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Cited by 643Suicide and Self-Harm StudiesPesticide Exposure and ToxicityHomicide, Infanticide, and Child Abuse

Suicide by intentional ingestion of pesticides: a continuing tragedy in developing countries

Open access
Gunnell, David, Eddleston, Michael·2003·International Journal of Epidemiology
DOI 10.1093/ije/dyg307PMC PMC2001280
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Abstract

Deliberate self-poisoning has become an increasingly common response to emotional distress in young adults,1 and it is now one of the most frequent reasons for emergency hospital admission.2 In industrialized countries, the drugs that people commonly take in overdose—analgesics, tranquillisers, antidepressants3—are relatively non-toxic. The estimated case fatality for overdose in England, for example, is around 0.5%.4 Most individuals who self-harm do not intend to die. Studies carried out in industrialized countries have found that only 2% go on to commit suicide in the subsequent 12 months.5 In developing countries the situation is quite different.6 The substances most commonly used for self-poisoning are agricultural pesticides.6–11 Overall case fatality ranges from 10% to 20%.12 For this reason, deaths from pesticide poisoning make a major contribution to patterns of suicide in developing nations, particularly in rural areas.6 In rural China, for example, pesticides account for over 60% of suicides.8 Similarly high proportions of suicides are due to pesticides in rural areas of Sri Lanka (71%),13 Trinidad (68%),14 and Malaysia (>90%).10 There is, however, no evidence that levels of suicidal intent associated with pesticide ingestion in these countries are any higher than those associated with drug overdose in industrialized countries, where the drugs taken in overdose are less toxic. In countries where the use of pesticides for self-harm is commonplace conventional epidemiological features of suicide appear to be distorted. In industrialized nations, suicide rates are two to three times higher in men than women, and its incidence tends to increase with age, although in some countries recent rises in young male suicides have distorted this pattern.15 The incidence of non-fatal self-harm in industrialized countries is 20+ times higher than that of suicide; in contrast to suicide, self-harm rates peak in 15–24 year olds and are generally highest in women (Figure 1a).16 A possible explanation for these differences in the age- and sex-patterning of fatal and non-fatal self-harm is that young people, particularly females, are more likely to engage in impulsive acts of self-harm—as indicated by the comparatively lower levels of suicidal intent in young people.17 Because these acts are unplanned, the methods used are those that are readily available at the time of acute distress—prescribed and non-prescribed medicines—and these are relatively non-toxic. If more lethal methods of self-harm, such as pesticides, were favoured and readily accessible in industrialized nations the epidemiology of suicide in these countries might be quite different. Thus the widespread availability of pesticides may contribute to the difference in the age- and sex-patterning of suicide in China,18 Sri Lanka,19 India,20 and several other developing countries compared with that commonly seen in industrialized nations (Figure 2). In these developing countries some of the highest rates are seen in young adults and the ratio of male:female suicide approaches or exceeds unity at this age. In China, whilst suicide rates do tend to increase with age, there is a notable peak in rates amongst males and females aged 20–24 (Figure 2); recent data show that this peak is more prominent in rural localities.18 In rural India rates of suicide in 15–24 year old females are higher than rates in males of the same age and most other female age groups.20 Similar patterns are seen in Sri Lanka (Figure 2). In both China and Sri Lanka pesticides are the most frequently used method of suicide, likewise in India self-poisoning is the commonest method20 and pesticides are the most frequently used agents.9,21 It is of note that the age- and sex-patterns of self-poisoning in Sri Lanka in the younger age groups are similar to those in industrialized countries, (Figure 1b) although in contrast, the case fatality in Sri Lanka is much higher.38 Part of the distinct age- and gender-patterns of suicide deaths in the developing world may therefore reflect a mixture of deaths with high suicidal intent (predominantly in the elderly) and an excess of deaths with low suicidal intent amongst the young where the method chosen for impulsive acts of self-harm (pesticide ingestion) is highly lethal. A possibility strikingly born out in Western Samoa in the 1980s, where two-thirds of all suicides were a result of pesticide ingestion and the age- and sex-patterning of suicide and non-fatal self-harm were almost identical.22 The common use of pesticides for self-harm in part reflects their ease of availability. Whilst their use in agriculture is widespread in industrialized countries, large-scale farming is practised by a small number of landowners, thus reducing the number of people with direct access to pesticides. In contrast, most people living in rural regions of developing countries are involved in agriculture and farm small areas of land. Subsistence farmers keep their own su

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  • Pesticides are highly lethal and the leading suicide method worldwide, and the decline in suicide deaths worldwide is largely due to restricting access to pesticides in rural China, India, and Sri Lanka.

    “Pesticides are highly lethal, the leading suicide method worldwide, and the decline in suicide deaths worldwide is largely due to restricting access to pesticides where those deaths happen, namely in rural China,(138, 158) India(129) and Sri Lanka.(159)”

    From Improving Suicide Prevention Through Evidence-Based Strategies: A Systematic Review (2021) · cites this paper as [158]

    The paper’s section on patterns of suicide reports that pesticide ingestion is highly lethal and is the most frequently used suicide method in China and Sri Lanka; in India, it is the most frequently used agent for self-poisoning. Its sections on method availability and prevention describe a large global death toll and advocate restricting access, but do not establish that pesticides are the leading method worldwide or that a worldwide decline in suicide deaths was largely caused by restrictions in China, India, and Sri Lanka. Page numbers were not provided in our copy. (LLM, conf=0.88)

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  • Access to lethal means plays a critical role in suicide mortality risk.

    “Access to lethal means plays a critical role in suicide mortality risk [23].”

    From Age, period, and cohort effects on suicide death in the United States from 1999 to 2018: moderation by sex, race, and firearm involvement (2021) · cites this paper as [23]

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Research works printed but not linked: 5

  1. [9]Singh S Wig N Chaudhary D Sood NK Sharma BK Changing pattern of acute poisoning in adults: experience of a large north-west Indian hospital 1970-1989 Journal of the Association of the Physicians of India 1997 45 194 197
  2. [17]Hawton K Casey D Hall S Simkin S Harriss L Bale E Bond A Shepherd A Deliberate self-harm in Oxford 2001 2002 Oxford The Centre For Suicide Research, Department of Psychiatry, University of Oxford
  3. [23]Abeysinghe RM A Study of Pesticide Poisoning in an Agricultural Community 1992 University of Colombo MSc Community Medicine Thesis
  4. [26]Wells N Suicide and Deliberate Self Harm 1981 1 56 White Crescent Press Ltd. Office of Health Economics
  5. [53]WHO Pesticide poisoning database in SEAR countries: Report of a regional workshop 2001 22 24 New Delhi Document SEA-EH-534

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Authors
Gunnell, D., & Eddleston, M.
Affiliations
  • University of Bristol (GB)
  • University of Oxford (GB)
Corresponding author
Gunnell, David
ORCID
Venue
International Journal of Epidemiology
Publisher
Oxford University Press (OUP)
Published
2003-12
Volume
32
Issue
6
Pages
902-909
ISSN
  • 0300-5771 (ISSN-L)
  • 1464-3685
DOI
10.1093/ije/dyg307
PMC
PMC2001280
OpenAlex
W2129597215
Cited by
643
References
59
Citations by year
2026: 9 · 2025: 10 · 2024: 16 · 2023: 30 · 2022: 27 · 2021: 25 · 2020: 28 · 2019: 25 · 2018: 20 · 2017: 23 · 2016: 31 · 2015: 35 · 2014: 26 · 2013: 31 · 2012: 22
FWCI
3.16
Type
journal article
Language
en
Open access
Locations
  • International Journal of Epidemiology (publishedVersion)
  • PubMed (publishedVersion)
  • Explore Bristol Research (publishedVersion)
  • PubMed Central (acceptedVersion)
Funders
  • Wellcome Trust (GR063560MA, 063560)
  • Medical Research Council
Topics
  • Social Sciences › Psychology › Clinical Psychology › Suicide and Self-Harm Studies
  • Life Sciences › Agricultural and Biological Sciences › Plant Science › Pesticide Exposure and Toxicity
  • Social Sciences › Sociology and Political Science › Homicide, Infanticide, and Child Abuse
Keywords
suicide, pesticide ingestion, self-poisoning, agricultural pesticides, developing countries, rural suicide, case fatality, suicidal intent, self-harm, suicide prevention, urban-rural differences, rural China, Sri Lanka, Trinidad, Malaysia, South Asia, Latin America, Africa, Middle East, Pacific Islands, South America, North America
MeSH terms
Suicide Prevention, Developing Countries, Humans, Pesticides, Suicide, Age Distribution, Sex Distribution

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