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‘We lost because of his drunkenness’: the social processes linking alcohol use to self-harm in the context of daily life stress in marriages and intimate relationships in rural Sri Lanka
  1. Jane Brandt Sørensen1,
  2. Thilini Agampodi2,
  3. Birgitte Refslund Sørensen3,
  4. Sisira Siribaddana4,
  5. Flemming Konradsen1,
  6. Thilde Rheinländer1
  1. 1Department of Public Health, University of Copenhagen, Copenhagen, Denmark
  2. 2Department of Community Medicine, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Saliyapura, Sri Lanka
  3. 3Department of Anthropology, University of Copenhagen, Copenhagen, Denmark
  4. 4Department of Medicine, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Saliyapura, Sri Lanka
  1. Correspondence to Jane Brandt Sørensen, Department of Public Health, University of Copenhagen, Copenhagen, Denmark; janebs{at}


Introduction Harmful alcohol use has been found to cause detriment to the consumers and those around them. Research carried out in Sri Lanka has described the socioeconomic consequences to families owing to alcohol consumption. However, the social processes around alcohol use and how it could result in behaviour such as self-harm was unclear. With an outset in daily life stressors in marriages and intimate relationships we explored alcohol use in families with a recent case of self-harm.

Methods Qualitative data were collected for 11 months in 2014 and 2015 in the North Central and North Western provinces of Sri Lanka. Narrative life story interviews with 19 individuals who had self-harmed where alcohol was involved and 25 of their relatives were conducted. Ten focus group discussions were carried out in gender and age segregated groups. An inductive content analysis was carried out.

Results Participants experienced two types of daily life stressors: non-alcohol-related stressors, such as violence and financial difficulties, and alcohol-related stressors. The alcohol-related stressors aggravated the non-alcohol-related daily life stressors within marriages and intimate relationships, which resulted in conflict between partners and subsequent self-harm. Women were disproportionately influenced by daily life stressors and were challenged in their ability to live up to gendered norms of marriage. Further, women were left responsible for their own and their husband’s inappropriate behaviour. Self-harm appeared to be a possible avenue of expressing distress. Gendered alcohol and marriage norms provided men with acceptable excuses for their behaviour, whether it was alcohol consumption, conflicts or self-harm.

Conclusions This study found that participants experienced both alcohol-related and non-alcohol-related daily life stressors. These two categories of daily life stressors, gender inequalities and alcohol norms should be considered when planning alcohol and self-harm prevention in this setting. Life situations also reflected larger community and structural issues.

  • Sri Lanka
  • alcohol
  • self-harm
  • suicide
  • everyday life
  • daily life stress
  • marriage
  • intimate relationships
  • gender

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  • Handling editor Stephanie Topp

  • Contributors JBS, TR and FK collaborated on conceptualising and designing the study and organising data collection. JBS carried out data collection, data analysis and drafting of the manuscript. TR and FK took part in analysis and drafting of the manuscript. BRS provided input to methodology and background information on the study site. TA and SS contributed to the context and cultural specificities, methodology, ethical considerations and initial analysis. All authors read and approved the final manuscript.

  • Funding This study was carried out with financial support from the University of Copenhagen, Denmark; Christian og Ottilia Brorsons Rejselegat for yngre videnskabsmænd og kvinder; Augustinus Fonden; Oticon Fonden; and Direktør Jacob Madsen og Hustru Olga Madsens Fond. None of the funding bodies played any role in the design of study or analysis of data.

  • Competing interests None declared.

  • Ethics approval Ethics Review Committee, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka (ERC/2014/014).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement No additional data are available.

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