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Reduction in older age groups followed and falls in all age groups occurred after all class I the most toxic pesticides were banned. 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. The introduction of pesticide regulations in Sri Lanka coincides with a reduction in suicide rates, with evidence of limited method substitution.
Electronic supplementary material The online version of this article doi: In most western countries the incidence of suicide increases with age; in rural Asia there is also an earlier peak in incidence in Local sex finder in kilinochchi year olds [ 1 — 4 ]. A suggested reason for the high incidence in young people is that self-harm with low suicide intent is highest in 15—34 year olds worldwide and is often impulsive. Consequently there should be a lowering of suicide incidence in young people, as well as a reduction in the overall suicide rate so long as equally lethal alternative methods are not adopted method substitution.
Sri Lanka was notorious for having one of the highest suicide rates in the world in the early s [ 7 ]. In subsequent years its suicide rate declined dramatically, a fall in rates which coincided with a series of bans on WHO class I pesticides starting in [ 89 ]. In a previous analysis of suicides in Sri Lanka —we found evidence that reductions in suicide in both men and women coincided with the ban of the most toxic pesticides [ 8 ]. Previous investigations of the decline did not assess age, birth-cohort or period specific effects on suicide trends; such an analysis would help clarify the impact of regulations on particular age groups and possible long term effects on a generation of individuals exposed during their early life to a high incidence of suicide in their community.
Furthermore, since our earlier analysis, a series of company trials and further regulations, starting in and culminating inhave occurred in Sri Lanka, these resulted in reductions in the toxicity of highly toxic paraquat formulations. These interventions were followed by a complete ban on paraquat, dimethoate, and fenthion, from [ 910 ]. Using police and hospital data we investigated: Methods Context Sri Lanka is an island state with a population of Suicide data Age, gender and method specific suicide data were obtained, where available, for — from the Department of Police, Division of Statistics, Sri Lanka http: These publicly available data cover the majority of the island, but due to the civil war —data from three districts, Mullaitivu, Kilinochchi and Mannar, are missing from — We do not have the data broken down by district for the other years but assume they exclude these areas, because the years we have district level data confirm their exclusion during the civil war and we have no reason to suspect they would have been included for any other reason in the other years post Based on the recent census these districts account for 1.
Using the approach employed by Gunnell et al. Method specific data was available from —, however, data by age and gender is incomplete. Data is only available as follows: Categories of suicide deaths coded during different periods Hospital data Publicly available hospital admission and hospital death data for poisoning ICD10 codes: Age and gender data was only available for — Data were available for the following age categories: Population data Censuses have been carried out in, and in Sri Lanka. Mid-year population estimates for — were obtained from the Registrar General for Sri Lanka publicly available.
With regard to the estimates, there were three abrupt changes to the population estimates for different age groups centred on the three census yearsand see Additional file 1suggesting the mid-year population figures had been imperfectly estimated for the different age groups. To adjust for this, we recalculated the mid-year populations between the census years —for further details see Additional file 1. The population estimate for has not been released; therefore the population was used as the denominator. Three year moving averages were used to smooth the estimates of trends in rates for graphical presentation, with averages centred on the middle year, e.
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Suicide in Sri Lanka 1975–2012: age, period and cohort analysis of police and hospital data
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