Suicides by ingestion of paraquat
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Paraquat and other acutely toxic pesticides have been misused to commit suicide. There is a problem in the recording of pesticide poisoning, however: ‘The problem is that suicides are overrepresented in illness-surveillance data. (...) In comparison, work-related pesticide poisonings are significantly underreported, due to, among other factors, the less severe nature of most causes, the fact that illnesses occurring on farms are often far from health facilities and are thus more frequently self-treated or not treated at all, and the unwillingness of employers to have workers' illnesses reported and thus incur insurance liabilities’ (Murray et al 2002). Unintentional deaths have been misclassified as intentional in Costa Rica, where suicides were classified on the basis of lesions in the stomach, assuming that unintentionally absorbed amounts are generally negligible. (Wesseling et al 1997)

Mortality or the proportion of poisonings with fatal outcome is considerably higher in cases with suicidal intent than in cases of accidental or occupational poisoning (Onyon & Volans 1987). The proportion of poisoning cases with suicidal intent and unintentional absorption of paraquat varies between different countries. Epidemics of paraquat poisoning have occurred in certain countries , e.g. in Japan. In Sri Lanka the proportion of self-harm was found to be high, and around the year 2001 organophoshates in WHO class II and paraquat accounted for the majority of poisonings (Roberts et al 2003). Mortality was high with endosulfan and paraquat in Sri Lanka, while risk factors for intentional self-poisoning were unemployment, lower educational status, problems in the family and a history of pesticide poisoning (van der Hoek et al 2005). In Andhra Pradesh, India, suicide epidemics among farmers were strongly related to poverty or indebtedness combined with an increased reliance on cash crops where pesticide use is high (Chowdhury & Banerjee 2001). Suicides by the misuse of pesticides present an entirely different problem from unintentional poisonings at the workplace and this problem requires various measures such as improvements in (mental) health services at the community level, besides restricting the availability of acutely toxic pesticides. It was seen in Samoa that restricted availabililty led to a reduction in the number of poisoning cases (WHO 2002, and reference therein: Bowles 1995). Banning particular pesticides may be effective but in the long run further measures are necessary to avoid that new poisons replace the old: reduction of harmful behaviour through community-level mental health care, improved medical management, improved storage of pesticides or medicines and the requirement of a ‘prescription’ for the purchase of these, as well as overall reduced use of agrochemicals (Eddleston 2000). Several authors demanded the restriction of the availability of paraquat. In Japan physicians in intensive care units are hoping for a ban of paraquat (Nagami et al 2005.


Bowles JR, Suicide in western Samoa: an example of a suicide prevention program in a developing country, In: Diekstra RFW, Gulbinat W, Kienhorst I, and de Leo D (eds), Preventive strategies on suicide, 173-206, Leiden: EJ Brill 1995

Chowdhury AN, and Banerjee S, Pesticides and suicide epidemic among Indian farmers: a grave health challenge, Indian Journal of Social Psychiatry 17(1-4), 62-69, 2001

Eddleston M, Patterns and problems of deliberate self-poisoning in the developing world, Quarterly Journal of Medicine 93(11), 715-731, 2000

Murray D, Wesseling C, Keifer M, Corriols M, and Henao S, Surveillance of pesticide-related illness in the developing world: putting the data to work, International Journal of Occupational and Environmental Health 8(3), 243-8, 2002

Onyon LJ, and Volans GN, The epidemiology and prevention of paraquat poisoning, Human Toxicology 6(1), 19-29, 1987

Roberts DM, Karunarathna A, Buckley NA, Manuweera G, Sheriff MH, and Eddleston M, Influence of pesticide regulation on acute poisoning deaths in Sri Lanka, Bulletin of the World Health Organization 81 (11), 789-798, 2003

van der Hoek W, and Konradsen F, Risk factors for acute pesticide poisoning in Sri Lanka, Tropical Medicine and International Health 10(6), 589-596, 2005

Wesseling C, Hogstedt C, Picado A, and Johansson L, Unintentional fatal paraquat poisonings among agricultural workers in Costa Rica: a report of fifteen cases, American Journal of Industrial Medicine 32 (5), 433-441, 1997

World Health Organization (WHO), World Report on Violence and Health, chapter 7, 2002

Nagami H, Nishigaki Y, Matsushima S, Matsushita T, Asanuma S, Yajima N, Usuda M, and Hirosawa M, Hospital-based survey of pesticide poisoning in Japan, 1998-2002, International Journal of Occupational and Environmental Health 11(2), 180-184, 2005

26.10.10   Lethal Toxicity of Agricultural Pesticides 
26.10.10   Restrict Access to Pesticide to Prevent Suicide 
01.06.10   Fatality in paraquat poisoning  
28.04.10   Paraquat Intoxication in Subjects Who Attempt Suicide: Why They Chose...
28.12.07   Paraquat Poisoning in Japan: A Hospital-based Survey  
21.12.07   Global distribution of fatal pesticide self-poisoning  
02.05.06   Deaths from pesticide poisoning: a global response  
01.01.05   Hospital-based survey of pesticide poisoning in Japan 
01.06.03   Paraquat and Suicide 
01.01.02   Paraquat intoxication in Korea 

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