Chan, Kathy P M adjunct associate professor¹; Lee, Dominic T S associate professor²; Lee, Sing professor²; Yip, Paul S F director³

Editor—The alarming escalation of charcoal burning suicide in Hong Kong supports Hawton and Williams's call for guidelines on the reporting of suicide. 1 We previously reported on the emergence of this new method of suicide in Hong Kong. 2

In November 1998 a 35 year old woman committed suicide by burning charcoal in a barbeque grill in her sealed and cramped apartment. Compared with jumping, which accounts for most local suicide deaths, suicide by burning charcoal was romanticised as an easy and comfortable way of dying. The incident was pictorially reported in the media. Two months after its appearance charcoal burning became the third commonest method of suicide in Hong Kong, where carbon monoxide poisoning was previously uncommon. 2 In 2001 it replaced hanging as the second commonest method of suicide, accounting for 25% of all deaths from suicide.

People committing suicide by charcoal burning were often middle aged and were portrayed as debt ridden because Hong Kong was experiencing its first recession after two decades of economic boom. Charcoal burning was represented as a legitimate way out of the person's financial predicaments. Our coroner's court findings were highly consistent with these media representations. 2

The influence of the media on suicide is contentious and has not been taken seriously in public health. 3 4 In the case of suicide by charcoal burning in Hong Kong, concerns have been raised by researchers and healthcare workers about the potentially contagious impact of media reporting. However, news editors have expressed reservations and remain unconvinced about the guidelines published by the World Health Organization on suicide reporting.

The first suicide intervention and prevention centre in China, funded by the Chinese government, was opened in December in Beijing. Media publicity was rightly adopted as one of the key strategies for raising public awareness. 5 None the less, given that the handy use of pesticides claimed most of the suicide deaths in rural China, the possible effect of such publicity deserves monitoring too.

1. Hawton K, Williams K. The influence of media on suicide. BMJ 2002;325:1374-1375. (14 December.) [Context Link]

2. Lee D, Chan K, Lee S, Yip P. Burning charcoal: A novel and contagious method of suicide in Asia. Arch Gen Psychiatry 2002;59:293-294. Ovid Full Text Internet Resources Bibliographic Links [Context Link]

3. Stack S. The effect of the media on suicide: Evidence from Japan 1955-1985. Suicide Life Threat Behav 1996;26:132-142. Internet Resources Bibliographic Links Document Delivery [Context Link]

4. Phillips DP. The influence of suggestion on suicide: substantive and theoretical implications of the Werther effect. Am Sociol Rev 1974;39:340-354. Internet Resources Bibliographic Links Document Delivery [Context Link]

5. Lee S, Kleinman A. Suicide as resistance in Chinese society. In: EJ Perry EJ, Selden M, eds. Chinese society: change, conflict and resistance. London: Routledge, 2000;221-240. [Context Link]