Self poisoning with pesticides

doi:10.1136/bmj.328.7430.42

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Michael Eddleston (eddlestonm@eureka.lk), Wellcome Trust career development fellow1,
Michael R Phillips, executive director2

¹Centre for Tropical Medicine, Nuffield Department of Clinical Medicine, University of Oxford, Oxford
²Beijing Suicide Research and Prevention Centre, Beijing Hui Long Guan Hospital, Beijing, People's Republic of China

Correspondence to: M Eddleston, Ox-Col Collaboration, Department of Clinical Medicine, Faculty of Medicine, PO Box 271, 25 Kynsey Road, Colombo-08, Sri Lanka

Accepted 17 November 2003

WHO's recent recommendations on reducing deaths from self harm will not help cut the high death rate from self poisoning in the Asia Pacific region

Self inflicted violence accounts for around half of the 1.6 million violent deaths that occur every year worldwide.1 About 63% of global deaths from self harm occur in the Asia Pacific region. Most of these deaths occur in rural areas, where easy access to highly toxic pesticides turns many impulsive acts of self poisoning into suicide. The World Health Organization's recent World Report on Violence and Health recommends that suicide prevention strategies focus on the identification and treatment of people with mental disorders.2 However, as impulsive self poisoning is often not associated with mental illness, this may not be the most effective approach for rural Asia.

Self inflicted violence

Self harm is a major problem in many nations in the Asia Pacific region, from the Pacific islands of Fiji and Samoa, to Asian nations as different as China and Sri Lanka.3 Suicide accounted for 71% (512 000/722 000) of all violent deaths in South East Asia and the Western Pacific region in 2000.2 Most deaths occur in rural communities: the incidence of fatal self harm in rural China is three to five times that in urban China,4 and self poisoning is the commonest cause of inpatient death in some rural Sri Lankan districts but a rare cause in the capital city.5

Suicide or fatal self harm?

Some experts believe that a distinction exists, particularly in terms of intent, between people who harm themselves (attempt suicide) and those who die (commit suicide).6 WHO's report on violence and health, however, acknowledges that, although an intent to die is a key element of suicide, determining the level of intent for an individual is difficult.2