title: Suicide by gases in England and Wales 2001-2011: evidence of the emergence of new methods of suicide.
abstract: BACKGROUND
  Increases in suicide deaths by gassing, particularly carbon monoxide poisoning from burning barbecue charcoal, have occurred in many parts of East Asia and resulted in rises in overall suicide rates in some countries. Recent trends in gas poisoning suicides outside Asia have received little attention.
  
  
  METHODS
  We analysed suicides by gassing in England and Wales (2001-2011) using national suicide mortality data enhanced by free text searching of information sent by coroners to the Office for National Statistics (ONS). We conducted specific searches for suicides involving barbecue charcoal gas, helium, and hydrogen sulphide. We analysed coroners' records of eight people who used helium as a method of suicide, identified from systematic searches of the records of four coroners.
  
  
  RESULTS
  Gassing accounted for 5.2% of suicide deaths in England and Wales during 2001-2011. The number of gas suicides declined from 368 in 2001 to 174 by 2011 (a 53% reduction). The fall was due to a decline in deaths involving car exhaust and other sources of carbon monoxide. There was a rapid rise in deaths due to helium inhalation over the period, from five deaths in the two year period 2001-2002 to 89 in 2010-2011 (a 17-fold increase). There were small rises in deaths involving hydrogen sulphide (0 cases in 2001-2002 versus 14 cases in 2010-2011) and barbecue charcoal gas (1 case in 2001-2002 versus 11 cases in 2010-2011). Compared to individuals using other methods, those suicides adopting new types of gas for suicide were generally younger and from more affluent socioeconomic groups. The corones' records of four of the eight individuals dying by helium inhalation whose records were reviewed showed evidence of Internet involvement in their choice of method.
  
  
  CONCLUSIONS
  We were not able to identify the source of carbon monoxide (car exhaust or barbecue charcoal) for over 50% of cases.
  
  
  CONCLUSIONS
  Increases in helium inhalation as a method of suicide have partially offset recent decreases in suicide by the use of car exhaust. Public health measures are urgently needed to prevent a potential epidemic rise in the use of helium similar to the recent rises in charcoal burning suicides in East Asia.
authors.affiliation: School of Social and Community Medicine, Canynge Hall, 39 Whatley Road, University of Bristol, Bristol BS8 2PS, United Kingdom. Electronic address: D.J.Gunnell@Bristol.ac.uk.
authors.forename: D
authors.initials: D
authors.lastname: Gunnell
authors.affiliation: School of Social and Community Medicine, Canynge Hall, 39 Whatley Road, University of Bristol, Bristol BS8 2PS, United Kingdom.
authors.forename: C
authors.initials: C
authors.lastname: Coope
authors.affiliation: Office for National Statistics, Newport, Wales NP10 8XG, United Kingdom.
authors.forename: V
authors.initials: V
authors.lastname: Fearn
authors.affiliation: Office for National Statistics, Newport, Wales NP10 8XG, United Kingdom.
authors.forename: C
authors.initials: C
authors.lastname: Wells
authors.affiliation: Hong Kong Jockey Club Centre for Suicide Research and Prevention, The University of Hong Kong, Pokfulam, Hong Kong, China; Department of Social Work and Social Administration, The University of Hong Kong, Pokfulam, Hong Kong, China.
authors.forename: S-S
authors.initials: SS
authors.lastname: Chang
authors.affiliation: Centre for Suicide Research, University of Oxford Department of Psychiatry, Warneford Hospital, Oxford OX3 7JX, United Kingdom.
authors.forename: K
authors.initials: K
authors.lastname: Hawton
authors.affiliation: Centre for Suicide Prevention, University of Manchester, Manchester M13 9PL, United Kingdom.
authors.forename: N
authors.initials: N
authors.lastname: Kapur
mesh_terms: D000059:Accidents; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001344:Autopsy; D002249:Carbon Monoxide Poisoning / Q000453:epidemiology / Q000523:psychology; D002606:Charcoal; D004739:England / Q000453:epidemiology; D005260:Female; D005739:Gas Poisoning / Q000453:epidemiology* / Q000523:psychology*; D006371:Helium / Q000506:poisoning; D006801:Humans; D006862:Hydrogen Sulfide / Q000506:poisoning; D038801:International Classification of Diseases; D008297:Male; D008875:Middle Aged; D012959:Socioeconomic Factors; D013405:Suicide / Q000523:psychology / Q000706:statistics & numerical data* / Q000639:trends*; D001335:Vehicle Emissions / Q000506:poisoning; D014852:Wales / Q000453:epidemiology; D055815:Young Adult
chemical_list: D001335:Vehicle Emissions; D002606:Charcoal; D006371:Helium; D006862:Hydrogen Sulfide
keywords: Carbon monoxide; Charcoal burning; Epidemiology; Helium; Suicide; Suicide methods