Social Psychiatry and Psychiatric Epidemiology
Volume 54, Issue 7, 2019, Pages 843-855

Socioeconomic position and suicidal behaviour in rural Sri Lanka: a prospective cohort study of 168,000+ people (Article) (Open Access)

Knipe D.W.* , Gunnell D. , Pieris R. , Priyadarshana C. , Weerasinghe M. , Pearson M. , Jayamanne S. , Hawton K. , Konradsen F. , Eddleston M. , Metcalfe C.
  • a Population Health Sciences, Bristol Medical School, University of Bristol, Canynge Hall 2.12, 39 Whatley Road, Bristol, BS8 2PS, United Kingdom, South Asian Clinical Toxicology Research Collaboration (SACTRC), Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
  • b Population Health Sciences, Bristol Medical School, University of Bristol, Canynge Hall 2.12, 39 Whatley Road, Bristol, BS8 2PS, United Kingdom, South Asian Clinical Toxicology Research Collaboration (SACTRC), Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
  • c South Asian Clinical Toxicology Research Collaboration (SACTRC), Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
  • d South Asian Clinical Toxicology Research Collaboration (SACTRC), Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
  • e South Asian Clinical Toxicology Research Collaboration (SACTRC), Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka, Department of Community Medicine, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Saliyapura, Anuradhapura, Sri Lanka
  • f South Asian Clinical Toxicology Research Collaboration (SACTRC), Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka, Pharmacology, Toxicology and Therapeutics, University/BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom
  • g South Asian Clinical Toxicology Research Collaboration (SACTRC), Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka, Faculty of Medicine, University of Kelaniya, Kelaniya, Sri Lanka
  • h Centre for Suicide Research, Department of Psychiatry, University of Oxford, Oxford, United Kingdom
  • i South Asian Clinical Toxicology Research Collaboration (SACTRC), Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka, Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
  • j South Asian Clinical Toxicology Research Collaboration (SACTRC), Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka, Pharmacology, Toxicology and Therapeutics, University/BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom
  • k Population Health Sciences, Bristol Medical School, University of Bristol, Canynge Hall 2.12, 39 Whatley Road, Bristol, BS8 2PS, United Kingdom

Abstract

Purpose: Lower socioeconomic position (SEP) is associated with an increased risk of suicidal behaviour in high income countries, but this association is not established in low- and middle-income countries (LMIC). Methods: We investigated the association of SEP with suicidal behaviour in a prospective cohort study of 168,771 Sri Lankans followed up for episodes of attempted suicide and suicide. SEP data were collected at baseline at the household and individual level at the start of the follow-up period. We used multilevel Poisson regression models to investigate the association of SEP at community, household and individual levels with attempted suicide/suicide. Results: Lower levels of asset ownership [IRR (95% CI) suicide 1.74 (0.92, 3.28); attempted suicide 1.67 (1.40, 2.00)] and education [suicide 3.16 (1.06, 9.45); attempted suicide 2.51 (1.70, 3.72)] were associated with an increased risk of suicidal behaviour. The association of these measures of SEP and attempted suicide was stronger in men than women. Individuals living in deprived areas [1.42 (1.16, 1.73)] and in households with a young female head of household [1.41 (1.04, 1.93)] or a temporary foreign migrant [1.47 (1.28, 1.68)] had an elevated risk of attempted suicide. Farmers and daily wage labourers had nearly a doubling in risk of attempted suicide compared to other occupations. Conclusions: Improved employment opportunities, welfare and mental health support services, as well as problem-solving skills development, may help support individuals with poorer education, farmers, daily wage labourers, individuals in young female-headed households and temporary foreign migrant households. © 2019, The Author(s).

Author Keywords

socioeconomic position Suicide Low and middle income country Sri Lanka Cohort study

Index Keywords

prospective study economics Prospective Studies human epidemiology middle aged rural population family size Family Characteristics Sri Lanka Young Adult Humans Occupations psychology Adolescent male occupation female adult social class employment Suicide
Link
https://www.scopus.com/inward/record.uri?eid=2-s2.0-85069680427&doi=10.1007%2fs00127-019-01672-3&partnerID=40&md5=c9f3fef5333faffe708886f1f577bdab
DOI: 10.1007/s00127-019-01672-3
ISSN: 09337954
Original Language: English