Evaluating sociodemographic and psychiatric contributors to suicide in Sri Lanka: An ecological survey

Background: Suicide is a major public health concern worldwide. Sri Lanka has the fourth highest suicide rate in the world, with trends suggesting that underlying factors related to suicide risk remain poorly understood, and may differ from those observed in high-income countries (HICs). Aim: The purpose of this study was twofold: First, to update country-wide suicide trends from 2009 to 2015 among geographic regions (districts), and second, to evaluate the association between suicide rates and demographic factors, social determinants, health-care access, and hospital presentations due to psychiatric illness. Methods: National- and district-level suicide rates were calculated from 2009 to 2015 using data from the police statistics unit. These data were used in conjunction with sociodemographic and population health data from the 2012 Census to evaluate the interrelationships. Both correlational and regression statistical models were employed. Results: Population density (PD), access to health resources, and social determinants including poverty, education, and employment were found to be associated with suicide rates in a correlational model. However, with regression analysis, low PD was the sole significant predictor of suicide risk. This finding supports the suggestion that suicide is a significant concern in rural areas, particularly in Sri Lanka and other LMICs. We found only a weak association between psychiatric morbidity and suicide rates in this study. While this is counterintuitive, it is in keeping with other reports from LMICs. It is suggested that LMICs may need unique suicide prevention strategies distinct from suicide prevention models adopted in HICs. Conclusion: We found a positive association between rurality and suicide risk, and a weak association between psychiatric morbidity and suicide rate in Sri Lanka.