Is socioeconomic position associated with risk of attempted suicide in rural Sri Lanka? A cross sectional study of 165,000 individuals

Duleeka W Knipe, David Gunnell, Ravi Pieris, Chamil Priyadarshana, Manjula Weerasinghe, Melissa Pearson, Shaluka Jayamanne, Andrew H Dawson, Fahim Mohamed, Indika Gawarammana, Keith Hawton, Flemming Konradsen, Michael Eddleston, Chris Metcalfe

Research output: Contribution to journalArticlepeer-review

Abstract

Background
Lower socioeconomic position (SEP) is associated with an increased risk of suicidal behaviour in high income countries, but this association is unclear in low and middle income countries.
Methods
We investigated the association of SEP with attempted suicide in a cross-sectional survey of 165 233 Sri Lankans. SEP data were collected at the household (assets, social standing (highest occupation of a household member), foreign employment, and young (≤40 years) female headed households) and individual level (education and occupation). Respondent-reported data on suicide attempts in the last year were recorded. Random effects logistic regression models, accounting for clustering, were used to investigate the association of SEP with attempted suicide.
Results
Households reported 398 attempted suicides in the preceding year (239 per 100 000). Fewer assets (OR 3.2 95% CI 2.4, 4.4) and having a daily wage labourer (i.e. insecure/low income job) (OR 2.3 95% CI 1.6, 3.2) as the highest occupation increased the risk of an attempted suicide within households. At an individual level, daily wage labourers were at an increased risk of attempted suicide compared to farmers. The strongest associations were with low levels of education (OR 4.6 95% CI 2.5, 8.4), with a stronger association in men than women.
Conclusion
We found that indicators of lower SEP are associated with increased risk of attempted suicide in rural Sri Lanka. Longitudinal studies with objective measures of suicide attempts are needed to confirm this association.
Original languageEnglish
JournalBMJ Open
Early online date22 Mar 2017
DOIs
Publication statusPublished - 22 Mar 2017

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