Study of suicides reported to the Coroner in Colombo, Sri Lanka.
BACKGROUND
Deaths from suicide reached a peak in Sri Lanka in 1995. Several interventions reduced the suicide rate of 48.7 per 100,000 in 1995 to 23 per 100,000 in 2006, though it is still a major socioeconomic problem. All suicides have to be reported to the Inquirer of Sudden Death (ISD) or 'Coroner', according to the Criminal Procedure Code.


METHODS
All deaths where a verdict of 'suicide' was given after an inquest at the Coroner's Court, Colombo, in 2006 were studied. Close relations or friends who attended the inquest were interviewed by medically qualified research assistants. Age, sex, marital and occupational status, level of education, living circumstances and method and reasons for the suicide were studied.


RESULTS
During 2006, 151 deaths from suicide were documented, of which 93 (62%) were men. The majority (47%) were aged between 20 and 29 years. One-third of the victims was unemployed. At the time of committing suicide, 75% were living with family; 89 (59%) were married and 46 (31%) were single. Poisoning was the cause of death in 66 (44%), 48 (70%) of which were due to pesticides. Burns caused 51 (34%) deaths. Other common causes of death included hanging (11%), jumping in front of a train (7%) and drowning (3%). The commonest reason for suicide was dispute with the spouse/marital disharmony (30%). Other reasons were dispute with parents (8%), financial matters (7%), organic diseases (7%), alcoholism (7%), psychiatric illnesses (6%) and disputes in love affairs (5%). In 29 cases (19%), no definite reason for the suicide was evident.


CONCLUSIONS
Self-poisoning and self-immolation were the commonest methods used to commit suicide. Marital disharmony was the main reason (30%). Psychiatric illnesses were responsible for only 6%. Future interventional activities should include secure access and restriction of the availability of pesticides and drugs, empowering people to manage anger and conflicts, and recognition and treatment of alcoholism and psychiatric illnesses. The success story of the reduction in the incidence of suicides in Sri Lanka should be a lesson to many developing countries where suicide is a major socioeconomic and health issue.
Fernando
Ravindra
R
Department of Forensic Medicine and Toxicology, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka. ravindrafernando@hotmail.co.uk
Hewagama
Medhani
M
Priyangika
W D D
WD
Range
Sonali
S
Karunaratne
Shashi
S
D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D003334:Coroners and Medical Examiners; D004522:Educational Status; D004651:Employment / Q000706:statistics & numerical data; D005260:Female; D005554:Forensic Medicine; D006801:Humans; D008297:Male; D017533:Marital Status / Q000706:statistics & numerical data; D008722:Methods; D008875:Middle Aged; D009790:Occupations / Q000706:statistics & numerical data; D011446:Prospective Studies; D017678:Sex Distribution; D013188:Sri Lanka / Q000453:epidemiology; D013405:Suicide / Q000706:statistics & numerical data*; D055815:Young Adult