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Suicide in Sri Lanka 1975–2012: age, period and cohort analysis of police and hospital data

BACKGROUND: 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 pesticid...

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Autores principales: Knipe, Duleeka W, Metcalfe, Chris, Fernando, Ravindra, Pearson, Melissa, Konradsen, Flemming, Eddleston, Michael, Gunnell, David
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2014
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4148962/
https://www.ncbi.nlm.nih.gov/pubmed/25118074
http://dx.doi.org/10.1186/1471-2458-14-839
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author Knipe, Duleeka W
Metcalfe, Chris
Fernando, Ravindra
Pearson, Melissa
Konradsen, Flemming
Eddleston, Michael
Gunnell, David
author_facet Knipe, Duleeka W
Metcalfe, Chris
Fernando, Ravindra
Pearson, Melissa
Konradsen, Flemming
Eddleston, Michael
Gunnell, David
author_sort Knipe, Duleeka W
collection PubMed
description BACKGROUND: 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. METHODS: Secular 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). RESULTS: There 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. CONCLUSIONS: The 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 MATERIAL: The online version of this article (doi:10.1186/1471-2458-14-839) contains supplementary material, which is available to authorized users.
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spelling pubmed-41489622014-08-30 Suicide in Sri Lanka 1975–2012: age, period and cohort analysis of police and hospital data Knipe, Duleeka W Metcalfe, Chris Fernando, Ravindra Pearson, Melissa Konradsen, Flemming Eddleston, Michael Gunnell, David BMC Public Health Research Article BACKGROUND: 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. METHODS: Secular 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). RESULTS: There 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. CONCLUSIONS: The 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 MATERIAL: The online version of this article (doi:10.1186/1471-2458-14-839) contains supplementary material, which is available to authorized users. BioMed Central 2014-08-13 /pmc/articles/PMC4148962/ /pubmed/25118074 http://dx.doi.org/10.1186/1471-2458-14-839 Text en © Knipe et al.; licensee BioMed Central Ltd. 2014 This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Research Article
Knipe, Duleeka W
Metcalfe, Chris
Fernando, Ravindra
Pearson, Melissa
Konradsen, Flemming
Eddleston, Michael
Gunnell, David
Suicide in Sri Lanka 1975–2012: age, period and cohort analysis of police and hospital data
title Suicide in Sri Lanka 1975–2012: age, period and cohort analysis of police and hospital data
title_full Suicide in Sri Lanka 1975–2012: age, period and cohort analysis of police and hospital data
title_fullStr Suicide in Sri Lanka 1975–2012: age, period and cohort analysis of police and hospital data
title_full_unstemmed Suicide in Sri Lanka 1975–2012: age, period and cohort analysis of police and hospital data
title_short Suicide in Sri Lanka 1975–2012: age, period and cohort analysis of police and hospital data
title_sort suicide in sri lanka 1975–2012: age, period and cohort analysis of police and hospital data
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4148962/
https://www.ncbi.nlm.nih.gov/pubmed/25118074
http://dx.doi.org/10.1186/1471-2458-14-839
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