Hostname: page-component-8448b6f56d-cfpbc Total loading time: 0 Render date: 2024-04-23T10:56:34.865Z Has data issue: false hasContentIssue false
  • English
  • Français

Domestic violence and self-poisoning in Sri Lanka

Published online by Cambridge University Press:  11 September 2020

Piumee Bandara Open the ORCID record for Piumee Bandara [Opens in a new window] ,
Andrew Page ,
Lalith Senarathna ,
Judi Kidger ,
Gene Feder ,
David Gunnell ,
Thilini Rajapakse  and
Duleeka Knipe
Piumee Bandara*
Affiliation:
Translational Health Research Institute, Western Sydney University, New South Wales, Australia South Asian Clinical Toxicology Research Collaboration, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
Andrew Page
Affiliation:
Translational Health Research Institute, Western Sydney University, New South Wales, Australia
Lalith Senarathna
Affiliation:
South Asian Clinical Toxicology Research Collaboration, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka Department of Health Promotion, Faculty of Applied Sciences, Rajarata University of Sri Lanka, Mihintale, Sri Lanka
Judi Kidger
Affiliation:
Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
Gene Feder
Affiliation:
Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK National Institute of Health Research Biomedical Research Centre, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
David Gunnell
Affiliation:
Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK National Institute of Health Research Biomedical Research Centre, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
Thilini Rajapakse
Affiliation:
South Asian Clinical Toxicology Research Collaboration, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka Department of Psychiatry, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
Duleeka Knipe
Affiliation:
South Asian Clinical Toxicology Research Collaboration, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
*
Author for correspondence: Piumee Bandara, E-mail: p.bandara@westernsydney.edu.au
Get access Rights & Permissions [Opens in a new window]

Abstract

Background

There is increasing evidence that domestic violence (DV) is an important risk factor for suicidal behaviour. The level of risk and its contribution to the overall burden of suicidal behaviour among men and women has not been quantified in South Asia. We carried out a large case-control study to examine the association between DV and self-poisoning in Sri Lanka.

Methods

Cases (N = 291) were patients aged ⩾18 years, admitted to a tertiary hospital in Kandy Sri Lanka for self-poisoning. Sex and age frequency matched controls were recruited from the hospital's outpatient department (N = 490) and local population (N = 450). Exposure to DV was collected through the Humiliation, Afraid, Rape, Kick questionnaire. Multivariable logistic regression models were conducted to estimate the association between DV and self-poisoning, and population attributable fractions were calculated.

Results

Exposure to at least one type of DV within the previous 12 months was strongly associated with self-poisoning for women [adjusted OR (AOR) 4.08, 95% CI 1.60–4.78] and men (AOR 2.52, 95% CI 1.51–4.21), compared to those reporting no abuse. Among women, the association was strongest for physical violence (AOR 14.07, 95% CI 5.87–33.72), whereas among men, emotional abuse showed the highest risk (AOR 2.75, 95% CI 1.57–4.82). PAF% for exposure to at least one type of DV was 38% (95% CI 32–43) in women and 22% (95% CI 14–29) in men.

Conclusions

Multi-sectoral interventions to address DV including enhanced identification in health care settings, community-based strategies, and integration of DV support and psychological services may substantially reduce suicidal behaviour in Sri Lanka.

Keywords

Domestic violencegender-based violenceintimate partner violenceself-harmself-poisoningsuicidal behavioursuicidesuicide attemptSri LankaSouth Asia
Type
Original Article
Information
Psychological Medicine , Volume 52 , Issue 6 , April 2022 , pp. 1183 - 1191
Check for updates
Copyright
Copyright © The Author(s), 2020. Published by Cambridge University Press

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Footnotes

*

These authors contributed equally.

References

Abramsky, T., Watts, C. H., Garcia-Moreno, C., Devries, K., Kiss, L., Ellsberg, M., … Heise, L. (2011). What factors are associated with recent intimate partner violence? Findings from the WHO multi-country study on women's health and domestic violence. BMC Public Health, 11(1), 109. doi: 10.1186/1471-2458-11-109CrossRefGoogle Scholar
Akotia, C. S., Knizek, B. L., Hjelmeland, H., Kinyanda, E., & Osafo, J. (2019). Reasons for attempting suicide: An exploratory study in Ghana. Transcultural Psychiatry, 56(1), 233–249.CrossRefGoogle ScholarPubMed
American Foundation for Suicide Prevention. (2018). The Association of Social Capital and Self-Harm in Rural Sri Lanka. Retrieved from https://afsp.org/grant/the-association-of-social-capital-and-self-harm-in-rural-sri-lankaGoogle Scholar
Chowdhary, N., & Patel, V. (2008). The effect of spousal violence on women's health: Findings from the Stree Arogya Shodh in Goa, India. Journal of Postgraduate Medicine, 54(4), 306. doi: 10.4103/0022-3859.43514CrossRefGoogle ScholarPubMed
Chowdhury, A. N., Brahma, A., Banerjee, S., & Biswas, M. (2009). Pattern of domestic violence amongst non-fatal deliberate self-harm attempters: A study from primary care of West Bengal. Indian Journal of Psychiatry, 51(2), 96. doi: 10.4103/0019-5545.49448CrossRefGoogle ScholarPubMed
Coker, A. L., Smith, P. H., Thompson, M. P., McKeown, R. E., Bethea, L., & Davis, K. E. (2002). Social support protects against the negative effects of partner violence on mental health. Journal of Women's Health & Gender-Based Medicine, 11(5), 465–476.CrossRefGoogle ScholarPubMed
Colucci, E., & Lester, D. (2012). Suicide and culture: Understanding the context. Cambridge, MA: Hogrefe Publishing.Google Scholar
DCS. (2012). Census of population and housing - 2012. Colombo: Department of Census and Statistics Sri Lanka.Google Scholar
DCS. (2016). Sri Lanka Demographic and health survey 2016. Colombo, Sri Lanka: Department of Census and Statistics (DCS) and Ministry of Health, Nutrition and Indigenous Medicine.Google Scholar
de Silva, V. A., Senanayake, S., Dias, P., & Hanwella, R. (2012). From pesticides to medicinal drugs: Time series analyses of methods of self-harm in Sri Lanka. Bulletin of the World Health Organization, 90, 40–46. doi: 10.2471/BLT.11.091785CrossRefGoogle ScholarPubMed
Devries, K. M., Mak, J. Y., Bacchus, L. J., Child, J. C., Falder, G., Petzold, M., … Watts, C. H. (2013). Intimate partner violence and incident depressive symptoms and suicide attempts: A systematic review of longitudinal studies. PLoS Medicine, 10(5), e1001439. doi: 10.1371/journal.pmed.1001439CrossRefGoogle ScholarPubMed
Devries, K. M., Watts, C., Yoshihama, M., Kiss, L., Schraiber, L. B., Deyessa, N., … Jansen, H. (2011). Violence against women is strongly associated with suicide attempts: Evidence from the WHO multi-country study on women's health and domestic violence against women. Social Science & Medicine, 73(1), 79–86. doi: 10.1016/j.socscimed.2011.05.006CrossRefGoogle Scholar
Eddleston, M., Gunnell, D., Karunaratne, A., De Silva, D., Sheriff, M. R., & Buckley, N. A. (2005). Epidemiology of intentional self-poisoning in rural Sri Lanka. The British Journal of Psychiatry, 187(6), 583–584. doi: 10.1192/bjp.187.6.583CrossRefGoogle ScholarPubMed
Ellsberg, M., Jansen, H. A., Heise, L., Watts, C. H., & Garcia-Moreno, C. (2008). Intimate partner violence and women's physical and mental health in the WHO multi-country study on women's health and domestic violence: An observational study. The Lancet, 371(9619), 1165–1172. doi: 10.1016/S0140-6736(08)60522-XCrossRefGoogle Scholar
Fedina, L., Mushonga, D. R., Bessaha, M. L., Jun, H.-J., Narita, Z., & DeVylder, J. (2019). Moderating effects of perceived neighborhood factors on intimate partner violence, psychological distress, and suicide risk. Journal of Interpersonal Violence, 1–18. doi: 10.1177/0886260519884687Google ScholarPubMed
Greenland, S., & Drescher, K. (1993). Maximum likelihood estimation of the attributable fraction from logistic models. Biometrics, 49 (3), 865–872. doi: 10.2307/2532206CrossRefGoogle ScholarPubMed
Guruge, S., Jayasuriya-Illesinghe, V., Gunawardena, N., & Perera, J. (2015). Intimate partner violence in Sri Lanka: A scoping review. Ceylon Medical Journal, 60(4), 133–138. doi: 10.4038/cmj.v60i4.8100CrossRefGoogle ScholarPubMed
Hassanian-Moghaddam, H., Zamani, N., & Sarjami, S. (2016). Violence and abuse against women who have attempted suicide by deliberate self-poisoning: A 2-year follow-up study in Iran. Journal of Interpersonal Violence, 31(7), 1257–1273. doi: 10.1177/0886260514564157CrossRefGoogle ScholarPubMed
Hester, M., Jones, C., Williamson, E., Fahmy, E., & Feder, G. (2017). Is it coercive controlling violence? A cross-sectional domestic violence and abuse survey of men attending general practice in England. Psychology of Violence, 7(3), 417. doi: 10.1037/vio0000107CrossRefGoogle Scholar
International Institute for Population Sciences. (2017). National Family Health Survey (NFHS-4), 2015–16: India. Mumbai: International Institute for Population Sciences.Google Scholar
Ishida, K., Stupp, P., Melian, M., Serbanescu, F., & Goodwin, M. (2010). Exploring the associations between intimate partner violence and women's mental health: Evidence from a population-based study in Paraguay. Social Science & Medicine, 71(9), 1653–1661. doi: 10.1016/j.socscimed.2010.08.007CrossRefGoogle ScholarPubMed
Jayatilleke, A., Poudel, K. C., Sakisaka, K., Yasuoka, J., Jayatilleke, A. U., & Jimba, M. (2011). Wives’ attitudes toward gender roles and their experience of intimate partner violence by husbands in Central Province, Sri Lanka. Journal of interpersonal violence, 26(3), 414–432. doi: 10.1177/0886260510363420CrossRefGoogle ScholarPubMed
Keynejad, R. C., Hanlon, C., & Howard, L. M. (2020). Psychological interventions for common mental disorders in women experiencing intimate partner violence in low-income and middle-income countries: A systematic review and meta-analysis. The Lancet Psychiatry, 7(2), 173–190. doi: 10.1016/S2215-0366(19)30510-3CrossRefGoogle ScholarPubMed
Knipe, D. W., Bandara, P., Senarathna, L., Kidger, J., López-López, J., & Rajapakse, T. (2019a). Childhood adversity and deliberate self-poisoning in Sri Lanka: A protocol for a hospital-based case–control study. BMJ Open, 9(8), e027766. doi: 10.1136/bmjopen-2018-027766CrossRefGoogle Scholar
Knipe, D. W., Gunnell, D., & Eddleston, M. (2017). Preventing deaths from pesticide self-poisoning—learning from Sri Lanka's success. The Lancet Global Health, 5(7), e651–e652. doi: 10.1016/S2214-109X(17)30208-5CrossRefGoogle ScholarPubMed
Knipe, D. W., Metcalfe, C., Hawton, K., Pearson, M., Dawson, A., Jayamanne, S., … Gunnell, D. (2019b). Risk of suicide and repeat self-harm after hospital attendance for non-fatal self-harm in Sri Lanka: A cohort study. The Lancet Psychiatry, 6(8), 659–666. doi: 10.1016/S2215-0366(19)30214-7CrossRefGoogle Scholar
Knipe, D. W., Williams, A. J., Hannam-Swain, S., Upton, S., Brown, K., Bandara, P., … Kapur, N. (2019c). Psychiatric morbidity and suicidal behaviour in low-and middle-income countries: A systematic review and meta-analysis. PLoS Medicine, 16(10), e1002905.CrossRefGoogle Scholar
Konradsen, F., van der Hoek, W., & Peiris, P. (2006). Reaching for the bottle of pesticide—a cry for help. Self-inflicted poisonings in Sri Lanka. Social Science & Medicine, 62(7), 1710–1719. doi: 10.1016/j.socscimed.2005.08.020CrossRefGoogle ScholarPubMed
McLaughlin, J., O'carroll, R., & O'connor, R. (2012). Intimate partner abuse and suicidality: A systematic review. Clinical Psychology Review, 32(8), 677–689. doi: 10.1016/j.cpr.2012.08.002CrossRefGoogle ScholarPubMed
National Institute of Population Studies, & ICF. (2019). Pakistan demographic and health survey 2017-18. Islamabad, Pakistan.Google Scholar
Office for National Statistics. (2019). Domestic abuse: Findings from the crime survey for England and Wales: Year ending March 2018. Retrieved from https://www.ons.gov.uk/peoplepopulationandcommunity/crimeandjustice/articles/domesticabusefindingsfromthecrimesurveyforenglandandwales/yearendingmarch2018Google Scholar
Paiman, A., Khan, M., Ali, T., Asad, N., & Azam, I. (2019). Psychosocial factors of deliberate self-harm in Afghanistan: A hospital based, matched case-control study. Eastern Mediterranean Health Journal, 25(11), 798–805. doi: 10.26719/emhj.19.021CrossRefGoogle ScholarPubMed
Parkar, S. R., Dawani, V., & Weiss, M. G. (2006). Clinical diagnostic and sociocultural dimensions of deliberate self-harm in Mumbai, India. Suicide and Life-Threatening Behavior, 36(2), 223–238. doi: 10.1521/suli.2006.36.2.223CrossRefGoogle ScholarPubMed
Pronyk, P. M., Hargreaves, J. R., Kim, J. C., Morison, L. A., Phetla, G., Watts, C., … Porter, J. D. (2006). Effect of a structural intervention for the prevention of intimate-partner violence and HIV in rural South Africa: A cluster randomised trial. The Lancet, 368(9551), 1973–1983. doi: 10.1016/S0140-6736(06)69744-4CrossRefGoogle ScholarPubMed
Rajapakse, T., Griffiths, K. M., & Christensen, H. (2013). Characteristics of non-fatal self-poisoning in Sri Lanka: A systematic review. BMC Public Health, 13(1), 331. doi: 10.1186/1471-2458-13-331CrossRefGoogle ScholarPubMed
Richardson, R., Nandi, A., Jaswal, S., & Harper, S. (2020). The effect of intimate partner violence on women's mental distress: A prospective cohort study of 3010 rural Indian women. Social Psychiatry and Psychiatric Epidemiology, 55(1), 71–79. doi: 10.1007/s00127-019-01735-5CrossRefGoogle ScholarPubMed
Senarathna, L., Jayamanna, S. F., Kelly, P. J., Buckley, N. A., Dibley, M. J., & Dawson, A. H. (2012). Changing epidemiologic patterns of deliberate self poisoning in a rural district of Sri Lanka. BMC Public Health, 12(1), 593. doi: 10.1186/1471-2458-12-593CrossRefGoogle Scholar
Sohal, H., Eldridge, S., & Feder, G. (2007). The sensitivity and specificity of four questions (HARK) to identify intimate partner violence: A diagnostic accuracy study in general practice. BMC Family Practice, 8(1), 49. doi: 10.1186/1471-2296-8-49CrossRefGoogle ScholarPubMed
StataCorp (2017). Stata statistical software: Release 15. College Station, TX: StataCorp LLC.Google Scholar
Syed, E. U., & Khan, M. M. (2008). Pattern of deliberate self-harm in young people in Karachi, Pakistan. Crisis, 29(3), 159–163. doi: 10.1027/0227-5910.29.3.159CrossRefGoogle ScholarPubMed
Wagman, J. A., Gray, R. H., Campbell, J. C., Thoma, M., Ndyanabo, A., Ssekasanvu, J., … Serwadda, D. (2015). Effectiveness of an integrated intimate partner violence and HIV prevention intervention in Rakai, Uganda: Analysis of an intervention in an existing cluster randomised cohort. The Lancet Global Health, 3(1), e23–e33. doi: 10.1016/S2214-109X(14)70344-4CrossRefGoogle Scholar
WHO. (2013). Global and regional estimates of violence against women: Prevalence and health effects of intimate partner violence and non-partner sexual violence. Geneva: World Health Organization.Google Scholar
WHO. (2014). Preventing suicide – a global imperative. Geneva: World Health Organization.Google Scholar
WHO. (2018). Country profile on gender-based violence in Sri Lanka. Colombo: World Health Organization, Country Office for Sri Lanka.Google Scholar
Widger, T. (2015). Suicide in Sri Lanka: The anthropology of an epidemic. Oxon, UK: Routledge.CrossRefGoogle ScholarPubMed
Supplementary material: File

Bandara et al. supplementary material

Tables S1-S3

Download Bandara et al. supplementary material(File)
File 16 KB