PURPOSE: In the late 1990s, an epidemic rise in suicides by carbon monoxide poisoning from burning barbecue charcoal began in Hong Kong and Taiwan. This study investigates the diffusion of this new method of suicide.
METHOD: Official mortality data for 1998-2010 in Taiwan and 1998-2009 in Hong Kong were collected; overall and method-specific suicide rates in different socio-demographic subgroups over the study period were compared. Multiple logistic regression analyses were conducted to assess the socio-demographic risk factors for charcoal-burning vs. non-charcoal-burning suicide.
RESULTS: In Hong Kong, the incidence of charcoal-burning suicide increased steeply within 1 year of the first reported cases, but its use has declined from 24.2 % of all suicides during the peak period (2002-2004) to 17.1 % (2007-2009); in Taiwan, the pace of diffusion was slower in onset, but it remains a popular method accounting for 31.0 % of all suicides in 2008-2010. The early adopters in both places tended to be young- and middle-aged men. As the epidemic progressed, the method has also been gradually adopted by older age groups and women, particularly in Taiwan, but in 2009/10, the method still accounted for <8 % of suicides in those aged >60 years in both areas.
CONCLUSIONS: Common features of the epidemic in both places were the greater levels of early uptake by the young- and middle-aged males. The different course of the charcoal-burning suicide epidemic may reflect social, geographic and media reporting differences. Surveillance to identify the emergence of new suicide methods is crucial in suicide prevention.