Received: 10 July 2009 / Accepted: 18 March 2010 / Published online: 7 April 2010 The Author(s) 2010. This article is published with open access at Springerlink.com Abstract Background One of the most important components of suicide prevention strategies is to target people who repeat self-harm as they are a high risk group. However, there is some evidence that the incidence of repeat self-harm is lower in Asia than in the West. The objective of this study was to investigate the prevalence of previous self-harm among a consecutive series of self-harm patients presenting to hospitals in rural Sri Lanka. F. Mohamed (&) A. Perera K. Wijayaweera M. Eddleston A. Dawson F. Konradsen D. Gunnell South Asian Clinical Toxicology Research Collaboration, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka e-mail: fahim@sactrc.org K. Kularatne Teaching Hospital, Peradeniya, Sri Lanka S. Jayamanne General Hospital, Polonnaruwa, Sri Lanka M. Eddleston Scottish Poisons Information Bureau, Royal Inﬁrmary of Edinburgh, Clinical Pharmacology Unit, University of Edinburgh, Edinburgh, UK A. Dawson Professorial Medicine Unit, POW Clinical School, University of NSW, Sydney, Australia F. Konradsen Department of International Health, Immunology and Microbiology, University of Copenhagen, Copenhagen, Denmark D. Gunnell Department of Social Medicine, University of Bristol, Bristol, UK Soc Psychiatry Psychiatr Epidemiol (2011) 46:517–520 DOI 10.1007/s00127-010-0217-z O R I G I N A L P A P E R The prevalence of previous self-harm amongst self-poisoning patients in Sri Lanka Fahim Mohamed • Aravinda Perera • Kusal Wijayaweera • Keerthi Kularatne • Shaluka Jayamanne • Michael Eddleston • Andrew Dawson • Flemming Konradsen • David Gunnell Method Six hundred and ninety-eight self-poisoning patients presenting to medical wards at two hospitals in Sri Lanka were interviewed about their previous episodes of self-harm. Results Sixty-one (8.7%, 95% CI 6.7–11%) patients reported at least one previous episode of self-harm [37 (10.7%) male, 24 (6.8%) female]; only 19 (2.7%, 95% CI 1.6– 4.2%) patients had made more than one previous attempt. Conclusion The low prevalence of previous self-harm is consistent with previous Asian research and is considerably lower than that seen in the West. Explanations for these low levels of repeat self-harm require investigation. Our data indicate that a focus on the aftercare of those who attempt suicide in Sri Lanka may have a smaller impact on suicide incidence than may be possible in the West. Keywords Sri Lanka Deliberate self-harm Developing countries Previous self-harm Self-poisoning Introduction Suicide is a major cause of preventable mortality throughout industrialised and non-industrialised nations [1]. More than half of the world’s suicides occur in Asia, mostly in rural communities. One key component of international suicide prevention strategies is to target individuals who self-harm as they represent an important high-risk group [2]. Around half of the people who present to hospital following self-harm in the West have previously self-harmed and around 20% repeat self-harm within 12 months of their index episode [3–6]. Risk of repetition of self-harm and later suicide is high in the West. More than 5% of the people who have attended hospital after an episode of self-harm will have died by suicide within 9 years [4]. 123