Background: Knowledge concerning the epidemiology of suicide in Sri Lanka is limited despite its suicide rates being amongst the highest in the world.

Aim: To examine the characteristics of a large sample of Sri Lankan suicides to inform approaches to prevention.

Method: Psychological autopsy study of suicides occurring in three rural districts of Sri Lanka during August-October 1997.

Results: Interviews were conducted with contacts of 372 (74%) of the 499 suicides that occurred over the study period. Males accounted for 79% of the deaths. Twenty-one percent of male and 57% of female suicides were aged <25 years of age. Pesticide self-poisoning accounted for 259 (70%) of the deaths. Almost two-thirds (62%) of the deaths occurred in hospital and 95 (26%) had made previous suicidal gestures. 138 (37%) were moderately or severely depressed and 144 (49%) of male suicides, but only 2 (2.5%) of the females, were alcohol dependent. Illegally brewed alcohol (kasippu) was the main product used by two thirds (62%) of problem drinkers. There was a family history of suicide in 20% of cases.

Conclusion: Pesticide self-poisoning accounts for over two thirds of suicides in rural Sri Lanka. Suicide prevention efforts in Sri Lanka should focus on restricting access to pesticides, improving the medical management of pesticide poisoning, reducing alcohol misuse-particularly targeting the supply of illegal alcohol-and improving the identification and aftercare of people who self-harm.