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Cited by 249Suicide and Self-Harm StudiesPesticide Exposure and ToxicityAgriculture and Farm Safety

Prevention of suicide with regulations aimed at restricting access to highly hazardous pesticides: a systematic review of the international evidence

Open access
Gunnell, David, Knipe, Duleeka, Chang, Shu-Sen, Pearson, Melissa, Konradsen, Flemming, Lee, Won Jin, Eddleston, Michael·2017·The Lancet Global Health
DOI 10.1016/s2214-109x(17)30299-1
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Abstract

BACKGROUND: Pesticide self-poisoning accounts for 14-20% of suicides worldwide. Regulation aimed at restricting access to pesticides or banning highly hazardous pesticides is one approach to reducing these deaths. We systematically reviewed the evidence of the effectiveness of pesticide regulation in reducing the incidence of pesticide suicides and overall suicides. METHODS: We did a systematic review of the international evidence. We searched MEDLINE, PsycINFO, and Embase for studies published between Jan 1, 1960, and Dec 31, 2016, which investigated the effect of national or regional bans, and sales or import restrictions, on the availability of one or more pesticides and the incidence of suicide in different countries. We excluded other interventions aimed at limiting community access to pesticides. We extracted data from studies presenting pesticide suicide data and overall suicide data from before and after national sales restrictions. Two reviewers independently assessed papers for inclusion, extracted data, and assessed risk of bias. We undertook a narrative synthesis of the data in each report, and where data were available for the years before and after a ban, we pooled data for the 3 years before and the 3 years after to obtain a crude estimate of the effect of the ban. This study is registered through PROSPERO, number CRD42017053329. FINDINGS: We identified 27 studies undertaken in 16 countries-five low-income or middle-income countries (Bangladesh, Colombia, India, Jordan and Sri Lanka), and 11 high-income countries (Denmark, Finland, Germany, Greece, Hungary, Ireland, Japan, South Korea, Taiwan, UK, and USA). Assessments largely focused on national bans of specific pesticides (12 studies of bans in six countries-Jordan, Sri Lanka, Bangladesh, Greece [Crete], South Korea, and Taiwan) or sales restrictions (eight studies of restrictions in five countries- India, Denmark, Ireland, the UK and the USA). Only five studies used optimum analytical methods. National bans on commonly ingested pesticides in five of the six countries studied, including four studies using optimum analytical methods, were followed by reductions in pesticide suicides and, in three of these countries, falls in overall suicide mortality. Greece was the only country studied that did not show a decrease in pesticide suicide following a ban. There were no high-quality studies of restricting sales to people for occupational uses; four of the seven studies (in three of the five countries studied-India, Denmark, and the USA) showed sales restrictions were followed by decreases in pesticide suicides; one of the two studies investigating trends in overall suicide mortality reported a fall in deaths in Denmark, but there were also decreases in suicide deaths from other methods. INTERPRETATION: National bans on highly hazardous pesticides, which are commonly ingested in acts of self-poisoning, seem to be effective in reducing pesticide-specific and overall suicide rates. Evidence is less consistent for sales restrictions. A worldwide ban on the use of highly hazardous pesticides is likely to prevent tens of thousands of deaths every year. FUNDING: None.

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  • Pesticide restrictions have been evaluated in 16 countries, and bans of highly hazardous pesticides were associated with reductions in suicides in Sri Lanka, Bangladesh, and South Korea.

    “Pesticide restrictions have been evaluated in 16 countries, and bans of the sale of highly hazardous pesticides were associated with reductions in suicides in Sri Lanka, Bangladesh, and South Korea.55”

    From Suicide (2020) · cites this paper as [55]

  • Worldwide, hanging accounts for approximately 40% of suicide deaths and pesticides for 14 to 20%.

    “Worldwide, hanging accounts for approximately 40% of deaths by suicide, and pesticides account for 14 to 20%.55”

    From Suicide (2020) · cites this paper as [55]

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4 of the 69 references couldn’t be matched to a known paper.

Research works printed but not linked: 5

  1. Cochrane Effective Practice and Organisation of Care Group (EPOC). Suggested risk of bias criteria for EPOC reviews 2015 (risk of bias for interrupted time series studies). http://epoc.cochrane.org/resources/epoc-resources-review-authors (accessed July 26, 2017).
  2. Berecz R, Szlivka A, Degrell I. [Characteristic features of completed suicides in Hungary between 1994-2001]. A befejezett ongyilkossagok jellemzoi Magyarorszagon 2003; 18: 399-407.
  3. Piola JC, Prada DB, Evangelista M, Cagna B. Intoxicaciones con Evolucion Letal (IEL) Atendidas en Rosario entre 1990 y 1999. Revista Medica de Rosario 2001; 67: 19-24.
  4. Davila CA, Pardo AM. [Suicide mortality in Colombia and Mexico: Trends and impact between 2000 and 2013]. Biomedica 2016; 36: 415-22.
  5. Cendales R, Vanegas C, Fierro M, Cordoba R, Olarte A. [Suicide trends in Colombia, 1985-2002]. Pan American J Pub Health 2007; 22: 231-38.

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Authors
Gunnell, D., Knipe, D., Chang, S.-S., Pearson, M., Konradsen, F., Lee, W. J., & Eddleston, M.
Affiliations
  • University of Peradeniya (LK)
  • National Taiwan University (TW)
  • Korea University (KR)
Corresponding author
Gunnell, David
ORCID
Venue
The Lancet Global Health
Publisher
Elsevier BV
Published
2017-10
Volume
5
Issue
10
Pages
e1026-e1037
ISSN
2214-109X (ISSN-L)
DOI
10.1016/s2214-109x(17)30299-1
OpenAlex
W2744735691
Cited by
246
References
69
Citations by year
2026: 23 · 2025: 24 · 2024: 27 · 2023: 25 · 2022: 37 · 2021: 34 · 2020: 35 · 2019: 24 · 2018: 12 · 2017: 5
FWCI
3.17
Type
journal article
Language
en
Open access
Licence
Locations
  • The Lancet Global Health (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • Research at the University of Copenhagen (University of Copenhagen) (publishedVersion, cc-by)
  • Edinburgh Research Explorer (University of Edinburgh) (publishedVersion, cc-by)
  • Bristol Research (University of Bristol) (publishedVersion, cc-by)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
  • Explore Bristol Research (submittedVersion, cc-by)
Funders
  • National Institute for Health and Care Research (NF-SI-0512-10068)
  • Economic and Social Research Council (ES/P009735/1)
Topics
  • Social Sciences › Psychology › Clinical Psychology › Suicide and Self-Harm Studies
  • Life Sciences › Agricultural and Biological Sciences › Plant Science › Pesticide Exposure and Toxicity
  • Life Sciences › Agricultural and Biological Sciences › Plant Science › Agriculture and Farm Safety
Keywords
suicide prevention, pesticide self-poisoning, pesticide regulation, pesticide ban, pesticide availability, suicide mortality, highly hazardous pesticides, suicide prevention policy, low- and middle-income countries, high-income countries, suicide prevention funding, suicide prevention research, suicide prevention training, suicide prevention education
MeSH terms
Suicide Prevention, Commerce, Developing Countries, Humans, Pesticides, Suicide, Randomized Controlled Trials as Topic, Developed Countries

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