Suicide prevention through means restriction: Impact of the 2008-2011 pesticide restrictions on suicide in Sri Lanka.
Suicide prevention through means restriction: Impact of the 2008-2011 pesticide restrictions on suicide in Sri Lanka.
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DOI：
10.1371/journal.pone.0172893
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发表时间：
2017
期刊：
影响因子：
3.7
通讯作者：
Gunnell D
中科院分区：
文献类型：
--
作者：
Knipe DW;Chang SS;Dawson A;Eddleston M;Konradsen F;Metcalfe C;Gunnell D
调查在2008-2010年和2009-2011年分别对杀虫剂乐果和倍硫磷和百草枯实施为期三年的阶段性禁令对斯里兰卡自杀死亡率的影响。使用斯里兰卡警方数据（1989-2015年）计算了标准化的总体，性别特异性和方法特异性自杀率。使用负二项回归模型，我们估计了禁令后几年（2011-15）自杀死亡率和数量的变化，与禁令前趋势（2001-10）的预期相比。2011年至2015年，自杀死亡率下降了21%，从每10万人中的18.3人下降到14.3人。在同一时期，农药自杀的下降幅度大于总体自杀率：从每10万人8.5人下降到4.2人，下降了50%。与此同时，非农药自杀死亡率也有小幅上升，上升了2%（每10万人中有9.9人至10.1人）。2015年，观察到的和预期的农药自杀率之间的比率为0.49（95%置信区间[CI] 0.40，0.62），相当于估计的937（95% CI 574，1389）比禁令前的自杀率少。敏感性分析的结果相似，使用2008年或2012年作为干预后阶段的开始。斯里兰卡禁止百草枯、乐果和倍硫磷与农药自杀死亡率和总体自杀死亡率的下降有关，尽管其他方法的自杀死亡率略有上升。这项研究进一步证明了农药管制在限制高度危险农药的供应，从而减少全球自杀人数方面的有效性。
To investigate the effect of 3-year phased bans of the pesticides dimethoate and fenthion in 2008–2010, and paraquat in 2009–2011, on suicide mortality in Sri Lanka. Age-standardised overall, sex-specific, and method-specific suicide rates were calculated using Sri Lankan police data (1989–2015). Using negative binomial regression models, we estimated the change in the rate and number of suicide deaths in post-ban years (2011–15) compared to those expected based on pre-ban trends (2001–10). Overall suicide mortality dropped by 21% between 2011 and 2015, from 18.3 to 14.3 per 100,000. The decline in pesticide suicides during this same period was larger than for overall suicides: from 8.5 to 4.2 per 100,000, a 50% reduction. This was accompanied by a smaller concurrent rise in non-pesticide suicide mortality with a 2% increase (9.9 to 10.1 per 100,000). In 2015, the ratio between the observed and expected pesticide suicide rates was 0.49 (95% confidence interval [CI] 0.40, 0.62), corresponding to an estimated 937 (95% CI 574, 1389) fewer pesticide suicides than expected from pre-ban suicide rates. Findings were similar in sensitivity analyses using 2008 or 2012 as commencement of the post intervention period. Bans of paraquat, dimethoate and fenthion in Sri Lanka were associated with a reduction in pesticide suicide mortality and in overall suicide mortality despite a small rise in other methods. This study provides further evidence for the effectiveness of pesticide regulation in limiting the availability of highly hazardous pesticides and thereby reducing the number of global suicides.