Medicinal overdoses in Sri Lanka: Associated factors – a qualitative study

Lakmini De Silva, Andrew Dawson, Sampath Tennakoon, Indika Gawarammana, Thilini Rajapakse

Objective: Attempted or non-fatal self-poisoning is a major public health problem in Sri Lanka. The objective of this study was to explore the factors associated with the self-poisoning behavior of those who have ingested a medicinal overdose.

Methods: This was a qualitative study. Semi-structured in-depth interviews were conducted with sixteen persons admitted to Teaching Hospital Peradeniya, Sri Lanka, for medical management of non-fatal selfpoisoning by medicinal overdose. A maximum variation sampling method was used. Interviews were audio recorded and transcribed for thematic analysis.

Results: Participants were aged between 14-46 years of whom 13 were female. A majority (10 participants) were students. The qualitative exploration generated several themes to describe the factors associated with non-fatal self-poisoning behavior of patients. One shared theme was the ingestion of a medicinal overdose with the intention of enlisting the help of a significant other, often soon after an interpersonal conflict. Here their intention was not to die; but as a result of the act of non-fatal selfpoisoning, they may have received solutions, attention or help. The participants appeared to have resorted to self-harm as a way of problem solving, most commonly following an interpersonal conflict situation. Several internal and external psychosocial factors associated with non-fatal self-poisoning emerged. Interpersonal conflicts, poor physical health, and alcohol were external factors and associated impulsivity, anger, suffering, pain, helplessness and loneliness were internal factors. Difficulty in coping with past distressing situations was also a common theme, with previous maladaptive coping when distressed, including self-cutting and alcohol ingestion. Many participants had tried unsuccessfully to express their distress by trying to talk to a close family member or friend–who was not contactable at that time. In retrospect, most regretted the attempted self-poisoning, and described it as a useless effort.  They also expressed regret because they had to undergo unpleasant subsequent hospital treatment and because of the serious distress caused to their family. In contrast, some expressed the attitude that their problem had been solved, as a result of this act.

Conclusion: The most prominent theme that emerged was that non-fatal self-poisoning appeared to be a maladaptive attempt at coping or problem solving especially in situations linked to interpersonal conflict. Overall, this study indicates the need for strategies to help young people develop adaptive coping skills to deal with distressing situations.

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