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1.
PLoS One ; 15(11): e0242437, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-33211766

RESUMEN

INTRODUCTION: Adverse childhood experiences (ACE) have been recognized as an important risk factor for suicidal behaviour among adults, but evidence from low and middle-income countries is lacking. This study explored associations between ACE and hospital admission due to non-fatal self-poisoning in Sri Lanka. METHODS: This was a case-control study. Adults admitted to a tertiary care hospital for medical management of self-poisoning were included as cases, and age and sex matched controls were recruited from the outpatient department. ACE were measured using the World Health Organization's Childhood Adversity Scale. Logistic regression models adjusting for age, sex, ethnicity, and religion were used to quantify the association between ACE and self-poisoning. RESULTS: The study included 235 cases and 451 controls. Cases were 2.5 times (95% CI 1.8, 3.6) more likely to report an ACE than controls and had higher ACE scores. Childhood physical abuse (OR 4.7, 95% CI 1.2, 19.0) and emotional abuse or neglect (OR 3.7, 95% CI 1.3, 10.1, and 3.7, 95% CI 2.3, 6.0 respectively), increased the risk of self-poisoning in adulthood, as did witnessing household violence (OR 2.2, 95% CI 1.4, 3.4), growing up in a household with a mentally ill or suicidal household member (OR 2.1, 95% CI 1.2, 3.4), and experiencing parental death/separation/divorce (OR 3.1, 95% CI 2.0, 4.9) as a child. CONCLUSIONS: Reducing exposures to ACEs should be a priority for prevention of suicide and self-harm in Sri Lanka. Innovative methods to increase support for children facing adversity should be explored.

2.
Psychol Med ; : 1-9, 2020 Sep 11.
Artículo en Inglés | MEDLINE | ID: mdl-32912344

RESUMEN

BACKGROUND: There is increasing evidence that domestic violence (DV) is an important risk factor for suicidal behaviour. The level of risk and its contribution to the overall burden of suicidal behaviour among men and women has not been quantified in South Asia. We carried out a large case-control study to examine the association between DV and self-poisoning in Sri Lanka. METHODS: Cases (N = 291) were patients aged ⩾18 years, admitted to a tertiary hospital in Kandy Sri Lanka for self-poisoning. Sex and age frequency matched controls were recruited from the hospital's outpatient department (N = 490) and local population (N = 450). Exposure to DV was collected through the Humiliation, Afraid, Rape, Kick questionnaire. Multivariable logistic regression models were conducted to estimate the association between DV and self-poisoning, and population attributable fractions were calculated. RESULTS: Exposure to at least one type of DV within the previous 12 months was strongly associated with self-poisoning for women [adjusted OR (AOR) 4.08, 95% CI 1.60-4.78] and men (AOR 2.52, 95% CI 1.51-4.21), compared to those reporting no abuse. Among women, the association was strongest for physical violence (AOR 14.07, 95% CI 5.87-33.72), whereas among men, emotional abuse showed the highest risk (AOR 2.75, 95% CI 1.57-4.82). PAF% for exposure to at least one type of DV was 38% (95% CI 32-43) in women and 22% (95% CI 14-29) in men. CONCLUSIONS: Multi-sectoral interventions to address DV including enhanced identification in health care settings, community-based strategies, and integration of DV support and psychological services may substantially reduce suicidal behaviour in Sri Lanka.

3.
BMJ Open ; 9(8): e027766, 2019 08 18.
Artículo en Inglés | MEDLINE | ID: mdl-31427319

RESUMEN

INTRODUCTION: Childhood adversity (CA) has been suggested as a key risk factor for suicidal behaviour, but evidence from low/middle-income countries is lacking. In Sri Lanka, CA, in the form of child maltreatment or as a consequence of maternal separation, has been highlighted in primarily qualitative or case series work, as a potentially important determinant of suicidal behaviour. To date, there have been no quantitative studies to investigate CA as a key exposure associated with suicidal behaviour in Sri Lanka. The aim of the research is to understand the association between CA and suicidal behaviour in Sri Lanka and to identify potentially modifiable factors to reduce any observed increased risk of suicidal behaviour associated with CA. METHODS AND ANALYSIS: This is a hospital-based case-control study. Cases (n=200) will be drawn from individuals admitted to the medical toxicology ward of the Teaching Hospital Peradeniya, Sri Lanka, for medical management of intentional self-poisoning. Sex and age frequency-matched controls (n=200) will be recruited from either patients or accompanying visitors presenting at the outpatient department and clinic of the same hospital for conditions unrelated to the outcome of interest. Conditional logistic regression will be used to investigate the association between CA and deliberate self-poisoning and whether the association is altered by other key factors including socioeconomic status, psychiatric morbidity, current experiences of domestic violence and social support. ETHICS AND DISSEMINATION: Ethics approval has been obtained from the Ethical Review Committee of the Faculty of Medicine, University of Peradeniya, Sri Lanka. Researchers have been trained in administering the questionnaire and a participant safety and distress protocol has been designed to guide researchers in ensuring participant safety and how to deal with a distressed participant. Results will be disseminated in local policy fora and peer-reviewed articles, local media, and national and international conferences.


Asunto(s)
Adultos Sobrevivientes del Maltrato a los Niños/estadística & datos numéricos , Hospitalización/estadística & datos numéricos , Envenenamiento/epidemiología , Conducta Autodestructiva/epidemiología , Intento de Suicidio/estadística & datos numéricos , Adulto , Adultos Sobrevivientes del Maltrato a los Niños/psicología , Estudios de Casos y Controles , Hospitales de Enseñanza , Humanos , Proyectos de Investigación , Factores de Riesgo , Sri Lanka/epidemiología , Intento de Suicidio/psicología
4.
Pilot Feasibility Stud ; 4: 150, 2018.
Artículo en Inglés | MEDLINE | ID: mdl-30258649

RESUMEN

Background: Deliberate self-harm in the form of non-fatal self-poisoning is a major public health problem in Sri Lanka. Previous work suggests that many nurses in Sri Lanka-particularly those who work in primary care in the medical treatment of persons who attempt self-poisoning-already approach their role in a holistic fashion and consider "advising" or "counseling" patients after self-poisoning to be a part of their nursing role. But there is no formal training given to such nurses at present nor has the efficacy or feasibility of such an intervention been assessed in Sri Lanka. The aims of this pilot study are to explore the potential efficacy, acceptability, and feasibility of carrying out a counseling intervention that could be delivered by nurses for persons who present to hospital for medical management of non-fatal self-poisoning. Methods/design: The study will be carried out at the Toxicology Unit of Teaching Hospital Peradeniya, Sri Lanka. A pilot randomized controlled trial will be carried out among participants admitted to Teaching Hospital Peradeniya for medical management of non-fatal self-poisoning. The primary objective of this study is to explore the acceptability and feasibility of a counseling intervention being delivered by nurses. The secondary objectives are to explore the efficacy of the intervention for the improvement of skills to cope with situations of acute emotional distress, and to reduce rates of anxiety, depression, and future repetition and suicidal ideation. A nurse's experiences and attitudes regarding the acceptability and feasibility of implementing this intervention and participant experiences of the intervention and its effects will be explored via qualitative interviews and focus group discussions. Discussion: It is anticipated that the findings of this pilot study will help determine and assess the acceptability and feasibility of this counseling intervention, as well as indicate the more useful aspects of this intervention in order to develop it for further exploration in a larger trial. Trial registration: SLCTR/2017/008 Registered on 21st March 2017.

5.
BMC Public Health ; 18(1): 572, 2018 05 02.
Artículo en Inglés | MEDLINE | ID: mdl-29716553

RESUMEN

BACKGROUND: Past research has identified links between intimate partner violence (IPV) and alcohol misuse and poverty in Sri Lanka. Services that address substance misuse are amongst the few interventions shown to reduce IPV in settings similar to Sri Lanka. This paper describes the protocol for a study examining the impact of a preschool-based capacity building intervention on the prevalence of IPV and substance misuse in parents with children attending preschools, including uptake of available government services. METHODS: The study is a cluster randomised controlled trial. Government-managed preschools (n = 34) in Galle and Colombo municipalities  will be randomly assigned to an intervention (n = 17) or control group (n = 17). Parents with children attending these preschools will be recruited to participate. The study intervention will build the capacity of selected community volunteers (parents) and preschool teachers in the provision of information and support to families affected by IPV and substance misuse. This intervention is directed at improving uptake, access and coordination of existing services. Data will be collected from all parents, and teachers in the intervention group, pre-intervention and 10 months post-intervention. The primary outcome for this study is experience of IPV amongst mothers of preschool-attending children. Secondary outcomes are substance misuse amongst fathers, measured via the locally adapted Alcohol Use Disorders Identification Test and Drug Abuse Screening Test; and awareness and uptake of services for these issues measured through locally-relevant tools. Demographic information and satisfaction with the intervention will also be assessed. DISCUSSION: By intervening through preschools we aim to support high-risk families early enough to arrest the cycle of violence that results in children themselves becoming victims and perpetrators of such violence. The innovative project design will reach the most vulnerable sections of the community and will provide a sustainable and feasible strategy for scale-up of the intervention. TRIAL REGISTRATION: This study is registered with the Sri Lankan Clinical Trials Registry (2017/038) and has been submitted to ClinicalTrials.gov (U.S National Institutes of Health) under the title "Randomized control trial: preschool-based training and support programs to reduce intimate partner violence (IPV) by addressing alcohol and drug misuse in young families in Sri Lanka"; Registration number: NCT03341455 ; Registration date: 14 November 2017.


Asunto(s)
Creación de Capacidad , Violencia de Pareja/prevención & control , Padres/psicología , Servicios de Salud Escolar/organización & administración , Trastornos Relacionados con Sustancias/prevención & control , Adulto , Preescolar , Protocolos Clínicos , Femenino , Humanos , Violencia de Pareja/estadística & datos numéricos , Masculino , Prevalencia , Evaluación de Programas y Proyectos de Salud , Sri Lanka/epidemiología , Trastornos Relacionados con Sustancias/epidemiología
6.
Asian J Psychiatr ; 19: 79-84, 2016 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-26957344

RESUMEN

Attempted or non-fatal self-poisoning in common in Sri Lanka, but little is known about variation of psychiatric morbidity and suicidal intent across differing ages. The aim of this study was to investigate factors associated with non-fatal self-poisoning in Sri Lanka across three different age groups (namely 14-24 years, 25-34 years and ≥ 35 years). It was anticipated that the findings of the study would inform and guide development of preventive interventions for non-fatal self-poisoning in this country. 935 participants were interviewed within one week of admission to hospital for medical management of non-fatal self-poisoning, over a consecutive 14-month period. Socio-demographic factors, types of poison ingested, triggers and psychiatric morbidity was examined as a function of age. Results showed that a majority (83%) of participants were aged below 35 years. Younger participants aged <25 years were significantly more likely to ingest medicinal overdoses, compared to older persons (aged 25-34 years, and ≥ 35 years), who were more likely to ingest pesticides. Recent interpersonal conflict was a proximal trigger seen in all age groups, but suicidal intent, depression and alcohol use disorders increased with age. The overall study findings indicate that most who carry out acts of non-fatal self-poisoning in Sri Lanka are young (aged <35 years). Interpersonal conflict as a trigger is common to all age groups, but psychiatric morbidity and suicidal intent is higher in the older age groups, as is pesticide ingestion. Age specific interventions may be efficacious in the prevention of non-fatal self-poisoning in Sri Lanka.


Asunto(s)
Sobredosis de Droga/psicología , Plaguicidas/envenenamiento , Ideación Suicida , Intento de Suicidio/psicología , Adolescente , Adulto , Distribución por Edad , Factores de Edad , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Intención , Acontecimientos que Cambian la Vida , Masculino , Persona de Mediana Edad , Sri Lanka , Adulto Joven
7.
BMC Public Health ; 15: 1167, 2015 Nov 24.
Artículo en Inglés | MEDLINE | ID: mdl-26602540

RESUMEN

BACKGROUND: Attempted or non-fatal self-poisoning is common in Sri Lanka. To date, most preventive strategies have focused on limitation of access to toxic pesticides, which has reduced the rates of fatal self-poisoning. However the ongoing phenomenon of non-fatal self-poisoning indicates the need for exploration of alternate preventive strategies. Self-poisoning in Sri Lanka has been described as impulsive, with little premeditation, but the motivations associated with this act have not been studied in depth. This research describes the triggers and motivations associated with non-fatal self-poisoning in Sri Lanka. It is anticipated that the findings would help guide future preventive strategies. METHODS: Two studies were carried out, at Teaching Hospital Peradeniya, Sri Lanka, each using a different methodology - Study 1 consisted of qualitative semi-structured interviews, and Study 2 was a cross sectional survey. Both studies were conducted among those who had recently attempted self-poisoning, and explored associated triggers and motivations associated with the act of self-poisoning. There was no overlap between participants of the two studies. RESULTS: A total of 24 persons participated in the semi-structured interviews (Study 1), and 921 took part in the cross-sectional survey (Study 2). Interpersonal conflict was the most common trigger prior to the act of non-fatal self-poisoning. A mixture of motivations was associated with the act of self-poisoning, including intent to die, to escape, and difficulty tolerating distress associated with interpersonal conflict. CONCLUSIONS: Development of interpersonal skills and interpersonal problem solving skills, particularly in adolescents and young people, emerges as a key primary preventive strategy. Further, there is value in exploring and helping people to develop more adaptive strategies to cope with emotional distress associated with interpersonal conflict. While distress tolerance and interpersonal skill training strategies used in the West may be considered, it is also important to adapt and develop strategies suited to the local cultural background. Further research is needed to develop and evaluate such strategies, and findings may have implications not only to Sri Lanka but also for other countries in South Asia.


Asunto(s)
Relaciones Interpersonales , Motivación , Venenos/administración & dosificación , Estrés Psicológico/complicaciones , Intento de Suicidio/psicología , Adaptación Psicológica , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Asia , Estudios Transversales , Femenino , Humanos , Masculino , Persona de Mediana Edad , Sri Lanka , Adulto Joven
8.
BMC Psychiatry ; 14: 221, 2014 Aug 08.
Artículo en Inglés | MEDLINE | ID: mdl-25103532

RESUMEN

BACKGROUND: In the recent past Sri Lanka has had a high rate of attempted suicide by pesticide ingestion, among both males and females. Recent evidence suggests that these trends in self-poisoning may be changing, with increasing medicinal overdoses and changing gender ratios. In the past, attempted suicide in Sri Lanka has been described as impulsive acts, but research regarding aspects such as suicidal intent is limited, and there has been no comparison between genders. The objective of this study was to describe gender differences in non-fatal self-poisoning in Sri Lanka with respect to substances ingested, triggers, stressors, suicidal intent and psychiatric morbidity. METHODS: Persons admitted to Teaching Hospital Peradeniya, Sri Lanka, for medical management of non-fatal self-poisoning over a consecutive 14-month period were eligible for the study. Participants were interviewed within one week of admission, with regard to demographic details, poison type ingested, triggers, psychiatric morbidity and suicidal intent. 949 participants were included in the study, of whom 44.2% were males, with a median age of 22 years. RESULTS: Males were significantly more likely to ingest agrochemicals, whereas females were more likely to overdose on pharmaceutical drugs. Interpersonal conflict was a common trigger associated with non-fatal self-poisoning for both males and females. Alcohol use disorders and high suicidal intent were significantly more likely in males. There was no difference in rates of depression between the genders. Multiple regression for both genders separately showed that the presence of depression and higher levels of hopelessness was the strongest predictor of suicidal intent, for both genders. CONCLUSIONS: Patterns of non-fatal self-poisoning in Sri Lanka appear to be changing to resemble Western patterns, with females having a greater rate of self-poisoning and more medicinal overdoses than males. Alcohol use disorder is a gender specific risk factor associated with non-fatal self-poisoning among males, indicating a need for specific intervention. However there are also many common risk factors that are common to both genders, particularly associations with interpersonal conflict as an acute trigger, and psychiatric morbidity such as depression and hopelessness being related to increased suicidal intent.


Asunto(s)
Envenenamiento/epidemiología , Envenenamiento/psicología , Intento de Suicidio/psicología , Adolescente , Adulto , Depresión/epidemiología , Depresión/psicología , Sobredosis de Droga/epidemiología , Sobredosis de Droga/psicología , Femenino , Humanos , Masculino , Admisión del Paciente/estadística & datos numéricos , Factores de Riesgo , Sri Lanka/epidemiología , Ideación Suicida , Adulto Joven
9.
BMC Public Health ; 13: 331, 2013 Apr 10.
Artículo en Inglés | MEDLINE | ID: mdl-23575389

RESUMEN

BACKGROUND: The rate of non-fatal self-poisoning in Sri Lanka has increased in recent years, with associated morbidity and economic cost to the country. This review examines the published literature for the characteristics and factors associated with non-fatal self-poisoning in Sri Lanka. METHODS: Electronic searches were conducted in Psychinfo, Proquest, Medline and Cochrane databases from inception to October 2011. RESULTS: 26 publications (representing 23 studies) were eligible to be included in the review. A majority of studies reported non-fatal self-poisoning to be more common among males, with a peak age range of 10-30 years. Pesticide ingestion was the most commonly used method of non-fatal self-poisoning. However three studies conducted within the last ten years, in urban areas of the country, reported non-fatal self-poisoning by medicinal overdose to be more common, and also reported non-fatal self-poisoning to be more common among females. Interpersonal conflict was the most commonly reported short-term stressor associated with self-poisoning. Alcohol misuse was reported among males who self-poisoned, and data regarding other psychiatric morbidity was limited. CONCLUSIONS: The findings indicate that pesticide ingestion is the commonest method of non-fatal self-poisoning in Sri Lanka, and it is more common among young males, similar to other Asian countries. However there appears to be an emerging pattern of increasing medicinal overdoses, paralleled by a gender shift towards increased female non-fatal self-poisoning in urban areas. Many non-fatal self-poisoning attempts appear to occur in the context of acute interpersonal stress, with short premeditation, and associated with alcohol misuse in males. Similar to other Asian countries, strategies to reduce non-fatal self-poisoning in Sri Lanka require integrated intervention programs with several key aspects, including culturally appropriate interventions to develop interpersonal skills in young people, community based programs to reduce alcohol misuse, and screening for and specific management of those at high risk of repetition following an attempt of self-poisoning.


Asunto(s)
Envenenamiento/epidemiología , Conducta Autodestructiva , Adolescente , Adulto , Distribución por Edad , Niño , Femenino , Humanos , Masculino , Envenenamiento/complicaciones , Distribución por Sexo , Sri Lanka/epidemiología
10.
Early Interv Psychiatry ; 5(3): 254-8, 2011 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-21707940

RESUMEN

AIM: The study aims to examine the themes of delusions and hallucinations in a cohort of adolescent and young adult patients (aged 15-26 years) presenting with a first episode of psychosis. METHODS: Information was collected retrospectively from 143 randomly selected medical files, using a questionnaire. RESULTS: Over 70% of patients were found to have either delusions or hallucinations at initial presentation. Delusions of persecution, reference and second person auditory hallucinations were the most commonly reported psychotic symptoms at initial presentation. CONCLUSIONS: Anxiety in the context of developmental life events may influence the presentation of patients in this age group. This patient group may also have a less well-developed system of delusional beliefs compared with older patients with established illness. A better understanding of delusions and hallucinations in a first episode of psychosis may help early identification and engagement of these patients.


Asunto(s)
Deluciones/psicología , Alucinaciones/psicología , Trastornos Psicóticos/diagnóstico , Trastornos Psicóticos/psicología , Adolescente , Conducta del Adolescente/psicología , Adulto , Estudios de Cohortes , Estudios Transversales , Deluciones/complicaciones , Femenino , Alucinaciones/complicaciones , Humanos , Masculino , Trastornos del Humor/complicaciones , Trastornos del Humor/psicología , Trastornos Psicóticos/complicaciones
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