Population Health Sciences, Bristol Medical School, University of Bristol, Canynge Hall 2.12, 39 Whatley Road, Bristol, BS8 2PS, UK.
South Asian Clinical Toxicology Research Collaboration (SACTRC), Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka.
Soc Psychiatry Psychiatr Epidemiol. 2019 Jul;54(7):843-855. doi: 10.1007/s00127-019-01672-3. Epub 2019 Feb 21.
Lower socioeconomic position (SEP) is associated with an increased risk of suicidal behaviour in high income countries, but this association is not established in low- and middle-income countries (LMIC).
We investigated the association of SEP with suicidal behaviour in a prospective cohort study of 168,771 Sri Lankans followed up for episodes of attempted suicide and suicide. SEP data were collected at baseline at the household and individual level at the start of the follow-up period. We used multilevel Poisson regression models to investigate the association of SEP at community, household and individual levels with attempted suicide/suicide.
Lower levels of asset ownership [IRR (95% CI) suicide 1.74 (0.92, 3.28); attempted suicide 1.67 (1.40, 2.00)] and education [suicide 3.16 (1.06, 9.45); attempted suicide 2.51 (1.70, 3.72)] were associated with an increased risk of suicidal behaviour. The association of these measures of SEP and attempted suicide was stronger in men than women. Individuals living in deprived areas [1.42 (1.16, 1.73)] and in households with a young female head of household [1.41 (1.04, 1.93)] or a temporary foreign migrant [1.47 (1.28, 1.68)] had an elevated risk of attempted suicide. Farmers and daily wage labourers had nearly a doubling in risk of attempted suicide compared to other occupations.
Improved employment opportunities, welfare and mental health support services, as well as problem-solving skills development, may help support individuals with poorer education, farmers, daily wage labourers, individuals in young female-headed households and temporary foreign migrant households.
在高收入国家，较低的社会经济地位（SEP）与自杀行为的风险增加有关，但这种关联在中低收入国家（LMIC）尚未得到证实。
我们在一项对 168771 名斯里兰卡人的前瞻性队列研究中调查了 SEP 与自杀行为的关联，这些人在随访期间发生了自杀未遂和自杀事件。SEP 数据在随访开始时在家庭和个人层面上在基线时收集。我们使用多水平泊松回归模型来研究社区、家庭和个人层面的 SEP 与自杀未遂/自杀的关联。
较低的资产拥有水平[自杀的相对危险度（95%可信区间）为 1.74（0.92，3.28）；自杀未遂为 1.67（1.40，2.00）]和教育程度[自杀为 3.16（1.06，9.45）；自杀未遂为 2.51（1.70，3.72）]与自杀行为风险增加相关。这些 SEP 衡量指标与自杀未遂的关联在男性中比女性更强。生活在贫困地区的个体[1.42（1.16，1.73）]和有年轻女性户主的家庭[1.41（1.04，1.93）]或临时外国移民的家庭[1.47（1.28，1.68）]自杀未遂的风险升高。农民和日薪工人与其他职业相比，自杀未遂的风险几乎增加了一倍。
改善就业机会、福利和心理健康支持服务，以及解决问题的技能发展，可能有助于支持教育程度较低的人、农民、日薪工人、年轻女性户主的家庭和临时外国移民的家庭。
