A project between Colombo and Oxford Universities found that suicide and self-harm rates in Sri Lanka were five times higher than in the UK.

In the UK, eight out of every 100,000 people commit suicide, but in rural areas in Sri Lanka the number rises to 40 out of every 100,000.

The study has implications for other developing countries, where mental health has, until recently, received little attention due to a concentration on physical health. Three million people in developing countries try to poison themselves every year. Around 220,000 die.

Writing in the British Medical Journal, Dr Michael Eddleston said: "We believe that reducing the number of suicides in the developing world should be an international public health priority."

High fatality rate

The study found that Sri Lankans who deliberately tried to poison themselves took up 41% of intensive care beds in Anuradhapura General Hospital in the north central province in 1995 and 1996, compared with 9% for heart complaints.

Sri Lanka has suicide rates five times as high as the UK

Organophosphates, paraquat and oleander seeds were the most common poisons taken.

The researchers found a high fatality rate for poisoning by pesticide, even though many of those who died apparently had not intended to commit suicide.

Two-thirds of those who poisoned themselves were under 30 and 60% of women who died were under 25.

Learning by example

The researchers said the young people were learning from those around them. A shocking 90% knew someone who had committed suicide. They also put the high numbers down to a lack of support for the young and the effects of war, poverty and lack of opportunities.

In the UK, 1.2% of people who drink pesticides die, compared with 12.7% in Sri Lanka. This is because rural hospitals often lack antidotes, because the pesticides are very strong and because staff are over-stretched.

Organophosphates are responsible for the highest death rate, with 21.8% of people who drink them dying.

Organophosphates cause breathing problems; paraquat causes multi-organ failure and eating oleander seeds can lead to heart failure.

Better management

The researchers called for better management of rural health centres, saying many people died before they could be transferred to specialist hospitals which could have saved them.

They also said young people had to be better educated about self-harm and more trials were needed on antidotes to poisons.