Suicide in Sri Lanka 1975-2012: age, period and cohort analysis of police and hospital data
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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.
I: BMC Public Health, Bind 14, 839, 2014.Publikation: Bidrag til tidsskrift › Tidsskriftartikel › Forskning › fagfællebedømt
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TY - JOUR
T1 - Suicide in Sri Lanka 1975-2012
T2 - age, period and cohort analysis of police and hospital data
AU - Knipe, Duleeka W
AU - Metcalfe, Chris
AU - Fernando, Ravindra
AU - Pearson, Melissa
AU - Konradsen, Flemming
AU - Eddleston, Michael
AU - Gunnell, David
PY - 2014
Y1 - 2014
N2 - 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.
AB - 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.
KW - Adolescent
KW - Adult
KW - Aged
KW - Child
KW - Cohort Studies
KW - Female
KW - Hospitalization
KW - Humans
KW - Incidence
KW - Male
KW - Middle Aged
KW - Police
KW - Sri Lanka
KW - Suicide
U2 - 10.1186/1471-2458-14-839
DO - 10.1186/1471-2458-14-839
M3 - Journal article
C2 - 25118074
VL - 14
JO - BMC Public Health
JF - BMC Public Health
SN - 1471-2458
M1 - 839
ER -
ID: 157042870