Social Psychiatry and Psychiatric Epidemiology

, Volume 50, Issue 2, pp 227–236 | Cite as

The diffusion of a new method of suicide: charcoal-burning suicide in Hong Kong and Taiwan

  • Ying-Yeh Chen
  • Paul SF Yip
  • Carmen KM Lee
  • David Gunnell
  • Kevin Chien-Chang WuEmail author
Original Paper



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.


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.


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.


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.


Suicide Charcoal burning Diffusion Hong Kong Taiwan 



This work was supported by the University of Hong Kong [Grant Number HKU784210M to P.S.F.Y.], the Ministry of Science and Technology, Taiwan [Grant Number 101-2314-B-532-005-MY2 to Y.Y.C.], the National Health Research Institute, Taiwan [Grant Number NHRI-EX100-10024PC to Y.Y.C.] and the Ministry of Science and Technology, Taiwan [Grant Number NSC 99-2410-H-002-137-MY3 to K.C.C.W.]. DG is an NIHR Senior Investigator.

Conflict of interest


Supplementary material

127_2014_910_MOESM1_ESM.docx (48 kb)
Supplementary material 1 (DOCX 48 kb)


  1. 1.
    Chen YY, Yip PSF, Lee C et al (2010) Economic fluctuations and suicide: a comparison of Taiwan and Hong Kong. Soc Sci Med 71:2083–2090PubMedCrossRefGoogle Scholar
  2. 2.
    Liu KY, Beautrais A, Caine E et al (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 61:248–253PubMedCentralPubMedCrossRefGoogle Scholar
  3. 3.
    Chang SS, Chen YY, Yip PSF, Lee WJ, Hagihara A, Gunnell D (2014) Regional changes in charcoal-burning suicide rates in East/Southeast Asia from 1995 to 2011: a time trend analysis. PLOS Med 11(4):e1001622PubMedCentralPubMedCrossRefGoogle Scholar
  4. 4.
    Center for Suicide Research and Prevention (2012) The University of Hong Kong. Accessed 1 June 2012
  5. 5.
    Department of Health, Executive Yuan, R.O.C. (Taiwan). (2012) Accessed 1 Jun 2012
  6. 6.
    Chang SS, Gunnell D, Wheeler BW et al (2010) The evolution of the epidemic of charcoal-burning suicide in Taiwan: a spatial and temporal analysis. PLoS Med 7:e1000212PubMedCentralPubMedCrossRefGoogle Scholar
  7. 7.
    National Satistics, R.O.C. (Taiwan) (2013).
  8. 8.
    Population Census Household Income Distribution in Hong Kong (2011).
  9. 9.
    Rogers EM (2002) Diffusion of preventive innovation. Addict Behav 27:989–993PubMedCrossRefGoogle Scholar
  10. 10.
    Mann JJ, Apter A, Bertolote J et al (2005) Suicide prevention strategies. JAMA 294:2064–2074PubMedCrossRefGoogle Scholar
  11. 11.
    Hitosugi M, Nagai T, Tokudome S (2009) Proposal of new ICD code for suicide by charcoal burning. J Epidemiol Community Health 63:862–863PubMedCrossRefGoogle Scholar
  12. 12.
    Lin JJ, Chen LH, Huang SM et al (2008) Problems in estimating the number of suicides by charcoal burning in Taiwan. J Epidemiol Community Health 62:566PubMedCrossRefGoogle Scholar
  13. 13.
    National Cancer Institute US National Institute of Health (2013) Joinpoint regression program. National Cancer Institute US National Institute of Health, Accessed 1 June 2012
  14. 14.
    Yip PSF, Lee DTS (2007) Charcoal-burning suicides and strategies for prevention. Crisis 28(Suppl 1):21–27Google Scholar
  15. 15.
    Chen YY, Lee MB, Chang CM et al (2009) Methods of suicide in different psychiatric diagnostic groups. J Affect Disord 118:196–200PubMedCrossRefGoogle Scholar
  16. 16.
    Rogers EM (2003) Diffusion of innovations. Free Press, New YorkGoogle Scholar
  17. 17.
    Geroski GA (2000) Models of technology diffusion. Res Policy 29:603–625CrossRefGoogle Scholar
  18. 18.
    Venkatesh V, Morris MG, Davis GB et al (2003) User acceptance of information technology: toward a unified view. MIS Q 27:425–478Google Scholar
  19. 19.
    Florentine JB, Crane C (2010) Suicide prevention by limiting access to methods: a review of theory and practice. Soc Sci Med 70:1626–1632PubMedCrossRefGoogle Scholar
  20. 20.
    Chen YY, Chen F, Yip PSF (2011) The impact of media reporting of suicide on actual suicides in Taiwan, 2002–05. J Epidemiol Community Health 65:934–940PubMedCrossRefGoogle Scholar
  21. 21.
    Chen YY, Yip PSF, Tsai CW et al (2012) Media representation of gender patterns of suicide in Taiwan. Crisis 33:144–150PubMedGoogle Scholar
  22. 22.
    Chen YY, Chen F, Gunnell D, Yip PSF (2013) The impact of media reporting on the emergence of charcoal burning suicide in Taiwan. PLoS ONE 8(1):e55000PubMedCentralPubMedCrossRefGoogle Scholar
  23. 23.
    Chen YY, Chen F, Yip PSF (2011) The impact of media reporting of suicide on actual suicides in Taiwan, 2002–05. J Epidemiol Community Health 65(10):934–940PubMedCrossRefGoogle Scholar
  24. 24.
    Yip PSF, Kwok SSM, Chen F, Xu X, Chen YY (2013) A study on the mutual causation of suicide reporting and suicide incidences. J Affect Disord 148(1):98–103PubMedCrossRefGoogle Scholar
  25. 25.
    Tsai CW, Gunnell D, Chou YH et al (2011) Why do people choose charcoal burning as a method of suicide? An interview based study of survivors in Taiwan. J Affect Disord 131:402–440PubMedCrossRefGoogle Scholar
  26. 26.
    Yip PSF, Caine E, Yousuf S, Chang SS, Wu KCC, Chen YY (2012) Means restriction for suicide prevention. Lancet 379(9834):2393–2399PubMedCrossRefGoogle Scholar
  27. 27.
    Chen YY, Yip PSF (2009) Prevention of suicide by jumping: experiences from Taipei City (Taiwan), Hong Kong and Singapore. In: Wasserman D, Wasserman C (eds) Oxford textbook of suicidology and suicide prevention. Oxford University Press, New York, pp 569–572Google Scholar
  28. 28.
    National Statistics, R. O. C. (Taiwan) (2012).
  29. 29.
    Cantor CH, Baume PJ (1998) Access to methods of suicide: what impact? Aust N Z J Psychiatry 32:8–14PubMedCrossRefGoogle Scholar
  30. 30.
    Daigle MS (2005) Suicide prevention through means restriction: assessing the risk of substitution. A critical review and synthesis. Accid Anal Prev 37:625–632PubMedCrossRefGoogle Scholar
  31. 31.
    Christakis NA, Fowler JH (2010) Social network sensors for early detection of contagious outbreaks. PLoS One 5(9):e12948. doi: 10.1371/journal.pone.0012948 PubMedCentralPubMedCrossRefGoogle Scholar
  32. 32.
    Baller RD, Richardson KK (2002) The “dark side” of the strength of weak ties: the diffusion of suicidal thoughts. J Health Soc Behav 50(3):261–276CrossRefGoogle Scholar
  33. 33.
    Colbaugh R, Glass K (2012) Early warning analysis for social diffusion event. Security Informatics 1:18, available at
  34. 34.
    Luke DA, Stamatakis KA (2012) Systems science methods in public health: dynamics, networks, and agents. Annu Rev Public Health 33:357–376PubMedCentralPubMedCrossRefGoogle Scholar
  35. 35.
    Niederkrotenthaler T, Voracek M, Herberth A et al (2010) Role of media reports in completed and prevented suicide: werther v. Papageno effects. Br J Psychiatry 197:234–243PubMedCrossRefGoogle Scholar
  36. 36.
    Fu KW, Cheng Q, Wong PWC, Yip PSF (2013) Responses to a self-presented suicide attempt in social media. Crisis 34(6):406–412PubMedCentralPubMedGoogle Scholar
  37. 37.
    Law CK, Yip PSF, Caine ED (2011) The contribution of charcoal burning to the rise and decline of suicides in Hong Kong from 1997–2007. Soc Psychiatry Psychiatr Epidemiol 46:797–803PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2014

Authors and Affiliations

  • Ying-Yeh Chen
    • 1
    • 2
  • Paul SF Yip
    • 3
    • 4
  • Carmen KM Lee
    • 3
    • 4
  • David Gunnell
    • 5
  • Kevin Chien-Chang Wu
    • 6
    • 7
    Email author
  1. 1.Taipei City Psychiatric CenterTaipei City HospitalTaipeiTaiwan
  2. 2.Institute of Public Health and Department of Public HealthNational Yang-Ming UniversityTaipeiTaiwan
  3. 3.Department of Social Work and Social AdministrationUniversity of Hong KongHong KongChina
  4. 4.Hong Kong Jockey Club Centre for Suicide Research and PreventionUniversity of Hong KongHong KongChina
  5. 5.School of Social and Community MedicineUniversity of BristolBristolUK
  6. 6.Department of Social MedicineNational Taiwan University College of Medicine School of MedicineTaipeiTaiwan
  7. 7.Department of PsychiatryNational Taiwan University HospitalTaipeiTaiwan

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