Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2014 Aug 13:14:839.
doi: 10.1186/1471-2458-14-839.

Suicide in Sri Lanka 1975-2012: age, period and cohort analysis of police and hospital data

Duleeka W Knipe  1 , Chris Metcalfe, Ravindra Fernando, Melissa Pearson, Flemming Konradsen, Michael Eddleston, David Gunnell
Affiliations

Suicide in Sri Lanka 1975-2012: age, period and cohort analysis of police and hospital data

Duleeka W Knipe et al. BMC Public Health. .

Abstract

Background: Sri Lanka has experienced major changes in its suicide rates since the 1970s, and in 1995 it had one of the highest rates in the world. Subsequent reductions in Sri Lanka's suicide rates have been attributed to the introduction of restrictions on the availability of highly toxic pesticides. We investigate these changes in suicide rates in relation to age, gender, method specific trends and birth-cohort and period effects, with the aim of informing preventative strategies.

Methods: Secular trends of suicide in relation to age, sex, method, birth-cohort and period effects were investigated graphically using police data (1975-2012). Poisoning case-fatality was investigated using national hospital admission data (2004-2010).

Results: There were marked changes to the age-, gender- and method-specific incidence of suicide over the study period. Year on year declines in rates began in 17-25 year olds in the early 1980s. Reduction in older age groups followed and falls in all age groups occurred after all class I (the most toxic) pesticides were banned. Distinct changes in the age/gender pattern of suicide are observed: in the 1980s suicide rates were highest in 21-35 year old men; by the 2000s, this pattern had reversed with a stepwise increase in male rates with increasing age. Throughout the study period female rates were highest in 17-25 year olds. There has been a rise in suicide by hanging, though this rise is relatively small in relation to the marked decline in self-poisoning deaths. The patterns of suicides are more consistent with a period rather than birth-cohort effect.

Conclusions: The epidemiology of suicide in Sri Lanka has changed noticeably in the last 30 years. The introduction of pesticide regulations in Sri Lanka coincides with a reduction in suicide rates, with evidence of limited method substitution.

PubMed Disclaimer

Figures

Figure 1
Figure 1
Age-specific suicide rates in Sri Lanka (3 years moving averages) 1975–2012 (a) Male (b) Female. Dotted vertical lines mark key historical milestones. *Class I Organophosphate - methylparathion and parathion. **All remaining Class I pesticides (monocrotphos and methamidophos).
Figure 2
Figure 2
Age profile of suicide by gender in (a) 1982–84 and (b) 2010–12. *Denominator 1983 mid-year population, **Denominator 2011 census population (5% sample).
Figure 3
Figure 3
Method specific suicide trends (3 year moving averages) (a) Male method specific suicide trends - 1982–2012 (b) Female method specific suicide trends - 1982–2012 (c) Overall method specific suicide trends - 1975–2012. *Includes drowning, fire-arm, cutting/stabbing, burning, jumping in front of a moving vehicle and jumping from a height.
Figure 4
Figure 4
Method, age and gender specific suicide trends 1989–2012 (3 year moving averages) - note that different scales are used on the y-axes for different methods (a) Male age-specific suicide rates for self-poisoning (b) Female age-specific suicide rates for self-poisoning (c) Male age-specific suicide rates for hanging (d) Female age-specific suicide rates for hanging (e) Male age-specific suicide rates for all other methods (f) Female age-specific suicide rates for all other methods. *Includes drowning, fire-arm, cutting/stabbing, burning, jumping in front of a moving vehicle and jumping from a height.
Figure 5
Figure 5
Suicide deaths in 5 year successive birth-cohorts at different ages. (a) Males; (b) Females.
Figure 6
Figure 6
Suicide deaths in 5 year periods at different ages. (a) Males; (b) Females.
See this image and copyright information in PMC

References

    1. De Silva V, Hanwella R, Senanayake M. Age and sex specific suicide rates in Sri Lanka from 1995–2011. Sri Lanka J Psychiatry. 2013;3(2):7–11.
    1. Patel V, Ramasundarahettige C, Vijayakumar L, Thakur JS, Gajalakshmi V, Gururaj G, Suraweera W, Jha P, Million Death Study C Suicide mortality in India: a nationally representative survey. Lancet. 2012;379(9834):2343–2351. doi: 10.1016/S0140-6736(12)60606-0. - DOI - PMC - PubMed
    1. Thalagala N. Suicide trends in Sri Lanka 1880–2006; social, demographic and geographical variations. J College of Community Physicians Sri Lanka. 2011;14(1):24–32. doi: 10.4038/jccpsl.v14i1.2945. - DOI
    1. Gunnell D, Eddleston M. Suicide by intentional ingestion of pesticides: a continuing tragedy in developing countries. Int J Epidemiol. 2003;32(6):902–909. doi: 10.1093/ije/dyg307. - DOI - PMC - PubMed
    1. Gunnell D, Hawton K, Murray V, Garnier R, Bismuth C, Fagg J, Simkin S. Use of paracetamol for suicide and non-fatal poisoning in the UK and France: are restrictions on availability justified? J Epidemiol Community Health. 1997;51(2):175–179. doi: 10.1136/jech.51.2.175. - DOI - PMC - PubMed
Pre-publication history
    1. The pre-publication history for this paper can be accessed here:http://www.biomedcentral.com/1471-2458/14/839/prepub