title: Impact of paraquat regulation on suicide in South Korea.
abstract: Ingestion of pesticides (mainly paraquat) accounted for one-fifth of suicides in South Korea in 2006-10. We investigated the effect on suicide mortality of regulatory action, culminating in a ban on paraquat in South Korea in 2011-12.
  
  
  
  We calculated age-standardized method-specific suicide mortality rates among people aged ≥15 in South Korea (1983-2013) using registered death data. Negative binomial regression was used to estimate changes in the rate and number of pesticide suicides in 2013, compared with those expected based on previous trends (2003-11).
  
  
  
  Pesticide suicide mortality halved from 5.26 to 2.67 per 100 000 population between 2011 and 2013. Compared with the number expected based on previous trends, the regulations were followed by an estimated 847 [95% confidence interval (CI) -1180 to -533] fewer pesticide suicides, a 37% reduction in rates (rate ratio = 0.63, 95% CI 0.55 to 0.73) in 2013. The decline in pesticide suicides after the regulations was seen in all age/sex/geographical groups. The absolute reduction in the number of suicides was greatest among men, the elderly and in rural areas. The reduction in pesticide suicides contributed to 56% of the decline in overall suicides that occurred between 2011 and 2013. There was no impact of the regulations on crop yield.
  
  
  
  The regulation of paraquat in South Korea in 2011-12 was associated with a reduction in pesticide suicide. Further legislative interventions to prevent the easy availability of highly lethal suicide methods are recommended for reducing the number of suicides worldwide.
authors.affiliation: Department of Preventive Medicine, Korea University College of Medicine, Seoul, South Korea.
authors.forename: Eun Shil
authors.initials: ES
authors.lastname: Cha
authors.affiliation: Institute of Health Behaviors and Community Sciences, and Department of Public Health, National Taiwan University, Taipei, Taiwan.
authors.forename: Shu-Sen
authors.initials: SS
authors.lastname: Chang
authors.affiliation: School of Social and Community Medicine, University of Bristol, Bristol, UK, South Asian Clinical Toxicology Research Collaboration, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka.
authors.forename: David
authors.initials: D
authors.lastname: Gunnell
authors.affiliation: South Asian Clinical Toxicology Research Collaboration, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka, University/BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK and.
authors.forename: Michael
authors.initials: M
authors.lastname: Eddleston
authors.affiliation: Department of Health Policy and Management, Seoul National University College of Medicine, and Institute of Health Policy and Management, Seoul National University Medical Research Center, Seoul, South Korea.
authors.forename: Young-Ho
authors.initials: YH
authors.lastname: Khang
authors.affiliation: Department of Preventive Medicine, Korea University College of Medicine, Seoul, South Korea, leewj@korea.ac.kr.
authors.forename: Won Jin
authors.initials: WJ
authors.lastname: Lee
mesh_terms: D000328:Adult; D017677:Age Distribution; D005260:Female; D033161:Government Regulation; D006540:Herbicides / Q000506:poisoning* / Q000600:supply & distribution; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D010269:Paraquat / Q000506:poisoning* / Q000600:supply & distribution; D011041:Poisoning / Q000401:mortality*; D056910:Republic of Korea / Q000453:epidemiology; D017678:Sex Distribution; D013405:Suicide / Q000208:ethnology / Q000706:statistics & numerical data* / Q000639:trends
chemical_list: D006540:Herbicides; D010269:Paraquat
keywords: Death; intentional poisoning; intervention; legislation; pesticides