It is well known that economic recessions and depressions are often
accompanied by psychological difficulties and suicides. Stories of businessmen
jumping out of windows following the stock-market crash of 1929 are
Little is known, however, about the kinds of people who commit suicide in
the wake of an economic downturn or about the specific circumstances that
prompt people to make such a tragic choice.
Now a study published in the January British Journal of Psychiatry
offers some tentative answers to these questions.
The study was headed by Kathy Chan, M.D., an honorary associate professor
at Kwai Chung Hospital in Hong Kong. Chan is also a research psychiatrist with
training in ethnography.
From the mid-1980s to the mid-1990s, Hong Kong experienced a breathtaking
economic "upper," or as Alan Greenspan would say, "an era of
irrational exuberance," where properties increased 600 percent in value
and the stock market soared over 400 percent.
In 1997, however, as Britain handed control of Hong Kong over to China,
Hong Kong plunged into a severe, unexpected recession, accompanied by
psychological repercussions. Between 1998 and 2000, more and more Hong Kong
residents killed themselves, and many used a novel tool to achieve
it—carbon-monoxide poisoning created by burning a charcoal grill in a
small, sealed room.
Chan and her coworkers set out to learn more about these individuals, as
well as the financial or psychological factors that might have prompted them
to undertake such an act.
The researchers performed financial and psychological"
autopsies" on 160 Hong Kong residents who committed suicide by
indoor charcoal burning between 1998 and 2000, as well as on 160 Hong Kong
residents who had committed suicide during the same period but used other
methods. Both cases and controls were matched on age and gender.
The persons who killed themselves by indoor charcoal burning tended to be
less likely to have preexisting mental illness than persons who killed
themselves by other methods. Further, financial indebtedness was significantly
more common among persons who had committed suicide by indoor charcoal burning
than it was among those who used other means.
Thus, those who killed themselves by indoor charcoal burning appeared to
undertake such actions not because of preexisting mental illness, but because
of financial debt.
Moreover, those who killed themselves by indoor charcoal burning tended to
be middle-aged men who planned their suicides in advance, but often they did
not attempt suicide until they were drinking alcohol.
Information gleaned from 25 survivors of indoor charcoal-burning suicide
attempts also suggested that many, if not most, of such suicides had been
driven by financial indebtedness. Said one survivor: "I had loans of 1
million Hong Kong dollars when I attempted to kill myself."
Information culled from the 25 survivors likewise implied that the
charcoal-burning suicide phenomenon may have been fueled by the public media
in Hong Kong. For instance, indoor charcoal burning was quickly connected with
indebtedness in newspaper reports. Newspapers carried pictures of the suicide
scene, the paraphernalia, and the necessary arrangements. The reports conveyed
the idea that indoor charcoal burning was an easy, painless, and effective
means of ending one's life, especially in the face of insurmountable debts.
Said one survivor, "I read about this method in the papers. I know it's
easy. Jumping and wrist-cutting need more courage."
On a more positive note, however, the researchers also found that persons
who are in debt and who seek help to resolve their financial problems are no
more at risk of suicide than is the general population. This information was
conveyed to Psychiatric News by Paul Yip, Ph.D., one of the study
authors and director of the University of Hong Kong's Center for Suicide
Research and Prevention.
Although suicide by indoor charcoal burning may be a local phenomenon, Chan
and her team believe that their findings might have implications for the
United States, the United Kingdom, and other countries, where, as they pointed
out in their study report, "overindebtedness is more serious than
The study was funded by the Hong Kong Health Care and Promotion Fund and
the Hong Kong Jockey Club Charities Trust.
An abstract of "Charcoal-Burning Suicide in Post-Transition
Hong Kong" is posted online at<http://bjp.rcpsych.org/cgi/content/abstract/186/1/67>.▪
Br J Psychiatry