{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,13]],"date-time":"2026-07-13T12:59:39Z","timestamp":1783947579549,"version":"3.55.0"},"reference-count":46,"publisher":"Public Library of Science (PLoS)","issue":"11","license":[{"start":{"date-parts":[[2020,11,19]],"date-time":"2020-11-19T00:00:00Z","timestamp":1605744000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100000265","name":"UK Medical Research Council","doi-asserted-by":"crossref","award":["MC_PC_MR\/R019622\/1"],"award-info":[{"award-number":["MC_PC_MR\/R019622\/1"]}],"id":[{"id":"10.13039\/501100000265","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\"><jats:title>Introduction<\/jats:title><jats:p>Adverse childhood experiences (ACE) have been recognized as an important risk factor for suicidal behaviour among adults, but evidence from low and middle-income countries is lacking. This study explored associations between ACE and hospital admission due to non-fatal self-poisoning in Sri Lanka.<\/jats:p><\/jats:sec><jats:sec id=\"sec002\"><jats:title>Methods<\/jats:title><jats:p>This was a case-control study. Adults admitted to a tertiary care hospital for medical management of self-poisoning were included as cases, and age and sex matched controls were recruited from the outpatient department. ACE were measured using the World Health Organization\u2019s Childhood Adversity Scale. Logistic regression models adjusting for age, sex, ethnicity, and religion were used to quantify the association between ACE and self-poisoning.<\/jats:p><\/jats:sec><jats:sec id=\"sec003\"><jats:title>Results<\/jats:title><jats:p>The study included 235 cases and 451 controls. Cases were 2.5 times (95% CI 1.8, 3.6) more likely to report an ACE than controls and had higher ACE scores. Childhood physical abuse (OR 4.7, 95% CI 1.2, 19.0) and emotional abuse or neglect (OR 3.7, 95% CI 1.3, 10.1, and 3.7, 95% CI 2.3, 6.0 respectively), increased the risk of self-poisoning in adulthood, as did witnessing household violence (OR 2.2, 95% CI 1.4, 3.4), growing up in a household with a mentally ill or suicidal household member (OR 2.1, 95% CI 1.2, 3.4), and experiencing parental death\/separation\/divorce (OR 3.1, 95% CI 2.0, 4.9) as a child.<\/jats:p><\/jats:sec><jats:sec id=\"sec004\"><jats:title>Conclusions<\/jats:title><jats:p>Reducing exposures to ACEs should be a priority for prevention of suicide and self-harm in Sri Lanka. Innovative methods to increase support for children facing adversity should be explored.<\/jats:p><\/jats:sec>","DOI":"10.1371\/journal.pone.0242437","type":"journal-article","created":{"date-parts":[[2020,11,19]],"date-time":"2020-11-19T19:01:17Z","timestamp":1605812477000},"page":"e0242437","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":24,"title":["Childhood adversity and self-poisoning: A hospital case control study in Sri Lanka"],"prefix":"10.1371","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9732-4666","authenticated-orcid":true,"given":"Thilini","family":"Rajapakse","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abigail Emma","family":"Russell","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Judi","family":"Kidger","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Piumee","family":"Bandara","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jos\u00e9 A.","family":"L\u00f3pez-L\u00f3pez","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lalith","family":"Senarathna","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8318-8907","authenticated-orcid":true,"given":"Chris","family":"Metcalfe","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Gunnell","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Duleeka","family":"Knipe","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2020,11,19]]},"reference":[{"key":"pone.0242437.ref001","first-page":"1","volume-title":"World Health Statistics 2019: Monitoring Health for the SGDs, sustainable develpment goals","author":"World Health Organization G","year":"2017"},{"key":"pone.0242437.ref002","volume-title":"Preventing suicide\u2014a global imperative","author":"World Health Organization G","year":"2014"},{"issue":"24","key":"pone.0242437.ref003","doi-asserted-by":"crossref","first-page":"3089","DOI":"10.1001\/jama.286.24.3089","article-title":"Childhood Abuse, Household Dysfunction, and the Risk of Attempted Suicide Throughout the Life Span: Findings From the Adverse Childhood Experiences Study","volume":"286","author":"SR Dube","year":"2001","journal-title":"JAMA"},{"issue":"9657","key":"pone.0242437.ref004","doi-asserted-by":"crossref","first-page":"68","DOI":"10.1016\/S0140-6736(08)61706-7","article-title":"Child Maltreatment 1 Burden and consequences of child maltreatment in high-income countries","volume":"373","author":"R Gilbert","year":"2009","journal-title":"The Lancet"},{"key":"pone.0242437.ref005","doi-asserted-by":"crossref","first-page":"147","DOI":"10.1016\/j.jad.2017.03.060","article-title":"Associations between suicidal behavior and childhood abuse and neglect: A meta-analysis","volume":"220","author":"J Liu","year":"2017","journal-title":"Journal of Affective Disorders"},{"key":"pone.0242437.ref006","doi-asserted-by":"crossref","first-page":"353","DOI":"10.1016\/j.psychres.2017.06.082","article-title":"Childhood trauma and suicide attempt: A meta-analysis of longitudinal studies from the last decade","volume":"256","author":"C Zatti","year":"2017","journal-title":"Psychiatry Research"},{"issue":"5","key":"pone.0242437.ref007","doi-asserted-by":"crossref","DOI":"10.2105\/AJPH.2007.120253","article-title":"Population attributable fractions of psychiatric disorders and suicide ideation and attempts associated with adverse childhood experiences","volume":"98","author":"TO Afifi","year":"2008","journal-title":"American Journal of Public Health"},{"key":"pone.0242437.ref008","unstructured":"World Health Organization G. 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