Exploration of associations between deliberate self-poisoning and psychiatric disorders in rural Sri Lanka: A case-control study.

P H G J Pushpakumara,Ranil Abeysinghe,S U B Thennakoon,A M P Adikari,T N Rajapakse,A H Dawson,Markos Tesfaye

doi:10.1371/journal.pone.0255805

Abstract

Psychiatric disorders are important predictors of deliberate self-harm. The present study was carried out to determine the associations between DSM-IV TR Axis- I & II disorders and deliberate self-poisoning (DSP) in a rural agricultural district in Sri Lanka. Patients residing in the district who presented with DSP were randomly selected for the study. Both the cases and age, sex, and, residential area, matched controls were assessed for DSM-IV TR Axis- I & II disorders based on the Structured Clinical Interview for DSM-IV-TR Axis I and II Disorders (SCID I & II) conducted by a specialist psychiatrist. Cases consisted of 208 (47.4%) males and 231 (52.6%) females. More than one third (37%) of males and more than half (53.7%) of females were aged below 20 years. DSM-IV TR axis-I and/or II psychiatric diagnoses were diagnosed in 89 (20.3%) of cases and 14 (3.2%) controls. Cases with a DSM-IV TR axis-I diagnosis were older than the cases without psychiatric diagnosis (32 and 19 years), p<0.0001. Having a depressive episode was associated with a 19 times higher risk for DSP. Being a male aged > = 30 years and having an alcohol use disorder carried a 21 times excess risk for DSP. A fivefold excess risk for DSP was found among 10–19 year old females with borderline personality traits. Depressive disorder and alcohol-related disorders were significantly associated with the older participants who presented with DSP. The overall prevalence of psychiatric disorders associated with DSP in rural Sri Lanka was significantly lower compared to the rates reported in the West and other countries in the region. Therefore, health and research priorities to reduce self-harm in Sri Lanka should focus both on psychiatric and non-psychiatric factors associated with DSP.

Highlights

Deliberate self-harm (DSH) is a global health issue that is responsible for about 800,000 deaths each year [1]
The findings of this study show that one in seven patients with deliberate self-poisoning (DSP) was suffering from a major psychiatric disorder
Depressive disorder and alcohol use disorders are significant predictors of DSP, especially for individuals aged above 30 years

Summary

Introduction

Deliberate self-harm (DSH) is a global health issue that is responsible for about 800,000 deaths each year [1]. Deliberate self-poisoning (DSP) is the predominant (> 80%) reason for DSH admission to the hospitals in Sri Lanka [4]. Rural areas in Sri Lanka have had a persistently high incidence of deliberate self-poisoning (DSP) since the early 1980s [5,6,7]. In contrast to the very high rate of DSH, a low prevalence of psychiatric co-morbidity, < 20%, has been reported in Sri Lanka [11]. It was much lower than the prevalence reported by countries in the Indian subcontinent [12,13,14,15]. A substantial heterogeneity between study estimates have been observed in all the regions including Sri Lanka [10, 11, 16]

Methods

Results

Discussion

Conclusion