Knipe D, et al. - Researchers examined a large cohort of patients presenting to hospital with self-harm in rural Sri Lanka for the risk of repeat self-harm and suicide and for factors associated with these outcomes. With a self-harm surveillance system established as part of a community randomized trial and based on data from all hospitals, coroners, and police stations in the study area, they detected 3,073 episodes of self-harm (fatal and non-fatal). The estimated risk of repeat self-harm and suicide in our study was considerably lower than that in high-income countries, according to survival models. Men displayed a higher risk of repeat self-harm vs women, as did in individuals aged 56 years and older vs those aged 10–25 years, and those who used methods other than poisoning in their index presentation. As per observations, despite a high suicide risk, focusing suicide prevention efforts might be somewhat less important in people who self-harm in low and middle-income countries vs high-income countries in view of the low risk of repeat self-harm and subsequent suicide death. Findings emphasize implementing strategies focusing on other risk factors for suicide as these might be more effective in reducing suicide deaths in low and middle-income countries in south Asia.