The important issue of suicide in developing countries is addressed in an editorial published today in the International Journal of Epidemiology (IJE), edited in the Department of Social Medicine at the University of Bristol. 

The editorial is authored by Professor David Gunnell, who is based in the Department, and Dr Michael Eddleston, who is based in Sri Lanka and researches the treatment and prevention of pesticide poisoning.

The World Health Organisation estimates that there are around 849,000 suicides worldwide each year.  Professor Gunnell and Dr Eddleston point out that there are very different patterns of fatal and non-fatal self-harm in industrialised compared to developing countries. 

In countries such as the UK, the drugs that people most commonly overdose with are prescription medications and analgesics, and fatality is relatively low.  However, in developing countries it is far more common to use agricultural pesticides for deliberate self-poisoning – as many as one out of every ten people who ingest these pesticides die as a result.  It is estimated that there may be up to 300,000 pesticide suicides each year in the China and South East Asia region alone.

In developing countries where a large proportion of the population are subsistence farmers, many people have access to pesticides and these are often stored in the home.  Studies have shown that suicidal impulses are often short lived and that by making the means of suicide less available, time can be ‘bought’ until the suicidal impulse passes.  For these reasons, the detoxification of the domestic gas supply in Britain in the 1960s was thought to have prevented several thousand suicides.  Recent restrictions on the availability of paracetamol follow the same logic.

Professor Gunnell and Dr Eddleston suggest a range of ways that pesticide suicides in developing countries can be reduced, including better hospital management, restricting availability, licensing, storage guidelines and improving public education.  However, there has been limited action on the part of international organizations.  Pesticides are a multi-billion dollar business.

Professor Gunnell said: “There has been limited global leadership concerning this issue.  International organizations, governments and industry all contribute to allowing the impact of pesticide ingestion on suicide mortality to persist.”

Also in the December issue of the IJE, a study from Taiwan by Dr Yiing-Jeng Chou and colleagues, looks at the impact of the 1999 earthquake – which killed over 2,400 people – on subsequent suicide.  They compared the suicide rates of those who had not been directly affected by the earthquake with those who had been victims (if a co-resident family member had died, they had been themselves injured, or they had had property damaged) for the period 2-15 months after the quake.

Victims were one and a half times more likely to commit suicide in the study period than non-victims. The authors surmise that suicide may represent only the tip of the iceberg of psychological distress following a natural disaster such as this, and that governments should focus specifically on victims directly affected, rather than on the whole population.