Abstract
BackgroundSri Lanka has experienced major changes in its suicide rates since the 1970s, and in 1995 it had one of the highest rates in the world. Subsequent reductions in Sri Lanka’s suicide rates have been attributed to the introduction of restrictions on the availability of highly toxic pesticides. We investigate these changes in suicide rates in relation to age, gender, method specific trends and birth-cohort and period effects, with the aim of informing preventative strategies.MethodsSecular trends of suicide in relation to age, sex, method, birth-cohort and period effects were investigated graphically using police data (1975–2012). Poisoning case-fatality was investigated using national hospital admission data (2004–2010).ResultsThere were marked changes to the age-, gender- and method-specific incidence of suicide over the study period. Year on year declines in rates began in 17–25 year olds in the early 1980s. Reduction in older age groups followed and falls in all age groups occurred after all class I (the most toxic) pesticides were banned. Distinct changes in the age/gender pattern of suicide are observed: in the 1980s suicide rates were highest in 21–35 year old men; by the 2000s, this pattern had reversed with a stepwise increase in male rates with increasing age. Throughout the study period female rates were highest in 17–25 year olds. There has been a rise in suicide by hanging, though this rise is relatively small in relation to the marked decline in self-poisoning deaths. The patterns of suicides are more consistent with a period rather than birth-cohort effect.ConclusionsThe epidemiology of suicide in Sri Lanka has changed noticeably in the last 30 years. The introduction of pesticide regulations in Sri Lanka coincides with a reduction in suicide rates, with evidence of limited method substitution.Electronic supplementary materialThe online version of this article (doi:10.1186/1471-2458-14-839) contains supplementary material, which is available to authorized users.
Highlights
Sri Lanka has experienced major changes in its suicide rates since the 1970s, and in 1995 it had one of the highest rates in the world
If the high rate of suicide in young people in rural Asia is a consequence of high lethality methods being used in impulsive acts of self-harm, reducing the toxicity of the pesticides available should reduce the case fatality associated with intentional poisoning and alter the epidemiology of suicide
In a previous analysis of suicides in Sri Lanka (1975–2005), we found evidence that reductions in suicide in both men and women coincided with the ban of the most toxic pesticides [8]
Summary
Sri Lanka has experienced major changes in its suicide rates since the 1970s, and in 1995 it had one of the highest rates in the world. Subsequent reductions in Sri Lanka’s suicide rates have been attributed to the introduction of restrictions on the availability of highly toxic pesticides We investigate these changes in suicide rates in relation to age, gender, method specific trends and birth-cohort and period effects, with the aim of informing preventative strategies. A suggested reason for the high incidence in young people is that self-harm with low suicide intent is highest in 15–34 year olds worldwide and is often impulsive In countries such as the UK, the methods that impulsive self-harmers have readily available, such as. If the high rate of suicide in young people in rural Asia is a consequence of high lethality methods being used in impulsive acts of self-harm, reducing the toxicity of the pesticides available should reduce the case fatality associated with intentional poisoning and alter the epidemiology (age/sex patterns) of suicide. These interventions were followed by a complete ban on paraquat, dimethoate, and fenthion, from 2011 [9,10]
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