title: Factors associated with the decline in suicide by pesticide poisoning in Taiwan: a time trend analysis, 1987-2010.
abstract: OBJECTIVE
  Pesticide self-poisoning accounts for one-third of suicides worldwide, but few studies have investigated the national epidemiology of pesticide suicide in countries where it is a commonly used method. We investigated trends in pesticide suicide, and factors associated with such trends, in Taiwan, a rapidly developing East Asian country.
  
  
  METHODS
  We conducted an ecological study using graphical approaches and Spearman's correlation coefficients to examine trends in pesticide suicide (1987-2010) in Taiwan in relation to pesticide sales, bans on selected pesticides, the proportion of the workforce involved in agriculture and unemployment. We compared pesticide products banned by the Taiwanese government with products that remained on the market and pesticides that accounted for the most poisoning deaths in Taiwan.
  
  
  RESULTS
  Age-standardised rates of pesticide suicide showed a 67% reduction from 7.7 per 100,000 (42% of all suicides) in 1987 to 2.5 per 100,000 (12% of all suicides) in 2010, in contrast to a 69% increase in suicide rates by other methods. Pesticide poisoning was the most commonly used method of suicide in 1987 but had become the third most common method by 2010. The reduction was paralleled by a 66% fall in the workforce involved in agriculture but there was no strong evidence for its association with trends in pesticide sales, bans on selected pesticide products or unemployment. The bans mostly post-dated the decline in pesticide suicides; furthermore, they did not include products (e.g. paraquat) that accounted for most deaths and were mainly restricted to selected high-strength formulated products whilst their equivalent low-strength products were not banned.
  
  
  CONCLUSIONS
  Access to pesticides, indicated by the size of agricultural workforce, appears to influence trends in pesticide suicide in Taiwan. Targeted bans on pesticides should focus on those products that account for most deaths.
authors.affiliation: School of Social and Community Medicine, University of Bristol, Bristol, UK.
authors.forename: Shu-Sen
authors.initials: SS
authors.lastname: Chang
authors.forename: Tsung-Hsueh
authors.initials: TH
authors.lastname: Lu
authors.forename: Michael
authors.initials: M
authors.lastname: Eddleston
authors.forename: Flemming
authors.initials: F
authors.lastname: Konradsen
authors.forename: Jonathan A C
authors.initials: JA
authors.lastname: Sterne
authors.forename: Jin-Jia
authors.initials: JJ
authors.lastname: Lin
authors.forename: David
authors.initials: D
authors.lastname: Gunnell
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000383:Agriculture; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010575:Pesticides / Q000506:poisoning*; D013405:Suicide / Q000706:statistics & numerical data* / Q000639:trends; D013624:Taiwan / Q000453:epidemiology; D013997:Time Factors
chemical_list: D010575:Pesticides