The impact of the COVID-19 pandemic and lockdowns on self-poisoning and suicide in Sri Lanka: An interrupted time series analysis

Thilini Rajapakse*, Tharuka Silva, Nirosha Madhuwanthi Hettiarachchi, David J Gunnell, Chris Metcalfe, Matt Spittal, Duleeka Knipe*

*Corresponding author for this work

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

6 Citations (Scopus)


Evidence from high income countries suggests that the impact of COVID-19 on suicide and self-harm has been limited, but evidence from low- and middle-income countries is lacking. Using data from a hospital-based self-poisoning register (Jan 2019-Dec 2021) and data from national records (2016-2021) of suicide in Sri Lanka, we aimed to assess the impact of the pandemic on both self-poisoning and suicide. We examined changes in admissions for self-poisoning and suicide using interrupted time series (ITS) analysis. For the self-poisoning hospital admission ITS models we defined the lockdown periods as follows: i) pre-lockdown:01/01/2019-19/03/2020; ii) first lockdown:20/03/2020-27/06/2020; iii) post first lockdown:28/06/2020-11/05/2021; iv) second lock-down:12/05/2021-21/06/2021; and v) post second lockdown:22/06/2021-31/12/2021. For suicide we defined the intervention according to pandemic period. We found that during lockdown periods there was a reduction in hospital admissions for self-poisoning, with evidence that admission following self-poisoning remained lower during the pandemic than would be expected based on pre-pandemic trends. In contrast, there was no evidence that the rate of suicide in the pandemic period differed to that which would be expected. As the long-term socioeconomic impacts of the pandemic are realised, it will be important to track rates of self-harm and suicide in LMICs to inform prevention.
Original languageEnglish
Article number1833
Pages (from-to)1-14
JournalInternational Journal of Environmental Research and Public Health
Issue number3
Publication statusPublished - 19 Jan 2023

Bibliographical note

Funding Information:
The authors acknowledge the support of the South Asian Clinical Toxicology Research Collaboration (SACTRC) and the SACTRC research team for this study. We also thank the staff of the Toxicology Unit, Teaching Hospital Peradeniya, Sri Lanka, for facilitating data collection.

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). D.K. 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. D.G. is supported by the NIHR Biomedical Research Centre at University Hospitals Bristol and Weston NHS Foundation Trust and the University of Bristol (BRC-1215-20011). M.J.S. is a recipient of an Australian Research Council Future Fellowship (project number FT180100075) funded by the Australian Government.

Publisher Copyright:
© 2023 by the authors.

Structured keywords

  • SASH


  • Suicide; self-harm; Sri Lanka; Covid-19; pandemic; low and middle income country; global mental health


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