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
. 2018 May:232:177-184.
doi: 10.1016/j.jad.2018.01.028. Epub 2018 Feb 5.

Attempted suicide in Sri Lanka - An epidemiological study of household and community factors

D W Knipe  1 , D Gunnell  2 , M Pearson  3 , S Jayamanne  4 , R Pieris  5 , C Priyadarshana  5 , M Weerasinghe  6 , K Hawton  7 , F Konradsen  8 , M Eddleston  3 , C Metcalfe  9
Affiliations

Attempted suicide in Sri Lanka - An epidemiological study of household and community factors

D W Knipe et al. J Affect Disord. 2018 May.

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.

Keywords: Asia; Multilevel models; Self-harm; Socioeconomic position; Sri Lanka; Suicide.

PubMed Disclaimer

Figures

Fig. 1
Fig. 1
Data structure and number of units per level.
See this image and copyright information in PMC

References

    1. Abeyasinghe R. Vijitha Yapa Publications; Colombo: 2002. Illicit Alcohol.
    1. Agerbo E., Sterne J.A., Gunnell D.J. Combining individual and ecological data to determine compositional and contextual socio-economic risk factors for suicide. Soc. Sci. Med. 2007;64:451–461. - PubMed
    1. Agresti A., Caffo B., Ohman-Strickland P. Examples in which misspecification of a random effects distribution reduces efficiency, and possible remedies. Comput. Stat. Data Anal. 2004;47:639–653.
    1. Bolz W. Psychological analysis of the Sri Lankan conflict culture with special reference to the high suicide rate. Crisis. 2002;23:167–170. - PubMed
    1. Chapin B.L. Rutgers University Press; 2014. Childhood in a Sri Lankan Village.

Publication types