The Evolution of the Epidemic of Charcoal-Burning Suicide in Taiwan: A Spatial and Temporal Analysis

English version České info

Background:
An epidemic of carbon monoxide poisoning suicide by burning barbecue charcoal has occurred in East Asia in the last decade. We investigated the spatial and temporal evolution of the epidemic to assess its impact on the epidemiology of suicide in Taiwan.

Methods and Findings:
Age-standardised rates of suicide and undetermined death by charcoal burning were mapped across townships (median population aged 15 y or over = 27,000) in Taiwan for the periods 1999–2001, 2002–2004, and 2005–2007. Smoothed standardised mortality ratios of charcoal-burning and non-charcoal-burning suicide and undetermined death across townships were estimated using Bayesian hierarchical models. Trends in overall and method-specific rates were compared between urban and rural areas for the period 1991–2007. The epidemic of charcoal-burning suicide in Taiwan emerged more prominently in urban than rural areas, without a single point of origin, and rates of charcoal-burning suicide remained highest in the metropolitan regions throughout the epidemic. The rural excess in overall suicide rates prior to 1998 diminished as rates of charcoal-burning suicide increased to a greater extent in urban than rural areas.

Conclusions:
The charcoal-burning epidemic has altered the geography of suicide in Taiwan. The observed pattern and its changes in the past decade suggest that widespread media coverage of this suicide method and easy access to barbecue charcoal may have contributed to the epidemic. Prevention strategies targeted at these factors, such as introducing and enforcing guidelines on media reporting and restricting access to charcoal, may help tackle the increase of charcoal-burning suicides.

: Please see later in the article for the Editors' Summary

Vyšlo v časopise: The Evolution of the Epidemic of Charcoal-Burning Suicide in Taiwan: A Spatial and Temporal Analysis. PLoS Med 7(1): e32767. doi:10.1371/journal.pmed.1000212
Kategorie: Research Article
prolekare.web.journal.doi_sk: https://doi.org/10.1371/journal.pmed.1000212

Souhrn

Zdroje

1. YipPS

LeeDTS

2007 Charcoal-burning suicides and strategies for prevention. Crisis 28 Suppl 1 21 27

2. LeeDT

ChanKP

LeeS

YipPS

2002 Burning charcoal: a novel and contagious method of suicide in Asia. Arch Gen Psychiatry 59 293 294

3. LiuKY

BeautraisA

CaineE

ChanK

ChaoA

2007 Charcoal burning suicides in Hong Kong and urban Taiwan: an illustration of the impact of a novel suicide method on overall regional rates. J Epidemiol Community Health 61 248 253

4. LinJJ

LuTH

2008 Suicide mortality trends by sex, age and method in Taiwan, 1971–2005. BMC Public Health 8 6

5. ChanKP

YipPS

AuJ

LeeDT

2005 Charcoal-burning suicide in post-transition Hong Kong. Br J Psychiatry 186 67 73

6. HuhGY

JoGR

KimKH

AhnYW

LeeSY

2009 Imitative suicide by burning charcoal in the southeastern region of Korea: the influence of mass media reporting. Leg Med (Tokyo) 11 S563 S564

7. PatelF

2008 Carbon copy deaths: carbon monoxide gas chamber. J Forensic Leg Med 15 398 401

8. LinJJ

LuTH

2008 High-risk groups for charcoal-burning suicide in Taiwan, 2001-2005. J Clin Psychiatry 69 1499 1501

9. JoinerTE

1999 The clustering and contagion of suicide. Curr Dir Psychol Sci 8 89 92

10. CantorCH

BaumePJ

1998 Access to methods of suicide: what impact? Aust N Z J Psychiatry 32 8 14

11. LinsleyKR

SchapiraK

KellyTP

2001 Open verdict v. suicide - importance to research. Br J Psychiatry 178 465 468

12. OhbergA

LonnqvistJ

1998 Suicides hidden among undetermined deaths. Acta Psychiatr Scand 98 214 218

13. ChangSS

SterneJA

LuTH

GunnellD

2009 ‘Hidden’ suicides amongst deaths certified as undetermined intent, accident by pesticide poisoning and accident by suffocation in Taiwan. Soc Psychiatry Psychiatr Epidemiol. In press

14. LinJJ

ChenLH

HuangSM

LuTH

2008 Problems in estimating the number of suicides by charcoal burning in Taiwan. J Epidemiol Community Health 62 566

15. LiuCY

HungYT

ChuangYL

ChenYJ

WengWS

2006 Incorporating development stratification of Taiwan townships into sampling design of large scale health interview survey. J Health Management (Chin) 4 1 22

16. Construction and Planning Agency, Taiwan 2001 Urban planning. Available: http://www.cpami.gov.tw/web/index.php?option=com_content&task=view&id=1126&Itemid=75. Accessed 1 May 2009

17. AssuncaoRM

ReisEA

1999 A new proposal to adjust Moran's I for population density. Stat Med 18 2147 2162

18. AnselinL

SyabriI

KhoY

2006 GeoDa: An introduction to spatial data analysis. Geogr Anal 38 5 22

19. ClaytonD

KaldorJ

1987 Empirical Bayes estimates of age-standardized relative risks for use in disease mapping. Biometrics 43 671 681

20. LawsonAB

BiggeriAB

BoehningD

LesaffreE

VielJF

2000 Disease mapping models: an empirical evaluation. Disease Mapping Collaborative Group. Stat Med 19 2217 2241

21. MiddletonN

SterneJA

GunnellDJ

2008 An atlas of suicide mortality: England and Wales, 1988–1994. Health Place 14 492 506

22. MollieA

2000 Bayesian mapping of Hodgkin's disease in France.

ElliotP

WakefieldJC

BestNG

BriggsDJ

Spatial epidemiology: methods and applications Oxford Oxford University Press 267 285

23. GilksWR

RichardsonS

SpiegelhalterDJ

1996 Markov chain Monte Carlo in practice. London Chapman & Hall

24. ThomasA

BestN

LunnD

ArnoldR

SpiegelhalterD

2003 GeoBUGS user manual, version 1.2. Cambridge MRC Biostatistics Unit

25. BrooksSP

GelmanA

1998 General methods for monitoring convergence of iterative simulations. J Comput Graph Stat 7 434 455

26. BrewerCA

MacEachrenAM

PickleLW

HerrmannD

1997 Mapping mortality: evaluating color schemes for choropleth maps. Ann Assoc Am Geogr 87 411 438

27. PanY-J

LiaoS-C

LeeM-B

2009 Suicide by charcoal burning in Taiwan, 1995–2006. J Affect Disord. In press

28. Mingpaonews 2000 Under the influence of internet information from Hong Kong, the first case of charcoal burning suicide emerged in Taiwan. Mingpaonews.

29. ChenYY

TsaiPC

ChenPH

FanCC

HungGC

2009 Effect of media reporting of the suicide of a singer in Taiwan: the case of Ivy Li. Soc Psychiatry Psychiatr Epidemiol In press

30. Directorate-General of Budget Accounting and Statistics, Taiwan 2000 National statistics. Important indicators for each county. Available: http://61.60.106.82/pxweb/Dialog/statfile9.asp. Accessed 5 May 2009

31. Research Developmennt and Evaluation Commission, Taiwan 2002 Digital divide in Taiwan, 2002. Available: http://www.rdec.gov.tw/ct.asp?xItem=4024389&ctNode=11171. Accessed 5 May 2009

32. LinJJ

LuTH

2006 Association between the accessibility to lethal methods and method-specific suicide rates: an ecological study in Taiwan. J Clin Psychiatry 67 1074 1079

33. Ajdacic-GrossV

WeissMG

RingM

HeppU

BoppM

2008 Methods of suicide: international suicide patterns derived from the WHO mortality database. Bull World Health Organ 86 726 732

34. LevinKA

LeylandAH

2005 Urban/rural inequalities in suicide in Scotland, 1981–1999. Soc Sci Med 60 2877 2890

35. MarzukPM

LeonAC

TardiffK

MorganEB

StajicM

1992 The effect of access to lethal methods of injury on suicide rates. Arch Gen Psychiatry 49 451 458

36. MehlumL

HyttenK

GjertsenF

1999 Epidemiological trends of youth suicide in Norway. Arch Suicide Res 5 193 205

37. PesonenTM

HintikkaJ

KarkolaKO

SaarinenPI

AntikainenM

2001 Male suicide mortality in eastern Finland–urban-rural changes during a 10-year period between 1988 and 1997. Scand J Public Health 29 189 193

38. MiddletonN

GunnellD

FrankelS

WhitleyE

DorlingD

2003 Urban-rural differences in suicide trends in young adults: England and Wales, 1981-1998. Soc Sci Med 57 1183 1194

39. RazvodovskyY

StickleyA

2009 Suicide in urban and rural regions of Belarus, 1990-2005. Public Health 123 27 31

40. SinghGK

SiahpushM

2002 Increasing rural-urban gradients in US suicide mortality, 1970-1997. Am J Public Health 92 1161 1167

41. KapustaND

ZormanA

EtzersdorferE

Ponocny-SeligerE

Jandl-JagerE

2008 Rural-urban differences in Austrian suicides. Soc Psychiatry Psychiatr Epidemiol 43 311 318

42. ChangSS

SterneJAC

HuangWC

ChuangHL

GunnellD

2009 The association of secular trends in unemployment with suicide in Taiwan, 1959–2007: a time-series analysis. Public Health. In press

43. ChangSS

GunnellD

SterneJAC

LuTH

ChengATA

2009 Was the economic crisis 1997-1998 responsible for rising suicide rates in East/Southeast Asia? A time-trend analysis for Japan, Hong Kong, South Korea, Taiwan, Singapore and Thailand. Soc Sci Med 68 1322 1331

44. PirkisJ

BloodRW

BeautraisA

BurgessP

SkehansJ

2006 Media guidelines on the reporting of suicide. Crisis 27 82 87

45. World Health Organization 2008 Preventing suicide. A resource for media professionals. Geneva World Health Organization