Is socioeconomic position associated with risk of attempted suicide in rural Sri Lanka? A cross-sectional study of 165 000 individuals.
Lower socioeconomic position (SEP) is associated with an increased risk of suicidal behaviour in high-income countries, but this association is unclear in low-income and middle-income countries.



We investigated the association of SEP with attempted suicide in a cross-sectional survey of 165 233 Sri Lankans. SEP data were collected at the household (assets, social standing (highest occupation of a household member), foreign employment and young (≤40 years) female-headed households) and individual level (education and occupation). Respondent-reported data on suicide attempts in the past year were recorded. Random-effects logistic regression models, accounting for clustering, were used to investigate the association of SEP with attempted suicide.



Households reported 398 attempted suicides in the preceding year (239 per 100 000). Fewer assets (OR 3.2, 95% CI 2.4 to 4.4) and having a daily wage labourer (ie, insecure/low-income job; OR 2.3, 95% CI 1.6 to 3.2) as the highest occupation increased the risk of an attempted suicide within households. At an individual level, daily wage labourers were at an increased risk of attempted suicide compared with farmers. The strongest associations were with low levels of education (OR 4.6, 95% CI 2.5 to 8.4), with a stronger association in men than women.



We found that indicators of lower SEP are associated with increased risk of attempted suicide in rural Sri Lanka. Longitudinal studies with objective measures of suicide attempts are needed to confirm this association.



NCT01146496; Pre-results.
School of Social and Community Medicine, University of Bristol, Bristol, UK.|Faculty of Medicine, South Asian Clinical Toxicology Research Collaboration (SACTRC), University of Peradeniya, Peradeniya, Sri Lanka.
D W
0000-0002-1040-7635
DW
Knipe
School of Social and Community Medicine, University of Bristol, Bristol, UK.|Faculty of Medicine, South Asian Clinical Toxicology Research Collaboration (SACTRC), University of Peradeniya, Peradeniya, Sri Lanka.
D
D
Gunnell
Faculty of Medicine, South Asian Clinical Toxicology Research Collaboration (SACTRC), University of Peradeniya, Peradeniya, Sri Lanka.
R
R
Pieris
Faculty of Medicine, South Asian Clinical Toxicology Research Collaboration (SACTRC), University of Peradeniya, Peradeniya, Sri Lanka.
C
C
Priyadarshana
Faculty of Medicine, South Asian Clinical Toxicology Research Collaboration (SACTRC), University of Peradeniya, Peradeniya, Sri Lanka.|Faculty of Medicine & Allied Sciences, Department of Community Medicine, Rajarata University of Sri Lanka, Anuradhapura, Sri Lanka.
M
M
Weerasinghe
Faculty of Medicine, South Asian Clinical Toxicology Research Collaboration (SACTRC), University of Peradeniya, Peradeniya, Sri Lanka.|Clinical Pharmacology Unit, University of Edinburgh, The Queen's Medical Research Institute, Edinburgh, UK.
M
M
Pearson
Faculty of Medicine, South Asian Clinical Toxicology Research Collaboration (SACTRC), University of Peradeniya, Peradeniya, Sri Lanka.|Faculty of Medicine, University of Kelanyia, Kelanyia, Sri Lanka.
S
S
Jayamanne
Faculty of Medicine, South Asian Clinical Toxicology Research Collaboration (SACTRC), University of Peradeniya, Peradeniya, Sri Lanka.|Central Clinical School, University of Sydney, Sydney, Australia.
A H
AH
Dawson
Faculty of Medicine, South Asian Clinical Toxicology Research Collaboration (SACTRC), University of Peradeniya, Peradeniya, Sri Lanka.|Translational Australian Clinical Toxicology (TACT) Group, School of Medical Science, University of Sydney, Sydney, Australia.
F
F
Mohamed
Faculty of Medicine, South Asian Clinical Toxicology Research Collaboration (SACTRC), University of Peradeniya, Peradeniya, Sri Lanka.|Faculty of Medicine, Department of Medicine, University of Peradeniya, Peradeniya, Sri Lanka.
I
I
Gawarammana
Department of Psychiatry, Centre for Suicide Research, University of Oxford, Oxford, UK.
K
K
Hawton
Faculty of Medicine, South Asian Clinical Toxicology Research Collaboration (SACTRC), University of Peradeniya, Peradeniya, Sri Lanka.|Faculty of Health and Medical Sciences, Department of Public Health, University of Copenhagen, Copenhagen, Denmark.
F
F
Konradsen
Faculty of Medicine, South Asian Clinical Toxicology Research Collaboration (SACTRC), University of Peradeniya, Peradeniya, Sri Lanka.|Clinical Pharmacology Unit, University of Edinburgh, The Queen's Medical Research Institute, Edinburgh, UK.
M
M
Eddleston
School of Social and Community Medicine, University of Bristol, Bristol, UK.
C
C
Metcalfe
D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D002648:Child; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D012424:Rural Population / Q000706:statistics & numerical data; D017678:Sex Distribution; D012959:Socioeconomic Factors; D013188:Sri Lanka; D013406:Suicide, Attempted / Q000706:statistics & numerical data*; D055815:Young Adult
EPIDEMIOLOGY; MENTAL HEALTH; PUBLIC HEALTH; SOCIAL MEDICINE