suicide and self-harm in sri lanka 1975-2010 · suicide and self-harm in sri lanka 1975-2010: age,...
TRANSCRIPT
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Suicide and Self-harm in Sri Lanka 1975-2010:
Age, gender and method time-trend analysis of Police data
Dee Knipe
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Overview
• Background
– Context
• Aims
• Methods
• Results
• Conclusion
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Context - Sri Lanka
• Population ~ 20.3 Million • 24,954 square miles • 1/3 population employed in
agriculture • Widespread use of high yielding
crops – agrochemicals heavily marketed
• Has one of the highest suicide rates worldwide
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Epidemiology • “Two peaks” in risk by
age (young and elderly)
• >50% acts of pesticide related suicide occur within 30min of initial thought*
• Case fatality = 15% (compared to <1% from medicine)
*Eddleston, M., A. Karunaratne, et al. (2006). "Choice of poison for intentional self-poisoning in rural Sri Lanka." Clin Toxicol (Phila) 44(3): 283-286 ** Gunnell DJ, Eddleston M: Suicide by intentional ingestion of pesticides: A continuing tragedy in developing countries. Int J Epidemiol 2003, 32(6):902-909.
England
Sri Lanka
Hospital Admissions for Self poisoning
Suicide Rates
**
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Suicide rates in Sri Lanka 1940–2005.
Gunnell D et al. Int. J. Epidemiol. 2007;36:1235-1242
Green Revolution
Pesticide Bans
Open Economy
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Aims
• Identify time-trends of method specific rates by age and gender
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Methods
DATA • Suicide Data: Police data* from
1975-2010 • Population Data: Census data
for 1971,1981 and 2001 obtained and calculated mid-year estimates
ANALYSIS • Calculate age-standardised rates • Graphical presentation of trends * From the Department of Police, Division of Statistics, Sri Lanka
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Results
1976 1978 1980 1982 1984 1986 1988 1990 1992 1994 1996 1998 2000 2002 2004 2006 2008
0
20
40
60
80
100
120
140
Su
icid
e r
ate
pe
r 1
00
,00
0
a) Male 17-25 26-35
36-55 55+
Open Economy
Civil War Begins
All Class I banned**
Civil War Ends
Endosulphan Import Ban
First Class I ban*
* Class I Organophosphate - methylparathion and parathion ** All remaining Class I pesticides (monocrotphos and methamidophos)
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Results
1976 1978 1980 1982 1984 1986 1988 1990 1992 1994 1996 1998 2000 2002 2004 2006 2008
0
20
40
60
80
100
120
140
Su
icid
e r
ate
pe
r 1
00
,00
0
b) Female
17-25 26-35
36-55 55+
Endosulphan Ban
Civil War Ends Open Economy
Civil War Begins
All Class I banned** First Class I ban*
* Class I Organophosphate - methylparathion and parathion ** All remaining Class I pesticides (monocrotphos and methamidophos)
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Pre* and Post** Pesticide Regulation
17-20 21-25 26-30 31-35 36-40 41-45 46-50 51-55 56-60 61+
0
50
100
150
200
250
300
350
Su
icid
e r
ate
pe
r 100,0
00
a) 1979-81*
M F 17-20 21-25 26-30 31-35 36-40 41-45 46-50 51-55 56-60 61+
0
50
100
150
200
250
300
350
Su
icid
e r
ate
pe
r 100,0
00
b) 2008 -10**
M F
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Method Specific Rates – the highlights
1975 1977 1979 1981 1983 1985 1987 1989 1991 1993 1995 1997 1999 2001 2003 2005 2007 2009
0
5
10
15
20
25
30
35
40
Su
icid
e R
ate
Per
100,0
00
Method-specific suicides combining poisoning and other methods: Sri Lanka 1975-2009
Hanging
Jumping in front of train
Drowning
Burning
Shooting
Sharp cutting instruments
Self-poisoning and "other" methods
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Strengths/Limitations
Strengths
• Uniquely rich data by age/gender/method
• Spans several years
Limitations
• Missing data for some of the north
• Potential underreporting
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Conclusion
• Dramatic change to age/gender/method specific trends
• Age/gender suicide patterning (post regulations) similar to pattern in the west, but only in men
• Still a high risk group in young women
• Some evidence of method substitution
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Acknowledgements
Prof David Gunnell Dr Chris Metcalfe Dr Ravindra Fernando (University of Colombo) Dr Michael Eddleston (University of Edinburgh) Registrar General for Sri Lanka With special thanks to: S.A.S .Bandulasena (Dept. of Census and Statistics) Ms Pushpa Gunasekara (Medical Statistics Unit, Sri Lanka)
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Questions?
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Suicide and Self-harm in Sri Lanka 1975-2010:
Age, method, period and cohort analysis of Police data
Dee Knipe