Socioeconomic position and suicidal behaviour in rural Sri Lanka: a prospective cohort study of 168,000+ people

Dee Knipe*, David Gunnell, Ravi Pieris, Chamil Priyadarshana, Manjula Weerasinghe, Melissa Pearson, Shaluka Jayamanne, Keith Hawton, Flemming Konradsen, Michael Eddleston, Chris Metcalfe

*Corresponding author for this work

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

6 Citations (Scopus)
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Purpose: Lower socioeconomic position (SEP) is associated with an increased risk of suicidal behaviour in high income countries, but this association is not established in low- and middle-income countries (LMIC). Methods: We investigated the association of SEP with suicidal behaviour in a prospective cohort study of 168,771 Sri Lankans followed up for episodes of attempted suicide and suicide. SEP data were collected at baseline at the household and individual level at the start of the follow-up period. We used multilevel Poisson regression models to investigate the association of SEP at community, household and individual levels with attempted suicide/suicide. Results: Lower levels of asset ownership [IRR (95% CI) suicide 1.74 (0.92, 3.28); attempted suicide 1.67 (1.40, 2.00)] and education [suicide 3.16 (1.06, 9.45); attempted suicide 2.51 (1.70, 3.72)] were associated with an increased risk of suicidal behaviour. The association of these measures of SEP and attempted suicide was stronger in men than women. Individuals living in deprived areas [1.42 (1.16, 1.73)] and in households with a young female head of household [1.41 (1.04, 1.93)] or a temporary foreign migrant [1.47 (1.28, 1.68)] had an elevated risk of attempted suicide. Farmers and daily wage labourers had nearly a doubling in risk of attempted suicide compared to other occupations. Conclusions: Improved employment opportunities, welfare and mental health support services, as well as problem-solving skills development, may help support individuals with poorer education, farmers, daily wage labourers, individuals in young female-headed households and temporary foreign migrant households.

Original languageEnglish
Pages (from-to)843-855
Number of pages13
JournalSocial Psychiatry and Psychiatric Epidemiology
Issue number7
Early online date21 Feb 2019
Publication statusPublished - 10 Jul 2019

Structured keywords

  • BTC (Bristol Trials Centre)
  • Centre for Surgical Research
  • SASH


  • Suicide
  • Sri Lanka
  • Cohort Study
  • Socioeconomic position
  • Low and middle income countries


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