title: A comparison of non-fatal self-poisoning among males and females, in Sri Lanka.
abstract: BACKGROUND
  In the recent past Sri Lanka has had a high rate of attempted suicide by pesticide ingestion, among both males and females. Recent evidence suggests that these trends in self-poisoning may be changing, with increasing medicinal overdoses and changing gender ratios. In the past, attempted suicide in Sri Lanka has been described as impulsive acts, but research regarding aspects such as suicidal intent is limited, and there has been no comparison between genders. The objective of this study was to describe gender differences in non-fatal self-poisoning in Sri Lanka with respect to substances ingested, triggers, stressors, suicidal intent and psychiatric morbidity.
  
  
  METHODS
  Persons admitted to Teaching Hospital Peradeniya, Sri Lanka, for medical management of non-fatal self-poisoning over a consecutive 14-month period were eligible for the study. Participants were interviewed within one week of admission, with regard to demographic details, poison type ingested, triggers, psychiatric morbidity and suicidal intent. 949 participants were included in the study, of whom 44.2% were males, with a median age of 22 years.
  
  
  RESULTS
  Males were significantly more likely to ingest agrochemicals, whereas females were more likely to overdose on pharmaceutical drugs. Interpersonal conflict was a common trigger associated with non-fatal self-poisoning for both males and females. Alcohol use disorders and high suicidal intent were significantly more likely in males. There was no difference in rates of depression between the genders. Multiple regression for both genders separately showed that the presence of depression and higher levels of hopelessness was the strongest predictor of suicidal intent, for both genders.
  
  
  CONCLUSIONS
  Patterns of non-fatal self-poisoning in Sri Lanka appear to be changing to resemble Western patterns, with females having a greater rate of self-poisoning and more medicinal overdoses than males. Alcohol use disorder is a gender specific risk factor associated with non-fatal self-poisoning among males, indicating a need for specific intervention. However there are also many common risk factors that are common to both genders, particularly associations with interpersonal conflict as an acute trigger, and psychiatric morbidity such as depression and hopelessness being related to increased suicidal intent.
authors.affiliation: Department of Psychiatry, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka. gemba471@gmail.com.
authors.forename: Thilini
authors.initials: T
authors.lastname: Rajapakse
authors.forename: Kathleen Margaret
authors.initials: KM
authors.lastname: Griffiths
authors.forename: Helen
authors.initials: H
authors.lastname: Christensen
authors.forename: Sue
authors.initials: S
authors.lastname: Cotton
mesh_terms: D000293:Adolescent; D000328:Adult; D003863:Depression / Q000453:epidemiology / Q000523:psychology; D062787:Drug Overdose / Q000453:epidemiology / Q000523:psychology; D005260:Female; D006801:Humans; D008297:Male; D010343:Patient Admission / Q000706:statistics & numerical data; D011041:Poisoning / Q000453:epidemiology* / Q000523:psychology*; D012307:Risk Factors; D013188:Sri Lanka / Q000453:epidemiology; D059020:Suicidal Ideation; D013406:Suicide, Attempted / Q000523:psychology*; D055815:Young Adult
references.citation: Acta Psychiatr Scand. 1996 May;93(5):327-38
references.pmid: 8792901
references.citation: Psychol Med. 2005 Aug;35(8):1197-204
references.pmid: 16116945
references.citation: BMC Public Health. 2009 Feb 24;9:69
references.pmid: 19239714
references.citation: Br J Psychiatry. 2000 Dec;177:484-5
references.pmid: 11102320
references.citation: Alcohol Alcohol. 2013 Mar-Apr;48(2):250-6
references.pmid: 23161893
references.citation: Suicide Life Threat Behav. 1998 Spring;28(1):1-23
references.pmid: 9560163
references.citation: Addiction. 1993 Jun;88(6):791-804
references.pmid: 8329970
references.citation: Curr Opin Psychiatry. 2010 May;23(3):195-204
references.pmid: 20308904
references.citation: Arch Intern Med. 2006 May 22;166(10):1092-7
references.pmid: 16717171
references.citation: Soc Psychiatry Psychiatr Epidemiol. 2008 Apr;43(4):280-5
references.pmid: 18253684
references.citation: Ann Epidemiol. 2005 Feb;15(2):167-74
references.pmid: 15652723
references.citation: Br J Psychiatry. 2008 Feb;192(2):98-105
references.pmid: 18245022
references.citation: Br J Psychiatry. 1981 Nov;139:391-6
references.pmid: 7332842
references.citation: Soc Psychiatry Psychiatr Epidemiol. 2004 Apr;39(4):318-25
references.pmid: 15085335
references.citation: Addiction. 2006 May;101(5):626-8
references.pmid: 16669884
references.citation: Clin Toxicol (Phila). 2006;44(3):225-31
references.pmid: 16749538
references.citation: Br J Psychiatry. 2005 Jan;186:60-6
references.pmid: 15630125
references.citation: Soc Sci Med. 2006 Apr;62(7):1710-9
references.pmid: 16165259
references.citation: Crisis. 2006;27(2):77-81
references.pmid: 16913329
references.citation: Acta Psychiatr Scand. 2006 Jan;113(1):13-22
references.pmid: 16390364
references.citation: J Affect Disord. 2012 Dec 15;142(1-3):143-9
references.pmid: 22877969
references.citation: Br J Psychiatry. 2010 Jul;197(1):20-7
references.pmid: 20592429
references.citation: Int J Soc Psychiatry. 1986 Summer;32(2):64-73
references.pmid: 3733351
references.citation: Indian J Psychol Med. 2013 Jan;35(1):75-9
references.pmid: 23833346
references.citation: Ind Psychiatry J. 2011 Jan;20(1):11-6
references.pmid: 22969174
references.citation: Bull World Health Organ. 1982;60(4):615-9
references.pmid: 6982784
references.citation: Psychol Med. 2002 May;32(4):585-94
references.pmid: 12102373
references.citation: Psychol Med. 2005 Oct;35(10):1467-74
references.pmid: 16164770
references.citation: Bull World Health Organ. 2012 Jan 1;90(1):40-6
references.pmid: 22271963
references.citation: Int J Soc Psychiatry. 1989 Summer;35(2):204-8
references.pmid: 2767925
references.citation: PLoS Med. 2009 Aug;6(8):e1000123
references.pmid: 19668361
references.citation: Arch Suicide Res. 2011;15(3):223-37
references.pmid: 21827312
references.citation: Indian J Crit Care Med. 2009 Jul-Sep;13(3):152-5
references.pmid: 20040813
references.citation: BMC Public Health. 2008 Jan 23;8:26
references.pmid: 18215262
references.citation: Ethn Health. 1998 Nov;3(4):255-63
references.pmid: 10403107
references.citation: Br J Psychiatry. 2005 Dec;187:583-4
references.pmid: 16319413
references.citation: Crisis. 2008;29(1):4-10
references.pmid: 18389640
references.citation: Suicide Life Threat Behav. 2002 Winter;32(4):359-69
references.pmid: 12501961
references.citation: Acta Psychiatr Scand. 2001 Nov;104(5):332-9
references.pmid: 11722313
references.citation: Crisis. 2009;30(2):85-9
references.pmid: 19525167
references.citation: Alcohol Alcohol. 2008 Jan-Feb;43(1):49-50
references.pmid: 17855334
references.citation: Int J Ment Health Syst. 2010 Feb 17;4(1):3
references.pmid: 20163711
references.citation: Psychiatry Res. 2006 Sep 30;144(1):79-86
references.pmid: 16919336
references.citation: Gen Hosp Psychiatry. 2007 Sep-Oct;29(5):388-95
references.pmid: 17888804
references.citation: Chang Gung Med J. 2009 Sep-Oct;32(5):543-52
references.pmid: 19840512
references.citation: Clin Toxicol (Phila). 2006;44(3):283-6
references.pmid: 16749546
references.citation: JAMA. 2005 Oct 26;294(16):2064-74
references.pmid: 16249421
references.citation: Ceylon Med J. 2012 Dec;57(4):152-8
references.pmid: 23292057
references.citation: J Epidemiol Community Health. 1997 Apr;51(2):175-9
references.pmid: 9196648
references.citation: Am J Psychiatry. 1985 May;142(5):559-63
references.pmid: 3985195
references.citation: Arch Gen Psychiatry. 1999 Jul;56(7):617-26
references.pmid: 10401507
references.citation: Am J Public Health. 2007 Oct;97(10):1842-6
references.pmid: 17395838
references.citation: Am J Psychiatry. 2010 Jul;167(7):801-8
references.pmid: 20478879
references.citation: Soc Psychiatry Psychiatr Epidemiol. 2005 Jan;40(1):64-71
references.pmid: 15624077
references.citation: Suicide Life Threat Behav. 2010 Aug;40(4):383-93
references.pmid: 20822365
references.citation: Br J Psychiatry. 1996 Jan;168(1):43-8
references.pmid: 8770427
references.citation: BMC Public Health. 2012 Aug 02;12:593
references.pmid: 22852867
references.citation: Addiction. 2009 Sep;104(9):1487-500
references.pmid: 19686518
references.citation: Epidemiology. 1990 Jan;1(1):43-6
references.pmid: 2081237
references.citation: Bull World Health Organ. 2009 Mar;87(3):180-5
references.pmid: 19377713
references.citation: Indian J Psychiatry. 2010 Jan;52(1):48-56
references.pmid: 20174518
references.citation: Arch Suicide Res. 2008;12(4):366-9
references.pmid: 18828040
references.citation: Indian J Psychiatry. 1999 Apr;41(2):122-30
references.pmid: 21455374
references.citation: Crisis. 2001;22(3):93-101
references.pmid: 11831606
references.citation: Crisis. 2009;30(3):136-43
references.pmid: 19767269
references.citation: Trop Med Int Health. 2005 Jun;10(6):589-96
references.pmid: 15941423
references.citation: Indian J Psychiatry. 2011 Jan;53(1):30-5
references.pmid: 21431005
references.citation: Acta Psychiatr Scand. 1990 Jul;82(1):77-81
references.pmid: 2399824
references.citation: JAMA. 2003 Jun 18;289(23):3095-105
references.pmid: 12813115
references.citation: Suicide Life Threat Behav. 2006 Apr;36(2):223-38
references.pmid: 16704326
references.citation: Gen Hosp Psychiatry. 2000 Jul-Aug;22(4):281-8
references.pmid: 10936636