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Socioeconomic position and suicidal behaviour in rural Sri Lanka: a prospective cohort study of 168,000 people

Research output: Contribution to journalArticle

Original languageEnglish
Number of pages13
JournalSocial Psychiatry and Psychiatric Epidemiology
Early online date21 Feb 2019
DOIs
DateAccepted/In press - 12 Feb 2019
DateE-pub ahead of print (current) - 21 Feb 2019

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 and education (IRR (95% CI) 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 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, and unemployment was a risk factor in young people (1·32 (1.04, 1·66)).

Conclusions: Improved employment opportunities, welfare and mental health support services, as well as problem-solving skills development (possibly delivered through schools), are needed to support individuals with poorer education, farmers, daily wage labourers, individuals in female-headed households and temporary foreign migrant households, and unemployed young people.

    Research areas

  • Suicide, Sri Lanka, Cohort Study, Socioeconomic position, Low and middle income countries

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    Rights statement: This is the final published version of the article (version of record). It first appeared online via Springer Nature at https://link.springer.com/article/10.1007/s00127-019-01672-3. Please refer to any applicable terms of use of the publisher.

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    Rights statement: This is the final published version of the article (version of record). It first appeared online via Springer Nature at https://link.springer.com/article/10.1007/s00127-019-01672-3. Please refer to any applicable terms of use of the publisher.

    Final published version, 106 KB, PDF-document

    Licence: CC BY

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