Domestic violence and suicidal behaviour in Sri Lanka

Abstract

Domestic violence (DV) and suicidal behaviour are significant contributors to mortality and morbidity worldwide. Although the association between DV and suicidal behaviour is well documented in high-income countries (HIC), this relationship has not been comprehensively examined in low- and middle-income countries (LMIC) such as Sri Lanka. This thesis investigated the association between DV and suicidal behaviour among females and males in Sri Lanka, and explored the sociodemographic, clinical, and psychosocial factors associated with abuse in Sri Lanka. This thesis used a series of epidemiological study designs using national datasets and data collected from a large case-control study. All investigations within this thesis showed strong and consistent evidence of an association between experience of past-year violence and suicidal behaviour in Sri Lanka. The consistency of this research with findings from Asia and high-income countries signals the importance of prioritising DV prevention to reduce not only suicide and self-harm but other related harmful consequences of DV. At a policy level, this research highlights the urgent need to integrate DV reduction for both sexes in national suicide prevention and mental health strategies, with trauma-informed approaches an important consideration for all survivors of DV, and individuals in post-conflict areas. Multi-sectoral strategies to address the risk and protective factors of abuse should be adopted, including promoting social support and tackling harmful gender norms through community mobilisation and school-based programs. This adoption may have particular relevance in countries with similar patriarchal structures. In addition, given the intersections between DV, mental health problems, and suicidal behaviour across international literature, clinical interventions such as routine screening of DV among self-harm admissions together with a referral and provision of appropriate support should be considered globally. Health care providers and lay workers should be adequately equipped and trained to respond. Enhanced coordination between mental health services, DV support, and other social services are also needed. Prospective studies and qualitative research among women and men are recommended to further understand causal pathways and explicate the mechanisms underlying the complex associations between DV and suicidal behaviour, and other related factors.

Date of Award	2022
Original language	English