Domestic violence and self-poisoning in Sri Lanka

Background
There is increasing evidence that domestic violence (DV) is an important risk factor for suicidal behaviour. The level of risk and its contribution to the overall burden of suicidal behaviour among men and women has not been quantified in South Asia. We carried out a large case-control study to examine the association between DV and self-poisoning in Sri Lanka.

Methods
Cases (N=291) were patients aged ≥18 years, admitted to a tertiary hospital in Kandy Sri Lanka for self-poisoning. Sex and age frequency matched controls were recruited from the hospital’s outpatient department (N=490) and local population (N=450). Exposure to DV was collected through the Humiliation, Afraid, Rape, Kick (HARK) questionnaire. Multivariable logistic regression models were conducted to estimate the association between DV and self-poisoning, and population attributable fractions (PAF) were estimated.

Results
Exposure to at least one type of DV within the previous 12 months was strongly associated with self-poisoning for women (adjusted OR [AOR] 4·08, 95%CI 1·60-4·78) and men (AOR 2·52, 95%CI 1·51-4·21), compared to those reporting no abuse. Among women, the association was strongest for physical violence (AOR 14·07, 95%CI 5·87-33·72), whereas among men, emotional abuse showed the highest risk (AOR 2·75, 95%CI 1·57-4·82). PAF% for exposure to at least one type of DV was 38% (95%CI 32-43) in women and 22% (95%CI 14-29) in men.

Conclusions
Multi-sectoral interventions to address DV including enhanced identification in health care settings, community-based strategies, and integration of DV support and psychological services may substantially reduce suicidal behaviour in Sri Lanka.