Hospital presentations for self-poisoning during COVID-19 in Sri Lanka: an interrupted time series analysis

Duleeka Knipe*, Tharuka Silva, Azra Aroos, Lalith Senarathna, Nirosha Madhuwanthi Hettiarachchi, Sampath R Galappaththi, Matthew J Spittal, David Gunnell, Chris Metcalfe, Thilini Rajapakse

*Corresponding author for this work

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

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Abstract

Background
There is widespread concern over the impact of public health measures, such as lockdowns, associated with COVID-19 on mental health, including suicide. High-quality evidence from low-income and middle-income countries, where the burden of suicide and self-harm is greatest, is scarce. We aimed to determine the effect of the pandemic on hospital presentations for self-poisoning.

Methods
In this interrupted time-series analysis, we established a new self-poisoning register at the tertiary care Teaching Hospital Peradeniya in Sri Lanka, a lower-middle-income country. Using a standard extraction sheet, data
were gathered for all patients admitted to the Toxicology Unit with self-poisoning between Jan 1, 2019, and Aug 31, 2020. Only patients classified by the treating clinician as having intentionally self-poisoned were included.
Data on date of admission, age or date of birth, sex, and poisoning method were collected. No data on ethnicity were available. We used interrupted time-series analysis to calculate weekly hospital admissions for self-poisoning before
(Jan 1, 2019–March 19, 2020) and during (March 20–Aug 31, 2020) the pandemic, overall and by age (age <25 years vs ≥25 years) and sex. Individuals with missing date of admission were excluded from the main analysis.
Findings Between Jan 1, 2019, and Aug 31, 2020, 1401 individuals (584 [41·7%] males, 761 [54·3%] females, and 56 [4·0%] of unknown sex) presented to the hospital with self-poisoning and had date of admission data. A 32%
(95% CI 12–48) reduction in hospital presentations for self-poisoning in the pandemic period compared with prepandemic trends was observed (rate ratio 0·68, 95% CI 0·52–0·88; p=0·0032). We found no evidence that the impact
of the pandemic differed by sex (rate ratio 0·64, 95% CI 0·44–0·94, for females vs 0·85, 0·57–1·26, for males; pinteraction=0·43) or age (0·64, 0·44–0·93, for patients aged <25 years vs 0·81, 0·57–1·16, for patients aged ≥25 years;
pinteraction=0·077).

Interpretation
This is the first study from a lower-middle-income country to estimate the impact of the pandemic on self-harm (non-fatal) accounting for underlying trends. If the fall in hospital presentations during the pandemic
reflects a reduction in the medical treatment of people who have self-poisoned, rather than a true fall in incidence, then public health messages should emphasise the importance of seeking help early.
Original languageEnglish
Pages (from-to)892-900
Number of pages9
JournalLancet Psychiatry
Volume8
Issue number10
Early online date29 Jul 2021
DOIs
Publication statusPublished - 1 Oct 2021

Bibliographical note

Funding Information:
This work was supported by the Centre for Pesticide Suicide Prevention and the Global Public Health strand of the Elizabeth Blackwell Institute for Health Research, which is funded by the Wellcome Trust and University of Bristol's Quality Related Global Challenged Research Fund strategy. The Centre for Pesticide Suicide Prevention is funded by an Incubator Grant from the Open Philanthropy Project Fund, an advised fund of the Silicon Valley Community Foundation, on the recommendation of GiveWell (San Francisco, CA, USA). DK was supported by the Wellcome Trust through an Institutional Strategic Support Fund Award to the University of Bristol (204813) and the Elizabeth Blackwell Institute for Health Research University of Bristol. DG is supported by the NIHR Biomedical Research Centre at University Hospitals Bristol and Weston NHS Foundation Trust and the University of Bristol. MJS is a recipient of an Australian Research Council Future Fellowship (project number FT180100075) funded by the Australian Government. The authors acknowledge the support of the South Asian Clinical Toxicology Research Collaboration (SACTRC) and the SACTRC research team for the study. In particular, we thank W U Jayarathna (SACTRC) for her support in responding to reviewers, and J F Mirza (senior registrar in the Department of Psychiatry at Teaching Hospital Peradeniya) for the Tamil translation of the abstract. We also thank the staff of the Toxicology Unit, Teaching Hospital Peradeniya, Sri Lanka, for facilitating data collection.

Publisher Copyright:
© 2021 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license

Structured keywords

  • Covid19
  • SASH

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