrospectively. Only 60.3% of the patients received a psychiatric assessment. Conclusions The majority of patients who self-poisoned using pesticides and received psychiatric assessment in Taiwan had psychiatric illness. Patients who ingested different groups of pesticides were similar in their characteristics. The choice of pesticides used in self-poisoning more likely relates to availability rather than intentional selection. Psychiatric assessment and treatment are important in patients who self-poisoned using pesticides, while restricting access to highly hazardous pesticides is likely to prevent many deaths from pesticide self-poisoning.
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Affiliation(s)
- Chao-Ying Tu
- Department of Psychiatry, National Taiwan University Hospital Yunlin Branch, Yunlin, Taiwan; Department of Psychiatry, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Tzung-Hai Yen
- Department of Nephrology and Clinical Poison Center, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Chia-Ming Chang
- Department of Psychiatry, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Hsien-Yi Chen
- Department of Emergency Medicine, Chang Gung Memorial Hospital, Linkou and College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Yung-Chieh Yen
- Department of Psychiatry, E-Da Hospital, Kaohsiung, Taiwan; School of Medicine, I-Shou University, Kaohsiung, Taiwan
| | - Ming-Chao Guo
- Department of Psychiatry, Camillian Saint Mary's Hospital Luodong, Yilan, Taiwan
| | - Tsung-Hua Lu
- Department of Psychiatry, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Chi-Shin Wu
- Department of Psychiatry, National Taiwan University Hospital Yunlin Branch, Yunlin, Taiwan; National Center for Geriatrics and Welfare Research, National Health Research Institutes
| | - I-Ming Chen
- Department of Psychiatry, National Taiwan University, Hospital and College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Hai-Ching Cheng
- Department of Psychiatry, National Taiwan University Hsin-Chu Hospital, Hsinchu, Taiwan
| | - Wei-Lieh Huang
- Department of Psychiatry, National Taiwan University Hospital Yunlin Branch, Yunlin, Taiwan; Department of Psychiatry, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Cheng-Che Chen
- Department of Psychiatry, College of Medicine, National Taiwan University, Taipei, Taiwan; Department of Psychiatry, National Taiwan University BioMedical Park Hospital, Hsinchu, Taiwan
| | - Michael Eddleston
- Department of Psychiatry, National Taiwan University BioMedical Park Hospital, Hsinchu, Taiwan; Center for Pesticide Suicide Prevention, University of Edinburgh, Edinburgh, UK; Pharmacology, Toxicology and Therapeutics, University and British Heart Foundation Center for Cardiovascular Science, University of Edinburgh, Edinburgh, UK; South Asian Clinical Toxicology Research Collaboration, University of Peradeniya, Peradeniya, Sri Lanka
| | - Shu-Sen Chang
- South Asian Clinical Toxicology Research Collaboration, University of Peradeniya, Peradeniya, Sri Lanka; Institute of Health Behaviors and Community Sciences and Global Health Program, and College of Public Health, National Taiwan University, Taipei, Taiwan; Psychiatric Research Center, Wan Fang Hospital, Taipei Medical University, Taipei City, Taiwan.
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13
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Sex education and self-poisoning in Sri Lanka: an explorative analysis. BMC Public Health 2022; 22:26. [PMID: 34991547 PMCID: PMC8740467 DOI: 10.1186/s12889-021-12374-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Accepted: 11/30/2021] [Indexed: 11/25/2022] Open
Abstract
Background Self-harm and suicide are important causes of morbidity and mortality in Sri Lanka, but our understanding of these behaviours is limited. Qualitative studies have implicated familial and societal expectations around sex and relationships. We conducted an explorative analysis using case-control data to investigate the association between sex education and self-poisoning in Sri Lanka. Methods Cases (N=298) were self-poisoning inpatients on a toxicology ward, Teaching Hospital Peradeniya. Controls (N=500) were sex and age frequency matched to cases and were outpatients/visitors to the same hospital. Participants were asked whether they had received sex education, and to rate the quality and usefulness of any sex education received. Logistic regression models adjusted for age, sex, and religion quantified the association between receipt, quality and usefulness of sex education and self-poisoning. We tested whether the associations differed by sex. Results Roughly 1-in-3 cases and 1-in-5 controls reported having not received sex education. Individuals who did not receive sex education were nearly twice as likely to have self-poisoned than those who did (OR 1.68 (95% CI 1.11-2.55)). Those who reported the sex education they received as not useful were more likely to have self-poisoned compared to those who reported it useful (OR 1.95 (95% CI 1.04-3.65)). We found no evidence of an association between self-poisoning and the self-rated quality of sex education, or that associations differed by participant sex. Conclusion As sex education is potentially modifiable at the population-level, further research should aim to explore this association in more depth, using qualitative methods and validated measurement tools. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-021-12374-4.
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14
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Pushpakumara PHGJ, Dawson AH, Adikari AMP, Thennakoon SUB, Abeysinghe R, Rajapakse TN. Exploration of associations between deliberate self-poisoning and psychiatric disorders in rural Sri Lanka: A case-control study. PLoS One 2021; 16:e0255805. [PMID: 34358271 PMCID: PMC8345854 DOI: 10.1371/journal.pone.0255805] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Accepted: 07/24/2021] [Indexed: 11/22/2022] Open
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.
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Affiliation(s)
- P. H. G. J. Pushpakumara
- Department of Family Medicine, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Saliyapura, Sri Lanka
- SACTRC, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
| | - A. H. Dawson
- SACTRC, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
- Central Clinical School, University of Sydney, Sydney, Australia
| | - A. M. P. Adikari
- Psychiatry Unit, Teaching Hospital Kurunegala, Kurunegala, Sri Lanka
| | - S. U. B. Thennakoon
- Department of Community Medicine, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
| | - Ranil Abeysinghe
- Department of Psychiatry, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
| | - T. N. Rajapakse
- Department of Psychiatry, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
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15
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Rambabu L, Mohamed F, Dhanarisi J, Gawarammana I, Raubenheimer J, Mackenzie L, Roberts MS, Buckley N, Eddleston M. Acute phenthoate self-poisoning: a prospective case series. Clin Toxicol (Phila) 2021; 60:214-220. [PMID: 33960866 DOI: 10.1080/15563650.2021.1917596] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND The clinical characteristics following self-poisoning with organophosphorus (OP) insecticides differs according to the insecticide ingested. Phenthoate is a dimethoxy WHO Hazard Class II OP pesticide with limited literature on its clinical characteristics and outcome. We aimed to better understand its clinical characteristics by studying patients with phenthoate self-poisoning in Sri Lanka. METHODS We conducted a prospective cohort study of patients presenting with phenthoate self-poisoning to eight hospitals in Sri Lanka between 2002 and 2018. Clinical outcomes were recorded for each patient. Blood samples for measuring plasma phenthoate concentration, cholinesterase activity, and response to oximes were available for a very small number of patients recruited to a clinical trial. RESULTS Two hundred and ninety-two patients who ingested agricultural phenthoate formulations were included in the study. Median time to admission was 3.9 (IQR 2.4 - 6.8) h. Forty-two (14.4%) patients were intubated, mostly (30/37, 81%) within 24 h of ingestion (median time to intubation 7.2 [IQR 2.6-20.9] h). Median duration of intubation was 74.8 (IQR 26.8-232.5) h; the longest duration in a survivor was 592 h. Nineteen died (case fatality 6.5%, 95% CI 4.0-10.0); median time to death was 37 (IQR 16 - 101.7) h. Median plasma phenthoate concentration in patients with samples (n = 81) was 135 (IQR 62.7-356.5) ng/mL (0.42 µmol/mL [0.2 to 1.1 µmol/mL]). Five of six patients receiving pralidoxime chloride 2 g showed an initial increase in AChE and BuChE activity that was not sustained despite an infusion of pralidoxime. CONCLUSION Phenthoate self-poisoning has a 6.5% case fatality rate. Most patients who experience respiratory failure undergo early intubation; most deaths occurred among those patients who were intubated less than 24 h after ingestion. There was a non-sustained increase in cholinesterase activity with pralidoxime, but further studies are required to analyse the extent to which oximes are clinically effective in phenthoate self-poisoning.
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Affiliation(s)
- Lekaashree Rambabu
- National Health Service Tayside, Dundee, UK.,Edinburgh Medical School, The University of Edinburgh, Edinburgh, UK
| | - Fahim Mohamed
- South Asian Clinical Toxicology Research Collaboration, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka.,Department of Pharmacy, Faculty of Allied Health Sciences, University of Peradeniya, Peradeniya, Sri Lanka
| | - Jeevan Dhanarisi
- South Asian Clinical Toxicology Research Collaboration, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
| | - Indika Gawarammana
- South Asian Clinical Toxicology Research Collaboration, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
| | - Jacques Raubenheimer
- Faculty of Medicine and Health, Discipline of Biomedical Informatics and Digital Health, Clinical Pharmacology and Toxicology Research Group, The University of Sydney, Sydney, Australia
| | - Lorraine Mackenzie
- Therapeutics Research Centre, Clinical and Health Sciences, University of South Australia, Adelaide, Australia.,Basil Hetzel Institute for Translational Research, The Queen Elizabeth Hospital, Woodville, Australia
| | - Michael S Roberts
- Therapeutics Research Centre, Clinical and Health Sciences, University of South Australia, Adelaide, Australia.,Therapeutics Research Centre, Diamantina Institute, Translational Research Institute, The University of Queensland, Brisbane, Australia
| | - Nicholas Buckley
- Clinical Pharmacology and Toxicology Research Group, Discipline of Pharmacology, University of Sydney, Sydney, Australia
| | - Michael Eddleston
- Pharmacology, Toxicology, & Therapeutics, University/BHF Centre for Cardiovascular Science, Edinburgh, UK.,Centre for Pesticide Suicide Prevention, University of Edinburgh, Edinburgh, UK
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16
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Knipe D, Moran P, Howe LD, Bandara P, Wickramage K, Gunnell D, Rajapakse T. Is being a 'left-behind' child associated with an increased risk of self-poisoning in adulthood? Findings from a case-control study in Sri Lanka. BMJ Glob Health 2021; 6:bmjgh-2020-003734. [PMID: 33648980 PMCID: PMC7925243 DOI: 10.1136/bmjgh-2020-003734] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 01/11/2021] [Accepted: 01/14/2021] [Indexed: 12/25/2022] Open
Abstract
PURPOSE The long-term consequences of parental emigration on offspring self-harm risk is unknown. METHODS We investigated the association between experiencing parental emigration in childhood with hospital presentations for self-poisoning in adulthood using a hospital case-control study. Cases were adult self-poisoning patients (≥18 year olds) admitted to the medical toxicology ward Teaching Hospital Peradeniya, Sri Lanka. Sex and age frequency matched controls were recruited from the outpatient department or nearby specialist clinics at the same hospital. Details of parental emigration were collected using a pre-piloted questionnaire. The relationship between parental emigration and self-poisoning in adulthood was estimated using logistic regression models. RESULTS 298 cases, and 500 hospital controls were interviewed for the study. We estimate that one in five adults experienced parental emmigration as children (95% CI 17% to 24%). We find limited evidence that children from households with emigrating parents were more likely to experience adverse childhood experiences than those with non-emigrating parents. We found no statistical evidence of an increased risk of self-poisoning in adulthood in individuals who experienced parental emigration (maternal or paternal) during childhood. There was no statistical evidence that the impact differed by the sex of the participant. CONCLUSION Adults who experienced parental emigration as children were no more likely to self-poison than adults with non-emigrating parents. Further research using longitudinal data are needed to understand whether any adverse outcomes observed in 'left-behind' children are a consequence of parental emigration or due to factors associated but predate the emigration. Prospective data are also important to investigate whether there are any lasting effects on children who experience parental emigration.
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Affiliation(s)
- Duleeka Knipe
- Population Health Sciences, University of Bristol, Bristol, UK,South Asian Clinical Toxicology Research Collaboration, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
| | - Paul Moran
- Population Health Sciences, University of Bristol, Bristol, UK,Centre for Academic Mental Health, Bristol Medical School, University of Bristol, Bristol, UK
| | - Laura D Howe
- Population Health Sciences, University of Bristol, Bristol, UK,MRC Integrative Epidemiology Unit, University of Bristol, Bristol, Bristol, UK
| | - Piumee Bandara
- Translational Health Research Institute, Western Sydney University, Penrith South, New South Wales, Australia
| | | | - David Gunnell
- Population Health Sciences, University of Bristol, Bristol, UK,National Institute of Health Research Biomedical Research Centre, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Thilini Rajapakse
- South Asian Clinical Toxicology Research Collaboration, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka,Department of Psychiatry, Facultly of Medicine, University of Peradeniya, Peradeniya, Central, Sri Lanka
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17
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Weerasinghe M, Konradsen F, Eddleston M, Pearson M, Jayamanne S, Knipe D, Hawton K, Gunnell D, Agampodi S. Factors associated with purchasing pesticide from shops for intentional self-poisoning in Sri Lanka. Trop Med Int Health 2021; 25:1198-1204. [PMID: 33463883 DOI: 10.1111/tmi.13469] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE In South Asia, up to one in five individuals who ingest pesticides for self-poisoning and survive purchased them from a shop immediately prior to the event. Thus far, no research has taken place to determine whether interventions implemented through the pesticide sellers might be acceptable or effective, despite the hundreds of thousands of such risk purchases each year. We aimed to investigate factors associated with purchasing pesticides for self-poisoning in Sri Lanka. METHODS We used a case-control study. Cases (n = 50) were individuals who ingested pesticides after purchasing them for the act, and controls (n = 200) were customers who bought pesticides but did not use them for self-harm. Logistic regression analysis was used to assess socio-demographic and purchase-specific risk factors. RESULTS Alcohol intoxication (adjusted odds ratios [AOR] 36.5, 95% confidence intervals [CI] 1.7-783.4) and being a non-farmer AOR 13.3, 95% CI 1.8-99.6 were the main distinguishing factors when purchasing pesticides for self-poisoning. The positive predictive values were 93.3% (95% CI 68.0-99.8%) and 88.2% (95% CI 72.5-96.7%), respectively. One and/or other of these factors characterised 72.0% of cases but only 2.5% controls. CONCLUSION While results need to be interpreted cautiously, sales restrictions to prevent alcohol-intoxicated persons and non-farmers purchasing pesticides for self-poisoning may be effective.
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Affiliation(s)
- Manjula Weerasinghe
- Department of Community Medicine, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Anuradhapura, Sri Lanka.,South Asian Clinical Toxicology Research Collaboration, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka.,Centre for Pesticide Suicide Prevention, and Pharmacology, Toxicology and Therapeutics, Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
| | - Flemming Konradsen
- South Asian Clinical Toxicology Research Collaboration, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka.,Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Michael Eddleston
- South Asian Clinical Toxicology Research Collaboration, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka.,Centre for Pesticide Suicide Prevention, and Pharmacology, Toxicology and Therapeutics, Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK.,Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Melissa Pearson
- South Asian Clinical Toxicology Research Collaboration, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka.,Centre for Pesticide Suicide Prevention, and Pharmacology, Toxicology and Therapeutics, Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
| | - Shaluka Jayamanne
- South Asian Clinical Toxicology Research Collaboration, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka.,Department of Medicine, Faculty of Medicine, University of Kelaniya, Ragama, Sri Lanka
| | - Duleeka Knipe
- South Asian Clinical Toxicology Research Collaboration, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka.,Population Health Sciences, University of Bristol, Bristol, UK
| | - Keith Hawton
- Centre for Suicide Research, Department of Psychiatry, University of Oxford, Oxford, UK
| | - David Gunnell
- Population Health Sciences, University of Bristol, Bristol, UK.,National Institute of Health Research Biomedical Research Centre at the University Hospitals Bristol NHS Foundation Trust and the University of Bristol, Bristol, UK
| | - Suneth Agampodi
- Department of Community Medicine, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Anuradhapura, Sri Lanka
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18
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Kamaruzaman NA, Leong YH, Jaafar MH, Mohamed Khan HR, Abdul Rani NA, Razali MF, Abdul Majid MI. Epidemiology and risk factors of pesticide poisoning in Malaysia: a retrospective analysis by the National Poison Centre (NPC) from 2006 to 2015. BMJ Open 2020; 10:e036048. [PMID: 32487578 PMCID: PMC7265005 DOI: 10.1136/bmjopen-2019-036048] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVE Pesticide poisoning is a global health problem, and its progressive deterioration is a major cause of concern. The objective of this study is to assess epidemiological characteristics and identify risk factors of pesticide poisoning in Malaysia. SETTING Pesticide poisoning database of Malaysia National Poison Centre (NPC) from 2006 to 2015. PARTICIPANTS Telephone enquiries regarding pesticide poisoning were made by healthcare professionals. Information received by the NPC was entered into a retrievable database of standardised Poison Case Report Form, as adapted from the World Health Organization (WHO). OUTCOMES The outcome of the study is to provide an overview of national epidemiological profile of pesticide poisoning. High-risk groups of people and their circumstances were also identified to ensure that appropriate measures are strategised. RESULTS Within the study period, a total of 11 087 pesticide poisoning cases were recorded. Sixty per cent of these cases were intentional in nature and most were found among male individuals (57%) of the Indian race (36.4%) aged between 20 and 29 years (25.5%), which occurred at home (90%) through the route of ingestion (94%). The highest number of poisoning was due to herbicides (44%) followed by agricultural insecticides (34%), rodenticides (9.9%), household insecticides (9.5%) and fungicides (0.5%). In addition, 93.6% of intentional pesticide poisoning cases were caused by suicide attempts. The results of this study show that there was an increasing trend in pesticide poisoning incidents over the 10-year duration. This indicates that pesticide poisoning is a prevalent public health problem in Malaysia, resulting in an average incidence rate of 3.8 per 100 000 population. CONCLUSIONS Deliberate pesticide ingestion as a method of suicide has become a disturbing trend among Malaysians. Therefore, regulation of highly hazardous pesticides must be enforced to ensure controlled and limited access to these chemicals by the public.
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Affiliation(s)
| | - Yin-Hui Leong
- Malaysia National Poison Centre, Universiti Sains Malaysia, 11800 USM, Penang, Malaysia
| | - Mohd Hafiidz Jaafar
- Malaysia National Poison Centre, Universiti Sains Malaysia, 11800 USM, Penang, Malaysia
- School of Industrial Technology, Universiti Sains Malaysia, 11800 USM, Penang, Malaysia
| | | | - Noor Afiza Abdul Rani
- Malaysia National Poison Centre, Universiti Sains Malaysia, 11800 USM, Penang, Malaysia
| | - Mohd Fadhli Razali
- Malaysia National Poison Centre, Universiti Sains Malaysia, 11800 USM, Penang, Malaysia
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Brandt Sørensen J, Pearson M, Armstrong G, Andersen MW, Weerasinghe M, Hawton K, Konradsen F. A Qualitative Analysis of Self-Harm and Suicide in Sri Lankan Printed Newspapers. CRISIS 2020; 42:56-63. [PMID: 32366170 PMCID: PMC8208295 DOI: 10.1027/0227-5910/a000687] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Background: Media reporting may influence suicidal behavior. In-depth exploration of how self-harm and suicide are portrayed in newspaper articles in a middle-income country such as Sri Lanka is lacking. Aims: We aimed to explore how self-harm and suicide are portrayed in Sri Lankan printed newspapers. Method: Seven English- and Sinhala-language Sri Lankan newspapers were screened for articles reporting on self-harm and suicide (December 1, 2014 to January 31, 2015). A thematic analysis was conducted. Results: In the 78 articles identified for analysis, certain aspects were overemphasized (inappropriate behavior) and others underemphasized (alcohol and complexities of self-harm). Explanations of self-harm were one-sided and a suicide prevention narrative was lacking. Limitations: Another time-frame and inclusion of Tamil newspapers as well as social media and online publications would provide additional understanding. Conclusion: The study found an indication of simplistic reporting. Greater focus on prevention and a nuanced portrayal of self-harm could reduce stigma and imitative behavior.
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Affiliation(s)
| | - Melissa Pearson
- School of Clinical Sciences and Community Health, The University of Edinburgh, UK
| | - Gregory Armstrong
- Nossal Institute for Global Health, Melbourne School of Population and Global Health, University of Melbourne, Australia
| | | | - Manjula Weerasinghe
- Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Sri Lanka
| | - Keith Hawton
- Centre for Suicide Research, University of Oxford, UK
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Pathiraja DY, Pathiraja RP, Senanayake L, Edirisinghe RM, Mapitigama N. Gender-based violence: Experiences from two tertiary care settings in Sri Lanka. F1000Res 2020; 9:269. [PMID: 32477497 PMCID: PMC7199284 DOI: 10.12688/f1000research.23120.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/08/2020] [Indexed: 11/20/2022] Open
Abstract
Background: This study aimed to obtain an overview of survivors of gender-based violence GBV who seek care, different types and consequences of (GBV), their modes of referral, factors associated with GBV, characteristics of the perpetrators, health-seeking behavior of the care-seekers and the service provided by GBV Care Centers in two tertiary care settings Methods: A retrospective cross-sectional study was conducted from January 2017 to December 2019 at two GBV care centers in a Women's Hospital and a General Hospital in Colombo, Sri Lanka. Sociodemographic details of care-seekers, referral methods, types of violence experienced and their consequences, factors associated with GBV, characteristics of the perpetrator, health seeking behavior of those seeking care, and the services provided, were obtained from the hospital records. Results: Records from all care seekers (n=495 women, no men) were obtained, and 488 were suitable for analysis. More women presented with GBV to the Women's Hospital compared to the General Hospital (395 vs 93, p<0.001), and there were significant differences in modes of referral between the two hospitals. A large majority had suffered emotional and economic violence, although physical or sexual violence were the reasons for referral to the centers. Suicidal tendencies had been reported by 20%. In 94.2% of cases the husband, lover or partner was the perpetrator. Physical violence was more likely in married women, those who did not report a stable relationship, and in those who were employed. Of the 488 women, 37% were pregnant at the time of violence. Most of the women had confided with another female about the violence. Less than 5% came for follow-up. Conclusions: GBV care services should be offered in all hospitals, especially those providing maternity and gynaecological care. Emotional and economic violence are common but often overlooked. There is a need to increase public awareness about GBV.
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Affiliation(s)
| | - Ramya Priyanwada Pathiraja
- Department of Obstetrics and Gynaecology, Faculty of Medical Sciences, University of Sri Jayewardenapura, Gangodawila, Nugegoda, Sri Lanka
| | | | - Rukshani Mayawanthi Edirisinghe
- Department of Obstetrics and Gynaecology, Faculty of Medical Sciences, University of Sri Jayewardenapura, Gangodawila, Nugegoda, Sri Lanka
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Gharbaoui M, Ben Khelil M, Harzallah H, Benzarti A, Zhioua M, Hamdoun M. Pattern of suicide by self-poisoning in Northern Tunisia: An eleven-year study (2005–2015). J Forensic Leg Med 2019; 61:1-4. [DOI: 10.1016/j.jflm.2018.10.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Revised: 09/10/2018] [Accepted: 10/19/2018] [Indexed: 11/25/2022]
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De Silva ANLM, Dawson AH, Gawarammana IB, Tennakoon S, Rajapakse T. Study protocol: a pilot randomized controlled trial to evaluate the acceptability and feasibility of a counseling intervention, delivered by nurses, for those who have attempted self-poisoning in Sri Lanka. Pilot Feasibility Stud 2018; 4:150. [PMID: 30258649 PMCID: PMC6151905 DOI: 10.1186/s40814-018-0341-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2018] [Accepted: 09/12/2018] [Indexed: 12/12/2022] Open
Abstract
Background Deliberate self-harm in the form of non-fatal self-poisoning is a major public health problem in Sri Lanka. Previous work suggests that many nurses in Sri Lanka—particularly those who work in primary care in the medical treatment of persons who attempt self-poisoning—already approach their role in a holistic fashion and consider “advising” or “counseling” patients after self-poisoning to be a part of their nursing role. But there is no formal training given to such nurses at present nor has the efficacy or feasibility of such an intervention been assessed in Sri Lanka. The aims of this pilot study are to explore the potential efficacy, acceptability, and feasibility of carrying out a counseling intervention that could be delivered by nurses for persons who present to hospital for medical management of non-fatal self-poisoning. Methods/design The study will be carried out at the Toxicology Unit of Teaching Hospital Peradeniya, Sri Lanka. A pilot randomized controlled trial will be carried out among participants admitted to Teaching Hospital Peradeniya for medical management of non-fatal self-poisoning. The primary objective of this study is to explore the acceptability and feasibility of a counseling intervention being delivered by nurses. The secondary objectives are to explore the efficacy of the intervention for the improvement of skills to cope with situations of acute emotional distress, and to reduce rates of anxiety, depression, and future repetition and suicidal ideation. A nurse’s experiences and attitudes regarding the acceptability and feasibility of implementing this intervention and participant experiences of the intervention and its effects will be explored via qualitative interviews and focus group discussions. Discussion It is anticipated that the findings of this pilot study will help determine and assess the acceptability and feasibility of this counseling intervention, as well as indicate the more useful aspects of this intervention in order to develop it for further exploration in a larger trial. Trial registration SLCTR/2017/008 Registered on 21st March 2017
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Affiliation(s)
- A N L M De Silva
- 1South Asian Clinical Toxicology Research Collaboration, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
| | - Andrew H Dawson
- 2Central Clinical School, University of Sydney, Sydney, Australia
| | - Indika B Gawarammana
- 3Department of Medicine, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
| | - Sampath Tennakoon
- 4Department of Community Medicine, University of Peradeniya, Peradeniya, Sri Lanka
| | - Thilini Rajapakse
- 5Department of Psychiatry, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
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Knipe D, Gunnell D, Pearson M, Jayamanne S, Pieris R, Priyadarshana C, Weerasinghe M, Hawton K, Konradsen F, Eddleston M, Metcalfe C. Attempted suicide in Sri Lanka - An epidemiological study of household and community factors. J Affect Disord 2018; 232:177-184. [PMID: 29494901 PMCID: PMC6081369 DOI: 10.1016/j.jad.2018.01.028] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2017] [Revised: 12/18/2017] [Accepted: 01/28/2018] [Indexed: 11/26/2022]
Abstract
BACKGROUND An individual's suicide risk is determined by personal characteristics, but is also influenced by their environment. Previous studies indicate a role of contextual effects on suicidal behaviour, but there is a dearth of quantitative evidence from Asia. METHODS Individual and community level data were collected on 165,233 people from 47,919 households in 171 communities in rural Sri Lanka. Data were collected on individual (age, sex, past suicide attempts and individual socioeconomic position (SEP)) and household (household SEP, pesticide access, alcohol use and multigenerational households) level factors. We used 3-level logit models to investigate compositional (individual) and contextual (household/community) effects. RESULTS We found significant variation between households 21% (95% CI 18%, 24%) and communities 4% (95% CI 3%, 5%) in the risk of a suicide attempt. Contextual factors as measured by low household SEP (OR 2.37 95% CI 2.10, 2.67), low community SEP (OR 1.45 95% CI 1.21, 1.74), and community 'problem' alcohol use (OR 1.44 95% CI 1.19, 1.75) were associated with an increased risk of suicide attempt. Women living in households with alcohol misuse were at higher risk of attempted suicide. We observed a protective effect of living in multigenerational households (OR 0.53 95% CI 0.42, 0.65). LIMITATIONS The outcome was respondent-reported and refers to lifetime reports of attempted suicide, therefore this study might be affected by socially desirable responding. CONCLUSIONS Our study finds that contextual factors are associated with an individual's risk of attempted suicide in Sri Lanka, independent of an individual's personal characteristics.
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Affiliation(s)
- D.W. Knipe
- Population Health Sciences, Bristol Medical School, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol BS8 2PS, UK,South Asian Clinical Toxicology Research Collaboration (SACTRC), Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka,Corresponding author at: Population Health Sciences, Bristol Medical School, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol BS8 2PS, UK.
| | - D. Gunnell
- Population Health Sciences, Bristol Medical School, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol BS8 2PS, UK,National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol NHS Foundation Trust and University of Bristol, UK
| | - M. Pearson
- South Asian Clinical Toxicology Research Collaboration (SACTRC), Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka,Pharmacology, Toxicology & Therapeutics, University/BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
| | - S. Jayamanne
- South Asian Clinical Toxicology Research Collaboration (SACTRC), Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka,Faculty of Medicine, University of Kelanyia, Kelanyia, Sri Lanka
| | - R. Pieris
- South Asian Clinical Toxicology Research Collaboration (SACTRC), Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
| | - C. Priyadarshana
- South Asian Clinical Toxicology Research Collaboration (SACTRC), Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
| | - M. Weerasinghe
- South Asian Clinical Toxicology Research Collaboration (SACTRC), Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka,Department of Community Medicine, Faculty of Medicine & Allied Sciences, Rajarata University of Sri Lanka, Saliyapura, Anuradhapura, Sri Lanka
| | - K. Hawton
- Centre for Suicide Research, Department of Psychiatry, University of Oxford, Oxford, UK
| | - F. Konradsen
- South Asian Clinical Toxicology Research Collaboration (SACTRC), Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka,Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - M. Eddleston
- South Asian Clinical Toxicology Research Collaboration (SACTRC), Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka,Pharmacology, Toxicology & Therapeutics, University/BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
| | - C. Metcalfe
- Population Health Sciences, Bristol Medical School, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol BS8 2PS, UK
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Hettiarachchi LV, Kinner SA, Tibble H, Borschmann R. Self-Harm among Young People Detained in the Youth Justice System in Sri Lanka. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:E209. [PMID: 29373512 PMCID: PMC5858278 DOI: 10.3390/ijerph15020209] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/12/2017] [Revised: 01/17/2018] [Accepted: 01/18/2018] [Indexed: 12/03/2022]
Abstract
Self-harm is prevalent in incarcerated adults, yet comparatively few studies of self-harm in detained youth (and even fewer in low- and middle-income countries) have been published. We examined the prevalence and correlates of self-harm in a sample of 181 young people (mean age 15.0 years, SD = 2.3) detained in the youth justice system in Sri Lanka. Structured face-to-face questionnaires assessed demographic characteristics, family and social background, substance use, self-harm history (including frequency, method, and intention), bullying victimization, physical and sexual abuse (victimization and perpetration), and exposure to self-harm/suicide by others. Seventy-seven participants (43%) reported a lifetime history of self-harm, 19 of whom (25%) who reported doing so with suicidal intent. Fifty participants (65% of those with a history of self-harm) reported engaging in self-harm impulsively, with no prior planning. A history of self-harm was associated with being female, prior sexual abuse victimization, prior exposure to self-harm by friends, and a lifetime history of self-harm ideation. High rates of substance use, bullying victimization, parental incarceration, and exposure to suicide were reported across the sample. Young people detained in the youth justice system in Sri Lanka are a vulnerable group with high rates of self-harm, substance use, and psychosocial risk factors. Strategies for identifying and preventing self-harm, and targeted psychological interventions designed specifically to address impulsivity, may contribute to more positive outcomes in this marginalised population.
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Affiliation(s)
- Lushan V Hettiarachchi
- Forensic Psychiatric Unit, National Institute of Mental Health, Colombo 10620, Sri Lanka.
| | - Stuart A Kinner
- Centre for Adolescent Health, Murdoch Children's Research Institute, Melbourne 3052, Australia.
- Centre for Mental Health, Melbourne School of Population of Global Health, University of Melbourne, Melbourne 3010, Australia.
- Mater Research Institute-UQ, University of Queensland, Brisbane 4072, Australia.
- Griffith Criminology Institute, Griffith University, Brisbane 4111, Australia.
- School of Public Health and Preventive Medicine, Monash University, Melbourne 3800, Australia.
| | - Holly Tibble
- Centre for Mental Health, Melbourne School of Population of Global Health, University of Melbourne, Melbourne 3010, Australia.
| | - Rohan Borschmann
- Centre for Adolescent Health, Murdoch Children's Research Institute, Melbourne 3052, Australia.
- Centre for Mental Health, Melbourne School of Population of Global Health, University of Melbourne, Melbourne 3010, Australia.
- Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London SE58AF, UK.
- Department of Psychiatry, University of Melbourne, Melbourne 3010, Australia.
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Benjamin RN, David T, Iyadurai R, Jacob KS. Suicidal Nonorganophosphate Poisoning in a Tertiary Hospital in South India: Nature, Prevalence, Risk Factors. Indian J Psychol Med 2018; 40:47-51. [PMID: 29403130 PMCID: PMC5795679 DOI: 10.4103/ijpsym.ijpsym_223_17] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND People who deliberately ingest poisons commonly present to emergency departments of hospitals in India. However, there is a dearth of information on poisoning using nonorganophosphorus pesticides. METHODS This prospective, hospital-based study attempted to examine the nonorganophosphorus poisons used to attempt suicide. Data on sociodemographic characteristics of patients, site and source of poisons, co-ingested substances, premeditation, and reason for poisoning were collected. A multinomial logistic regression was performed to determine association between poison class and these exposure characteristics. RESULTS Three hundred and forty-one cases of attempted suicide presented during the 6-month period (1.7% of all emergency room admissions). The majority was predominantly male and was young adults. Poisoning was the most common mode (91.7%), followed by hanging (7.3%) and self-injury (3, 0.9%). Pesticides (44.3%) including organophosphates (25.5%) were the predominant poisons, followed by pharmaceuticals (27.9%), caustics/chemicals (12.0%), and plant poisons (7.0%). One hundred and nine were available for prospective interview as the others who presented were not detained for prolonged observation the emergency department. Most patients who ingested such poisons were women, from rural backgrounds and were educated. The majority sourced the poisons from home, consumed poison at home, and mixed the poison with water; these attempts were impulsive and seemed to be in response to relationship conflicts. In the multivariate analysis, education (P = 0.08) and poison source (outside the home) were significant predictors of pesticide ingestion. CONCLUSIONS Suicidal poisoning results from a complex synthesis of socioeconomic and psychological factors; certain patterns of poisoning are likely to be more prevalent in demographic niche groups.
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Affiliation(s)
| | - Thambu David
- Department of Medicine, Unit 2, Christian Medical College, Vellore, Tamil Nadu, India
| | - Ramya Iyadurai
- Department of Medicine, Unit 5, Christian Medical College, Vellore, Tamil Nadu, India
| | - K S Jacob
- Department of Psychiatry, Unit 1, Christian Medical College, Vellore, Tamil Nadu, India
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Sørensen JB, Agampodi T, Sørensen BR, Siribaddana S, Konradsen F, Rheinländer T. 'We lost because of his drunkenness': the social processes linking alcohol use to self-harm in the context of daily life stress in marriages and intimate relationships in rural Sri Lanka. BMJ Glob Health 2017; 2:e000462. [PMID: 29259823 PMCID: PMC5728297 DOI: 10.1136/bmjgh-2017-000462] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Revised: 09/20/2017] [Accepted: 09/22/2017] [Indexed: 11/04/2022] Open
Abstract
Introduction Harmful alcohol use has been found to cause detriment to the consumers and those around them. Research carried out in Sri Lanka has described the socioeconomic consequences to families owing to alcohol consumption. However, the social processes around alcohol use and how it could result in behaviour such as self-harm was unclear. With an outset in daily life stressors in marriages and intimate relationships we explored alcohol use in families with a recent case of self-harm. Methods Qualitative data were collected for 11 months in 2014 and 2015 in the North Central and North Western provinces of Sri Lanka. Narrative life story interviews with 19 individuals who had self-harmed where alcohol was involved and 25 of their relatives were conducted. Ten focus group discussions were carried out in gender and age segregated groups. An inductive content analysis was carried out. Results Participants experienced two types of daily life stressors: non-alcohol-related stressors, such as violence and financial difficulties, and alcohol-related stressors. The alcohol-related stressors aggravated the non-alcohol-related daily life stressors within marriages and intimate relationships, which resulted in conflict between partners and subsequent self-harm. Women were disproportionately influenced by daily life stressors and were challenged in their ability to live up to gendered norms of marriage. Further, women were left responsible for their own and their husband’s inappropriate behaviour. Self-harm appeared to be a possible avenue of expressing distress. Gendered alcohol and marriage norms provided men with acceptable excuses for their behaviour, whether it was alcohol consumption, conflicts or self-harm. Conclusions This study found that participants experienced both alcohol-related and non-alcohol-related daily life stressors. These two categories of daily life stressors, gender inequalities and alcohol norms should be considered when planning alcohol and self-harm prevention in this setting. Life situations also reflected larger community and structural issues.
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Affiliation(s)
| | - Thilini Agampodi
- Department of Community Medicine, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Saliyapura, Sri Lanka
| | | | - Sisira Siribaddana
- Department of Medicine, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Saliyapura, Sri Lanka
| | - Flemming Konradsen
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Thilde Rheinländer
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
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Ssemugabo C, Halage AA, Neebye RM, Nabankema V, Kasule MM, Ssekimpi D, Jørs E. Prevalence, Circumstances, and Management of Acute Pesticide Poisoning in Hospitals in Kampala City, Uganda. ENVIRONMENTAL HEALTH INSIGHTS 2017; 11:1178630217728924. [PMID: 28904524 PMCID: PMC5588792 DOI: 10.1177/1178630217728924] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Accepted: 07/31/2017] [Indexed: 06/07/2023]
Abstract
This study was aimed at assessing prevalence, circumstance, and management of acute pesticide poisoning in hospitals in Kampala. It was a retrospective cross-sectional study that involved reviewing of 739 poisoning patient records from 5 hospitals in Kampala. Of the 739 patients, 212 were due to pesticide poisoning resulting in a prevalence of 28.8%. About 91.4% (191/210) of the cases were due to organophosphate poisoning, 63.3% (133/210) were intentional, and 98.1% (206/210) were exposed through ingestion. Diagnosis was majorly based on poisoning history 91.2% (187/205), and clinical features such as airways, breathing, and circulation examination 48.0% (95/198); nausea and vomiting 42.9% (91/212); muscle weakness 29.7% (63/212); excessive salivation 23.1% (49/212); and confusion 20.3% (43/212). More than half of the patients admitted were treated using atropine 52.3% (113/212). The prevalence of acute pesticide poisoning was high with most managed based on physical and clinical examination.
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Affiliation(s)
- Charles Ssemugabo
- Department of Disease Control and Environmental Health, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Abdullah Ali Halage
- Department of Disease Control and Environmental Health, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Ruth Mubeezi Neebye
- Department of Disease Control and Environmental Health, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Victoria Nabankema
- Pesticide Use, Health and Environment project, Uganda National Association of Community and Occupational Health, Kampala, Uganda
| | - Massy Moses Kasule
- Pesticide Use, Health and Environment project, Uganda National Association of Community and Occupational Health, Kampala, Uganda
| | - Deogratius Ssekimpi
- Department of Disease Control and Environmental Health, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda
- Pesticide Use, Health and Environment project, Uganda National Association of Community and Occupational Health, Kampala, Uganda
| | - Erik Jørs
- Pesticide Use, Health and Environment project, Uganda National Association of Community and Occupational Health, Kampala, Uganda
- Department of Occupational Medicine, Odense University Hospital, Odense, Denmark
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Pesticide poisoning in Chitwan, Nepal: a descriptive epidemiological study. BMC Public Health 2017; 17:619. [PMID: 28673345 PMCID: PMC5496432 DOI: 10.1186/s12889-017-4542-y] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2016] [Accepted: 06/26/2017] [Indexed: 11/24/2022] Open
Abstract
Background Globally, there is a growing concern over pesticides use, which has been linked to self-harm and suicide. However, there is paucity of research on the epidemiology of pesticides poisoning in Nepal. This study is aimed at assessing epidemiological features of pesticides poisoning among hospital-admitted cases in selected hospitals of Chitwan District of Nepal. Methods A hospital-based quantitative study was carried out in four major hospitals of Chitwan District. Information on all pesticides poisoning cases between April 1 and December 31, 2015, was recorded by using a Pesticides Exposure Record (PER) form. Results A total of 439 acute pesticides poisoning cases from 12 districts including Chitwan and adjoining districts attended the hospitals during the 9-month-long study period. A majority of the poisoned subjects deliberately used pesticides (89.5%) for attempted suicide. The total incidence rate was 62.67/100000 population per year. Higher annual incidence rates were found among young adults (111.66/100000 population), women (77.53/100000 population) and individuals from Dalit ethnic groups (98.22/100000 population). Pesticides responsible for poisoning were mostly insecticides (58.0%) and rodenticides (20.8%). The most used chemicals were organophosphates (37.3%) and pyrethroids (36.7%). Of the total cases, 98.6% were hospitalized, with intensive care required for 41.3%. The case fatality rate among admitted cases was 3.8%. Conclusions This study has indicated that young adults, females and socially disadvantaged ethnic groups are at a higher risk of pesticides poisoning. Pesticides are mostly misused intentionally as an easy means for committing suicide. It is recommended that the supply of pesticides be properly regulated to prevent easy accessibility and misuse. A population-based study is warranted to reveal the actual problem of pesticides exposure and intoxication in the community.
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Pedersen B, Ssemugabo C, Nabankema V, Jørs E. Characteristics of Pesticide Poisoning in Rural and Urban Settings in Uganda. ENVIRONMENTAL HEALTH INSIGHTS 2017; 11:1178630217713015. [PMID: 28615953 PMCID: PMC5462555 DOI: 10.1177/1178630217713015] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/30/2016] [Accepted: 05/08/2017] [Indexed: 06/07/2023]
Abstract
Pesticide poisoning is a significant burden on health care systems in many low-income countries. This study evaluates cases of registered pesticide poisonings treated in selected rural (N = 101) and urban (N = 212) health facilities in Uganda from January 2010 to August 2016. In the urban setting, pesticides were the most prevalent single poison responsible for intoxications (N = 212 [28.8%]). Self-harm constituted a significantly higher proportion of the total number of poisonings in urban (63.3%) compared with rural areas (25.6%) where unintentional poisonings prevailed. Men were older than women and represented a majority of around 60% of the cases in both the urban and rural settings. Unintentional cases were almost the only ones seen below the age of 10, whereas self-harm dominated among adolescents and young persons from 10 to 29 years of age. Organophosphorus insecticides accounted for 73.0% of the poisonings. Urban hospitals provided a more intensive treatment and had registered fever complications than rural health care settings. To minimize self-harm with pesticides, a restriction of pesticide availability as shown to be effective in other low-income countries is recommended. Training of health care workers in proper diagnosis and treatment of poisonings and improved equipment in the health care settings should be strengthened.
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Affiliation(s)
| | - Charles Ssemugabo
- Department of Disease Control and Environmental Health, College of Health Sciences, Makerere University School of Public Health, Kampala, Uganda
| | - Victoria Nabankema
- PHE-project - coordinating officer, Uganda National Association of Community and Occupational Health, Kampala, Uganda
| | - Erik Jørs
- Department of Occupational Medicine, Odense University Hospital, Odense, Denmark
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Aggarwal S, Patton G, Reavley N, Sreenivasan SA, Berk M. Youth self-harm in low- and middle-income countries: Systematic review of the risk and protective factors. Int J Soc Psychiatry 2017; 63:359-375. [PMID: 28351292 DOI: 10.1177/0020764017700175] [Citation(s) in RCA: 60] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND Self-harm (defined here as an act of intentionally causing harm to own self, irrespective of the type, motive or suicidal intent) is one of the strongest antecedents of suicide in youth. While there have been a number of studies of youth self-harm in low- and middle-income countries (LMICs), there is currently no systematic review of studies of prevalence rates and risk and protective factors. AIM To systematically review the evidence relating to the prevalence rates and forms of self-harm in youth in LMICs and its relationship to family economic status, family functioning, relationship with the peer group, social relationships and academic performance. METHODS Electronic searches of three databases, MEDLINE, PsycINFO and Scopus, were performed. In total, 27 school-, community- and hospital-based studies evaluating self-harm in LMICs with youth focus (with participants between 12 and 25 years) were included. RESULTS The self-harm was divided into suicidal and non-suicidal depending on the nature of self-harm. The 12-month prevalence rates of non-suicidal self-harm varied from 15.5% to 31.3%, and the range of suicidal behaviour rates was from 3.2% to 4.7%. Banging and hitting were the most common in the community-based studies, followed by cutting, scratching and wound picking. Self-poisoning with pesticides was most commonly reported in hospital-based studies. Risk factors for self-harm were family conflict, peer groups with members indulging in self-harm, truancy and school absenteeism. Protective factors were having an understanding family, having friends and higher school competence. Risk factors for suicidal thoughts and attempts were lack of close friends and history of suicide by a friend. CONCLUSION The 12-month prevalence rates of youth self-harm in LMICs are comparable to high-income countries (HICs). The profile of risk and protective factors suggests that family-based interventions could be useful in treatment and prevention. Future studies should aim for greater consistency in assessment methods and the constructs under evaluation.
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Affiliation(s)
- Shilpa Aggarwal
- 1 IMPACT Strategic Research Centre, School of Medicine, Deakin University, Geelong, VIC, Australia
| | - George Patton
- 2 Department of Pediatrics, Royal Children's Hospital, Parkville, VIC, Australia.,3 Melbourne School of Population and Global Health, University of Melbourne, Carlton, VIC, Australia
| | - Nicola Reavley
- 3 Melbourne School of Population and Global Health, University of Melbourne, Carlton, VIC, Australia
| | | | - Michael Berk
- 1 IMPACT Strategic Research Centre, School of Medicine, Deakin University, Geelong, VIC, Australia.,4 Orygen: The National Centre of Excellence in Youth Mental Health, University of Melbourne, Parkville, VIC, Australia
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Gjelsvik B, Heyerdahl F, Holmes J, Lunn D, Hawton K. Is There a Relationship between Suicidal Intent and Lethality in Deliberate Self-Poisoning? Suicide Life Threat Behav 2017; 47:205-216. [PMID: 27416812 DOI: 10.1111/sltb.12277] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2015] [Accepted: 02/29/2016] [Indexed: 11/25/2022]
Abstract
The relationship between suicidal intent and lethality of deliberate self-poisoning (DSP) episodes and their associations with suicide have yielded contradictory findings. The aims of this study were to investigate the association between patients' suicidal intent and independently rated lethality of DSP episodes, and whether the association changes over time. Eighty-nine DSP patients were investigated longitudinally. Self-reported suicidal intent, including perceived likelihood of dying, wish to die, and whether or not the DSP was considered a suicide attempt, was measured at the time of the index episode (t1), 3 months (t2), and 12 months (t3) later. Lethality was assessed independently by three clinical toxicologists. Lethality was significantly associated with patients' reported wish to die (p = .01) and perceived likelihood of dying (p = .04) at t1, but not at t2 and t3. No association was found between whether the episode was considered a suicide attempt or not and lethality at t1, t2, or t3. Lethality and suicidal intent should be considered as largely separate dimensions of self-harm. Clinicians should bear this in mind during clinical assessment, especially regarding historical information.
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Affiliation(s)
- Bergljot Gjelsvik
- Department of Psychology, University of Oslo, Oslo, Norway.,Oxford Mindfulness Centre and Centre for Suicide Research, Department of Psychiatry, University of Oxford, Oxford, UK
| | - Fridtjof Heyerdahl
- Department of Acute Medicine, Ullevaal, Oslo University Hospital, Oslo, Norway
| | - Jane Holmes
- Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Daniel Lunn
- Department of Statistics, Oxford University, Oxford, UK
| | - Keith Hawton
- Centre for Suicide Research, Department of Psychiatry, Oxford University, Oxford, UK
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Regional variation in suicide rates in Sri Lanka between 1955 and 2011: a spatial and temporal analysis. BMC Public Health 2017; 17:193. [PMID: 28196502 PMCID: PMC5310090 DOI: 10.1186/s12889-016-3961-5] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2015] [Accepted: 12/17/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Between 1955 and 2011 there were marked fluctuations in suicide rates in Sri Lanka; incidence increased six-fold between 1955 and the 1980s, and halved in the early 21st century. Changes in access to highly toxic pesticides are thought to have influenced this pattern. This study investigates variation in suicide rates across Sri Lanka's 25 districts between 1955 and 2011. We hypothesised that changes in the incidence of suicide would be most marked in rural areas due to the variation in availability of highly toxic pesticides in these locations during this time period. METHODS We mapped district-level suicide rates in 1955, 1972, 1980 and 2011. These periods preceded, included and postdated the rapid rise in Sri Lanka's suicide rates. We investigated the associations between district-level variations in suicide rates and census-derived measures of rurality (population density), unemployment, migration and ethnicity using Spearman's rank correlation and negative binomial models. RESULTS The rise and fall in suicide rates was concentrated in more rural areas. In 1980, when suicide rates were at their highest, population density was inversely associated with area variation in suicide rates (r = -0.65; p < 0.001), i.e. incidence was highest in rural areas. In contrast the association was weakest in 1950, prior to the rise in pesticide suicides (r = -0.10; p = 0.697). There was no strong evidence that levels of migration or ethnicity were associated with area variations in suicide rates. The relative rates of suicide in the most rural compared to the most urban districts before (1955), during (1980) and after (2011) the rise in highly toxic pesticide availability were 1.1 (95% CI 0.5 to 2.4), 3.7 (2.0 to 6.9) and 2.1 (1.6 to 2.7) respectively. CONCLUSIONS The findings provide some support for the hypothesis that changes in access to pesticides contributed to the marked fluctuations in Sri Lanka's suicide rate, but the impact of other factors cannot be ruled out.
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De Silva SA, Colucci E, Mendis J, Kelly CM, Jorm AF, Minas H. Suicide first aid guidelines for Sri Lanka: a Delphi consensus study. Int J Ment Health Syst 2016; 10:53. [PMID: 27579055 PMCID: PMC5004258 DOI: 10.1186/s13033-016-0085-3] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2016] [Accepted: 08/18/2016] [Indexed: 11/10/2022] Open
Abstract
Background Sri Lanka has one of the highest suicide rates in the world. Gatekeeper programs aimed at specific target groups could be a promising suicide prevention strategy in the country. The aim of this study was to develop guidelines that help members of the public to provide first aid to persons in Sri Lanka who are at risk of suicide. Methods The Delphi method was used to elicit consensus on potential helping statements to include in the guidelines. These statements describe information members of the public should have and actions they can take to help a person who is experiencing suicidal thoughts. An expert panel, comprised of mental health and suicide experts in Sri Lanka, rated each statement. The panellists were encouraged to suggest any additional action that was not included in the original questionnaire and, in particular, to include items that were culturally appropriate or gender specific. Responses to open-ended questions were used to generate new items. These items were included in the subsequent Delphi rounds. Three Delphi rounds were carried out. Statements were accepted for inclusion in the guidelines if they were endorsed (rated as essential or important) by at least 80 % of the panel. Statements endorsed by 70–79 % of the panel were re-rated in the following round. Statements with less than 70 % endorsement, or re-rated items that did not receive 80 % or higher endorsement were rejected. Results The output from the Delphi process was a set of endorsed statements. In the first round questionnaire 473 statements were presented to the panel and 58 new items were generated from responses to the open-ended questions. Of the total 531 statements presented, 304 were endorsed. These statements were used to develop the suicide first aid guidelines for Sri Lanka. Conclusion By engaging Sri Lankans who are experts in the field of mental health or suicide this research developed culturally appropriate guidelines for providing mental health first aid to a person at risk of suicide in Sri Lanka. The guidelines may serve as a basis for developing training for members of the public to provide mental health first aid to persons at risk of suicide as part of Sri Lanka’s suicide prevention strategy. Electronic supplementary material The online version of this article (doi:10.1186/s13033-016-0085-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Saranga A De Silva
- Global and Cultural Mental Health Unit, Centre for Mental Health, Melbourne School of Population and Global Health, The University of Melbourne, 207 Bouverie Street, Carlton, VIC 3053 Australia
| | - Erminia Colucci
- Global and Cultural Mental Health Unit, Centre for Mental Health, Melbourne School of Population and Global Health, The University of Melbourne, 207 Bouverie Street, Carlton, VIC 3053 Australia
| | - Jayan Mendis
- National Institute of Mental Health, Colombo, Sri Lanka
| | - Claire M Kelly
- Mental Health First Aid Australia, Parkville, Australia ; School of Psychology, Deakin University, Geelong, Australia
| | - Anthony F Jorm
- Population Mental Health Unit, Centre for Mental Health, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia
| | - Harry Minas
- Global and Cultural Mental Health Unit, Centre for Mental Health, Melbourne School of Population and Global Health, The University of Melbourne, 207 Bouverie Street, Carlton, VIC 3053 Australia
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Indu TH, Raja D, Ponnusankar S. Toxicoepidemiology of acute poisoning cases in a secondary care hospital in rural South India: A 5-year analysis. J Postgrad Med 2016; 62:48-9. [PMID: 26732197 PMCID: PMC4944331 DOI: 10.4103/0022-3859.173214] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
| | | | - S Ponnusankar
- Department of Pharmacy Practice, JSS College of Pharmacy, Udhagamandalam, Tamil Nadu; Department of Pharmacy Practice, Jagadguru Sri Shivarathreeswara (JSS) University, Mysore, Karnataka, India
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Rajapakse T, Christensen H, Cotton S, Griffiths KM. Non-fatal self-poisoning across age groups, in Sri Lanka. Asian J Psychiatr 2016; 19:79-84. [PMID: 26957344 DOI: 10.1016/j.ajp.2016.01.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2015] [Revised: 12/29/2015] [Accepted: 01/01/2016] [Indexed: 11/17/2022]
Abstract
Attempted or non-fatal self-poisoning in common in Sri Lanka, but little is known about variation of psychiatric morbidity and suicidal intent across differing ages. The aim of this study was to investigate factors associated with non-fatal self-poisoning in Sri Lanka across three different age groups (namely 14-24 years, 25-34 years and ≥ 35 years). It was anticipated that the findings of the study would inform and guide development of preventive interventions for non-fatal self-poisoning in this country. 935 participants were interviewed within one week of admission to hospital for medical management of non-fatal self-poisoning, over a consecutive 14-month period. Socio-demographic factors, types of poison ingested, triggers and psychiatric morbidity was examined as a function of age. Results showed that a majority (83%) of participants were aged below 35 years. Younger participants aged <25 years were significantly more likely to ingest medicinal overdoses, compared to older persons (aged 25-34 years, and ≥ 35 years), who were more likely to ingest pesticides. Recent interpersonal conflict was a proximal trigger seen in all age groups, but suicidal intent, depression and alcohol use disorders increased with age. The overall study findings indicate that most who carry out acts of non-fatal self-poisoning in Sri Lanka are young (aged <35 years). Interpersonal conflict as a trigger is common to all age groups, but psychiatric morbidity and suicidal intent is higher in the older age groups, as is pesticide ingestion. Age specific interventions may be efficacious in the prevention of non-fatal self-poisoning in Sri Lanka.
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Affiliation(s)
- Thilini Rajapakse
- Department of Psychiatry, Faculty of Medicine, University of Peradeniya, Sri Lanka.
| | - Helen Christensen
- Black Dog Institute, University of New South Wales, Hospital Road, Randwick 2013, NSW, Australia.
| | - Sue Cotton
- Centre for Youth Mental Health, University of Melbourne, 35, Poplar Road, Parkville 3052, VIC, Australia.
| | - Kathleen Margaret Griffiths
- National Institute for Mental Health Research, Australian National University, Building 63, Canberra 0200, ACT, Australia.
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Cha ES, Chang SS, Gunnell D, Eddleston M, Khang YH, Lee WJ. Impact of paraquat regulation on suicide in South Korea. Int J Epidemiol 2015; 45:470-9. [PMID: 26582846 DOI: 10.1093/ije/dyv304] [Citation(s) in RCA: 76] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/22/2015] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Ingestion of pesticides (mainly paraquat) accounted for one-fifth of suicides in South Korea in 2006-10. We investigated the effect on suicide mortality of regulatory action, culminating in a ban on paraquat in South Korea in 2011-12. METHODS We calculated age-standardized method-specific suicide mortality rates among people aged ≥15 in South Korea (1983-2013) using registered death data. Negative binomial regression was used to estimate changes in the rate and number of pesticide suicides in 2013, compared with those expected based on previous trends (2003-11). RESULTS Pesticide suicide mortality halved from 5.26 to 2.67 per 100 000 population between 2011 and 2013. Compared with the number expected based on previous trends, the regulations were followed by an estimated 847 [95% confidence interval (CI) -1180 to -533] fewer pesticide suicides, a 37% reduction in rates (rate ratio = 0.63, 95% CI 0.55 to 0.73) in 2013. The decline in pesticide suicides after the regulations was seen in all age/sex/geographical groups. The absolute reduction in the number of suicides was greatest among men, the elderly and in rural areas. The reduction in pesticide suicides contributed to 56% of the decline in overall suicides that occurred between 2011 and 2013. There was no impact of the regulations on crop yield. CONCLUSIONS The regulation of paraquat in South Korea in 2011-12 was associated with a reduction in pesticide suicide. Further legislative interventions to prevent the easy availability of highly lethal suicide methods are recommended for reducing the number of suicides worldwide.
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Affiliation(s)
- Eun Shil Cha
- Department of Preventive Medicine, Korea University College of Medicine, Seoul, South Korea
| | - Shu-Sen Chang
- Institute of Health Behaviors and Community Sciences, and Department of Public Health, National Taiwan University, Taipei, Taiwan
| | - David Gunnell
- School of Social and Community Medicine, University of Bristol, Bristol, UK, South Asian Clinical Toxicology Research Collaboration, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
| | - Michael Eddleston
- South Asian Clinical Toxicology Research Collaboration, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka, University/BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK and
| | - Young-Ho Khang
- Department of Health Policy and Management, Seoul National University College of Medicine, and Institute of Health Policy and Management, Seoul National University Medical Research Center, Seoul, South Korea
| | - Won Jin Lee
- Department of Preventive Medicine, Korea University College of Medicine, Seoul, South Korea,
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Straight B, Pike I, Hilton C, Oesterle M. Suicide in Three East African Pastoralist Communities and the Role of Researcher Outsiders for Positive Transformation: A Case Study. Cult Med Psychiatry 2015; 39:557-78. [PMID: 25381581 DOI: 10.1007/s11013-014-9417-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
We examine cultural understandings and practices surrounding suicide in Pokot, Samburu, and Turkana pastoralists in north-central Kenya--three geographically overlapping and mutually interacting pastoralist communities. We collected our data in the context of a study of poverty, violence, and distress. In all three communities, stigma associated with suicide circumscribed individual responses to the World Health Organization's Self-Report Questionnaire, which led to an ethnographic sub-study of suicide building upon our long-standing research in East Africa on distress, violence, and death. As is true for most of sub-Saharan Africa, reliable statistical data are non-existent for these communities. Thus, we deliberately avoid making assertions about generalizable statistical trends. Rather, we take the position that ethnographically nuanced studies like the one we offer here provide a necessary basis for the respectful collection of accurate quantitative data on this important and troubling practice. Moreover, our central point in this paper is that positive transformational work relating to suicide is most likely when researcher outsiders practice 'deep engagement' while respectfully restricting their role to (1) iterative, community-driven approaches that contextualize suicide; and (2) sharing contextualized analyses with other practitioners. We contend that situating suicide within a broader cultural framework that includes attitudes and practices surrounding other forms of death is essential to both aspects of anthropological-outsiders' role.
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Affiliation(s)
- Bilinda Straight
- Department of Anthropology, Western Michigan University, 1020 Moore Hall, Kalamazoo, MI, 49008, USA,
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Weerasinghe M, Konradsen F, Eddleston M, Pearson M, Gunnell D, Hawton K, Jayamanne S, Pabasara C, Jayathilaka T, Dissanayaka K, Rajapaksha S, Thilakarathna P, Agampodi S. Risk factors associated with purchasing pesticide from shops for self-poisoning: a protocol for a population-based case-control study. BMJ Open 2015; 5:e007822. [PMID: 25995242 PMCID: PMC4442210 DOI: 10.1136/bmjopen-2015-007822] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION Pesticide self-poisoning is one of the most frequently used methods of suicide worldwide, killing over 300,000 people annually. Around 15-20% of pesticide self-poisonings occur soon after the person has bought the pesticide from a shop. We aim to determine the characteristics of individuals who purchase pesticides directly from shops and how they differ from individuals who access pesticides from other sources such as home, home garden or farmland. This information will help inform possible vendor/shop-based intervention strategies aimed at reducing access to pesticides used for self-harm. METHODS AND ANALYSIS This study will investigate risk factors associated with purchasing pesticides for acts of self-poisoning from pesticide shops, including cases identified over a 9-month period using a population-based case-control group approach. Four interviewer-administered data collection tools will be used for this study: a semistructured questionnaire, Beck Suicidal Intent Scale (SIS), Clinical Interview Schedule-Sinhalese version (CIS-Sn) and Alcohol Use Disorders Identification Test (AUDIT). Each case (expected n=33) will be compared with two groups of individuals: (1) those who have self-poisoned using pesticides from the home, home garden or farmland and (2) those who bought pesticides from the same shops as the above cases, but not did not self-poison. Logistic regression models will be used to identify risk factors of purchasing pesticides for self-poisoning from shops. ETHICS AND DISSEMINATION The study has received ethical approval from the Ethical Review Committee of the Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka. A sensitive data collection technique will be used and ethical issues will be considered throughout the study. Results will be disseminated in scientific peer-reviewed articles.
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Affiliation(s)
- Manjula Weerasinghe
- Department of Community Medicine, Faculty of Medicine & Allied Sciences, Rajarata University of Sri Lanka, Saliyapura, Anuradhapura, Sri Lanka
- Faculty of Medicine, South Asian Clinical Toxicology Research Collaboration (SACTRC), University of Peradeniya, Peradeniya, Sri Lanka
| | - Flemming Konradsen
- Faculty of Medicine, South Asian Clinical Toxicology Research Collaboration (SACTRC), University of Peradeniya, Peradeniya, Sri Lanka
- Department of Public Health, Faculty of Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Michael Eddleston
- Faculty of Medicine, South Asian Clinical Toxicology Research Collaboration (SACTRC), University of Peradeniya, Peradeniya, Sri Lanka
- Department of Public Health, Faculty of Sciences, University of Copenhagen, Copenhagen, Denmark
- Pharmacology, Toxicology and Therapeutics, University of Edinburgh, Edinburgh, UK
| | - Melissa Pearson
- Faculty of Medicine, South Asian Clinical Toxicology Research Collaboration (SACTRC), University of Peradeniya, Peradeniya, Sri Lanka
- Pharmacology, Toxicology and Therapeutics, University of Edinburgh, Edinburgh, UK
| | - David Gunnell
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Keith Hawton
- Department of Psychiatry, Centre for Suicide Research, University of Oxford, Oxford, UK
| | - Shaluka Jayamanne
- Faculty of Medicine, South Asian Clinical Toxicology Research Collaboration (SACTRC), University of Peradeniya, Peradeniya, Sri Lanka
- Department of Medicine, Faculty of Medicine, University of Kelaniya, Ragama, Sri Lanka
| | - Chathurani Pabasara
- Faculty of Medicine, South Asian Clinical Toxicology Research Collaboration (SACTRC), University of Peradeniya, Peradeniya, Sri Lanka
| | - Tharidu Jayathilaka
- Faculty of Medicine, South Asian Clinical Toxicology Research Collaboration (SACTRC), University of Peradeniya, Peradeniya, Sri Lanka
| | - Kalpani Dissanayaka
- Faculty of Medicine, South Asian Clinical Toxicology Research Collaboration (SACTRC), University of Peradeniya, Peradeniya, Sri Lanka
| | - Sandamali Rajapaksha
- Faculty of Medicine, South Asian Clinical Toxicology Research Collaboration (SACTRC), University of Peradeniya, Peradeniya, Sri Lanka
| | - Prasanna Thilakarathna
- Faculty of Medicine, South Asian Clinical Toxicology Research Collaboration (SACTRC), University of Peradeniya, Peradeniya, Sri Lanka
| | - Suneth Agampodi
- Department of Community Medicine, Faculty of Medicine & Allied Sciences, Rajarata University of Sri Lanka, Saliyapura, Anuradhapura, Sri Lanka
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Taking stock -- what is known about suicide in Sri Lanka: a systematic review of diverse literature. CRISIS 2015; 35:90-101. [PMID: 24491824 DOI: 10.1027/0227-5910/a000244] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Suicide is and has been a major public health problem in Sri Lanka and has generated a wide range of literature. AIMS This review aimed to systematically appraise what is known about suicide in Sri Lanka. The patterns and content of articles were examined and recommendations for further research proposed. METHOD The paper describes the systematic search, retrieval, and quality assessment of studies. Thematic analysis techniques were applied to the full text of the articles to explore the range and extent of issues covered. RESULTS Local authors generated a large body of evidence of the problem in early studies. The importance of the method of suicide, suicidal intention, and the high incidence of suicide were identified as key foci for publications. Neglected areas have been policy and health service research, gender analysis, and contextual issues. CONCLUSION The literature reviewed has produced a broad understanding of the clinical factors, size of the problem, and social aspects. However, there remains limited evidence of prevention, risk factors, health services, and policy. A wide range of solutions have been proposed, but only regulation of pesticides and improved medical management proved to be effective to date.
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Widger T. Suicide and the ‘Poison Complex’: Toxic Relationalities, Child Development, and the Sri Lankan Self-Harm Epidemic. Med Anthropol 2015; 34:501-16. [DOI: 10.1080/01459740.2015.1012616] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Pearson M, Zwi AB, Buckley NA, Manuweera G, Fernando R, Dawson AH, McDuie-Ra D. Policymaking 'under the radar': a case study of pesticide regulation to prevent intentional poisoning in Sri Lanka. Health Policy Plan 2015; 30:56-67. [PMID: 24362640 PMCID: PMC4287191 DOI: 10.1093/heapol/czt096] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/02/2013] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Suicide in Sri Lanka is a major public health problem and in 1995 the country had one of the highest rates of suicide worldwide. Since then reductions in overall suicide rates have been largely attributed to efforts to regulate a range of pesticides. The evolution, context, events and implementation of the key policy decisions around regulation are examined. METHODS This study was undertaken as part of a broader analysis of policy in two parts-an explanatory case study and stakeholder analysis. This article describes the explanatory case study that included an historical narrative and in-depth interviews. RESULTS A timeline and chronology of policy actions and influence were derived from interview and document data. Fourteen key informants were interviewed and four distinct policy phases were identified. The early stages of pesticide regulation were dominated by political and economic considerations and strongly influenced by external factors. The second phase was marked by a period of local institution building, the engagement of local stakeholders, and expanded links between health and agriculture. During the third phase the problem of self-poisoning dominated the policy agenda and closer links between stakeholders, evidence and policymaking developed. The fourth and most recent phase was characterized by strong local capacity for policymaking, informed by evidence, developed in collaboration with a powerful network of stakeholders, including international researchers. CONCLUSIONS The policy response to extremely high rates of suicide from intentional poisoning with pesticides shows a unique and successful example of policymaking to prevent suicide. It also highlights policy action taking place 'under the radar', thus avoiding policy inertia often associated with reforms in lower and middle income countries.
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Affiliation(s)
- Melissa Pearson
- South Asian Clinical Toxicology Research Collaboration, Faculty of Medicine, University of Peradeniya, Sri Lanka and School of Social Sciences, Faculty of Arts and Social Sciences, University of New South Wales, Randwick NSW, 2502 Australia, Health, Rights and Development (HEARD@UNSW), School of Social Sciences, Faculty of Arts and Social Sciences, University of New South Wales, Sydney, Australia, South Asian Clinical Toxicology Research Collaboration, Prince of Wales Hospital Clinical School, University of New South Wales, NSW, Australia, Scientific Support Branch, Secretariat of the Basel, Rotterdam and Stockholm Conventions, United Nations Environment Programme, South Asian Clinical Toxicology Research Collaboration, University of Peradeniya Sri Lanka and Department of Forensic Medicine, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka, South Asian Clinical Toxicology Research Collaboration, University of Peradeniya Sri Lanka and NSW Poisons Information Service, Westmead Childrens Hospital, Sydney, Australia and School of Social Sciences and International Studies, Faculty of Arts and Social Sciences, University of New South Wales, Sydney, Australia
| | - Anthony B Zwi
- South Asian Clinical Toxicology Research Collaboration, Faculty of Medicine, University of Peradeniya, Sri Lanka and School of Social Sciences, Faculty of Arts and Social Sciences, University of New South Wales, Randwick NSW, 2502 Australia, Health, Rights and Development (HEARD@UNSW), School of Social Sciences, Faculty of Arts and Social Sciences, University of New South Wales, Sydney, Australia, South Asian Clinical Toxicology Research Collaboration, Prince of Wales Hospital Clinical School, University of New South Wales, NSW, Australia, Scientific Support Branch, Secretariat of the Basel, Rotterdam and Stockholm Conventions, United Nations Environment Programme, South Asian Clinical Toxicology Research Collaboration, University of Peradeniya Sri Lanka and Department of Forensic Medicine, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka, South Asian Clinical Toxicology Research Collaboration, University of Peradeniya Sri Lanka and NSW Poisons Information Service, Westmead Childrens Hospital, Sydney, Australia and School of Social Sciences and International Studies, Faculty of Arts and Social Sciences, University of New South Wales, Sydney, Australia
| | - Nicholas A Buckley
- South Asian Clinical Toxicology Research Collaboration, Faculty of Medicine, University of Peradeniya, Sri Lanka and School of Social Sciences, Faculty of Arts and Social Sciences, University of New South Wales, Randwick NSW, 2502 Australia, Health, Rights and Development (HEARD@UNSW), School of Social Sciences, Faculty of Arts and Social Sciences, University of New South Wales, Sydney, Australia, South Asian Clinical Toxicology Research Collaboration, Prince of Wales Hospital Clinical School, University of New South Wales, NSW, Australia, Scientific Support Branch, Secretariat of the Basel, Rotterdam and Stockholm Conventions, United Nations Environment Programme, South Asian Clinical Toxicology Research Collaboration, University of Peradeniya Sri Lanka and Department of Forensic Medicine, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka, South Asian Clinical Toxicology Research Collaboration, University of Peradeniya Sri Lanka and NSW Poisons Information Service, Westmead Childrens Hospital, Sydney, Australia and School of Social Sciences and International Studies, Faculty of Arts and Social Sciences, University of New South Wales, Sydney, Australia
| | - Gamini Manuweera
- South Asian Clinical Toxicology Research Collaboration, Faculty of Medicine, University of Peradeniya, Sri Lanka and School of Social Sciences, Faculty of Arts and Social Sciences, University of New South Wales, Randwick NSW, 2502 Australia, Health, Rights and Development (HEARD@UNSW), School of Social Sciences, Faculty of Arts and Social Sciences, University of New South Wales, Sydney, Australia, South Asian Clinical Toxicology Research Collaboration, Prince of Wales Hospital Clinical School, University of New South Wales, NSW, Australia, Scientific Support Branch, Secretariat of the Basel, Rotterdam and Stockholm Conventions, United Nations Environment Programme, South Asian Clinical Toxicology Research Collaboration, University of Peradeniya Sri Lanka and Department of Forensic Medicine, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka, South Asian Clinical Toxicology Research Collaboration, University of Peradeniya Sri Lanka and NSW Poisons Information Service, Westmead Childrens Hospital, Sydney, Australia and School of Social Sciences and International Studies, Faculty of Arts and Social Sciences, University of New South Wales, Sydney, Australia
| | - Ravindra Fernando
- South Asian Clinical Toxicology Research Collaboration, Faculty of Medicine, University of Peradeniya, Sri Lanka and School of Social Sciences, Faculty of Arts and Social Sciences, University of New South Wales, Randwick NSW, 2502 Australia, Health, Rights and Development (HEARD@UNSW), School of Social Sciences, Faculty of Arts and Social Sciences, University of New South Wales, Sydney, Australia, South Asian Clinical Toxicology Research Collaboration, Prince of Wales Hospital Clinical School, University of New South Wales, NSW, Australia, Scientific Support Branch, Secretariat of the Basel, Rotterdam and Stockholm Conventions, United Nations Environment Programme, South Asian Clinical Toxicology Research Collaboration, University of Peradeniya Sri Lanka and Department of Forensic Medicine, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka, South Asian Clinical Toxicology Research Collaboration, University of Peradeniya Sri Lanka and NSW Poisons Information Service, Westmead Childrens Hospital, Sydney, Australia and School of Social Sciences and International Studies, Faculty of Arts and Social Sciences, University of New South Wales, Sydney, Australia
| | - Andrew H Dawson
- South Asian Clinical Toxicology Research Collaboration, Faculty of Medicine, University of Peradeniya, Sri Lanka and School of Social Sciences, Faculty of Arts and Social Sciences, University of New South Wales, Randwick NSW, 2502 Australia, Health, Rights and Development (HEARD@UNSW), School of Social Sciences, Faculty of Arts and Social Sciences, University of New South Wales, Sydney, Australia, South Asian Clinical Toxicology Research Collaboration, Prince of Wales Hospital Clinical School, University of New South Wales, NSW, Australia, Scientific Support Branch, Secretariat of the Basel, Rotterdam and Stockholm Conventions, United Nations Environment Programme, South Asian Clinical Toxicology Research Collaboration, University of Peradeniya Sri Lanka and Department of Forensic Medicine, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka, South Asian Clinical Toxicology Research Collaboration, University of Peradeniya Sri Lanka and NSW Poisons Information Service, Westmead Childrens Hospital, Sydney, Australia and School of Social Sciences and International Studies, Faculty of Arts and Social Sciences, University of New South Wales, Sydney, Australia
| | - Duncan McDuie-Ra
- South Asian Clinical Toxicology Research Collaboration, Faculty of Medicine, University of Peradeniya, Sri Lanka and School of Social Sciences, Faculty of Arts and Social Sciences, University of New South Wales, Randwick NSW, 2502 Australia, Health, Rights and Development (HEARD@UNSW), School of Social Sciences, Faculty of Arts and Social Sciences, University of New South Wales, Sydney, Australia, South Asian Clinical Toxicology Research Collaboration, Prince of Wales Hospital Clinical School, University of New South Wales, NSW, Australia, Scientific Support Branch, Secretariat of the Basel, Rotterdam and Stockholm Conventions, United Nations Environment Programme, South Asian Clinical Toxicology Research Collaboration, University of Peradeniya Sri Lanka and Department of Forensic Medicine, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka, South Asian Clinical Toxicology Research Collaboration, University of Peradeniya Sri Lanka and NSW Poisons Information Service, Westmead Childrens Hospital, Sydney, Australia and School of Social Sciences and International Studies, Faculty of Arts and Social Sciences, University of New South Wales, Sydney, Australia
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Rimkeviciene J, O'Gorman J, De Leo D. Impulsive suicide attempts: a systematic literature review of definitions, characteristics and risk factors. J Affect Disord 2015; 171:93-104. [PMID: 25299440 DOI: 10.1016/j.jad.2014.08.044] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2014] [Revised: 08/26/2014] [Accepted: 08/26/2014] [Indexed: 11/26/2022]
Abstract
BACKGROUND Extensive research on impulsive suicide attempts, but lack of agreement on the use of this term indicates the need for a systematic literature review of the area. The aim of this review was to examine definitions and likely correlates of impulsive attempts. METHODS A search of Medline, Psychinfo, Scopus, Proquest and Web of Knowledge databases was conducted. Additional articles were identified using the cross-referencing function of Google Scholar. RESULTS 179 relevant papers were identified. Four different groups of research criteria used to assess suicide attempt impulsivity emerged: (a) time-related criteria, (b) absence of proximal planning/preparations, (c) presence of suicide plan in lifetime/previous year, and (d) other. Subsequent analysis used these criteria to compare results from different studies on 20 most researched hypotheses. Conclusions regarding the characteristics of impulsive attempts are more consistent than those on the risk factors specific to such attempts. No risk factors were identified that uniformly related to suicide attempt impulsivity across all criteria groups, but relationships emerged between separate criteria and specific characteristics of suicide attempters. LIMITATIONS Only published articles were included. Large inconsistencies in methods of the studies included in this review prevented comparison of effect sizes. CONCLUSIONS The vast disparities in findings on risk factors for impulsive suicide attempts among different criteria groups suggest the need to address the methodological issues in defining suicide attempt impulsivity before further research into correlates of such attempts can effectively progress. Specific recommendations are offered for necessary research.
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Affiliation(s)
- Jurgita Rimkeviciene
- Australian Institute for Suicide Research and Prevention, National Centre of Excellence in Suicide Prevention, World Health Organisation Collaborating Centre for Research and Training in Suicide Prevention, Griffith University, Australia.
| | - John O'Gorman
- Australian Institute for Suicide Research and Prevention, National Centre of Excellence in Suicide Prevention, World Health Organisation Collaborating Centre for Research and Training in Suicide Prevention, Griffith University, Australia; Griffith Health Institute, Australia
| | - Diego De Leo
- Australian Institute for Suicide Research and Prevention, National Centre of Excellence in Suicide Prevention, World Health Organisation Collaborating Centre for Research and Training in Suicide Prevention, Griffith University, Australia
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Sørensen JB, Rheinländer T, Sørensen BR, Pearson M, Agampodi T, Siribaddana S, Konradsen F. An investigation into the role of alcohol in self-harm in rural Sri Lanka: a protocol for a multimethod, qualitative study. BMJ Open 2014; 4:e005860. [PMID: 25293385 PMCID: PMC4187453 DOI: 10.1136/bmjopen-2014-005860] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
INTRODUCTION Sri Lanka has one of the highest suicide and self-harm rates in the world and although alcohol has been found to be a risk factor for self-harm in Sri Lanka, we know little about the connection between the two. This paper comprises a protocol for a qualitative study investigating alcohol's role in self-harm in rural Sri Lanka at three levels: the individual, community and policy level. The analysis will bring new understanding of the link between alcohol and self-harm in Sri Lanka, drawing on structural, cultural and social concepts. It will equip researchers, health systems and policy makers with vital information for developing strategies to address alcohol-related problems as they relate to self-harm. METHODS AND ANALYSIS To capture the complexity of the link between alcohol and self-harm in the Anuradhapura district in the North Central Province in Sri Lanka, qualitative methods will be utilised. Specifically, the data will consist of serial narrative life-story interviews with up to 20 individuals who have non-fatally self-harmed and where alcohol directly or indirectly was involved in the incidence as well as with their significant others; observations in communities and families; six focus group discussions with community members; and key-informant interviews with 15-25 stakeholders who have a stake in alcohol distribution, marketing, policies, prevention and treatment as they relate to self-harm. ETHICS AND DISSEMINATION The study has received ethical approval from the Ethical Review Committee of the Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka. A sensitive data collection technique will be used and ethical issues will be considered throughout the study. RESULTS The results will be disseminated in scientific peer-reviewed articles in collaboration with Sri Lankan and other international research partners.
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Affiliation(s)
- Jane Brandt Sørensen
- Department of International Health, Immunology and Microbiology, University of Copenhagen, Copenhagen, Denmark
| | - Thilde Rheinländer
- Department of International Health, Immunology and Microbiology, University of Copenhagen, Copenhagen, Denmark
| | | | - Melissa Pearson
- Pharmacology, Toxicology and Therapeutics, University of Edinburgh, UK and South Asian Clinical Toxicology Research Collaboration, Edinburgh, UK
| | - Thilini Agampodi
- Department of Community Medicine, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Saliyapura, Sri Lanka
| | - Sisira Siribaddana
- Department of Medicine, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Saliyapura, Sri Lanka
| | - Flemming Konradsen
- Department of International Health, Immunology and Microbiology, University of Copenhagen, Copenhagen, Denmark
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Rajapakse T, Griffiths KM, Christensen H, Cotton S. A comparison of non-fatal self-poisoning among males and females, in Sri Lanka. BMC Psychiatry 2014; 14:221. [PMID: 25103532 PMCID: PMC4149235 DOI: 10.1186/s12888-014-0221-z] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2014] [Accepted: 07/23/2014] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND In the recent past Sri Lanka has had a high rate of attempted suicide by pesticide ingestion, among both males and females. Recent evidence suggests that these trends in self-poisoning may be changing, with increasing medicinal overdoses and changing gender ratios. In the past, attempted suicide in Sri Lanka has been described as impulsive acts, but research regarding aspects such as suicidal intent is limited, and there has been no comparison between genders. The objective of this study was to describe gender differences in non-fatal self-poisoning in Sri Lanka with respect to substances ingested, triggers, stressors, suicidal intent and psychiatric morbidity. METHODS Persons admitted to Teaching Hospital Peradeniya, Sri Lanka, for medical management of non-fatal self-poisoning over a consecutive 14-month period were eligible for the study. Participants were interviewed within one week of admission, with regard to demographic details, poison type ingested, triggers, psychiatric morbidity and suicidal intent. 949 participants were included in the study, of whom 44.2% were males, with a median age of 22 years. RESULTS Males were significantly more likely to ingest agrochemicals, whereas females were more likely to overdose on pharmaceutical drugs. Interpersonal conflict was a common trigger associated with non-fatal self-poisoning for both males and females. Alcohol use disorders and high suicidal intent were significantly more likely in males. There was no difference in rates of depression between the genders. Multiple regression for both genders separately showed that the presence of depression and higher levels of hopelessness was the strongest predictor of suicidal intent, for both genders. CONCLUSIONS Patterns of non-fatal self-poisoning in Sri Lanka appear to be changing to resemble Western patterns, with females having a greater rate of self-poisoning and more medicinal overdoses than males. Alcohol use disorder is a gender specific risk factor associated with non-fatal self-poisoning among males, indicating a need for specific intervention. However there are also many common risk factors that are common to both genders, particularly associations with interpersonal conflict as an acute trigger, and psychiatric morbidity such as depression and hopelessness being related to increased suicidal intent.
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Affiliation(s)
- Thilini Rajapakse
- Department of Psychiatry, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka.
| | - Kathleen Margaret Griffiths
- National Institute for Mental Health Research, The Australian National University, Building 63, Canberra, ACT 0200 Australia
| | - Helen Christensen
- Black Dog Institute, University of New South Wales, Hospital Road, Randwich, NSW 2013 Australia
| | - Sue Cotton
- Centre for Youth Mental Health, University of Melbourne, 35, Poplar Road, Parkville, VIC 3052 Australia
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Jørs E, Christoffersen M, Veirum NH, Aquilar GC, Morant RC, Konradsen F. Suicide attempts and suicides in Bolivia from 2007 to 2012: pesticides are the preferred method - females try but males commit suicide! Int J Adolesc Med Health 2014; 26:361-367. [PMID: 24114895 DOI: 10.1515/ijamh-2013-0309] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2013] [Accepted: 08/01/2013] [Indexed: 06/02/2023]
Abstract
BACKGROUND Suicide attempts and suicides constitute a significant burden on communities and health systems, especially in low income countries. However, many low income countries lack epidemiological information on which to base future preventive strategies. This study reports on gender and age profiles as well as the likely background and means used for suicide attempts and suicides in Bolivia. METHOD This study presents 1124 cases from four different sources of information: (i) emergency ward data with suicide attempts by poisoning from the year 2007, (ii) psychiatric ward data including suicide attempts from July 2011 to July 2012, (iii) newspaper articles reporting attempted suicides and suicides from 2009 to 2011, and (iv) the National Statistics on Crime reporting suicides from the years 2010-2011. Data on age was stratified into three age groups: adolescents aged 10-19 years, young adults aged 20-29 years, and older adults aged above 29 years. Data from the hospital wards and Crime Statistics were pooled to compare characteristics of suicide attempts with suicides concerning age and gender. Data on age, gender, methods used, and reasons were analyzed using IBM SPSS version 21. RESULTS Hospital data showed that more females (403/657, 61%) than males (254/657, 39%) attempted suicide, and females attempted suicide at a younger age than males (p<0.05). In contrast to this, more males (208/293, 70.5%) than females (85/293, 29.5%) committed suicide, and furthermore it was most prevalent among young adults aged 20-29 years of both genders, as observed from the Crime Statistics. The dominant method was pesticide poisoning varying from 400 out of 657 (70.5%) of the hospital poisoning cases to 65 out of 172 (37.8%) of the newspaper cases. Newspaper data showed a higher mortality rate (65/77, 85.1%) among those using violent methods such as hanging and jumping compared to non-violent methods (43/84, 50.9%) such as ingesting chemicals and drugs (p<0.05). The reasons were related to interpersonal problems, economic problems, depression, and unwanted pregnancies. Many cases of suicide seemed to be hidden due to cultural and religious reasons. CONCLUSION More females attempted suicide, whereas more males realized suicide. Suicide attempts were most numerous among adolescents in contrast to suicides being most prevalent in the older age groups. Self-poisoning with pesticides was the most popular method used. Access to potential suicide materials should be restricted and psychosocial interventions initiated to prevent suicides.
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Stallones L, Doenges T, Dik BJ, Valley MA. Occupation and suicide: Colorado, 2004-2006. Am J Ind Med 2013; 56:1290-5. [PMID: 23873359 DOI: 10.1002/ajim.22228] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/24/2013] [Indexed: 11/06/2022]
Abstract
BACKGROUND Occupation has been identified as a risk factor for suicide. Changes in work environments over time suggest occupations at high risk of suicide may also change. Therefore, periodic examination of suicide by occupation is warranted. The purpose of this article is to describe suicide rates by occupation, sex, and means used in Colorado for the period 2004-2006. METHODS To provide information useful in designing suicide prevention programs, the methods used in suicide across occupational groups also are examined. Data from the Colorado Violent Death Reporting System (COVDRS) were obtained for suicides that occurred between 2004 and 2006. Denominators to calculate rates by age, sex, and race used are from the 2000 US Census of the Population data. RESULTS Men had higher suicide rates than women in all occupation categories except computers and mathematics. Among men, those in farming, fishing, and forestry (475.6 per 100,000) had the highest age-adjusted suicide rates. Among women, workers with the highest suicide rates were in construction and extraction (134.3 per 100,000). The examination of lethal means showed that workers in farming, fishing, and forestry had higher rates of suicide by firearms (50.18 per 100,000) compared with other workers. Healthcare practitioners and technicians had the highest rate of suicide by poisoning (14.25 per 100,000). Workers involved in construction and extraction (26.43 per 100,000) had higher rates of suicide by hanging, suffocation, or strangling. CONCLUSIONS Significant differences in means of suicide were seen by occupation, which could guide future suicide prevention interventions that may decrease work-related suicide risks.
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Affiliation(s)
| | | | - Bryan J. Dik
- Department of Psychology; Colorado State University; Fort Collins; Colorado
| | - Morgan A. Valley
- Department of Psychology; Colorado State University; Fort Collins; Colorado
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Senarathna L, Hunter C, Dawson AH, Dibley MJ. Social dynamics in rural Sri Lankan hospitals: revelations from self-poisoning cases. QUALITATIVE HEALTH RESEARCH 2013; 23:1481-1494. [PMID: 24135311 DOI: 10.1177/1049732313510361] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Different hospitals produce different cultures-products of relationships between people of different staff categories and people from external community groups. These relationships demonstrate unique social dynamics in rural peripheral hospitals that form a major part of the health care system in Sri Lanka and other developing countries. Understanding the existing social dynamics might be useful when trying to implement new treatment guidelines that can involve behavior change. We aimed to explore the existing social dynamics in peripheral hospitals in rural Sri Lanka by examining the treatment related to cases of acute self-poisoning that is a common, highly interactive medical emergency. These hospitals demonstrate higher levels of community influence in treatment decisions and closer interactions between hospital staff. We argue that health care teamwork is effective in peripheral hospitals, resulting in benefits to all staff, who see these hospitals as better places to work and train, in contrast to a commonly held belief that such rural hospitals are disadvantaged and difficult places.
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A central storage facility to reduce pesticide suicides--a feasibility study from India. BMC Public Health 2013; 13:850. [PMID: 24041373 PMCID: PMC3847561 DOI: 10.1186/1471-2458-13-850] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2012] [Accepted: 09/13/2013] [Indexed: 11/28/2022] Open
Abstract
Background Pesticide suicides are considered the single most important means of suicide worldwide. Centralized pesticide storage facilities have the possible advantage of delaying access to pesticides thereby reducing suicides. We undertook this study to examine the feasibility and acceptability of a centralized pesticide storage facility as a preventive intervention strategy in reducing pesticide suicides. Methods A community randomized controlled feasibility study using a mixed methods approach involving a household survey; focus group discussions (FGDs) and surveillance were undertaken. The study was carried out in a district in southern India. Eight villages that engaged in floriculture were identified. Using the lottery method two were randomized to be the intervention sites and two villages constituted the control site. Two centralized storage facilities were constructed with local involvement and lockable storage boxes were constructed. The household survey conducted at baseline and one and a half years later documented information on sociodemographic data, pesticide usage, storage and suicides. Results At baseline 4446 individuals (1097 households) in the intervention and 3307 individuals (782 households) in the control sites were recruited while at follow up there were 4308 individuals (1063 households) in the intervention and 2673 individuals (632 households) in the control sites. There were differences in baseline characteristics and imbalances in the prevalence of suicides between intervention and control sites as this was a small feasibility study. The results from the FGDs revealed that most participants found the storage facility to be both useful and acceptable. In addition to protecting against wastage, they felt that it had also helped prevent pesticide suicides as the pesticides stored here were not as easily and readily accessible. The primary analyses were done on an Intention to Treat basis. Following the intervention, the differences between sites in changes in combined, completed and attempted suicide rates per 100,000 person-years were 295 (95% CI: 154.7, 434.8; p < 0.001) for pesticide suicide and 339 (95% CI: 165.3, 513.2, p < 0.001) for suicide of all methods. Conclusions Suicide by pesticides poisoning is a major public health problem and needs innovative interventions to address it. This study, the first of its kind in the world, examined the feasibility of a central storage facility as a means of limiting access to pesticides and, has provided preliminary results on its usefulness. These results need to be interpreted with caution in view of the imbalances between sites. The facility was found to be acceptable, thereby underscoring the need for larger studies for a longer duration. Trial registration ISRCTN: ISRCTN04912407
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Weerasinghe M, Pearson M, Peiris R, Dawson AH, Eddleston M, Jayamanne S, Agampodi S, Konradsen F. The role of private pesticide vendors in preventing access to pesticides for self-poisoning in rural Sri Lanka. Inj Prev 2013; 20:134-7. [PMID: 23736739 PMCID: PMC3963527 DOI: 10.1136/injuryprev-2012-040748] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
In 15% to 20% of self-poisoning cases, the pesticides used are purchased from shops just prior to ingestion. We explored how pesticide vendors interacted with customers at risk of self-poisoning to identify interventions to prevent such poisonings. Two strategies were specifically discussed: selling pesticides only to farmers bearing identity cards or customers bearing pesticide ‘prescriptions’. Vendors reported refusing to sell pesticides to people thought to be at risk of self-poisoning, but acknowledged the difficulty of distinguishing them from legitimate customers; vendors also stated they did want to help to improve identification of such customers. The community did not blame vendors when pesticides used for self-poison were purchased from their shops. Vendors have already taken steps to restrict access, including selling low toxic products, counselling and asking customer to return the next day. However, there was little support for the proposed interventions of ‘identity cards’ and ‘prescriptions’. Novel public health approaches are required to complement this approach.
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Affiliation(s)
- Manjula Weerasinghe
- South Asian Clinical Toxicology Research Collaboration, Faculty of Medicine, , University of Peradeniya, Peradeniya, Sri Lanka
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Roberts G, Wahab MSA, Ali AA, Zulkifly HH, Welch SA, Munzner EE, Richardson KL, Thunga G, Patel H, Robert N, Nair S, Kunhikatta V, Acharya R, Graudins LV, Al-Worafi YM, Pariti B, Thunga G, Unnikrishnan M, Muralidhar V. Letters to the Editor. JOURNAL OF PHARMACY PRACTICE AND RESEARCH 2013. [DOI: 10.1002/j.2055-2335.2013.tb00242.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
| | | | | | - Hanis Hanum Zulkifly
- Department of Pharmacy Practice, Faculty of Pharmacy; Universiti Teknologi MARA; Malaysia
| | - Susan A Welch
- St Vincent's Hospital, Faculty of Pharmacy; The University of Sydney; Sydney NSW 2006
| | | | | | | | | | | | | | | | - Raviraj Acharya
- Department of Medicine, Kasturba Hospital; Manipal University; Manipal 576104 India
| | | | | | | | | | | | - Varma Muralidhar
- Department of General Medicine, Kasturba Medical College; Manipal University; Manipal 576104 India
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