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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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Vidyasagaran AL, McDaid D, Faisal MR, Nasir M, Muliyala KP, Thekkumkara S, Wright J, Huque R, Benkalkar S, Siddiqi N. Prevalence of mental disorders in South Asia: A systematic review of reviews. Glob Ment Health (Camb) 2023; 10:e78. [PMID: 38161740 PMCID: PMC10755414 DOI: 10.1017/gmh.2023.72] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 08/24/2023] [Accepted: 11/02/2023] [Indexed: 01/03/2024] Open
Abstract
Mental disorders are increasing in South Asia (SA), but their epidemiological burden is under-researched. We carried out a systematic umbrella review to estimate the prevalence of mental disorders and intentional self-harm in the region. Multiple databases were searched and systematic reviews reporting the prevalence of at least one mental disorder from countries in SA were included. Review data were narratively synthesised; primary studies of common mental disorders (CMDs) among adults were identified from a selected subset of reviews and pooled. We included 124 reviews. The majority (n = 65) reported on mood disorders, followed by anxiety disorders (n = 45). High prevalence of mental disorders and intentional self-harm was found in general adult and vulnerable populations. Two reviews met our pre-defined criteria for identifying primary studies of CMDs. Meta-analysis of 25 primary studies showed a pooled prevalence of 16.0% (95% CI = 11.0-22.0%, I 2 = 99.9%) for depression, 12.0% (5.0-21.0%, I 2 = 99.9%) for anxiety, and 14.0% (10.0-19.0, I 2 = 99.9%) for both among the general adult population; pooled estimates varied by country and assessment tool used. Overall, reviews suggest high prevalence for mental disorders in SA, but evidence is limited on conditions other than CMDs.
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Affiliation(s)
| | - David McDaid
- Care Policy and Evaluation Centre, Department of Health Policy, London School of Economics and Political Science, London, UK
| | | | - Muhammad Nasir
- Department of Economics, Institute of Business Administration (IBA), Karachi, Pakistan
| | - Krishna P. Muliyala
- Department of Psychiatry, National Institute of Mental Health & Neurosciences (NIMHANS), Bengaluru, India
| | | | - Judy Wright
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | | | | | - Najma Siddiqi
- Department of Health Sciences, University of York, Heslington, 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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Hasan MJ, Hassan MK, Ahmed Z, Khan MAS, Fardous J, Tabasssum T, Chowdhury FR, Gozal D, Amin MR. Acute Poisoning in Bangladesh: A Systematic Narrative Review. Asia Pac J Public Health 2022; 34:812-816. [PMID: 36189754 DOI: 10.1177/10105395221127523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
| | - Md Kamrul Hassan
- Shaheed Syed Nazrul Islam Medical College, Kishoreganj, Bangladesh
| | | | | | | | | | | | - David Gozal
- Department of Child Health, MU Women's and Children's Hospital, University of Missouri School of Medicine, Columbia, MO, USA
| | - Mohammad Robed Amin
- Department of Medicine, Dhaka Medical College and Hospital, Dhaka, Bangladesh.,Toxicology Society of Bangladesh, Dhaka, Bangladesh
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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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Scarth B, Pavlova A, Hetrick SE, Witt KG, Hawton K, Fortune S. Service users’ experiences of emergency care following an episode of self-harm: a mixed evidence synthesis. Hippokratia 2021. [DOI: 10.1002/14651858.cd014940] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Affiliation(s)
- Bonnie Scarth
- WellSouth, Primary Care Organisation; Dunedin New Zealand
| | - Alina Pavlova
- Psychological Medicine; University of Otago; Dunedin New Zealand
| | - Sarah E Hetrick
- Department of Psychological Medicine, Faculty of Medical and Health Sciences; The University of Auckland; Auckland New Zealand
- Children and Young People Satellite, Cochrane Common Mental Disorders; The University of Auckland; Auckland New Zealand
| | - Katrina G Witt
- Orygen; Parkville, Melbourne Australia
- Centre for Youth Mental Health; The University of Melbourne; Melbourne Australia
| | - Keith Hawton
- Centre for Suicide Research, Department of Psychiatry; University of Oxford; Oxford UK
| | - Sarah Fortune
- Department of Social and Community Health, Faculty of Medical and Health Sciences; The University of Auckland; Auckland New Zealand
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First responder, clinician, and non‐clinical support staff knowledge, attitudes, and behaviours towards people presenting for emergency care following self‐harm: a mixed evidence synthesis. Cochrane Database Syst Rev 2021; 2021:CD014939. [PMCID: PMC8668017 DOI: 10.1002/14651858.cd014939] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2024]
Abstract
This is a protocol for a Cochrane Review (qualitative). The objectives are as follows: The objectives of this review are threefold, as follows. Firstly, to assess the content of knowledge, attitudes, and behaviours of first responders, clinicians, and non‐clinical support staff towards service users with SH presentations. Secondly, to understand how service user and staff characteristics (e.g. age, gender, sociodemographic background), type of SH presentation (e.g. method, repetition), and contextual factors (e.g. hospital environment, presence of bystanders) affect the knowledge, attitudes, and behaviours of first responders, clinicians, and non‐clinical support staff in providing acute care. Thirdly, to assess whether clinicians' knowledge, attitudes, and behaviours have evolved over time.
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Arafat SMY, Ali SAEZ, Menon V, Hussain F, Ansari DS, Baminiwatta A, Saleem T, Singh R, Varadharajan N, Biyyala D, Kar SK, Khan MM. Suicide methods in South Asia over two decades (2001-2020). Int J Soc Psychiatry 2021; 67:920-934. [PMID: 34027683 DOI: 10.1177/00207640211015700] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
BACKGROUND Suicide is a global preventable public health problem. About a quarter of all suicides in the world occur in South Asia. As means restriction is an important suicide prevention strategy, gaining knowledge of the common suicide methods and their changing trends in each country and region is crucial. AIMS We aimed to assess the suicide methods in South Asian countries over the last two decades. METHODS A search was performed in PubMed, PubMed Central, Scopus, and Google Scholar with the search terms. Original articles of quantitative studies, published in the English language, from 2001 to 2020, with full-accessible text, that rank different methods of suicide in eight South Asian countries, were included. RESULTS A total of 68 studies were found eligible for review. The Maximum number of studies were found from India (n = 38), followed by Bangladesh (n = 12), Pakistan (n = 9), Sri Lanka (n = 6), and Nepal (n = 3). Hanging (n = 40, 55.8%) and poisoning (n = 24, 35.3%) were the two most common suicide methods reported, in that order. Hanging followed by poisoning were the commonest suicide methods in Bangladesh, India, and Pakistan while in Sri Lanka, poisoning was the preferred method to hanging. There is a decline in suicide by poisoning and an increase in suicide by hanging in Sri Lanka, Bangladesh, and India. Although hanging is still the commonest method in Pakistan, the use of firearms is growing in recent years (2011-2020). CONCLUSIONS There is a steady decline in the incidence of suicides by poisoning following pesticide regulations in South Asian countries. However, there is heterogeneity of study methods, probable under-reporting of suicide, and lack of robust suicide data.
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Affiliation(s)
- S M Yasir Arafat
- Department of Psychiatry, Enam Medical College and Hospital, Savar, Dhaka, Bangladesh
| | | | - Vikas Menon
- Department of Psychiatry, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, PY, India
| | - Fahad Hussain
- Department of Pharmacy, Noakhali Science and Technology University, Noakhali, Bangladesh
| | - Daniyal Shabbir Ansari
- Department of Critical Care Unit (Anesthesia and ICU), Civil Hospital, Bahawalpur, Pakistan
| | | | - Tamkeen Saleem
- Department of Psychology, International Islamic University, Islamabad, IS, Pakistan
| | - Rakesh Singh
- Department of Community Health Sciences, PatanAcademy of Health Sciences, Lalitpur, BA, Nepal
| | - Natarajan Varadharajan
- Department of Psychiatry, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, PY, India
| | - Deepika Biyyala
- Department of Psychiatry, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, PY, India
| | - Sujita Kumar Kar
- Department of Psychiatry, King George's Medical University, Lucknow, UP, India
| | - Murad M Khan
- Department of Psychiatry, Aga Khan University, Karachi, SD, Pakistan
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Nair SJ, Sujatha C, Chettiar K P S, Sasikala K. Toxico-epidemiology of acute poisoning; an exploratory study from a tertiary care hospital in South India along with global comparisons and solutions. J Forensic Leg Med 2021; 83:102247. [PMID: 34454338 DOI: 10.1016/j.jflm.2021.102247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Revised: 08/03/2021] [Accepted: 08/20/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Poisoning has been and still is a major problem faced throughout the globe. But its patterns are different and changing in different parts of the world due to local influences. This calls for a study to explore the issue in this unique South Indian state. METHODS A cross-sectional exploratory study was conducted to analyse the patterns of poisoning and the socio-demographic characteristics of the patients. Subgroups were compared using Fisher-Freeman-Halton exact test and further analysed by multivariate logistic regression. RESULTS 48% of cases were of pharmaceutical drug poisoning. 27.5% of these cases involved polymedication and Paracetamol (Acetaminophen) turned out to be the single most drug used. Suicide was the most common circumstance. 10% of patients had co-diagnoses of psychiatric disorders. Univariate analysis separately showed that females (p < 0.001), higher educated (p = 0.149), higher socioeconomic strata (p = 0.136) and non-addicts (p = 0.002) were more exposed to drugs whereas males, lower educated, lower socioeconomic strata and addicts are skewed to pesticides for poisoning. Most repeat suicide attempts were with the same poisonous agent. 70% of patients with a diagnosed psychiatric disorder have attempted suicide before using some drugs (p < 0.001). CONCLUSION Our study highlights the importance of a region-wise, targeted approach in policymaking to curb poisoning.
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Affiliation(s)
| | - Chintha Sujatha
- Department of Community Medicine, Government Medical College, Trivandrum, Kerala, India
| | | | - K Sasikala
- Department of Forensic Medicine and Toxicology, Government Medical College, Trivandrum, Kerala, India
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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
- * E-mail:
| | - 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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11
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Prevalence of mental disorders in South Asia: An umbrella review of systematic reviews and meta-analyses. Asian J Psychiatr 2020; 51:102041. [PMID: 32315966 DOI: 10.1016/j.ajp.2020.102041] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 03/21/2020] [Accepted: 03/25/2020] [Indexed: 01/08/2023]
Abstract
Mental disorders are highly prevalent in eight South Asian countries, yet there is a gap of a synthesized overview of the prevalence of mental disorders in this region. This umbrella review aims to summarize the prevalence of mental disorders from systematic reviews and meta-analyses of South Asian studies. A systematic search of 11 major databases and additional sources was conducted until December 11, 2019. Articles were included if they were systematic reviews or meta-analyses, reported the prevalence of mental disorders, and reported primary studies conducted in South Asian countries only. Among 2591 citations, a total of 23 reviews met all the criteria of this umbrella review. The synthesized findings from those reviews suggest high prevalence rates for mental disorders, including depressive disorders, anxiety disorders, mood disorders, suicidal behavior and self-harm, schizophrenia, substance use disorders, neurodevelopmental disorders, dementia, and other mental health problems. Also, findings suggest a high burden of maternal depression, psychiatric comorbidities in chronic physical illnesses, and various mental disorders among children, elderly adults, refugees, and other vulnerable populations. Most studies were from India whereas evidence from Afghanistan, Bhutan, and Maldives was limited. The findings of this review are constrained with heterogeneity in prevalence estimations, methodologies, sampling issues, and limitations in the existing literature, which should be addressed in future research. The evidence synthesized in this review provides national and regional overview of the prevalence of mental disorders, which may inform better policymaking and practice advancing mental health in South Asia.
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12
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Bonvoisin T, Utyasheva L, Knipe D, Gunnell D, Eddleston M. Suicide by pesticide poisoning in India: a review of pesticide regulations and their impact on suicide trends. BMC Public Health 2020; 20:251. [PMID: 32075613 PMCID: PMC7031890 DOI: 10.1186/s12889-020-8339-z] [Citation(s) in RCA: 70] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2019] [Accepted: 02/10/2020] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Pesticide self-poisoning is a common means of suicide in India. Banning highly hazardous pesticides from agricultural use has been successful in reducing total suicide numbers in several South Asian countries without affecting agricultural output. Here, we describe national and state-level regulation of highly hazardous pesticides and explore how they might relate to suicide rates across India. METHODS Information on pesticide regulation was collated from agriculture departments of the central government and all 29 state governments (excluding union territories). National and state-level data on suicides from 1995 to 2015 were obtained from the National Crime Records Bureau (NCRB). We used joinpoint analysis and negative binomial regression to investigate the trends in suicide rates nationally and in Kerala, in view of the robust measures Kerala has taken to restrict a number of HHPs, to identify any effect on suicides. RESULTS As of October 2019, 318 pesticides were registered for use in India, of which 18 were extremely (Class Ia) or highly (Class Ib) hazardous according to World Health Organization toxicity criteria. Despite many highly hazardous pesticides still being available, several bans have been implemented during the period studied. In our quantitative analyses we focused on the permanent bans in Kerala in 2005 (of endosulfan) and 2011 (of 14 other pesticides); and nationally in 2011 (of endosulfan). NCRB data indicate that pesticides were used in 441,918 reported suicides in India from 1995 to 2015, 90.3% of which occurred in 11 of the 29 states. There was statistical evidence of lower than expected rates of pesticide suicides (rate ratio [RR] 0.52, 95% CI 0.49-0.54) and total suicides nationally by 2014 (0.90, 0.87-0.93) after the 2011 endosulfan ban. In Kerala, there was a lower than expected rate of pesticide suicides (0.45, 0.42-0.49), but no change to the already decreasing trend in total suicides (1.02, 1.00-1.05) after the 2011 ban of 14 pesticides. The 2005 ban on endosulfan showed a similar effect - lower than expected pesticide suicides (0.79, 0.64-0.99), but no change to the decreasing trend of total suicides (0.97, 0.93-1.02) in 2010. There was no evidence of a decline in agricultural outputs following the bans. CONCLUSION Highly hazardous pesticides continue to be used in India and pesticide suicide remains a serious public health problem. However, some pesticide bans do appear to have impacted previous trends in the rates of both pesticide suicides and all suicides. Comprehensive national bans of highly hazardous pesticides could lead to a reduction in suicides across India, in addition to reduced occupational poisoning, with minimal effects on agricultural yield.
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Affiliation(s)
- Toby Bonvoisin
- Hull University Teaching Hospitals NHS Trust, Hull, UK
- Centre for Pesticide Suicide Prevention, University of Edinburgh, QMRI E3.22a, 47 Little France Crescent, Edinburgh, EH16 4TJ, UK
| | - Leah Utyasheva
- Centre for Pesticide Suicide Prevention, University of Edinburgh, QMRI E3.22a, 47 Little France Crescent, Edinburgh, EH16 4TJ, UK
| | - Duleeka Knipe
- Centre for Pesticide Suicide Prevention, University of Edinburgh, QMRI E3.22a, 47 Little France Crescent, Edinburgh, EH16 4TJ, UK
- Population Health Sciences Institute, Bristol Medical School, Bristol, UK
| | - David Gunnell
- Centre for Pesticide Suicide Prevention, University of Edinburgh, QMRI E3.22a, 47 Little France Crescent, Edinburgh, EH16 4TJ, UK
- Population Health Sciences Institute, Bristol Medical School, Bristol, UK
| | - Michael Eddleston
- Centre for Pesticide Suicide Prevention, University of Edinburgh, QMRI E3.22a, 47 Little France Crescent, Edinburgh, EH16 4TJ, UK.
- Population Health Sciences Institute, Bristol Medical School, Bristol, UK.
- Pharmacology, Toxicology & Therapeutics, University/BHF Centre for Cardiovascular Science University of Edinburgh, Edinburgh, UK.
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13
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Agampodi T, Agampodi S, Glozier N, Wms C, Ypjn W, Siribaddana S. How context matters: Demonstrating microgeographical differences in social capital and its implications for mental wellbeing in pregnancy with a novel bubble diagram technique. Health Place 2019; 60:102231. [PMID: 31629193 DOI: 10.1016/j.healthplace.2019.102231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Revised: 07/15/2019] [Accepted: 09/25/2019] [Indexed: 11/26/2022]
Abstract
There has been limited exploration of social capital at the contextual level in relation to maternal health, and in particular with the "obstetric transition" and associated mental health problems. In the North Central Province of Sri Lanka, with socio-culturally diverse communities, and a recent history of major conflict, the leading cause of maternal death is suicide. The objective of this study was to identify contextual patterns of social capital constructs that lead to poor maternal mental wellbeing, using a novel bubble visualisation technique, to demonstrate the use of data derived from qualitative approaches. We conducted a qualitative study of pregnant women based on diary entries (n = 41) and interviews (n = 38) in eight different communities of the Anuradhapura district of Sri Lanka. Bubble diagrams were constructed to visualize each context using the frequency and weight of responses given in diaries. Marital, family and neighbourhood cohesion were not homogenous in the district and the bubble diagrams displayed clear microgeographical patterns in which women living in specific communities had poorer mental wellbeing. Such techniques can be used to convey complex social capital implications in digestible way for policy makers and planners to enact locally specific strategies addressing health inequalities.
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Affiliation(s)
- Thilini Agampodi
- Department of Community Medicine, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Sri Lanka.
| | - Suneth Agampodi
- Department of Community Medicine, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Sri Lanka
| | - Nicholas Glozier
- Central Clinical School, Brain and Mind Centre, Faculty of Medicine and Health, The University of Sydney, Sri Lanka
| | - Chithrani Wms
- Department of Community Medicine, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Sri Lanka
| | - Warnasekara Ypjn
- Department of Community Medicine, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Sri Lanka
| | - Sisira Siribaddana
- Department of Medicine, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Sri Lanka
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14
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Knipe DW, Bandara P, Senarathna L, Kidger J, López-López J, Rajapakse T. Childhood adversity and deliberate self-poisoning in Sri Lanka: a protocol for a hospital-based case-control study. BMJ Open 2019; 9:e027766. [PMID: 31427319 PMCID: PMC6701561 DOI: 10.1136/bmjopen-2018-027766] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION Childhood adversity (CA) has been suggested as a key risk factor for suicidal behaviour, but evidence from low/middle-income countries is lacking. In Sri Lanka, CA, in the form of child maltreatment or as a consequence of maternal separation, has been highlighted in primarily qualitative or case series work, as a potentially important determinant of suicidal behaviour. To date, there have been no quantitative studies to investigate CA as a key exposure associated with suicidal behaviour in Sri Lanka. The aim of the research is to understand the association between CA and suicidal behaviour in Sri Lanka and to identify potentially modifiable factors to reduce any observed increased risk of suicidal behaviour associated with CA. METHODS AND ANALYSIS This is a hospital-based case-control study. Cases (n=200) will be drawn from individuals admitted to the medical toxicology ward of the Teaching Hospital Peradeniya, Sri Lanka, for medical management of intentional self-poisoning. Sex and age frequency-matched controls (n=200) will be recruited from either patients or accompanying visitors presenting at the outpatient department and clinic of the same hospital for conditions unrelated to the outcome of interest. Conditional logistic regression will be used to investigate the association between CA and deliberate self-poisoning and whether the association is altered by other key factors including socioeconomic status, psychiatric morbidity, current experiences of domestic violence and social support. ETHICS AND DISSEMINATION Ethics approval has been obtained from the Ethical Review Committee of the Faculty of Medicine, University of Peradeniya, Sri Lanka. Researchers have been trained in administering the questionnaire and a participant safety and distress protocol has been designed to guide researchers in ensuring participant safety and how to deal with a distressed participant. Results will be disseminated in local policy fora and peer-reviewed articles, local media, and national and international conferences.
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Affiliation(s)
- Duleeka W Knipe
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Piumee Bandara
- Translational Health Research Institute, Western Sydney University, Campbelltown, New South Wales, Australia
| | - Lalith Senarathna
- Department of Health Promotion, Rajarata University of Sri Lanka, Mihintale, Sri Lanka
| | - Judi Kidger
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - José López-López
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Thilini Rajapakse
- Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
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15
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Pushpakumara PHGJ, Thennakoon SUB, Rajapakse TN, Abeysinghe R, Dawson AH. A prospective study of repetition of self-harm following deliberate self-poisoning in rural Sri Lanka. PLoS One 2019; 14:e0199486. [PMID: 30753193 PMCID: PMC6372162 DOI: 10.1371/journal.pone.0199486] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Accepted: 01/26/2019] [Indexed: 11/19/2022] Open
Abstract
Introduction Repetition of deliberate self-harm is an important predictor of subsequent suicide. Repetition rates in Asian countries appear to be significantly lower than in western high-income countries. Methodological differences in studies, and the impact of access to means of self-harm with comparatively higher lethality have been suggested as reasons for these reported differences. This prospective study determines the rates and demographic patterns of deliberate self-poisoning (DSP), suicide and repeated deliberate self-harm resulting non-fatal and fatal outcomes in rural Sri Lanka. Methods Details of DSP admission in all hospitals (n = 46) and suicides reported to all police stations (n = 28) in a rural district were collected for the years 2011, 2012 and 2013. Demographic details of the cohort of patients admitted to all hospitals in 2011 due to deliberate self-poisoning (N = 4022), were screened to link with patient records and police reports of the successive two years with high sensitivity using a computer program. Then high specificity manual matching of all screened links was performed to identify repetition within 2 years of initial presentation. Life time repetition was assessed in a randomly selected subset of DSP patients (n = 433). Results There were 15,639 DSP admissions, aged more than 9 years, and 1078 suicides during the study period. The incidence of deliberate self-poisoning and suicide in the population within the study area were 248.3/100,000 and 20.7/100,000 respectively, in 2012. Repetition rates at four weeks, one-year and two-years were 1.9% (95% CI 1.5–2.3%), 5.7% (95% CI 5.0–6.4) and 7.9% (95% CI 7.1–8.8) respectively. The median interval between two attempts were 92 (IQR 10–238) and 191 (IQR 29–419.5) days for the one and two-year repetition groups. The majority of patients used the same poison in the repeat attempt. The age and duration of hospital stay of individuals with repetitive events were not significantly different from those who had no repetitive events. The rate of suicide at two years following DSP was 0.7% (95% CI 0.4–0.9%). The reported life time history of deliberate self-harm attempts was 9.5% (95% CI 6.7–12.2%). Conclusions The comparatively low rates of repetition in rural Sri Lanka was not explained by higher rates of suicide, access to more lethal means or differences in study methodology.
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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
- * E-mail:
| | - S. U. B. Thennakoon
- Department of Community Medicine, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
| | - T. N. Rajapakse
- Department of Psychiatry, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
| | - Ranil Abeysinghe
- Department of Psychiatry, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
| | - A. H. Dawson
- Central Clinical School, University of Sydney, Sydney, Australia
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16
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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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17
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Steeg S, Carr M, Emsley R, Hawton K, Waters K, Bickley H, Ness J, Geulayov G, Kapur N. Suicide and all-cause mortality following routine hospital management of self-harm: Propensity score analysis using multicentre cohort data. PLoS One 2018; 13:e0204670. [PMID: 30261030 PMCID: PMC6161837 DOI: 10.1371/journal.pone.0204670] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Accepted: 09/12/2018] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Observational studies are suited to examining links between the routine hospital management of self-harm and future suicide and all-cause mortality due to their large scale. However, care must be taken when attempting to infer causal associations in non-experimental settings. METHODS Data from the Multicentre Study of Self-Harm in England were used to examine associations between four types of hospital management (specialist psychosocial assessment, general hospital admission, psychiatric outpatient referral and psychiatric admission) following self-harm and risks of suicide and all-cause mortality in the subsequent 12 months. Missing data were handled by multiple imputation and propensity score (PS) methods were used to address observed differences between patients at baseline. Unadjusted, PS stratified and PS matched risk ratios (RRs) were calculated. RESULTS The PSs balanced the majority of baseline differences between treatment groups. Unadjusted RRs showed that all four treatment types were associated with either increased risks or no change in risks of suicide and all-cause mortality within a year. None of the four types of hospital management were associated with lowered risks of suicide or all-cause mortality following propensity score stratification (psychosocial assessment and medical admission) and propensity score matching (psychiatric outpatient referral and psychiatric admission), though there was no longer an increased risk among people admitted to a psychiatric bed. Individuals who self-cut were at an increased risk of death from any cause following psychosocial assessment and medical admission. Medical admission appeared to be associated with reduced risk of suicide in individuals already receiving outpatient or GP treatment for a psychiatric disorder. CONCLUSIONS More intensive forms of hospital management following self-harm appeared to be appropriately allocated to individuals with highest risks of suicide and all-cause mortality. PS adjustment appeared to attenuate only some of the observed increased risks, suggesting that either differences between treatment groups remained, or that some treatments had little impact on reducing subsequent suicide or all-cause mortality risk. These findings are in contrast to some previous studies that have suggested psychosocial assessment by a mental health specialist reduces risk of repeat self-harm. Future observational self-harm studies should consider increasing the number of potential confounding variables collected.
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Affiliation(s)
- Sarah Steeg
- Centre for Mental Health and Safety, School of Health Sciences,
University of Manchester, Manchester Academic Health Science Centre, Manchester,
United Kingdom
| | - Matthew Carr
- Centre for Mental Health and Safety, School of Health Sciences,
University of Manchester, Manchester Academic Health Science Centre, Manchester,
United Kingdom
| | - Richard Emsley
- Biostatistics and Health Informatics, Institute of Psychiatry, King’s
College London, London, United Kingdom
| | - Keith Hawton
- Centre for Suicide Research, University of Oxford Department of
Psychiatry, Warneford Hospital, Oxford, United Kingdom
| | - Keith Waters
- Centre for Self-Harm and Suicide Prevention Research, Derbyshire
Healthcare NHS Foundation Trust, Derby, United Kingdom
| | - Harriet Bickley
- Centre for Mental Health and Safety, School of Health Sciences,
University of Manchester, Manchester Academic Health Science Centre, Manchester,
United Kingdom
| | - Jennifer Ness
- Centre for Self-Harm and Suicide Prevention Research, Derbyshire
Healthcare NHS Foundation Trust, Derby, United Kingdom
| | - Galit Geulayov
- Centre for Suicide Research, University of Oxford Department of
Psychiatry, Warneford Hospital, Oxford, United Kingdom
| | - Nav Kapur
- Centre for Mental Health and Safety, School of Health Sciences,
University of Manchester, Manchester Academic Health Science Centre, Manchester,
United Kingdom
- Greater Manchester Mental Health NHS Foundation Trust, Manchester, United
Kingdom
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18
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Rathish D, Agampodi S, Jayasumana C. Acetylcholinesterase inhibitor insecticides related acute poisoning, availability and sales: trends during the post-insecticide-ban period of Anuradhapura, Sri Lanka. Environ Health Prev Med 2018; 23:27. [PMID: 29945568 PMCID: PMC6020334 DOI: 10.1186/s12199-018-0716-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Accepted: 06/01/2018] [Indexed: 11/30/2022] Open
Abstract
Background Acetylcholinesterase inhibitor insecticides (AChEIIs) were used extensively in the agrarian region of Anuradhapura for the past few decades. As a result, the region faced a heightened risk of toxicity. Carbaryl, carbofuran, chlorpyrifos, dimethoate, and fenthion were the five hazardous AChEIIs banned from Anuradhapura in 2014. Assessment of post-ban trends in acute poisoning will reveal the impact of the ban. Data on availability and sales of remaining AChEIIs will guide towards preventive measures against related toxicities. Methods Cross-sectional surveys were conducted at Anuradhapura district of Sri Lanka. Details related to acute AChEII poisoning were sorted from the Teaching Hospital Anuradhapura. Main insecticide vendors in Anuradhapura were surveyed to find information on availability and sales of AChEIIs. Chi-square for goodness of fit was performed for trends in acute poisoning and sales. Results Hospital admissions related to acute AChEII poisoning have declined from 554 in 2013 to 272 in 2017. Deaths related to acute AChEII poisoning have declined from 27 in 2013 to 13 in 2017. Sales of all five banned AChEIIs had reduced by 100%. Sales of the remaining AChEIIs were declining, except for acephate, phenthoate, and profenofos. However, one of the top selling, most frequently abused carbosulfan, had the highest risk of toxicity. Chi-square for goodness of fit showed a significance (P < 0.001) between the trends of hospital admissions for acute AChEII poisoning and the sales related to AChEIIs. Conclusions Hospital admissions related to acute poisoning was declining along with the overall sales of remaining AChEIIs, during the post-AChEII ban period. Nevertheless, future vigilance is needed on the remaining AChEIIs to predict and prevent related toxicities. Electronic supplementary material The online version of this article (10.1186/s12199-018-0716-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Devarajan Rathish
- Department of Pharmacology, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Saliyapura, Sri Lanka.
| | - Suneth Agampodi
- Department of Community Medicine, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Saliyapura, Sri Lanka
| | - Channa Jayasumana
- Department of Pharmacology, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Saliyapura, Sri Lanka
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Malalagama AS, Tennakoon S, Abeyasinghe DRR. Validation of Adolescent Suicide Assessment Protocol-20 (ASAP-20) to Sri Lankan adolescents. Asian J Psychiatr 2018; 33:11-17. [PMID: 29505971 DOI: 10.1016/j.ajp.2018.02.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Revised: 02/02/2018] [Accepted: 02/23/2018] [Indexed: 10/17/2022]
Abstract
PURPOSE Youth suicide rates are rising worldwide, including Sri Lanka, where 46.5/100,000 among 15-19yrs was reported in 1986. Identifying high risk adolescents is vital. Dearth of trained professionals, demands an instrument utilizable by non-psychiatrists. Such was not available in Sinhalese. Adolescent Suicide Assessment Protocol (ASAP-20) and its' manual was translated and validated to Sri Lankan adolescents. METHOD A validation study. Forward/back translations followed by cultural adaptation. Face validity, operational equivalence were assessed. Panel of Psychiatrists assessed semantics, conceptual, content/construct validity using external criticism. Final Sinhalese version was applied to 100 Sinhalese speaking 10-19yr olds referred to Psychiatry units of two Teaching Hospitals following a suicide attempt or with suicidal ideation (cases) excluding psychotic disorder, acute emergencies or special needs and compared with same aged adolescents on treatment for respiratory problems as controls. Discriminant ability was calculated using area under the Receiver Operating Curve (AUC). Reliability was calculated using Cronbach's alpha. RESULTS Sinhalese version showed satisfactory face/contents/construct validity and operational equivalence. Median suicide risk score was 18 and mean 17.99 (SD = 7.56) for cases, median = 4 and mean = 4.86 (SD = 2.41) for controls. AUC was 0.969 (SE = 0.11), indicating a high ability to discriminate moderate/high from low suicidal risk. Cut off value, 8.5 was lower than original tool at a sensitivity of 91% and a specificity of 91%. Cronbach's alpha was 0.811 indicating high reliability and consistency. CONCLUSION Sinhalese version of ASAP-20 is a successful screening instrument to detect high suicide risk among adolescents in clinical and non clinical settings.
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Affiliation(s)
- A S Malalagama
- Psychiatry Unit, Teaching Hospital Kandy, William Gopallawa Mawatha, Kandy, Sri Lanka.
| | - S Tennakoon
- Department of Community Medicine, Faculty of Medicine, University of Peradeniya, Sri Lanka.
| | - D R R Abeyasinghe
- Department of Psychiatry, Faculty of Medicine, University of Peradeniya, Sri Lanka.
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20
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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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21
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Leung Kwok C, Yip PSF. Estimating Incidence Rate of Hospital-Treated Self-Harm in Hong Kong Using Capture-Recapture Approach. CRISIS 2017; 39:205-217. [PMID: 29216754 DOI: 10.1027/0227-5910/a000494] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND A surveillance system for self-harm has not been established in Hong Kong. The existing data source has an unknown degree of underreporting, and therefore a capture-recapture method has been proposed to correct for the incompleteness. AIMS To assess the underestimation of the incidence of self-harm cases presenting to hospital in Hong Kong using a capture and recapture method. METHOD Two different yet overlapping hospital administrative datasets of self-harm were obtained from all public hospitals in Hong Kong. From 2002 to 2011, 59,473 distinct episodes involving 36,411 patients were identified. A capture-recapture model considering heterogeneous capture probabilities was applied to estimate the number of self-harm episodes. RESULTS The estimated number of self-harm incidence was 79,923, equally shared by females and males. Cases of self-harm by females were more likely to be ascertained than those by males. The estimated annual incidence rate of self-harm in Hong Kong from 2002 to 2011 ranged from 96.4 in 2010 to 132.7 in 2002. LIMITATIONS The proposed method does not include patients who required no medical attention and those where the patient consulted private doctors. CONCLUSION The capture-recapture model is a useful method for adjusting the underestimation of self-harm cases from existing databases when surveillance system is not available and to reveal some hidden patterns.
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Affiliation(s)
- Chi Leung Kwok
- 1 HKJC Centre for Suicide Research and Prevention, the University of Hong Kong, PRC
| | - Paul S F Yip
- 1 HKJC Centre for Suicide Research and Prevention, the University of Hong Kong, PRC.,2 Department of Social Work and Social Administration, the University of Hong Kong, PRC
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22
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Carter G, Page A, Large M, Hetrick S, Milner AJ, Bendit N, Walton C, Draper B, Hazell P, Fortune S, Burns J, Patton G, Lawrence M, Dadd L, Dudley M, Robinson J, Christensen H. Royal Australian and New Zealand College of Psychiatrists clinical practice guideline for the management of deliberate self-harm. Aust N Z J Psychiatry 2016; 50:939-1000. [PMID: 27650687 DOI: 10.1177/0004867416661039] [Citation(s) in RCA: 99] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
OBJECTIVE To provide guidance for the organisation and delivery of clinical services and the clinical management of patients who deliberately self-harm, based on scientific evidence supplemented by expert clinical consensus and expressed as recommendations. METHOD Articles and information were sourced from search engines including PubMed, EMBASE, MEDLINE and PsycINFO for several systematic reviews, which were supplemented by literature known to the deliberate self-harm working group, and from published systematic reviews and guidelines for deliberate self-harm. Information was reviewed by members of the deliberate self-harm working group, and findings were then formulated into consensus-based recommendations and clinical guidance. The guidelines were subjected to successive consultation and external review involving expert and clinical advisors, the public, key stakeholders, professional bodies and specialist groups with interest and expertise in deliberate self-harm. RESULTS The Royal Australian and New Zealand College of Psychiatrists clinical practice guidelines for deliberate self-harm provide up-to-date guidance and advice regarding the management of deliberate self-harm patients, which is informed by evidence and clinical experience. The clinical practice guidelines for deliberate self-harm is intended for clinical use and service development by psychiatrists, psychologists, physicians and others with an interest in mental health care. CONCLUSION The clinical practice guidelines for deliberate self-harm address self-harm within specific population sub-groups and provide up-to-date recommendations and guidance within an evidence-based framework, supplemented by expert clinical consensus.
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Affiliation(s)
- Gregory Carter
- Clinical Practice Guideline for Deliberate Self-harm Working Group, RANZCP, Melbourne, Victoria, Australia Centre for Translational Neuroscience and Mental Health, Faculty of Health and Medicine, The University of Newcastle, Callaghan, NSW, Australia Department of Consultation Liaison Psychiatry, Calvary Mater Newcastle Hospital, Waratah, NSW, Australia
| | - Andrew Page
- Clinical Practice Guideline for Deliberate Self-harm Working Group, RANZCP, Melbourne, Victoria, Australia Centre for Health Research, Western Sydney University, Richmond, NSW, Australia
| | - Matthew Large
- Clinical Practice Guideline for Deliberate Self-harm Working Group, RANZCP, Melbourne, Victoria, Australia School of Psychiatry, The University of New South Wales, Sydney, NSW, Australia
| | - Sarah Hetrick
- Clinical Practice Guideline for Deliberate Self-harm Working Group, RANZCP, Melbourne, Victoria, Australia Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, VIC, Australia
| | - Allison Joy Milner
- Clinical Practice Guideline for Deliberate Self-harm Working Group, RANZCP, Melbourne, Victoria, Australia Centre for Population Health Research, School of Health and Social Development, Deakin University, Burwood VIC, Australia Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Nick Bendit
- Clinical Practice Guideline for Deliberate Self-harm Working Group, RANZCP, Melbourne, Victoria, Australia School of Medicine and Public Health, Faculty of Health and Medicine, The University of Newcastle, Callaghan, NSW, Australia School of Psychology, Faculty of Science and Information Technology, The University of Newcastle, Callaghan, NSW, Australia
| | - Carla Walton
- Clinical Practice Guideline for Deliberate Self-harm Working Group, RANZCP, Melbourne, Victoria, Australia Centre for Psychotherapy, Hunter New England Mental Health Service and Centre for Translational Neuroscience and Mental Health, The University of Newcastle, Callaghan, NSW, Australia
| | - Brian Draper
- Clinical Practice Guideline for Deliberate Self-harm Working Group, RANZCP, Melbourne, Victoria, Australia School of Psychiatry, The University of New South Wales, Sydney, NSW, Australia Academic Department for Old Age Psychiatry, Prince of Wales Hospital, Sydney, NSW, Australia
| | - Philip Hazell
- Clinical Practice Guideline for Deliberate Self-harm Working Group, RANZCP, Melbourne, Victoria, Australia Discipline of Psychiatry, Sydney Medical School, The University of Sydney, Sydney, NSW, Australia
| | - Sarah Fortune
- Clinical Practice Guideline for Deliberate Self-harm Working Group, RANZCP, Melbourne, Victoria, Australia The University of Auckland, Auckland, New Zealand University of Leeds, Leeds, UK Kidz First, Middlemore Hospital, Auckland, New Zealand
| | - Jane Burns
- Clinical Practice Guideline for Deliberate Self-harm Working Group, RANZCP, Melbourne, Victoria, Australia Young and Well Cooperative Research Centre, The University of Melbourne, Melbourne, VIC, Australia Brain & Mind Research Institute, The University of Sydney, Sydney, NSW, Australia Orygen Youth Health Research Centre, Melbourne, VIC, Australia
| | - George Patton
- Clinical Practice Guideline for Deliberate Self-harm Working Group, RANZCP, Melbourne, Victoria, Australia Department of Paediatrics, The University of Melbourne, Melbourne, VIC, Australia National Health and Medical Research Council, Canberra, ACT, Australia Centre for Adolescent Health, The Royal Children's Hospital, Melbourne, VIC, Australia Murdoch Children's Research Institute, Melbourne, VIC, Australia
| | - Mark Lawrence
- Clinical Practice Guideline for Deliberate Self-harm Working Group, RANZCP, Melbourne, Victoria, Australia Tauranga Hospital, Bay of Plenty, New Zealand
| | - Lawrence Dadd
- Clinical Practice Guideline for Deliberate Self-harm Working Group, RANZCP, Melbourne, Victoria, Australia Mental Health & Substance Use Service, Hunter New England, NSW Health, Waratah, NSW, Australia Awabakal Aboriginal Medical Service, Hamilton, NSW, Australia Pital Tarkin, Aboriginal Medical Student Mentoring Program, The Wollotuka Institute, The University of Newcastle, Callaghan, NSW, Australia Specialist Outreach NT, Darwin, Northern Territory, Australia
| | | | - Jo Robinson
- Clinical Practice Guideline for Deliberate Self-harm Working Group, RANZCP, Melbourne, Victoria, Australia Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, VIC, Australia
| | - Helen Christensen
- Clinical Practice Guideline for Deliberate Self-harm Working Group, RANZCP, Melbourne, Victoria, Australia Black Dog Institute, The University of New South Wales, Sydney, NSW, Australia
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Ralapanawa U, Jayawickreme KP, Ekanayake EMM, Dissanayake AMSDM. A study on paracetamol cardiotoxicity. BMC Pharmacol Toxicol 2016; 17:30. [PMID: 27411502 PMCID: PMC4944443 DOI: 10.1186/s40360-016-0073-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2015] [Accepted: 07/01/2016] [Indexed: 11/24/2022] Open
Abstract
Background Sri Lanka has a high suicide rate, with more than 40 % of poisoning admissions due to overdose of drugs with Paracetamol being the commonest. Data regarding cardiotoxicity to paracetamol is very minimal though hepatotoxicity following poisoning is well studied. Paracetamol cardiotoxicity has rarely been clinically significant and may have well been overlooked. The possibility that paracetamol overdose might be directly cardiotoxic has been the subject of a few reports. Unexplained deaths and electrocardiographic changes associated with paracetamol poisoning have also been reported in which cardiac origin cannot be clearly ruled out. Although some studies state that paracetamol poisoning has no direct cardiotoxic effect, electrocardiographic changes due to metabolic derangement of hepatotoxicity have been shown in certain studies. Thus, we conducted this study to assess in detail the cardiotoxic effect of paracetamol poisoning. Methods This is a cross sectional descriptive study done on those with confirmed paracetamol poisoning. Serum paracetamol levels, Electrocardiogram, Echocardiogram, troponin I, and other basic investigations were done. Results Paracetamol ingestion is more common among teenagers and the young population in Sri Lanka. Although several cases of paracetamol poisoning induced cardiotoxicity has been described in the past, this study demonstrated no electrocardiographic, echocardiographic or cardiac biomarkers changes of myocardial toxicity. Conclusion Though literature review support cardiotoxicity following paracetamol poisoning, our study does not provide enough evidence for this. Continuous cardiac monitoring, serial troponin and echocaediogram assessment would be voluble adjunct in its management. Further experiments and research in this subject would be useful with a larger number of samples to further evaluate this important problem.
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Affiliation(s)
- Udaya Ralapanawa
- Department of Medicine, University of Peradeniya, Peradeniya, Sri Lanka.
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Weerasinghe M, Konradsen F, Eddleston M, Pearson M, Agampodi T, Storm F, Agampodi S. Overdose of oral contraceptive pills as a means of intentional self-poisoning amongst young women in Sri Lanka: considerations for family planning. THE JOURNAL OF FAMILY PLANNING AND REPRODUCTIVE HEALTH CARE 2016; 43:147-150. [PMID: 27006385 DOI: 10.1136/jfprhc-2015-101171] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/06/2015] [Revised: 02/02/2016] [Accepted: 02/25/2016] [Indexed: 11/03/2022]
Abstract
OBJECTIVE Oral contraceptive pills (OCPs) are one of the most popular family planning methods in Sri Lanka. As part of two hospital-based studies on self-harm, the use of OCPs was identified, from yet unpublished results, as a means of intentional self-poisoning. To inform future guidelines for better OCP promotion, this article aims to describe the extent, patient characteristics and outcomes of OCP self-poisoning in the North Central Province of Sri Lanka. METHODS A secondary analysis was carried out on two hospital-based self-harm case series, from January 2011 to June 2014. RESULTS Fifty-four patients (52 women and two men) with an overdose of OCP as a means of intentional self-poisoning were admitted to one of the surveyed hospitals. The median age of the patients was 19 (interquartile range, 5) years. None of the patients were severely sick from their overdose and two-thirds of the patients were discharged within a day of admission. Intentional self-poisoning with OCPs represented less than 5% of all types of intentional medicine self-poisonings recorded at the hospitals. Information available for a subset of female patients indicates that many cases (13/23, 56.5%) were in their first year of marriage. CONCLUSIONS More research is required to understand why young women in rural Sri Lanka overdose with OCPs as a means of intentional self-poisoning. Although the toxicity of OCPs is low and the public health significance of OCP poisoning remains minor, reproductive health service providers should be attentive to OCP overdose, monitor the development of this problem, and ensure appropriate information to OCP users.
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Affiliation(s)
- Manjula Weerasinghe
- PhD Fellow and Research Co-ordinator, Department of Community Medicine, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Saliyapura, Anuradhapura, Sri Lanka and South Asian Clinical Toxicology Research Collaboration (SACTRC), Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
| | - Flemming Konradsen
- Professor, Head of section, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Michael Eddleston
- Professor of Clinical Toxicology and Lister Prize Fellow and Director of the National Poison Information Service South Asian Clinical Toxicology Research Collaboration (SACTRC), Pharmacology, Toxicology and Therapeutics, University of Edinburgh, UK, South Asian Clinical Toxicology Research Collaboration (SACTRC), Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka and Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Melissa Pearson
- Dr, Trial Manager, South Asian Clinical Toxicology Research Collaboration (SACTRC), Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka and Department of Pharmacology, Toxicology and Therapeutics, University of Edinburgh, Edinburgh, UK
| | - Thilini Agampodi
- Dr, Senior Lecturer, Head of the Department, Department of Community Medicine, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Saliyapura, Anuradhapura, Sri Lanka
| | - Frederikke Storm
- Research Assistant, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Suneth Agampodi
- Professor in Community Medicine, Department of Community Medicine, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Saliyapura, Anuradhapura, Sri Lanka
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Knipe DW, Carroll R, Thomas KH, Pease A, Gunnell D, Metcalfe C. Association of socio-economic position and suicide/attempted suicide in low and middle income countries in South and South-East Asia - a systematic review. BMC Public Health 2015; 15:1055. [PMID: 26472204 PMCID: PMC4608117 DOI: 10.1186/s12889-015-2301-5] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2015] [Accepted: 09/18/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Forty percent of the world's suicide deaths occur in low and middle income countries (LAMIC) in Asia. There is a recognition that social factors, such as socioeconomic position (SEP), play an important role in determining suicidal risk in high income countries, but less is known about the association in LAMIC. METHODS The objective of this systematic review was to synthesise existing evidence of the association between SEP and attempted suicide/suicide risk in LAMIC countries in South and South East Asia. Web of Science, MEDLINE, MEDLINE in Process, EMBASE, PsycINFO, and article reference lists/forward citations were searched for eligible studies. Epidemiological studies reporting on the association of individual SEP with suicide and attempted suicide were included. Study quality was assessed using an adapted rating tool and a narrative synthesis was conducted. RESULTS Thirty-one studies from nine countries were identified; 31 different measures of SEP were reported, with education being the most frequently recorded. Most studies suggest that lower levels of SEP are associated with an increased risk of suicide/attempted suicide, though findings are not always consistent between and within countries. Over half of the studies included in this review were of moderate/low quality. The SEP risk factors with the most consistent association across studies were asset based measures (e.g. composite measures); education; measures of financial difficulty and subjective measures of financial circumstance. Several studies show a greater than threefold increased risk in lower SEP groups with the largest and most consistent association with subjective measures of financial circumstance. CONCLUSION The current evidence suggests that lower SEP increases the likelihood of suicide/attempted suicide in LAMIC in South and South East Asia. However, the findings are severely limited by study quality; larger better quality studies are therefore needed. SYSTEMATIC REVIEW REGISTRATION PROSPERO 2014: CRD42014006521.
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Affiliation(s)
- Duleeka W Knipe
- School of Social and Community Medicine, 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.
| | - Robert Carroll
- School of Social and Community Medicine, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK.
| | - Kyla H Thomas
- School of Social and Community Medicine, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK.
| | - Anna Pease
- School of Social and Community Medicine, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK.
| | - David Gunnell
- School of Social and Community Medicine, 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.
| | - Chris Metcalfe
- School of Social and Community Medicine, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK.
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26
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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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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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Pfortmueller CA, Stotz M, Lindner G, Müller T, Rodondi N, Exadaktylos AK. Multimorbidity in adult asylum seekers: a first overview. PLoS One 2013; 8:e82671. [PMID: 24376565 PMCID: PMC3869724 DOI: 10.1371/journal.pone.0082671] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2013] [Accepted: 10/26/2013] [Indexed: 11/18/2022] Open
Abstract
PRINCIPALS Over the last two decades, the total annual number of applications for asylum in the countries of the European Union has increased from 15,000 to more than 300,000 people. The aim of this study was to give a first overview on multimorbidity of adult asylum seekers. METHODS Our retrospective Swiss single center data analysis examined multimorbidity of adult asylums seekers admitted to our ED between 1 January 2000 and 31 December 2012. RESULTS A total of 3170 patients were eligible for the study; they were predominantly male (2392 male, 75.5% versus 778 female, 24.5). The median age of the patients was 28 years (range 28-82). The most common region of origin was Africa (1544, 48.7%), followed by the Middle East (736, 23.6%). 2144 (67.6%) of all patients were not multimorbid. A total of 1183 (37.7%) of our patients were multimorbid. The mean Charlson comorbidity index was 0.25 (SD 1.1, range 0-12). 634 (20%) of all patients sufferem from psychiatric diseases, followed by chronic medical conditions (12.6%, 399) and infectious diseases (4.7%, 150). Overall, 11% (349) of our patients presented as a direct consequence of prior violence. Patients from Sri Lanka/India most often suffered from addictions problems (50/240, 20.8%, p<0.0001). Infectious diseases were most frequent in patients from Africa (6.6%), followed by the Balkans and Eastern Europe/Russia (each 3.8%). CONCLUSION The health care problems of asylum seekers are manifold. More than 60% of the study population assessed in our study did not suffer from more than one disease. Nevertheless a significant percentage of asylum seekers is multimorbid and exhibits underlying psychiatric, infectious or chronic medical conditions despite their young age.
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Affiliation(s)
- Carmen A. Pfortmueller
- University Department of General Internal Medicine, University Hospital and University of Bern, Bern, Switzerland
- * E-mail:
| | - Manuela Stotz
- Division of General Internal Medicine, Baden Cantonal Hospital, Baden, Switzerland
| | - Gregor Lindner
- University Department of General Internal Medicine, University Hospital and University of Bern, Bern, Switzerland
| | - Thomas Müller
- University Hospital of Psychiatry and University of Bern, Bern, Switzerland
| | - Nicolas Rodondi
- University Department of General Internal Medicine, University Hospital and University of Bern, Bern, Switzerland
| | - Aristomenis K. Exadaktylos
- University Department of Emergency Medicine, University Hospital and University of Bern, Bern, Switzerland
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