دانلود رایگان مقاله انگلیسی تلاش برای خودکشی در سریلانکا - یک مطالعه از خانوارها و عوامل اجتماعی - الزویر 2018

ABSTRACT

Background An individual’s suicide risk is determined by personal characteristics, but is also influenced by their environment. Previous studies indicate a role of contextual effects on suicidal behaviour, but there is a dearth of quantitative evidence from Asia. Methods Individual and community level data were collected on 165,233 people from 47,919 households in 171 communities in rural Sri Lanka. Data were collected on individual (age, gender, past suicide attempts and individual socioeconomic position (SEP)) and household (household SEP, pesticide access, alcohol use and multigenerational households) level factors. We used 3-level logit models to investigate compositional (individual) and contextual (household/community) effects. Results We found significant variation between households 21% (95% CI 18%, 24%) and communities 4% (95% CI 3%, 5%) in the risk of a suicide attempt. Contextual factors as measured by low household SEP (OR 2.37 95% CI 2.10, 2.67), low community SEP (OR 1.45 95% CI 1.21, 1.74), and community ‘problem’ alcohol use (OR 1.44 95% CI 1.19, 1.75) were associated with an increased risk of suicide attempt. Women living in households with alcohol misuse were at higher risk of attempted suicide. We observed a protective effect of living in multigenerational households (OR 0.53 95% CI 0.42, 0.65). Limitations The outcome was respondent-reported and refers to lifetime reports of attempted suicide, therefore this study might be affected by socially desirable responding. Conclusions Our study finds that contextual factors are associated with an individual’s risk of an attempted suicide in Sri Lanka, independent of an individual’s personal characteristics.

CONCLUSION

Multilevel modelling of the risk of attempted suicide indicated that household and community level factors (i.e. contextual factors) played an important role in influencing an individual’s risk of an attempted suicide, independent of an individual’s personal characteristics. We found that nearly a quarter of the variation in this Sri Lankan dataset is attributed to the household and community level. Higher rates of attempted suicide were seen in more deprived household and community environments. However, individuals in multigenerational households had a reduced risk of an attempted suicide. There was also evidence that communities with higher levels of problem alcohol use increased the associated risk of attempted suicide. This study highlights possible areas for community intervention, but we are unable to conclude what these intervention strategies should be. A further qualitative investigation of the meaning of observed contextual associations with attempted suicide risk will be needed.