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Objective: Data from South Asia indicate that for 15%–20% of suicide attempts, pesticides are purchased from shops; otherwise, pesticides are obtained from an individual's house or nearby environment. We aimed to investigate the difference between individuals who directly purchase pesticides from shops for suicide attempts and suicide deaths versus those related to accessing the pesticides from an individual's house or nearby environment. Methods: We conducted two comparative studies in rural Sri Lanka: (1) non‐fatal shop cases (n = 50) were survivors of self‐poisoning with pesticides who ingested the pesticides after purchasing them from a shop; non‐fatal domestic cases (n = 192) were survivors who accessed pesticides from their house or nearby environment. (2) fatal shop cases (n = 50) were individuals who died after ingesting pesticides they purchased for the act; fatal domestic cases (n = 102) were patients who died after ingesting pesticides they accessed at house or nearby environment. Logistic regression analysis was used to assess the characteristics which distinguished between the shop and domestic cases. Results: Data indicate that 20.7% and 32.9% of individuals who used pesticides for suicide attempts and suicide deaths had purchased them from shops, respectively. Being a non‐farmer was the main distinguishing characteristic of shop cases: adjusted odds ratios (AOR) 8.9, 95% confidence intervals (CI) 3.2–24.4 for non‐fatal shop cases, and AOR 4.0, 95% CI 1.5–10.6 for fatal shop cases. Non‐fatal shop cases also had higher suicide intent (AOR 3.0, CI 1.0–8.9), and ingesting an insecticide (AOR 4.8, CI 1.8–1.0–8.9) than non‐fatal domestic cases. Conclusion: A high suicide intent of individuals who purchase pesticides for the event explains the high proportion of such fatal cases. Such high suicide intent makes the prevention implications difficult to spell out for those individuals who purchase pesticides for self‐poisoning. However, our findings are valuable for clinicians to assess pesticide poisoning cases in hospitals. [ABSTRACT FROM AUTHOR]

Background There is increasing evidence that domestic violence is an important risk factor for suicidal behaviour. The level of risk of domestic violence (DV) and its contribution to the overall burden of suicidal behaviour has not been quantified in South Asia, where 37% of suicide deaths globally occur. We examined the association between DV and self-poisoning in Sri Lanka through a large case-control study. Open in new tab Download slide Open in new tab Download slide Methods Multivariable logistic regression models were conducted on 298 self-poisoning cases and 500 hospital controls to estimate the association between domestic violence and self-poisoning, and population attributable fractions (PAF) were estimated. Sensitivity analyses were conducted using 455 population-based controls. Results DV exposure 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 no abuse. Physical violence showed the highest risk among women, 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 DV was strongly associated with suicidal behaviour for men and women. Almost 40% of female self-poisoning cases and a fifth of male cases may be reduced if domestic violence is addressed. Key messages The significant contribution of DV to the overall burden of self-poisoning suggests preventative and curative interventions to address domestic violence may yield significant gains in reducing suicidal behaviour in Sri Lanka, and other similar settings. [ABSTRACT FROM AUTHOR]