title: Non-fatal self-poisoning in Sri Lanka: associated triggers and motivations.
abstract: BACKGROUND
  Attempted or non-fatal self-poisoning is common in Sri Lanka. To date, most preventive strategies have focused on limitation of access to toxic pesticides, which has reduced the rates of fatal self-poisoning. However the ongoing phenomenon of non-fatal self-poisoning indicates the need for exploration of alternate preventive strategies. Self-poisoning in Sri Lanka has been described as impulsive, with little premeditation, but the motivations associated with this act have not been studied in depth. This research describes the triggers and motivations associated with non-fatal self-poisoning in Sri Lanka. It is anticipated that the findings would help guide future preventive strategies.
  
  
  METHODS
  Two studies were carried out, at Teaching Hospital Peradeniya, Sri Lanka, each using a different methodology - Study 1 consisted of qualitative semi-structured interviews, and Study 2 was a cross sectional survey. Both studies were conducted among those who had recently attempted self-poisoning, and explored associated triggers and motivations associated with the act of self-poisoning. There was no overlap between participants of the two studies.
  
  
  RESULTS
  A total of 24 persons participated in the semi-structured interviews (Study 1), and 921 took part in the cross-sectional survey (Study 2). Interpersonal conflict was the most common trigger prior to the act of non-fatal self-poisoning. A mixture of motivations was associated with the act of self-poisoning, including intent to die, to escape, and difficulty tolerating distress associated with interpersonal conflict.
  
  
  CONCLUSIONS
  Development of interpersonal skills and interpersonal problem solving skills, particularly in adolescents and young people, emerges as a key primary preventive strategy. Further, there is value in exploring and helping people to develop more adaptive strategies to cope with emotional distress associated with interpersonal conflict. While distress tolerance and interpersonal skill training strategies used in the West may be considered, it is also important to adapt and develop strategies suited to the local cultural background. Further research is needed to develop and evaluate such strategies, and findings may have implications not only to Sri Lanka but also for other countries in South Asia.
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.affiliation: Centre for Mental Health Research, The Australian National University, Building 63, Canberra, ACT 0200, Australia. Kathy.Griffiths@anu.edu.au.
authors.forename: Kathleen Margaret
authors.initials: KM
authors.lastname: Griffiths
authors.affiliation: Black Dog Institute, University of New South Wales, Hospital Road, Randwich, NSW, 2013, Australia. h.christensen@blackdog.org.au.
authors.forename: Helen
authors.initials: H
authors.lastname: Christensen
authors.affiliation: Centre for Youth Mental Health, University of Melbourne, 35, Poplar Road, Parkville, VIC, 3052, Australia. smcotton@unimelb.edu.au.
authors.forename: Sue
authors.initials: S
authors.lastname: Cotton
mesh_terms: D000223:Adaptation, Psychological; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001208:Asia; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D007398:Interpersonal Relations; D008297:Male; D008875:Middle Aged; D009042:Motivation; D011042:Poisons / Q000008:administration & dosage*; D013188:Sri Lanka; D013315:Stress, Psychological / Q000150:complications*; D013406:Suicide, Attempted / Q000523:psychology*; D055815:Young Adult
chemical_list: D011042:Poisons