Is Perceived Poor School Connectedness Associated With Self-Poisoning in Adulthood in a Sri Lankan Population? A Case–Control Study

Background:
Globally over 720,000 deaths yearly are due to suicide, approximately 20% due to pesticide self-poisoning. Poor school-connectedness has been shown to be associated with increased risk of suicidal thoughts and behaviors in high-income countries, while good school-connectedness is protective of suicidality. This study investigated associations between poor school-connectedness and self-poisoning in a low- and middle-income country.

Methods:
We used data collected in a hospital-based case–control study in rural Sri Lanka. Cases (n = 298) were adults admitted due to self-poisoning, and controls (n = 596) frequency matched on age and sex. Structured interviews assessed school-connectedness using four questions, and data on confounders (ethnicity, parental migration, child adversity, and parental education) were also collected. Associations were quantified using logistic regression.

Results:
Individuals with poorer relationships with other students (OR = 1.90, 95% CI 1.22, −2.95) and lower levels of school enjoyment (OR = 1.34, 95% CI 0.94, −1.92) were more likely to present for self-poisoning in adulthood. They were also more likely to report poor relationships with teachers, but this relationship was not as strong (OR = 1.30, 95% CI 0.90, −1.88).

Limitations:
The questionnaire used is not validated in this setting. Additionally, this is a retrospective study using a hospital sample, which may be impacted by recall bias and/or excluding individuals who did not seek hospital treatment.

Conclusions:
Interventions to improve school-connectedness in Sri Lanka, with a particular focus on relationships between students, may reduce self-poisoning in adulthood. Further research is needed to explore how to achieve this, and to understand the reasons for association between school-connectedness and self-poisoning.