The impact of the COVID-19 pandemic and lockdowns on self-poisoning and suicide in Sri Lanka:An interrupted time series analysis

Evidence from high income countries suggests that the impact of COVID-19 on suicide and self-harm has been limited, but evidence from low- and middle-income countries is lacking. Using data from a hospital-based self-poisoning register (Jan 2019-Dec 2021) and data from national records (2016-2021) of suicide in Sri Lanka, we aimed to assess the impact of the pandemic on both self-poisoning and suicide. We examined changes in admissions for self-poisoning and suicide using interrupted time series (ITS) analysis. For the self-poisoning hospital admission ITS models we defined the lockdown periods as follows: i) pre-lockdown:01/01/2019-19/03/2020; ii) first lockdown:20/03/2020-27/06/2020; iii) post first lockdown:28/06/2020-11/05/2021; iv) second lock-down:12/05/2021-21/06/2021; and v) post second lockdown:22/06/2021-31/12/2021. For suicide we defined the intervention according to pandemic period. We found that during lockdown periods there was a reduction in hospital admissions for self-poisoning, with evidence that admission following self-poisoning remained lower during the pandemic than would be expected based on pre-pandemic trends. In contrast, there was no evidence that the rate of suicide in the pandemic period differed to that which would be expected. As the long-term socioeconomic impacts of the pandemic are realised, it will be important to track rates of self-harm and suicide in LMICs to inform prevention.