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Restricting the means of suicide by charcoal burning

  • Paul S. F. Yip (a1), C. K. Law (a2), King-Wa Fu (a3), Y. W. Law (a4), Paul W. C. Wong (a4) and Ying Xu (a5)...
Summary

We conducted an exploratory controlled trial to examine the efficacy of restricting access to charcoal in preventing suicides from carbon monoxide poisoning by charcoal burning in Hong Kong. All charcoal packs were removed from the open shelves of major retail outlets in the intervention region for 12 months; in the control region, charcoal packs were displayed as usual. The suicide rate from charcoal burning was reduced by a statistically significant margin in the intervention region (P<0.05) but not in the control region. We observed no significant change in the suicide rate using other methods in either location.

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Copyright
Corresponding author
Paul Yip, HKJC Centre for Suicide Research and Prevention, University of Hong Kong, Hong Kong. Email: sfpyip@hku.hk
Footnotes
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This research was supported by the Bureau of Labour and Welfare of the Hong Kong Government of Special Administrative Region.

Declaration of interest

None.

Footnotes
References
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1 Yip, PSF. Suicide in Asia: Causes and Prevention. Hong Kong University Press, 2008.
2 Chan, KP, Lee, DT, Yip, PS. Media influence on suicide. Media's role is double edged. BMJ 2003; 326: 498.
3 Chan, KP, Yip, PS, Au, J, Lee, DT. Charcoal-burning suicide in post-transition Hong Kong. Br J Psychiatry 2005; 186: 6773.
4 Yip, PSF, Lee, DTS. Charcoal-burning suicides and strategies for prevention. Crisis 2007; 28: 21–7.
5 Liu, KY, Beautrais, A, Caine, E, Chan, K, Chao, A, Conwell, Y, et al. Charcoal burning suicides in Hong Kong and urban Taiwan: an illustration of the impact of a novel suicide method on overall regional rates. J Epidemiol Community Health 2007; 61: 248–53.
6 Chen, YY, Yip, PSF. Rethinking suicide prevention in Asian countries. Lancet 2008; 372: 1629–30.
7 Mann, JJ, Apter, A, Bertolote, J, Beautrais, A, Currier, D, Haas, A, et al. Suicide prevention strategies: a systematic review. JAMA 2005; 294: 2064–74.
8 Beautrais, AL. Effectiveness of barriers at suicide jumping sites: a case study. Aust N Z J Psychiatry 2001; 35: 557–62.
9 Law, CK, Yip, PS, Chan, WS, Fu, KW, Wong, PW, Law, YW. Evaluating the effectiveness of barrier installation for preventing railway suicides in Hong Kong. J Affect Disord 2009; 114: 254–62.
10 Hawton, K, Townsend, E, Deeks, J, Appleby, L, Gunnell, D, Bennewith, O, et al. Effects of legislation restricting pack sizes of paracetamol and salicylate on self-poisoning in the United Kingdom: before and after study. BMJ 2001; 322: 1203–7.
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The British Journal of Psychiatry
  • ISSN: 0007-1250
  • EISSN: 1472-1465
  • URL: /core/journals/the-british-journal-of-psychiatry
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Restricting the means of suicide by charcoal burning

  • Paul S. F. Yip (a1), C. K. Law (a2), King-Wa Fu (a3), Y. W. Law (a4), Paul W. C. Wong (a4) and Ying Xu (a5)...
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eLetters

PREVENTING SUICIDES: LESSONS FROM ASIA

Santosh Loganathan, Assistant Professor of Psychiatry
28 June 2010

Intentional burning of charcoal in a confined space leading to death by carbon monoxide poisoning has emerged as one of the important causes ofsuicide in Hong Kong. Yip and colleagues demonstrated a reduction in suicide rates in a district in Hong Kong by restricting access to charcoal.1

A successful suicide prevention strategy was observed in Sri Lanka, another Asian country that had very high suicide rates of 47 per 100,000 till about 1995. A ban on import of World Health Organization’s Class I pesticides in 1995 and endosulphan in 1998, by the government, led to a dramatic effect of reduction in suicide fatality rates to about 25 per 100,000 in 2005.2 Yip’s study and Sri Lanka’s example where a policy decision by the government lead to a significant impact in bringing down the country’s suicide rate, have tremendous implications for initiating suicide prevention in many other Asian countries where intentional poisoning with pesticides is the most common means of suicide, for exampleChina, India, Malaysia and Republic of Korea.3 Suicide Prevention International (SPI) initiated the Strategies to Prevent Suicide (STOPS) project in Asia, to analyze information on the current status of suicide and the preventive strategies being employed by participating countries.4 Based on this, the project aims to develop newer projects that are likely to improve the situation. In India, intentional pesticide poisoning is responsible for most suicides. Very high rates of suicide were reported from Bangalore (43%) and the Union Territory of Pondicherry (49%), when compared to the national average of 10.8% in 2007.5 Suicide prevention lessons from Sri Lanka could be tested and applied in Bangalore, one of the fastest growing cities in Asia with an unfortunate distinction of being labeled as the ‘Suicide capital of India’.

One of the crucial aims of the STOPS project is to create awareness and improve media coverage about depression and suicide (for reasons unclear, India and Vietnam are excluded). Media sensationalizing suicide can possibly introduce or enhance suicidal behavior similar to the way described in the media. This ‘copycat suicide’ is of significant concern in Asia as it has been in Western countries. For this very reason, intentional burning of charcoal that has been rapidly spreading across South-east Asia through the internet as a novel means of committing suicide needs to be curtailed before it catches attention among other Asian countries, particularly India, for the following reasons. Charcoal is readily available in rural and urban India. Charcoal is commonly used in India by a vast number of people as an excellent cooking fuel and for conducting various ‘pujas’ during traditional and religious rituals. A single suicidal attempt by burning charcoal coupled with a sensational media report is enough to trigger an epidemic akin to the one in South-east Asia. Considering the rapidity of information accessibility in the current era and the findings from Yip’s study, there is perhaps a role fordecision makers to enforce a ban on websites sensationalizing and endorsing charcoal burning as a novel means of suicide.

References

1.Yip PSF, Law CK, Fu K, Law YW, Wong PWC, Xu Y. Restricting the means of suicide by charcoal burning. Br J Psychiatry 2010; 196: 241- 242.doi: 10.1192/bjp.bp.109.065185.

2.Gunnell D, Fernando R, Hewagama M, Priyangika WDD, Konradsen F, Eddleston M. The impact of pesticide regulations on suicide in Sri Lanka. International Journal of Epidemiology 2007; 36: 1235- 1242. doi:10.1093/ije/dym164.

3.World Health Organisation (2008). Epidemiology of Suicide in Asia.Hendin H, Vijayakumar L, Bertolote JM (Ed.). Department of Mental Health and Substance Abuse, World Health Organisation, Geneva, Switzerland.

4.World Health Organisation (2008). Suicide and suicide prevention in Asia. Hendin H., Phillips M., Vijayakumar L (Ed.). Department of Mental Health and Substance Abuse, World Health Organisation, Geneva, Switzerland.

5.Accidental Deaths and Suicides in India 2006. New Delhi: National Crime Records Bureau Ministry of Affairs, 2007.
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