Sex education and self-poisoning in Sri Lanka: an explorative analysis

Grace F Crowley; Piumee Bandara; Lalith Senarathna; Ayodhya S Malalagama; Sonali Gunasekera; Thilini N Rajapakse; Duleeka  Knipe

doi:10.1186/s12889-021-12374-4

Sex education and self-poisoning in Sri Lanka: an explorative analysis

Grace F Crowley^*, Piumee Bandara, Lalith Senarathna, Ayodhya S Malalagama, Sonali Gunasekera, Thilini N Rajapakse, Duleeka Knipe

^*Corresponding author for this work

Research output: Contribution to journal › Article (Academic Journal) › peer-review

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Abstract

Background: Self-harm and suicide are important causes of morbidity and mortality in Sri Lanka, but our understanding of these behaviours is limited. Qualitative studies have implicated familial and societal expectations around sex and relationships. We conducted an explorative analysis using case-control data to investigate the association between sex education and self-poisoning in Sri Lanka.

Methods: Cases (N=298) were self-poisoning inpatients on a toxicology ward, Teaching Hospital Peradeniya. Controls (N=500) were sex and age frequency matched to cases and were outpatients/visitors to the same hospital. Participants were asked whether they had received sex education, and to rate the quality and usefulness of any sex education received. Logistic regression models adjusted for age, sex, and religion quantified the association between receipt, quality and usefulness of sex education and self-poisoning. We tested whether the associations differed by sex.

Results: Roughly 1-in-3 cases and 1-in-5 controls reported having not received sex education. Individuals who did not receive sex education were nearly twice as likely to have self-poisoned than those who did (OR 1.68 (95% CI 1.11-2.55)). Those who reported the sex education they received as not useful were more likely to have self-poisoned compared to those who reported it useful (OR 1.95 (95% CI 1.04-3.65)). We found no evidence of an association between self-poisoning and the self-rated quality of sex education, or that associations differed by participant sex.

Conclusion: As sex education is potentially modifiable at the population-level, further research should aim to explore this association in more depth, using qualitative methods and validated measurement tools.

Original language	English
Article number	26
Number of pages	11
Journal	BMC Public Health
Volume	22
Issue number	1
DOIs	https://doi.org/10.1186/s12889-021-12374-4
Publication status	Published - 6 Jan 2022

Bibliographical note

Funding Information:
The authors would like to thank the senior academics who have acted as advisors for the study: Professors Chris Metcalfe, David Gunnell and Gene Feder (University of Bristol), Professor Michael Eddleston (University of Edinburgh) and Professor Flemming Konradsen (University of Copenhagen). The authors would also like to thank Dr Asha Abeyasekera (University of Colombo) for providing support with interpreting the findings of this analysis and offering comments on the initial draft of the manuscript. The authors would like to thank the staff at SACTRC, in particular Chamil Kumara, Indunil Abeyratne, and Sujani Ekanayake for their support in setting up the study and would like to acknowledge the substantial contribution of the data collection team Azra Aroos, Kasuni Silva, Tharuka Silva and Sandareka Samarakoon, and the staff at the Teaching Hospital Peradeniya for accommodating this research. The authors thank Mr Upali Perera for designing and maintaining the study database. Finally, the authors would like to acknowledge the Elizabeth Blackwell Institute for Health Research, University of Bristol and the Wellcome Trust Institutional Strategic Support Fund for supporting DK.

Funding Information:
The authors would like to thank the senior academics who have acted as advisors for the study: Professors Chris Metcalfe, David Gunnell and Gene Feder (University of Bristol), Professor Michael Eddleston (University of Edinburgh) and Professor Flemming Konradsen (University of Copenhagen). The authors would also like to thank Dr Asha Abeyasekera (University of Colombo) for providing support with interpreting the findings of this analysis and offering comments on the initial draft of the manuscript. The authors would like to thank the staff at SACTRC, in particular Chamil Kumara, Indunil Abeyratne, and Sujani Ekanayake for their support in setting up the study and would like to acknowledge the substantial contribution of the data collection team Azra Aroos, Kasuni Silva, Tharuka Silva and Sandareka Samarakoon, and the staff at the Teaching Hospital Peradeniya for accommodating this research. The authors thank Mr Upali Perera for designing and maintaining the study database. Finally, the authors would like to acknowledge the Elizabeth Blackwell Institute for Health Research, University of Bristol and the Wellcome Trust Institutional Strategic Support Fund for supporting DK.

Funding Information:
This work was supported by the UK Medical Research Council (grant number MC_PC_MR/R019622/1), and the Elizabeth Blackwell Institute for Health Research, University of Bristol. This research was funded in part by the Wellcome Trust Institutional Strategic Support Fund [ISSF3: 204813/Z/16/Z]. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Publisher Copyright:
© 2021, The Author(s).

Structured keywords

SASH

Keywords

Self-poisoning
Self-harm
Suicidal behaviour
Sex education
Sri-Lanka

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.1186/s12889-021-12374-4

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Hospital based case-control study of self-poisoning in Sri Lanka
Knipe, D., Kidger, J. L., Lopez-Lopez, J. A., Senarathna, L. & Rajapakse, T. N.
8/03/18 → 28/02/19
Project: Research

Data from ACE & Self harm Sri Lanka (10-2020)
Knipe, D. (Creator) & Kidger, J. L. (Creator), University of Bristol, 5 Oct 2020
DOI: 10.5523/bris.37pg6mv6x35r12b98aoq4blcgs, http://data.bris.ac.uk/data/dataset/37pg6mv6x35r12b98aoq4blcgs
Dataset

Cite this

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title = "Sex education and self-poisoning in Sri Lanka: an explorative analysis",

abstract = "Background: Self-harm and suicide are important causes of morbidity and mortality in Sri Lanka, but our understanding of these behaviours is limited. Qualitative studies have implicated familial and societal expectations around sex and relationships. We conducted an explorative analysis using case-control data to investigate the association between sex education and self-poisoning in Sri Lanka.Methods: Cases (N=298) were self-poisoning inpatients on a toxicology ward, Teaching Hospital Peradeniya. Controls (N=500) were sex and age frequency matched to cases and were outpatients/visitors to the same hospital. Participants were asked whether they had received sex education, and to rate the quality and usefulness of any sex education received. Logistic regression models adjusted for age, sex, and religion quantified the association between receipt, quality and usefulness of sex education and self-poisoning. We tested whether the associations differed by sex. Results: Roughly 1-in-3 cases and 1-in-5 controls reported having not received sex education. Individuals who did not receive sex education were nearly twice as likely to have self-poisoned than those who did (OR 1.68 (95% CI 1.11-2.55)). Those who reported the sex education they received as not useful were more likely to have self-poisoned compared to those who reported it useful (OR 1.95 (95% CI 1.04-3.65)). We found no evidence of an association between self-poisoning and the self-rated quality of sex education, or that associations differed by participant sex.Conclusion: As sex education is potentially modifiable at the population-level, further research should aim to explore this association in more depth, using qualitative methods and validated measurement tools.",

keywords = "Self-poisoning, Self-harm, Suicidal behaviour, Sex education, Sri-Lanka",

author = "Crowley, {Grace F} and Piumee Bandara and Lalith Senarathna and Malalagama, {Ayodhya S} and Sonali Gunasekera and Rajapakse, {Thilini N} and Duleeka Knipe",

note = "Funding Information: The authors would like to thank the senior academics who have acted as advisors for the study: Professors Chris Metcalfe, David Gunnell and Gene Feder (University of Bristol), Professor Michael Eddleston (University of Edinburgh) and Professor Flemming Konradsen (University of Copenhagen). The authors would also like to thank Dr Asha Abeyasekera (University of Colombo) for providing support with interpreting the findings of this analysis and offering comments on the initial draft of the manuscript. The authors would like to thank the staff at SACTRC, in particular Chamil Kumara, Indunil Abeyratne, and Sujani Ekanayake for their support in setting up the study and would like to acknowledge the substantial contribution of the data collection team Azra Aroos, Kasuni Silva, Tharuka Silva and Sandareka Samarakoon, and the staff at the Teaching Hospital Peradeniya for accommodating this research. The authors thank Mr Upali Perera for designing and maintaining the study database. Finally, the authors would like to acknowledge the Elizabeth Blackwell Institute for Health Research, University of Bristol and the Wellcome Trust Institutional Strategic Support Fund for supporting DK. Funding Information: The authors would like to thank the senior academics who have acted as advisors for the study: Professors Chris Metcalfe, David Gunnell and Gene Feder (University of Bristol), Professor Michael Eddleston (University of Edinburgh) and Professor Flemming Konradsen (University of Copenhagen). The authors would also like to thank Dr Asha Abeyasekera (University of Colombo) for providing support with interpreting the findings of this analysis and offering comments on the initial draft of the manuscript. The authors would like to thank the staff at SACTRC, in particular Chamil Kumara, Indunil Abeyratne, and Sujani Ekanayake for their support in setting up the study and would like to acknowledge the substantial contribution of the data collection team Azra Aroos, Kasuni Silva, Tharuka Silva and Sandareka Samarakoon, and the staff at the Teaching Hospital Peradeniya for accommodating this research. The authors thank Mr Upali Perera for designing and maintaining the study database. Finally, the authors would like to acknowledge the Elizabeth Blackwell Institute for Health Research, University of Bristol and the Wellcome Trust Institutional Strategic Support Fund for supporting DK. Funding Information: This work was supported by the UK Medical Research Council (grant number MC_PC_MR/R019622/1), and the Elizabeth Blackwell Institute for Health Research, University of Bristol. This research was funded in part by the Wellcome Trust Institutional Strategic Support Fund [ISSF3: 204813/Z/16/Z]. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. Publisher Copyright: {\textcopyright} 2021, The Author(s).",

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month = jan,

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doi = "10.1186/s12889-021-12374-4",

language = "English",

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TY - JOUR

T1 - Sex education and self-poisoning in Sri Lanka: an explorative analysis

AU - Crowley, Grace F

AU - Bandara, Piumee

AU - Senarathna, Lalith

AU - Malalagama, Ayodhya S

AU - Gunasekera, Sonali

AU - Rajapakse, Thilini N

AU - Knipe, Duleeka

N1 - Funding Information: The authors would like to thank the senior academics who have acted as advisors for the study: Professors Chris Metcalfe, David Gunnell and Gene Feder (University of Bristol), Professor Michael Eddleston (University of Edinburgh) and Professor Flemming Konradsen (University of Copenhagen). The authors would also like to thank Dr Asha Abeyasekera (University of Colombo) for providing support with interpreting the findings of this analysis and offering comments on the initial draft of the manuscript. The authors would like to thank the staff at SACTRC, in particular Chamil Kumara, Indunil Abeyratne, and Sujani Ekanayake for their support in setting up the study and would like to acknowledge the substantial contribution of the data collection team Azra Aroos, Kasuni Silva, Tharuka Silva and Sandareka Samarakoon, and the staff at the Teaching Hospital Peradeniya for accommodating this research. The authors thank Mr Upali Perera for designing and maintaining the study database. Finally, the authors would like to acknowledge the Elizabeth Blackwell Institute for Health Research, University of Bristol and the Wellcome Trust Institutional Strategic Support Fund for supporting DK. Funding Information: The authors would like to thank the senior academics who have acted as advisors for the study: Professors Chris Metcalfe, David Gunnell and Gene Feder (University of Bristol), Professor Michael Eddleston (University of Edinburgh) and Professor Flemming Konradsen (University of Copenhagen). The authors would also like to thank Dr Asha Abeyasekera (University of Colombo) for providing support with interpreting the findings of this analysis and offering comments on the initial draft of the manuscript. The authors would like to thank the staff at SACTRC, in particular Chamil Kumara, Indunil Abeyratne, and Sujani Ekanayake for their support in setting up the study and would like to acknowledge the substantial contribution of the data collection team Azra Aroos, Kasuni Silva, Tharuka Silva and Sandareka Samarakoon, and the staff at the Teaching Hospital Peradeniya for accommodating this research. The authors thank Mr Upali Perera for designing and maintaining the study database. Finally, the authors would like to acknowledge the Elizabeth Blackwell Institute for Health Research, University of Bristol and the Wellcome Trust Institutional Strategic Support Fund for supporting DK. Funding Information: This work was supported by the UK Medical Research Council (grant number MC_PC_MR/R019622/1), and the Elizabeth Blackwell Institute for Health Research, University of Bristol. This research was funded in part by the Wellcome Trust Institutional Strategic Support Fund [ISSF3: 204813/Z/16/Z]. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. Publisher Copyright: © 2021, The Author(s).

PY - 2022/1/6

Y1 - 2022/1/6

N2 - Background: Self-harm and suicide are important causes of morbidity and mortality in Sri Lanka, but our understanding of these behaviours is limited. Qualitative studies have implicated familial and societal expectations around sex and relationships. We conducted an explorative analysis using case-control data to investigate the association between sex education and self-poisoning in Sri Lanka.Methods: Cases (N=298) were self-poisoning inpatients on a toxicology ward, Teaching Hospital Peradeniya. Controls (N=500) were sex and age frequency matched to cases and were outpatients/visitors to the same hospital. Participants were asked whether they had received sex education, and to rate the quality and usefulness of any sex education received. Logistic regression models adjusted for age, sex, and religion quantified the association between receipt, quality and usefulness of sex education and self-poisoning. We tested whether the associations differed by sex. Results: Roughly 1-in-3 cases and 1-in-5 controls reported having not received sex education. Individuals who did not receive sex education were nearly twice as likely to have self-poisoned than those who did (OR 1.68 (95% CI 1.11-2.55)). Those who reported the sex education they received as not useful were more likely to have self-poisoned compared to those who reported it useful (OR 1.95 (95% CI 1.04-3.65)). We found no evidence of an association between self-poisoning and the self-rated quality of sex education, or that associations differed by participant sex.Conclusion: As sex education is potentially modifiable at the population-level, further research should aim to explore this association in more depth, using qualitative methods and validated measurement tools.

AB - Background: Self-harm and suicide are important causes of morbidity and mortality in Sri Lanka, but our understanding of these behaviours is limited. Qualitative studies have implicated familial and societal expectations around sex and relationships. We conducted an explorative analysis using case-control data to investigate the association between sex education and self-poisoning in Sri Lanka.Methods: Cases (N=298) were self-poisoning inpatients on a toxicology ward, Teaching Hospital Peradeniya. Controls (N=500) were sex and age frequency matched to cases and were outpatients/visitors to the same hospital. Participants were asked whether they had received sex education, and to rate the quality and usefulness of any sex education received. Logistic regression models adjusted for age, sex, and religion quantified the association between receipt, quality and usefulness of sex education and self-poisoning. We tested whether the associations differed by sex. Results: Roughly 1-in-3 cases and 1-in-5 controls reported having not received sex education. Individuals who did not receive sex education were nearly twice as likely to have self-poisoned than those who did (OR 1.68 (95% CI 1.11-2.55)). Those who reported the sex education they received as not useful were more likely to have self-poisoned compared to those who reported it useful (OR 1.95 (95% CI 1.04-3.65)). We found no evidence of an association between self-poisoning and the self-rated quality of sex education, or that associations differed by participant sex.Conclusion: As sex education is potentially modifiable at the population-level, further research should aim to explore this association in more depth, using qualitative methods and validated measurement tools.

KW - Self-poisoning

KW - Self-harm

KW - Suicidal behaviour

KW - Sex education

KW - Sri-Lanka

U2 - 10.1186/s12889-021-12374-4

DO - 10.1186/s12889-021-12374-4

M3 - Article (Academic Journal)

C2 - 34991547

SN - 1471-2458

VL - 22

JO - BMC Public Health

JF - BMC Public Health

IS - 1

M1 - 26

ER -

Sex education and self-poisoning in Sri Lanka: an explorative analysis

Abstract

Bibliographical note

Structured keywords

Keywords

UN SDGs

Access to Document

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Embargoed Document

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Projects

Hospital based case-control study of self-poisoning in Sri Lanka

Datasets

Data from ACE & Self harm Sri Lanka (10-2020)

Cite this