518 Evidence from a number of Asian studies indicates that levels of previous self-harm amongst those who present to hospital following self-harm and who die by suicide are low. Only 17% of admissions to a tertiary hospital in urban Colombo, Sri Lanka, had a past history of self-harm [7]. Other studies from different regions of Sri Lanka report that between 1 and 26% of self-poisoning cases have pre- viously self-harmed [8–10]. In a study carried out in southern India only 13% of suicides had previously self- harmed [11]. In Sri Lanka, a recent study found that 26% of suicides had made a previous ‘‘suicidal gesture’’ [12], a ﬁgure similar to that of 25% reported in a large Chinese study [13]. These ﬁndings are lower than ﬁgures of 30– 47% reported in the West [14]. We have investigated the prevalence of reports of pre- vious self-harm amongst a consecutive series of self-poi- soning patients presenting to one general and one tertiary hospital in Sri Lanka. Method All self-poisoning patients admitted to Polonnaruwa Gen- eral Hospital (July 2005 and January 2006) and to Perad- eniya Teaching Hospital (November 2006–March 2007) were seen on admission by study doctors who recorded their history of previous self-harm. Both study hospitals are referral hospitals. Polonnaruwa hospital [District popula- tion is 358,984 (July 2001)] [15] serves a rural area and 60% of its poisoning admissions are transfers from other rural hospital. Peradeniya hospital [District population is 1,279,028 (July 2001)] [15] serves a more urban area; 45% of its poisoning admissions are transfers from rural hos- pitals, the remainder are directly admitted from the community. Data collection Patients were asked to recall previous episodes of self- harm (e.g. poisoning, hanging, and drowning). All con- scious patients [Glasgow coma scale (GCS) [ 15] were interviewed on admission soon after initial resuscitation. Patients with lower GCS scores were interviewed prior to discharge. Validation of the responses of the study participant’s previous self-harm history was performed by cross- matching the age, gender, name, village of each study subject against previous admission recorded on the research databases for the previous 3 years in Polo- nnaruwa. Validation was not possible in Peradeniya as there were no research databases prior to the start of this study. 123 Data analysis Results Soc Psychiatry Psychiatr Epidemiol (2011) 46:517–520 Ethics statement Ethical approval for data collection was obtained from ethics committees of the Australian National University, Sri Lanka Medical Association, and Medical Faculties of Peradeniya and Colombo Universities. Data were entered onto an excel database and analysed using Stata version 10 [16]. During the study period, 816 self-poisoning patients were admitted to the two study hospitals (579 to Polonnaruwa and 237 to Peradeniya). Altogether 118 (14.5%) patients were excluded from the study because data on their pre- vious episodes of self-harm were incomplete or not recorded because of death (n = 20), transfer to other hos- pitals (n = 4), or oversight by the study doctors (n = 94). The patients included in the analysis (n = 698) had lower case fatality (6.1%, 95% CI 4.4–8.2%) compared to excluded patients (16.9%, 95% CI 10.6–24.9%) although the age (median age 24 vs. 25 years) and sex distributions (50.4 vs. 50.8% female) respectively of included and excluded patients were similar. Amongst the 698 included in the analysis the common methods of self-poisoning were the ingestion of pesticides [n = 313 (44.8%)], pharma- ceuticals [n = 188 (26.9%)], and oleander (Thevetia peruviana) seeds [n = 119 (17.0%)]. Median length of hospital stay for our study subjects was 3 days (IQR 2–3). Sixty-one patients (8.7%, 95% CI 6.7–11%) reported at least one previous episode of self-harm (Table 1). Levels of previous self-harm were higher in males (n = 37, 10.7%) than females (n = 24, 6.8%, p = 0.03). Subjects with a previous history of self-harm were older than those without such a history (median ages 29 vs. 23 years, p = 0.05); similar proportions of those with (45.9%) and without (44.7%) a previous episode of self-harm ingested pesticides in their index admission (v2 = 0.03, p = 0.86). Few patients reported more than one previous episode of self-harm: only 19 (2.7%, 95% CI 1.6–4.2%) patients had made two or more previous attempts. The proportion of patients with a past history of self-harm in Polonnaruwa hospital was lower than that of Peradeniya [36/467 (7.7%) in Polonnaruwa vs. 25/231 (10.8%) in Peradeniya (v2 = 1.87, p = 0.17)]. Case fatality amongst those who had previously self-harmed was similar (6.6%) to those who had not previously self-harmed (6.1%) (v2 = 0.01, p = 0.89).