The World Health Organization (WHO) estimated that suicide claimed about one million lives in 2001, which exceeded the number of deaths by homicide and war combined.1
To prevent such tragic deaths, restriction of lethal means and responsible media reporting have been proposed to be two important measures.2
The well‐known findings of decreased suicide rates after the detoxification of domestic gas in the UK3
and the reduction of subway suicides and suicide attempts after the change in media reporting in Vienna4
have demonstrated the effectiveness of these two prevention strategies.
Although existing studies3,5,6,7,8,9,10
on method availability and suicide provide valuable information on prevention strategies, they have primarily focused on the effect on suicide rates when a specific method was restricted. It is also crucial, however, to examine the effect on suicide rates when a new method appears, if the emergence of its use can be clearly demarcated. Existing studies have not defined a clear distinction between the potential effects on suicide rates when a method is restricted (potentially leading to reduced rates or seeking alternative methods for suicide) and when an apparently new method is used by individuals to attempt suicide. The conceptual difference between these two scenarios is potentially significant: means restrictions can limit the range of choices but it should have no apparent impact on the size of the population actively seeking to undertake lethal suicidal acts. The emergence of a new method, however, may increase the size of that population at risk through the high availability and desirability11
inherent in this new method.
The potential negative impact of medial portrayals of suicide on subsequent suicide rates has been well documented and extensively reviewed.12,13,14,15
Similar findings also have been reported in Japan.16,17
Marzuk et al18
report an increase in the number of suicides by asphyxiation in New York City, a method recommended by Final exit
, a book published in 1991 advocating voluntary euthanasia. However, there has been little discussion on the role of the everyday mass media in disseminating knowledge about methods of suicide. In the case of a new method of suicide, the effect of mass media reporting may be especially considerable, as many people can gain information about the new method's availability and desirability through such reporting. The mass media could also have “spread” the method beyond the country in which it was invented. From a public health perspective, it is important to monitor the impact of a new method on overall suicide rates in the country of origin as well as in other areas.
In October 1998, a 38 year old woman in Hong Kong committed suicide by burning barbecue charcoal in a small, sealed bedroom to create a carbon monoxide chamber. This method for killing oneself was vividly portrayed by the media as a painless, non‐violent way to end one's life. The media portrayal of charcoal burning suicides has been shown to not adhere to WHO's guidelines on presenting suicide news, and the way the decedents committed suicide was described in great detail.19
Prior studies suggest the way the method was portrayed in the mass media played a key role in its rapid gain of popularity.20,21,22,23
Those who committed suicide by charcoal burning in Hong Kong were found more likely to be middle‐aged, economically active, and without pre‐existing mental illness.21
Subsequently, suicides by charcoal burning have been reported in predominantly Chinese communities in Taiwan and Macau,24
and there have also been cases reported in Southern China, Canada, the USA and Japan. Little is known, however, about the impact of charcoal burning suicides on overall and other method‐specific suicide rates in Hong Kong and other affected populations. This study examined the impact of the emergence of charcoal burning on overall suicide rates of Hong Kong and urban Taiwan between 1997 and 2002. These two populations were chosen because they share many similarities and have frequent information exchange. We specifically focussed on the urban population of Taiwan because rural areas tend to differ from their urban counterparts in the pattern of suicide as well as methods used (for example, pesticide), and are therefore not directly comparable to the all‐urban Hong Kong population. Our research questions were as follows:
- When a novel method of suicide emerges, does it become an option that draws individuals who would have used other methods and therefore lead to little changes in the overall suicide rates, or does the new method appeal to individuals who might not have used the other available methods, and therefore lead to an increase in overall suicide rates?
- Can the availability of the new method lead to substantial increases in suicide rates across geographical boundaries?
To address these questions, we examined the trends of overall suicide rates and method‐specific suicide rates in Hong Kong and urban Taiwan between 1997 and 2002. The demographic characteristics of those who committed suicide by charcoal burning and other methods in 2002 were compared.