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Factors influencing the decision to use hanging as a method of suicide: qualitative study

  • Lucy Biddle (a1), Jenny Donovan (a1), Amanda Owen-Smith (a1), John Potokar (a2), Damien Longson (a3), Keith Hawton (a4), Nav Kapur (a5) and David Gunnell (a6)...
Abstract
Background

Hanging is the most frequently used method of suicide in the UK and has high case fatality (>70%).

Aims

To explore factors influencing the decision to use hanging.

Method

Semi-structured qualitative interviews with 12 men and 10 women who had survived a near-fatal suicide attempt. Eight respondents had attempted hanging. Data were analysed thematically and with constant comparison.

Results

Hanging was adopted or contemplated for two main reasons: the anticipated nature of a death from hanging; and accessibility. Those favouring hanging anticipated a certain, rapid and painless death with little awareness of dying and believed it was a ‘clean’ method that would not damage the body or leave harrowing images for others. Materials for hanging were easily accessed and respondents considered it ‘simple’ to perform without the need for planning or technical knowledge. Hanging was thus seen as the ‘quickest’ and ‘easiest’ method with few barriers to completion and sometimes adopted despite not being a first choice. Respondents who rejected hanging recognised it could be slow, painful and ‘messy’, and thought technical knowledge was needed for implementation.

Conclusions

Prevention strategies should focus on countering perceptions of hanging as a clean, painless and rapid method that is easily implemented. However, care is needed in the delivery of such messages as some individuals could gain information that might facilitate fatal implementation. Detailed research needs to focus on developing and evaluating interventions that can manage this tension.

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Copyright
Corresponding author
Professor David Gunnell, Centre for Suicide Prevention, Community Based Medicine, University Place, University of Manchester, Oxford Road, Manchester M13 9PL, UK. Email: d.j.gunnell@bristol.ac.uk
Footnotes
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The study was funded and sponsored by the Department of Health (UK).

Declaration of interest

None.

Footnotes
References
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  • ISSN: 0007-1250
  • EISSN: 1472-1465
  • URL: /core/journals/the-british-journal-of-psychiatry
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Factors influencing the decision to use hanging as a method of suicide: qualitative study

  • Lucy Biddle (a1), Jenny Donovan (a1), Amanda Owen-Smith (a1), John Potokar (a2), Damien Longson (a3), Keith Hawton (a4), Nav Kapur (a5) and David Gunnell (a6)...
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eLetters

Factors influencing hanging as a method of suicide

Manjeet S. Bhatia, Professor & Head, Department of Psychiatry
26 January 2011

Lucy Biddle et al have excellently reviewed the important factors influencing the decision to use hanging as a method of suicide in U.K. There are some observations as related to hanging in India. The authors have mentioned that hanging has a high case fatality rate of 70%. It wouldhave been more informative if rest 30% have been analysed because in our study in India, hanging has a high case fatality rate of about 99%.In our analysis, hanging is viewed as a rapid,easily accessible, having high fatality and require no technical knowledge.Most of the patients have no knowledge whether it is painful or not. Those who reject hanging are ambivalent about committing suicide and also that if they use other methods e.g. poisoning, they might be saved. None of the patients view it as a slow or 'messy' as reported by authors. In conclusions, authors are not correct in mentioning that prevention strategies should focus on perceptions of hanging as a clean, painless and rapid method. Rather, prevention must focus on strategies to treat underlying cause and prevent suicide rather than substituting a method of suicide with another. ... More

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