Abstract
Background: Psychiatric disorders are important predictors of self-harm behaviour. The present study was carried out to determine associations between DSM-IV TR Axis- I & II disorders and deliberate self poisoning (DSP) in a Sri Lankan rural agricultural district. Methods: Patients who had attempted DSP, who resided within the district were selected randomly 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. Findings: Cases consisted of 207 (47.3%) males and 231 (52.7%) females. TR axis-I and/or TR axis-II psychiatric diagnoses was found in 89 (25.6%) of cases and 14 (3.2%) controls. Cases with a TR axis-I diagnosis were older (32 and 19 years), p =30 years and having an alcohol use disorder carried a 21 time excess risk for DSP. A fivefold excess risk for DSP was found among 10-19 years old females with borderline personality traits. Interpretations: Depressive disorder and alcohol related disorders were significantly associated with older participants who had attempted DSP. The prevalence of psychiatric disorders among DSP in rural Sri Lanka is significantly lower than reported rates in western countries. Health and research priorities to reduce self-harm in Sri Lanka will also need to address non-psychiatric issues. Trial Registration: (Sri Lanka Clinical Trial Registry No. SLCTR/2010/008). Funding Statement: The study was supported by two Australian National Health and Medical Research Council grants: NHMRC 630650 and NHMRC Fellowship 1059542 (https://www.nhmrc.gov.au/). Declaration of Interests: The authors declare no competing interests. Ethics Approval Statement: Ethics approval for “A clustered RCT of educational interventions on treatment of patients with acute poisoning in rural Asian hospitals” was obtained from Ethical Review Committee of the Faculty of Medicine, University of Peradeniya. Ethical approval for the sub study was obtained from the human ethics review committee of the Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka.
Highlights
Psychiatric disorders are important predictors of self-harm behaviour
Depressive disorder and alcohol related disorders were significantly associated with older participants who had attempted deliberate self poisoning (DSP)
The prevalence of psychiatric disorders among DSP in rural Sri Lanka is significantly lower than reported rates in western countries
Summary
Psychiatric disorders are important predictors of self-harm behaviour. The present study was carried out to determine associations between DSM-IV TR Axis- I & II disorders and deliberate self poisoning (DSP) in a Sri Lankan rural agricultural district. Deliberate self-harm (DSH) is a global health issue which is responsible for about 800 000 deaths each year.[1] Studies show that the rates of non fatal suicidal behaviours is 10 to 40 times greater than suicide. A major psychiatric diagnosis is one predictor of both DSH and subsequent suicide.[7] personality traits [8, 9] and personality disorders have been identified as risk factors for DSH.[10] The high rates of self-harm in SL are multifactorial, with both cultural and environmental factors playing a role. A systematic review of studies of self-harm in Sri Lanka [11] did not identify any studies that investigated possible associations between non-fatal self-poisoning and psychiatric conditions such as anxiety disorders, impulse control disorders, or bipolar disorder
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