Abstract
BackgroundAn 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. MethodsIndividual 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. ResultsWe 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). LimitationsThe outcome was respondent-reported and refers to lifetime reports of attempted suicide, therefore this study might be affected by socially desirable responding. ConclusionsOur 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.
Highlights
In the early 19th century, even before the seminal work by Durkheim(1951), there was a recognition that an individual's suicide risk is determined by individual characteristics, and influenced by the society within which they live (Goldney et al, 2008)
Based on the variance partition coefficient (VPC), 4% of the total variance in the prevelance of lifetime suicide attempts, was accounted for by OR
The findings suggest that contextual factors such as household/community socioeconomic position (SEP) and community level problematic alcohol use are associated with an increased risk of a suicide attempt, over and above that which would be expected due to the individuals living in these households or communities
Summary
In the early 19th century, even before the seminal work by Durkheim(1951), there was a recognition that an individual's suicide risk is determined by individual characteristics, and influenced by the society within which they live (Goldney et al, 2008). The limitation of many of the previous quantitative studies (including Durkheim's work) is that the data were either collected at an area or an individual level, and the two levels of data were not combined These studies have been criticised for not being able to disentangle whether the area effect observed is due to the characteristics of the individuals living in these areas (compositional1), or because of characteristics of the area itself (contextual2), over and above that due to its composition. Statistical techniques are available that can distinguish compositional or contextual effects allowing us to investigate whether individuals living in areas of concentrated poverty have a higher risk of suicide regardless of their own level of poverty. 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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