Trends in solids/liquids poisoning suicide rates in Taiwan: A test of the substitution hypothesis

Background: Several previous studies have illustrated that restricting access to lethal methods can reduce suicide rates. The most often cited example was Kreitman's study, showing a reduction not only in gas-specific suicide rates, but also in the overall suicide rates because of the lack of increase of other methods. However, method substitution is still a major concern in the application of the means restriction strategy to prevent suicide. The aim of the study was to investigate whether the reduction in the solids/liquids poisoning suicide rate in 1983-1993 after the launching of pesticide restriction interventions in Taiwan was accompanied with an increase in the suicide rate using other methods (method substitution). Methods. Data on age-, sex- and method-specific suicide rates for 1971-1993 in Taiwan were obtained. Changes in solids/liquids poisoning suicide rates were compared with suicide rates by hanging and other methods between 1983 and 1993. Results: No concomitant increase in suicide rates by hanging or other methods was noted from 1983 to 1993, during which the suicide rates by poisoning with solids/liquids (mainly pesticides) decreased markedly and steadily. The phenomenon of method substitution was also not found by sex and age groups. Conclusion: In general, no method substitution was found along with the reduction in solids/liquids suicide rates in Taiwan. Our study results have also added the evidence that restricting access to methods maybe a promising strategy in preventing suicide, particularly in those countries where the "target method" has been found to contribute greatly to the suicide rates.