Information Accessibility of the Charcoal Burning Suicide Method in Mainland China

BACKGROUND There has been a marked rise in suicide by charcoal burning (CB) in some East Asian countries but little is known about its incidence in mainland China. We examined media-reported CB suicides and the availability of online information about the method in mainland China. METHODS We extracted and analyzed data for i) the characteristics and trends of fatal and nonfatal CB suicides reported by mainland Chinese newspapers (1998-2014); ii) trends and geographic variations in online searches using keywords relating to CB suicide (2011-2014); and iii) the content of Internet search results. RESULTS 109 CB suicide attempts (89 fatal and 20 nonfatal) were reported by newspapers in 13 out of the 31 provinces or provincial-level-municipalities in mainland China. There were increasing trends in the incidence of reported CB suicides and in online searches using CB-related keywords. The province-level search intensities were correlated with CB suicide rates (Spearman's correlation coefficient = 0.43 [95% confidence interval: 0.08-0.68]). Two-thirds of the web links retrieved using the search engine contained detailed information about the CB suicide method, of which 15% showed pro-suicide attitudes, and the majority (86%) did not encourage people to seek help. LIMITATIONS The incidence of CB suicide was based on newspaper reports and likely to be underestimated. CONCLUSIONS Mental health and suicide prevention professionals in mainland China should be alert to the increased use of this highly lethal suicide method. Better surveillance and intervention strategies need to be developed and implemented.