Socioeconomic position and suicidal behaviour in rural Sri Lanka: a prospective cohort study of 168,000+ people
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...
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| Veröffentlicht in: | Social Psychiatry and Psychiatric Epidemiology 2019-07, Vol.54 (7), p.843-855 |
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| creator | Knipe, D. W. Gunnell, D. Pieris, R. Priyadarshana, C. Weerasinghe, M. Pearson, M. Jayamanne, S. Hawton, K. Konradsen, F. Eddleston, M. Metcalfe, C. |
| description | 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 [IRR (95% CI) suicide 1.74 (0.92, 3.28); attempted suicide 1.67 (1.40, 2.00)] and education [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 young 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.
Conclusions
Improved employment opportunities, welfare and mental health support services, as well as problem-solving skills development, may help support individuals with poorer education, farmers, daily wage labourers, individuals in young female-headed households and temporary foreign migrant households. |
| doi_str_mv | 10.1007/s00127-019-01672-3 |
| format | Article |
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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 [IRR (95% CI) suicide 1.74 (0.92, 3.28); attempted suicide 1.67 (1.40, 2.00)] and education [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 young 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.
Conclusions
Improved employment opportunities, welfare and mental health support services, as well as problem-solving skills development, may help support individuals with poorer education, farmers, daily wage labourers, individuals in young female-headed households and temporary foreign migrant households.</description><identifier>ISSN: 0933-7954</identifier><identifier>EISSN: 1433-9285</identifier><identifier>DOI: 10.1007/s00127-019-01672-3</identifier><identifier>PMID: 30790026</identifier><language>eng</language><publisher>Berlin/Heidelberg: Springer Berlin Heidelberg</publisher><subject>Adolescent ; Adult ; Analysis ; Cohort analysis ; Education ; Employment - psychology ; Epidemiology ; Family Characteristics ; Female ; Households ; Humans ; Income ; Male ; Medicine ; Medicine & Public Health ; Mental health ; Middle Aged ; Occupations ; Occupations - statistics & numerical data ; Original Paper ; Poisson density functions ; Problem solving ; Prospective Studies ; Psychiatry ; Regression models ; Risk ; Rural Population - statistics & numerical data ; Self destructive behavior ; Social Class ; Socioeconomic factors ; Sri Lanka - epidemiology ; Statistical analysis ; Suicidal behavior ; Suicide ; Suicide - economics ; Suicides & suicide attempts ; Support services ; Young Adult</subject><ispartof>Social Psychiatry and Psychiatric Epidemiology, 2019-07, Vol.54 (7), p.843-855</ispartof><rights>The Author(s) 2019</rights><rights>COPYRIGHT 2019 Springer</rights><rights>Social Psychiatry and Psychiatric Epidemiology is a copyright of Springer, (2019). All Rights Reserved. © 2019. This work is published under http://creativecommons.org/licenses/by/4.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c541t-65dc3f17dbeef3b427e3ded32271c8074aa711187eaa99d517e369dfc265fc683</citedby><cites>FETCH-LOGICAL-c541t-65dc3f17dbeef3b427e3ded32271c8074aa711187eaa99d517e369dfc265fc683</cites><orcidid>0000-0002-1040-7635</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s00127-019-01672-3$$EPDF$$P50$$Gspringer$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s00127-019-01672-3$$EHTML$$P50$$Gspringer$$Hfree_for_read</linktohtml><link.rule.ids>230,314,776,780,881,27901,27902,41464,42533,51294</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/30790026$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Knipe, D. W.</creatorcontrib><creatorcontrib>Gunnell, D.</creatorcontrib><creatorcontrib>Pieris, R.</creatorcontrib><creatorcontrib>Priyadarshana, C.</creatorcontrib><creatorcontrib>Weerasinghe, M.</creatorcontrib><creatorcontrib>Pearson, M.</creatorcontrib><creatorcontrib>Jayamanne, S.</creatorcontrib><creatorcontrib>Hawton, K.</creatorcontrib><creatorcontrib>Konradsen, F.</creatorcontrib><creatorcontrib>Eddleston, M.</creatorcontrib><creatorcontrib>Metcalfe, C.</creatorcontrib><title>Socioeconomic position and suicidal behaviour in rural Sri Lanka: a prospective cohort study of 168,000+ people</title><title>Social Psychiatry and Psychiatric Epidemiology</title><addtitle>Soc Psychiatry Psychiatr Epidemiol</addtitle><addtitle>Soc Psychiatry Psychiatr Epidemiol</addtitle><description>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 [IRR (95% CI) suicide 1.74 (0.92, 3.28); attempted suicide 1.67 (1.40, 2.00)] and education [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 young 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.
Conclusions
Improved employment opportunities, welfare and mental health support services, as well as problem-solving skills development, may help support individuals with poorer education, farmers, daily wage labourers, individuals in young female-headed households and temporary foreign migrant households.</description><subject>Adolescent</subject><subject>Adult</subject><subject>Analysis</subject><subject>Cohort analysis</subject><subject>Education</subject><subject>Employment - psychology</subject><subject>Epidemiology</subject><subject>Family Characteristics</subject><subject>Female</subject><subject>Households</subject><subject>Humans</subject><subject>Income</subject><subject>Male</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Mental health</subject><subject>Middle Aged</subject><subject>Occupations</subject><subject>Occupations - statistics & numerical data</subject><subject>Original Paper</subject><subject>Poisson density functions</subject><subject>Problem solving</subject><subject>Prospective Studies</subject><subject>Psychiatry</subject><subject>Regression models</subject><subject>Risk</subject><subject>Rural Population - statistics & numerical data</subject><subject>Self destructive behavior</subject><subject>Social Class</subject><subject>Socioeconomic factors</subject><subject>Sri Lanka - epidemiology</subject><subject>Statistical analysis</subject><subject>Suicidal behavior</subject><subject>Suicide</subject><subject>Suicide - economics</subject><subject>Suicides & suicide attempts</subject><subject>Support services</subject><subject>Young Adult</subject><issn>0933-7954</issn><issn>1433-9285</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2019</creationdate><recordtype>article</recordtype><sourceid>C6C</sourceid><sourceid>EIF</sourceid><sourceid>8G5</sourceid><sourceid>BENPR</sourceid><sourceid>GUQSH</sourceid><sourceid>M2O</sourceid><recordid>eNp9UV1rFDEUDaLYdfUP-CABH3VqvjPxoVCKX7DgQ_U5ZJM7u6m7yZjMLPTfm7q1tSASQsK9556cnIPQS0pOKSH6XSWEMt0RatpWmnX8EVpQwXlnWC8fowUx7a6NFCfoWa1XhBBuNH-KTjjRhhCmFihfZh8z-JzyPno85hqnmBN2KeA6Rx-D2-E1bN0h5rngmHCZSytdlohXLv1w77HDY8l1BD_FA2Cft7lMuE5zuMZ5wFT1b9vDb_AIedzBc_RkcLsKL27PJfr-8cO3i8_d6uunLxfnq85LQadOyeD5QHVYAwx8LZgGHiBwxjT1PdHCOU0p7TU4Z0yQtPWVCYNnSg5e9XyJzo6847zeQ_CQpibbjiXuXbm22UX7sJPi1m7ywSolVd98W6LXtwQl_5yhTvaqGZCaZstoLzjrhRb3qI3bgY1pyI3M72P19lxTJQSVUjbU6T9QbQVopucEQ2z1BwPsOOCbs7XAcCecEnuTvT1mb1v29nf29kbxq7-_fDfyJ-wG4EdAba20gXL_pf_Q_gIvrblv</recordid><startdate>20190701</startdate><enddate>20190701</enddate><creator>Knipe, D. W.</creator><creator>Gunnell, D.</creator><creator>Pieris, R.</creator><creator>Priyadarshana, C.</creator><creator>Weerasinghe, M.</creator><creator>Pearson, M.</creator><creator>Jayamanne, S.</creator><creator>Hawton, K.</creator><creator>Konradsen, F.</creator><creator>Eddleston, M.</creator><creator>Metcalfe, C.</creator><general>Springer Berlin Heidelberg</general><general>Springer</general><general>Springer Nature B.V</general><scope>C6C</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>88G</scope><scope>8AO</scope><scope>8C1</scope><scope>8FE</scope><scope>8FG</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>8G5</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>ARAPS</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>BGLVJ</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>GUQSH</scope><scope>HCIFZ</scope><scope>K9.</scope><scope>M0S</scope><scope>M1P</scope><scope>M2M</scope><scope>M2O</scope><scope>MBDVC</scope><scope>P5Z</scope><scope>P62</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PSYQQ</scope><scope>Q9U</scope><scope>5PM</scope><orcidid>https://orcid.org/0000-0002-1040-7635</orcidid></search><sort><creationdate>20190701</creationdate><title>Socioeconomic position and suicidal behaviour in rural Sri Lanka: a prospective cohort study of 168,000+ people</title><author>Knipe, D. W. ; Gunnell, D. ; Pieris, R. ; Priyadarshana, C. ; Weerasinghe, M. ; Pearson, M. ; Jayamanne, S. ; Hawton, K. ; Konradsen, F. ; Eddleston, M. ; Metcalfe, C.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c541t-65dc3f17dbeef3b427e3ded32271c8074aa711187eaa99d517e369dfc265fc683</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2019</creationdate><topic>Adolescent</topic><topic>Adult</topic><topic>Analysis</topic><topic>Cohort analysis</topic><topic>Education</topic><topic>Employment - psychology</topic><topic>Epidemiology</topic><topic>Family Characteristics</topic><topic>Female</topic><topic>Households</topic><topic>Humans</topic><topic>Income</topic><topic>Male</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Mental health</topic><topic>Middle Aged</topic><topic>Occupations</topic><topic>Occupations - statistics & numerical data</topic><topic>Original Paper</topic><topic>Poisson density functions</topic><topic>Problem solving</topic><topic>Prospective Studies</topic><topic>Psychiatry</topic><topic>Regression models</topic><topic>Risk</topic><topic>Rural Population - statistics & numerical data</topic><topic>Self destructive behavior</topic><topic>Social Class</topic><topic>Socioeconomic factors</topic><topic>Sri Lanka - epidemiology</topic><topic>Statistical analysis</topic><topic>Suicidal behavior</topic><topic>Suicide</topic><topic>Suicide - economics</topic><topic>Suicides & suicide attempts</topic><topic>Support services</topic><topic>Young Adult</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Knipe, D. W.</creatorcontrib><creatorcontrib>Gunnell, D.</creatorcontrib><creatorcontrib>Pieris, R.</creatorcontrib><creatorcontrib>Priyadarshana, C.</creatorcontrib><creatorcontrib>Weerasinghe, M.</creatorcontrib><creatorcontrib>Pearson, M.</creatorcontrib><creatorcontrib>Jayamanne, S.</creatorcontrib><creatorcontrib>Hawton, K.</creatorcontrib><creatorcontrib>Konradsen, F.</creatorcontrib><creatorcontrib>Eddleston, M.</creatorcontrib><creatorcontrib>Metcalfe, C.</creatorcontrib><collection>Springer Nature OA/Free Journals</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>Psychology Database (Alumni)</collection><collection>ProQuest Pharma Collection</collection><collection>Public Health Database</collection><collection>ProQuest SciTech Collection</collection><collection>ProQuest Technology Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>Research Library (Alumni Edition)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>Advanced Technologies & Aerospace Collection</collection><collection>ProQuest Central Essentials</collection><collection>ProQuest Central</collection><collection>Technology Collection</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Central Student</collection><collection>Research Library Prep</collection><collection>SciTech Premium Collection</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>ProQuest Psychology</collection><collection>Research Library</collection><collection>Research Library (Corporate)</collection><collection>Advanced Technologies & Aerospace Database</collection><collection>ProQuest Advanced Technologies & Aerospace Collection</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest One Psychology</collection><collection>ProQuest Central Basic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Social Psychiatry and Psychiatric Epidemiology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Knipe, D. W.</au><au>Gunnell, D.</au><au>Pieris, R.</au><au>Priyadarshana, C.</au><au>Weerasinghe, M.</au><au>Pearson, M.</au><au>Jayamanne, S.</au><au>Hawton, K.</au><au>Konradsen, F.</au><au>Eddleston, M.</au><au>Metcalfe, C.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Socioeconomic position and suicidal behaviour in rural Sri Lanka: a prospective cohort study of 168,000+ people</atitle><jtitle>Social Psychiatry and Psychiatric Epidemiology</jtitle><stitle>Soc Psychiatry Psychiatr Epidemiol</stitle><addtitle>Soc Psychiatry Psychiatr Epidemiol</addtitle><date>2019-07-01</date><risdate>2019</risdate><volume>54</volume><issue>7</issue><spage>843</spage><epage>855</epage><pages>843-855</pages><issn>0933-7954</issn><eissn>1433-9285</eissn><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 [IRR (95% CI) suicide 1.74 (0.92, 3.28); attempted suicide 1.67 (1.40, 2.00)] and education [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 young 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.
Conclusions
Improved employment opportunities, welfare and mental health support services, as well as problem-solving skills development, may help support individuals with poorer education, farmers, daily wage labourers, individuals in young female-headed households and temporary foreign migrant households.</abstract><cop>Berlin/Heidelberg</cop><pub>Springer Berlin Heidelberg</pub><pmid>30790026</pmid><doi>10.1007/s00127-019-01672-3</doi><tpages>13</tpages><orcidid>https://orcid.org/0000-0002-1040-7635</orcidid><oa>free_for_read</oa></addata></record> |
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| ispartof | Social Psychiatry and Psychiatric Epidemiology, 2019-07, Vol.54 (7), p.843-855 |
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| language | eng |
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| source | MEDLINE; SpringerLink Journals |
| subjects | Adolescent Adult Analysis Cohort analysis Education Employment - psychology Epidemiology Family Characteristics Female Households Humans Income Male Medicine Medicine & Public Health Mental health Middle Aged Occupations Occupations - statistics & numerical data Original Paper Poisson density functions Problem solving Prospective Studies Psychiatry Regression models Risk Rural Population - statistics & numerical data Self destructive behavior Social Class Socioeconomic factors Sri Lanka - epidemiology Statistical analysis Suicidal behavior Suicide Suicide - economics Suicides & suicide attempts Support services Young Adult |
| title | Socioeconomic position and suicidal behaviour in rural Sri Lanka: a prospective cohort study of 168,000+ people |
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