Childhood adversity and deliberate self-poisoning in Sri Lanka: a protocol for a hospital-based case-control study

Duleeka W. Knipe*, Piumee Bandara, Lalith Senarathna, Judi Kidger, José López-López, Thilini Rajapakse

*Corresponding author for this work

Research output: Contribution to journalArticle (Academic Journal)peer-review

4 Citations (Scopus)
227 Downloads (Pure)


Childhood adversity (CA) has been suggested as a key risk factor for suicidal behaviour, but evidence from low and middle-income countries (LMIC) is lacking. In Sri Lanka, CA, in the form of child maltreatment or as a consequence of maternal separation, has been highlighted in primarily qualitative or case-series work as a potentially important determinant of suicidal behaviour. To date, there have been no quantitative studies to investigate CA as a key exposure associated with suicidal behaviour in Sri Lanka. The aim of the research is to understand the association between CA and suicidal behaviour in Sri Lanka and to identify potentially modifiable factors to reduce any observed increased risk of suicidal behaviour associated with CA.

Methods and analysis:
This is a hospital-based case-control study. Cases (n=200) will be drawn from individuals admitted to the medical toxicology ward of the Teaching Hospital Peradeniya (THP), Sri Lanka for medical management of intentional self-poisoning. Sex and age frequency matched controls (n=200) will be recruited from either patients or accompanying visitors presenting at the outpatient department and clinic of the same hospital for conditions unrelated to the outcome of interest. Conditional logistic regression will be used to investigate the association between CA and deliberate self-poisoning and whether the association is altered by other key factors including socio-economic status, psychiatric morbidity, current experiences of domestic violence and social support.

Ethics and dissemination:
Ethics approval has been obtained from the Ethical Review Committee of the Faculty of Medicine, University of Peradeniya, Sri Lanka. Researchers have been trained in administering the questionnaire and a participant safety and distress protocol has been designed to guide researchers in ensuring participant safety and how to deal with a distressed participant. Results will be disseminated in local policy fora and peer-reviewed articles, local media, and national and international conferences.
Original languageEnglish
Article numbere027766
Number of pages6
JournalBMJ Open
Publication statusPublished - 18 Aug 2019

Structured keywords

  • SASH


  • childhood adversity
  • domestic violence
  • low and middle-income countries
  • suicide & self-harm


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