August 16, 2007

Hong Kong Suicides, Revisited

A reader asked me to help promote the Hong Kong Mental Health Support Group.  My first reaction (after being flattered) was to silently muse, "well, why Hong Kong only?"  What's the difference?   I realize that people from Hong Kong might like the sense of community, but I'd bet anyone from Hong Kong is already plugged into a community-- why another one for mental health issues?  What's the real advantage?  Understand that I am not an idiot-- I see how people would feel more comfortable, but I'm asking whether there is any real, actual, measurable benefit to a culture specific group vs. a general group.

Which got me thinking of this: in the massive push for biological bases for mental illnesses, have we ignored the very real influence of culture on mental health?  And suicide?   Cultural influences so strong, that they not only overwhelm biology but even probability?


In numerous articles (e.g. here) the debate is whether a famous suicide incites others to also commit suicide (who would not have otherwise) or if it simply incites people who would have committed suicide to simply copy the method.

It occurs to me that this question is flawed, because it assumes all people-- races, genders, nationalities, ages-- are the same.

Two articles about suicide in Hong Kong.  for background, 95% of the people in Hong Kong live in high rises.  Coincidentally, or causally, 50% of all suicides are by jumping out/off a building. 30% are hanging.

Prior to 11/23/98, almost no one ever lit charcoal briquets in a closed room and killed thmselves by CO poisoning. On that day, however, someone did do this (supposedly imitating a Japanese movie), and the case went to the front pages of the newspapers.  And then this happened:

CO suicides hong kong 


See that spike?  That's not random, man. 

What is even more unusual about Hong Kong, in comparison to the U.S., is that this increase in charcoal suicides was not at the expense of another method-- in other words, more people committed suicide overall--23% more:


all hong kong suicides 


The increase in overall suicides in Hong Kong were only related to increases in the charcoal poisonings.  In essence, it was as if a whole new subset of people were killing themselves, specifically by this method.

Who were they?  

Mean age was 39 (the second study found ages 24-39; compare to 47 for jumping and 55 for hanging) and 64% were men. 90% happened at home.  Only 20% used sedatives or alcohol coincidentally.

Interestingly, charcoal suicides are on the rise in Taiwan, China overall, and Japan, where they had a rash of charcoal suicide pacts.

So the questions to answer-- and I'm soliciting answers--

  • why does the copycat phenomenon, at least with respect to charcoal, clearly exist in east Asia, when it barely exists in the U.S./Europe?  Is it cultural, and what are the relevant factors?
  • what kind of people are using charcoal (is it different than the jumpers?)  For example, is it men creeping on middle age, who have no job, live at home, etc, shamed by their lack of success?
  • If the above evidence is true, and the charcoal suiciders would not have killed themselves otherwise, what is it about the charcoal or the copying that incites them to want to die?