Why suicide rates are high in China.

Abstract

We read with interest G. Miller's article describing a discrepancy between Chinese rates of suicide and depression (“China: healing the metaphorical heart,” News Focus, 27 Jan., p. [462][1]). However, we feel that Miller, by concentrating on fatal self-harm rather than all acts of self-harm, misses an opportunity to understand the discrepancy he notes. High rates of suicide and low rates of depression are not restricted to China. Many countries of the Asian “suicide belt” have suicide rates higher than those of China ([1][2], [2][3]). Suicide rates result from the incidence of self-harm and the resulting fatality rate among those individuals. Our research in Sri Lanka indicates that high rates of suicide from self-poisoning are due to a high fatality rate rather than a high incidence of self-harm itself ([3][4]). A useful contrast can be made with the UK. Self-poisoning in the UK is very common, with an annual incidence of presentation to hospital of around 300 per 100,000. However, self-poisoning is rarely lethal, with a fatality rate per 1000 incidents normally less than 0.5% ([4][5]). Self-poisoning is also common in Sri Lanka, with an estimated incidence of around 363 per 100,000 in one rural district. However, the fatality rate is significantly higher at ∼7.4%—at least 15 times higher than in the UK ([3][4]). The reason for this higher fatality rate in Sri Lanka, as in China, is the common use of highly toxic poisons such as pesticides. Sri Lankan self-poisoners are not more keen to die—they simply have easier access to pesticides than do the residents of the UK ([5][6]). The high suicide rate in Sri Lanka and China is not due to higher levels of mental illness or rates of self-harm, but to a higher lethality of self-harm acts. Concentrating solely on rates of mental illness in Asia will not explain the high rate of suicide in this region. 1. 1.[↵][7] 1. P. Brown , New Sci., 22 Mar. 1997, p. 34. 2. 2.[↵][8] 1. A. Joseph 2. et al. , Br. Med. J. (2003) 326, 1121. 3. 3.[↵][9] 1. M. Eddleston 2. et al. , Bull. World Health Org., in press. 4. 4.[↵][10] 1. D. Gunnell, 2. D. D. Ho, 3. V. Murray , Emergency Med. J. (2004) 21, 35. 5. 5.[↵][11] 1. M. Eddleston 2. et al. , Clin. Toxicol., in press. [1]: /lookup/doi/10.1126/science.311.5760.462 [2]: #ref-1 [3]: #ref-2 [4]: #ref-3 [5]: #ref-4 [6]: #ref-5 [7]: #xref-ref-1-1 View reference 1. in text [8]: #xref-ref-2-1 View reference 2. in text [9]: #xref-ref-3-1 View reference 3. in text [10]: #xref-ref-4-1 View reference 4. in text [11]: #xref-ref-5-1 View reference 5. in text