Domestic violence and self-poisoning in Sri Lanka.
Domestic violence and self-poisoning in Sri Lanka.
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DOI：
10.1017/s0033291720002986
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发表时间：
2022-04
影响因子：
6.9
通讯作者：
Knipe D
中科院分区：
文献类型：
--
作者：
Bandara P;Page A;Senarathna L;Kidger J;Feder G;Gunnell D;Rajapakse T;Knipe D
越来越多的证据表明，家庭暴力是自杀行为的一个重要危险因素。在南亚，风险水平及其对男性和女性自杀行为总体负担的影响尚未量化。我们进行了一项大型病例对照研究，以检查斯里兰卡DV与自我中毒之间的关系。病例（N=291）为年龄≥18岁的患者，因自我中毒在斯里兰卡康提的一家三级医院住院。从医院门诊部（N=490）和当地人口（N=450）中招募性别和年龄频率匹配的对照组。家庭暴力暴露情况通过羞辱、害怕、强奸、踢（HARK）问卷收集。采用多变量logistic回归模型估计DV与自我中毒之间的关系，并估计群体归因分数（PAF）。在过去12个月内暴露于至少一种家暴与女性（调整后的OR [AOR] 4.08, 95%CI 1.60 - 4.78）和男性（AOR [AOR] 2.52, 95%CI 1.51 - 1.21）的自我中毒密切相关。在女性中，身体暴力的相关性最强（AOR为14.07,95%CI为5.87 ~ 33.72），而在男性中，精神虐待的相关性最高（AOR为2.75,95%CI为1.57 ~ 4.82）。暴露于至少一种DV的PAF%女性为38% (95%CI 32-43)，男性为22% （95%CI 14-29）。解决家庭暴力问题的多部门干预措施，包括在保健机构中加强识别、以社区为基础的战略以及将家庭暴力支助和心理服务结合起来，可大大减少斯里兰卡的自杀行为。
There is increasing evidence that domestic violence (DV) is an important risk factor for suicidal behaviour. The level of risk and its contribution to the overall burden of suicidal behaviour among men and women has not been quantified in South Asia. We carried out a large case-control study to examine the association between DV and self-poisoning in Sri Lanka. Cases (N=291) were patients aged ≥18 years, admitted to a tertiary hospital in Kandy Sri Lanka for self-poisoning. Sex and age frequency matched controls were recruited from the hospital’s outpatient department (N=490) and local population (N=450). Exposure to DV was collected through the Humiliation, Afraid, Rape, Kick (HARK) questionnaire. Multivariable logistic regression models were conducted to estimate the association between DV and self-poisoning, and population attributable fractions (PAF) were estimated. Exposure to at least one type of DV 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 those reporting no abuse. Among women, the association was strongest for physical violence (AOR 14·07, 95%CI 5·87-33·72), 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. Multi-sectoral interventions to address DV including enhanced identification in health care settings, community-based strategies, and integration of DV support and psychological services may substantially reduce suicidal behaviour in Sri Lanka.