Patterns of suicide in countries where pesticide poisoning is commonplace

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.