A review of the changing patterns of suicide and deliberate self-harm in Sri Lanka

Abstract

Background In the mid 1990s, Sri Lanka had the second highest rate of suicide in the world, due to ingestion of pesticides. Since then, Sri Lanka has seen significant changes in the rates of suicide and self-harm by attempted or non-fatal self-poisoning. Aims The objective of this article is to examine the changes in rates and modes of suicide and attempted self-poisoning in Sri Lanka, from 1995 to the present, and discuss the significance of these changing patterns. Methods Electronic searches were carried out in Pubmed, using the following key words; suicide, deliberate self-harm, poisoning, attempted suicide and Sri Lanka. Results Since 1995 the rate of suicide in Sri Lanka has declined, with the annual suicide rate falling from 47.0 per 100,000 in 1995 to 19.6 per 100,000 in 2009. Self-poisoning still remains the most common method of suicide, with a relatively small increase in suicide by other methods, such as hanging. But after 1995, there has been increased hospital admissions due to attempted self-poisoning, with more medication overdoses. Conclusion The fall in suicide rates in Sri Lanka is a positive outcome of preventive measures taken, including restriction of access to toxic pesticides. These need to be continued, together with increased focus on management of psychological contributory factors, such as depression and alcohol use disorders. At the same time, innovative and culturally appropriate preventive strategies are needed to address the increasing public health problem of attempted self-poisoning.