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Knipe DW, Gunnell D, Pieris R, Priyadarshana C, Weerasinghe M, Pearson M, Jayamanne S, Hawton K, Konradsen F, Eddleston M, Metcalfe C. Socioeconomic position and suicidal behaviour in rural Sri Lanka: a prospective cohort study of 168,000+ people. Soc Psychiatry Psychiatr Epidemiol 2019; 54:843-855. [PMID: 30790026 PMCID: PMC6656893 DOI: 10.1007/s00127-019-01672-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Accepted: 02/12/2019] [Indexed: 11/15/2022]
Abstract
PURPOSE Lower socioeconomic position (SEP) is associated with an increased risk of suicidal behaviour in high income countries, but this association is not established in low- and middle-income countries (LMIC). METHODS We investigated the association of SEP with suicidal behaviour in a prospective cohort study of 168,771 Sri Lankans followed up for episodes of attempted suicide and suicide. SEP data were collected at baseline at the household and individual level at the start of the follow-up period. We used multilevel Poisson regression models to investigate the association of SEP at community, household and individual levels with attempted suicide/suicide. RESULTS Lower levels of asset ownership [IRR (95% CI) suicide 1.74 (0.92, 3.28); attempted suicide 1.67 (1.40, 2.00)] and education [suicide 3.16 (1.06, 9.45); attempted suicide 2.51 (1.70, 3.72)] were associated with an increased risk of suicidal behaviour. The association of these measures of SEP and attempted suicide was stronger in men than women. Individuals living in deprived areas [1.42 (1.16, 1.73)] and in households with a young female head of household [1.41 (1.04, 1.93)] or a temporary foreign migrant [1.47 (1.28, 1.68)] had an elevated risk of attempted suicide. Farmers and daily wage labourers had nearly a doubling in risk of attempted suicide compared to other occupations. CONCLUSIONS Improved employment opportunities, welfare and mental health support services, as well as problem-solving skills development, may help support individuals with poorer education, farmers, daily wage labourers, individuals in young female-headed households and temporary foreign migrant households.
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Affiliation(s)
- D W Knipe
- Population Health Sciences, Bristol Medical School, University of Bristol, Canynge Hall 2.12, 39 Whatley Road, Bristol, BS8 2PS, UK.
- South Asian Clinical Toxicology Research Collaboration (SACTRC), Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka.
| | - D Gunnell
- Population Health Sciences, Bristol Medical School, University of Bristol, Canynge Hall 2.12, 39 Whatley Road, Bristol, BS8 2PS, UK
- South Asian Clinical Toxicology Research Collaboration (SACTRC), Faculty of Medicine, University of Peradeniya, Peradeniya, 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 and Allied Sciences, Rajarata University of Sri Lanka, Saliyapura, Anuradhapura, Sri Lanka
| | - M Pearson
- South Asian Clinical Toxicology Research Collaboration (SACTRC), Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
- Pharmacology, Toxicology and 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 Kelaniya, Kelaniya, 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 and 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 2.12, 39 Whatley Road, Bristol, BS8 2PS, UK
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Knipe DW, Gunnell D, Pieris R, Priyadarshana C, Weerasinghe M, Pearson M, Jayamanne S, Dawson AH, Mohamed F, Gawarammana I, Hawton K, Konradsen F, Eddleston M, Metcalfe C. Is socioeconomic position associated with risk of attempted suicide in rural Sri Lanka? A cross-sectional study of 165 000 individuals. BMJ Open 2017; 7:e014006. [PMID: 28336743 PMCID: PMC5372106 DOI: 10.1136/bmjopen-2016-014006] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Lower socioeconomic position (SEP) is associated with an increased risk of suicidal behaviour in high-income countries, but this association is unclear in low-income and middle-income countries. METHODS We investigated the association of SEP with attempted suicide in a cross-sectional survey of 165 233 Sri Lankans. SEP data were collected at the household (assets, social standing (highest occupation of a household member), foreign employment and young (≤40 years) female-headed households) and individual level (education and occupation). Respondent-reported data on suicide attempts in the past year were recorded. Random-effects logistic regression models, accounting for clustering, were used to investigate the association of SEP with attempted suicide. RESULTS Households reported 398 attempted suicides in the preceding year (239 per 100 000). Fewer assets (OR 3.2, 95% CI 2.4 to 4.4) and having a daily wage labourer (ie, insecure/low-income job; OR 2.3, 95% CI 1.6 to 3.2) as the highest occupation increased the risk of an attempted suicide within households. At an individual level, daily wage labourers were at an increased risk of attempted suicide compared with farmers. The strongest associations were with low levels of education (OR 4.6, 95% CI 2.5 to 8.4), with a stronger association in men than women. CONCLUSIONS We found that indicators of lower SEP are associated with increased risk of attempted suicide in rural Sri Lanka. Longitudinal studies with objective measures of suicide attempts are needed to confirm this association. TRIAL REGISTRATION NUMBER NCT01146496; Pre-results.
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Affiliation(s)
- D W Knipe
- School of Social and Community Medicine, University of Bristol, Bristol, UK
- Faculty of Medicine, South Asian Clinical Toxicology Research Collaboration (SACTRC), University of Peradeniya, Peradeniya, Sri Lanka
| | - D Gunnell
- School of Social and Community Medicine, University of Bristol, Bristol, UK
- Faculty of Medicine, South Asian Clinical Toxicology Research Collaboration (SACTRC), University of Peradeniya, Peradeniya, Sri Lanka
| | - R Pieris
- Faculty of Medicine, South Asian Clinical Toxicology Research Collaboration (SACTRC), University of Peradeniya, Peradeniya, Sri Lanka
| | - C Priyadarshana
- Faculty of Medicine, South Asian Clinical Toxicology Research Collaboration (SACTRC), University of Peradeniya, Peradeniya, Sri Lanka
| | - M Weerasinghe
- Faculty of Medicine, South Asian Clinical Toxicology Research Collaboration (SACTRC), University of Peradeniya, Peradeniya, Sri Lanka
- Faculty of Medicine & Allied Sciences, Department of Community Medicine, Rajarata University of Sri Lanka, Anuradhapura, Sri Lanka
| | - M Pearson
- Faculty of Medicine, South Asian Clinical Toxicology Research Collaboration (SACTRC), University of Peradeniya, Peradeniya, Sri Lanka
- Clinical Pharmacology Unit, University of Edinburgh, The Queen's Medical Research Institute, Edinburgh, UK
| | - S Jayamanne
- Faculty of Medicine, South Asian Clinical Toxicology Research Collaboration (SACTRC), University of Peradeniya, Peradeniya, Sri Lanka
- Faculty of Medicine, University of Kelanyia, Kelanyia, Sri Lanka
| | - A H Dawson
- Faculty of Medicine, South Asian Clinical Toxicology Research Collaboration (SACTRC), University of Peradeniya, Peradeniya, Sri Lanka
- Central Clinical School, University of Sydney, Sydney, Australia
| | - F Mohamed
- Faculty of Medicine, South Asian Clinical Toxicology Research Collaboration (SACTRC), University of Peradeniya, Peradeniya, Sri Lanka
- Translational Australian Clinical Toxicology (TACT) Group, School of Medical Science, University of Sydney, Sydney, Australia
| | - I Gawarammana
- Faculty of Medicine, South Asian Clinical Toxicology Research Collaboration (SACTRC), University of Peradeniya, Peradeniya, Sri Lanka
- Faculty of Medicine, Department of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
| | - K Hawton
- Department of Psychiatry, Centre for Suicide Research, University of Oxford, Oxford, UK
| | - F Konradsen
- Faculty of Medicine, South Asian Clinical Toxicology Research Collaboration (SACTRC), University of Peradeniya, Peradeniya, Sri Lanka
- Faculty of Health and Medical Sciences, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - M Eddleston
- Faculty of Medicine, South Asian Clinical Toxicology Research Collaboration (SACTRC), University of Peradeniya, Peradeniya, Sri Lanka
- Clinical Pharmacology Unit, University of Edinburgh, The Queen's Medical Research Institute, Edinburgh, UK
| | - C Metcalfe
- School of Social and Community Medicine, University of Bristol, Bristol, UK
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Abstract
BACKGROUND The medium-term hemodynamic performance of stentless valves has not been widely reported, particularly in comparison with in vitro studies. Therefore, we have assessed prospectively the hemodynamics of the Edwards Prima valve in its fifth year after implantation in the aortic position, and compared the results with those at 1 month after implantation and also with in vitro data. METHODS Thirty-five patients (age, 77 +/- 6 years; 19 men) were prospectively studied by Doppler echocardiography at 1 month and 52 +/- 8 months after implantation of a Prima stentless valve. Valve hemodynamics were assessed by measuring the mean pressure gradient, mean valve resistance, and effective orifice area. Left ventricular systolic function was quantified by ejection fraction, the degree of hypertrophy by ventricular mass index, and the ratio of ventricular wall thickness to cavity radius as a measure of ventricular geometry. RESULTS With a mean valve size of 24.6 +/- 2.2 mm in the fifth year after implantation, the mean pressure gradient was 6.2 +/- 3.5 mm Hg, the mean valve resistance, 29 +/- 16 dyne x s(-1) x cm(-5)), and the effective orifice area was 2.05 +/- 0.50 cm2. Compared with 1 month after operation, there was a 47% decrease in mean valve resistance (p = 0.002) and a 39% increase in effective orifice area (p = 0.001). Furthermore, both effective orifice area and mean valve resistance in the fifth year did not differ from their in vitro counterparts, whereas the left ventricular ejection fraction (0.64 +/- 0.14), the left ventricular mass index (119 +/- 49 g/m2), and the ratio of ventricular wall thickness to cavity radius (0.44 +/- 0.13) were within the normal range. CONCLUSIONS This study suggests that the Prima valve is a reliable stentless aortic bioprosthesis. This is supported by a favorable medium-term clinical outcome, durable hemodynamic performance, and normal mean values of left ventricular ejection fraction and mass index in the fifth year after implantation.
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Affiliation(s)
- X Y Jin
- Department of Cardiac Surgery, Oxford Heart Centre, John Radcliffe Hospital, England
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Pieris R. Motivations relating to family planning in Sri Lanka. Marga 1978; 5:73-92. [PMID: 12261998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/19/2023]
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