A retrospective analysis of calls to the New Zealand National Poisons Centre regarding Pacific patients.

AIMS: Poisoning is a common type of injury in New Zealand. The New Zealand National Poisons Centre (NZNPC) offers a free 24/7 specialist assessment service for enquiries about substance exposures for all New Zealanders. This study aimed to characterise calls to the NZNPC relating to Pasifika patients to explore the potential for unmet need or health disparity in this area. METHODS: A retrospective analysis of 2018-2019 human exposure call data was performed. Patients were stratified into three groups: those with at least one Pacific ethnicity listed (Pasifika); those with known ethnicities but no Pacific ethnicity listed (non-Pasifika); those of unknown ethnicity (unknown). Demographic variables and substance groups were described. RESULTS: Of the 40,185 human exposure patients, 1,367 (3.4%) were Pasifika, 24,892 (61.9%) were non-Pasifika and 13,926 (34.7%) were of unknown ethnicity. The median age of Pasifika patients was 2.0 years, with 78.0% aged 0-5, and the exposure most commonly involved a liquid product (46.6%) and a simple analgesic (8.3%). CONCLUSIONS: The NZNPC receives a relatively small number of calls about exposures to Pasifika patients, especially given the youthful population demographic. It is unclear whether there is unmet need for this service, and this study suggests the need for further research.

Disproportionately higher unintentional injury mortality among Alaska Native people, 2006-2015.

We compared rates of unintentional injury (UI) deaths (total and by injury category) among Alaska Native (AN) people to rates of U.S. White (USW) and Alaska White (AKW) populations during 2006-2015. The mortality data for AN and AKW populations were obtained from Alaska Bureau of Vital Statistics and USW mortality data were obtained from WISQARS, the Center for Disease Control and Prevention online injury data program. AN and AKW rates were age-adjusted to the U.S. 2000 Standard Population and rate ratios (RR) were calculated. AN people had higher age-adjusted total UI mortality than the USW (RR = 2.6) and AKW (RR = 2.3) populations. Poisoning was the leading cause of UI death among AN people (35.9 per 100,000), more than twice that of USW (RR = 2.9) and AKW (RR = 2.5). Even greater disparities were found between AN people and USW for: natural environment (RR = 20.7), transport-other land (RR = 12.4), and drowning/submersion (RR = 9.1). Rates of AN UI were markedly higher than rates for either USW or AKW. Identifying all the ways in which alcohol/drugs contribute to UI deaths would aid in prevention efforts. All transportation deaths should be integrated into one fatality rate to provide more consistent comparisons between groups.

The Epidemic of Despair Among White Americans: Trends in the Leading Causes of Premature Death, 1999-2015.

OBJECTIVES: To evaluate trends in premature death rates by cause of death, age, race, and urbanization level in the United States. METHODS: We calculated cause-specific death rates using the Compressed Mortality File, National Center for Health Statistics data for adults aged 25 to 64 years in 2 time periods: 1999 to 2001 and 2013 to 2015. We defined 48 subpopulations by 10-year age groups, race/ethnicity, and county urbanization level (large urban, suburban, small or medium metropolitan, and rural). RESULTS: The age-adjusted premature death rates for all adults declined by 8% between 1999 to 2001 and 2013 to 2015, with decreases in 39 of the 48 subpopulations. Most decreases in death rates were attributable to HIV, cardiovascular disease, and cancer. All 9 subpopulations with increased death rates were non-Hispanic Whites, largely outside large urban areas. Most increases in death rates were attributable to suicide, poisoning, and liver disease. CONCLUSIONS: The unfavorable recent trends in premature death rate among non-Hispanic Whites outside large urban areas were primarily caused by self-destructive health behaviors likely related to underlying social and economic factors in these communities.

A descriptive study of intentional self-poisoning from New Zealand national registry data.

OBJECTIVE: Understanding which population groups intentionally poison themselves by overdose and which substances are used are key to developing prevention efforts for such injuries. This paper uses Ministry of Health (MOH) data to explore the demographic characteristics of those who intentionally self-poison and the substances used, identifies limitations of existing data collections and makes recommendations for the future. METHODS: MOH mortality data from 2000 to 2012, and public hospital presentation data from 2000-2014 of cases of intentional self-poisoning (ISP), and poisoning of undetermined intent (UDP), were examined. RESULTS: Men were more at risk of fatal intentional poisonings, while young women and people from deprived areas were predominant in hospital presentations for ISP and UDP. While ICD-10 categories were available, there was limited information in the majority of MOH data about specific substances used in the poisonings. CONCLUSIONS: The current format of MOH data indicates that developing interventions to help young people and those living in deprived areas may be useful. Finding specific solutions is challenging when only limited nationwide substance-specific poisoning information is available. Implications for public health: Including specific substances in national data collections is important for addressing the public health challenge of intentional overdose morbidity and mortality.

Associations of Adverse Clinical Course and Ingested Substances among Patients with Deliberate Drug Poisoning: A Cohort Study from an Intensive Care Unit in Japan.

OBJECTIVES: Some patients with deliberate drug poisoning subsequently have an adverse clinical course. The present study aimed to examine whether the type of drugs ingested and psychiatric diagnoses were related to an adverse clinical course. METHODS: We conducted a cohort study of patients with deliberate drug poisoning admitted to the intensive care unit of a university hospital located in Tokyo, Japan, between September 2006 and June 2013. Intensive care unit (ICU) stay of ≥4 days was used as a primary outcome measure, while the incidence of aspiration pneumonitis was used as a secondary outcome measure. Ingested substances and psychiatric diagnoses were used as explanatory variables. RESULTS: Of the 676 patients with deliberate drug poisoning, 88% had a history of psychiatric treatment and 82% had ingested psychotropic drugs. Chlorpromazine-promethazine-phenobarbital combination drug (Vegetamin®) ranked fifth among the most frequently ingested substances in cases of deliberate drug poisoning and had the highest incidence of prolonged ICU stay (20%) and aspiration pneumonitis (29%). The top three major classes consisted of benzodiazepines (79%), new-generation antidepressants (25%), and barbiturates/non-barbiturates (23%). Barbiturate overdose was independently associated with increased odds of both prolonged ICU stay (8% vs. 17%; odds ratio [OR], 2.97; 95% confidence interval [CI], 1.60-5.55) and aspiration pneumonitis (8% vs. 24%; OR, 3.83; 95% CI, 2.18-6.79) relative to those associated with overdose of only other sedative-hypnotics (i.e., benzodiazepines). CONCLUSION: These results suggest that judicious prescribing of barbiturates by psychiatrists could reduce the risk of an adverse clinical course when a patient attempts an overdose.

Inequalities in Hospitalized Unintentional Injury Between Aboriginal and Non-Aboriginal Children in New South Wales, Australia.

OBJECTIVES: To quantify inequalities in rates of unintentional injury-related hospitalizations between Australian Aboriginal and non-Aboriginal children. METHODS: We used linked hospital and mortality data to construct a retrospective whole-of-population birth cohort including 1,124,717 children born in the state of New South Wales, Australia, between July 1, 2000 and December 31, 2012. We adjusted hazard ratios (HRs) of first injury hospitalization for geographic clustering and individual- and area-level factors. RESULTS: Aboriginal children were 1.6 times more likely than were non-Aboriginal children to be hospitalized for an unintentional injury. The largest inequalities were for poisoning (HR = 2.7; 95% CI = 2.4, 3.0) and injuries stemming from exposure to fire, flames, heat, and hot substances (HR = 2.4; 95% CI = 2.1, 2.7). Adjustment reduced the inequality for all unintentional injury overall (HR = 1.4; 95% CI = 1.3, 1.4) and within leading injury mechanisms. CONCLUSIONS: Australian Aboriginal children suffer a disproportionately high burden of unintentional injury.

Toxic Epidemics: Agent Orange Sickness in Vietnam and the United States.

Social scientists studying toxic epidemics have often endeavored to shed light on the differences between scientists' and nonscientists' epistemic perspectives. Yet, little attention has been paid to the processes through which a toxic epidemic emerges as a phenomenon. A Luoi Valley of Central Vietnam was extensively sprayed with chemical defoliants (including Agent Orange) during the Vietnam War. The latent toxic effects of these chemicals, however, went largely unnoticed until the late 1990s. By juxtaposing the history through which the notion of "Agent Orange Sickness" emerged in the United States with an ethnographic study of A Luoi, I explore the notion of poison under which Agent Orange became recognizable as a poison.

Hospital outcomes and economic costs from poisoning cases in Illinois.

CONTEXT: Since 2009, poisonings have been the leading cause of fatal injuries in the United States (US) and remain a continuing public health issue. Because of the varying definitions for what constitutes a poisoning case, there are inconsistencies in the annual number of cases reported among national health surveys. OBJECTIVES: The main objective of this study was to describe poisonings treated in Illinois hospitals by type of exposure, as well as to detail demographic characteristics, acute outcomes, and general cost estimates for those exposed to poisoning. We also compared a broad definition for poisoning used in our analysis with the definitions used by four national health surveys in order to assess the adequacy of various definitions in capturing poisonings for surveillance. MATERIAL AND METHODS: We conducted a comprehensive analysis of outpatients and inpatients treated in Illinois hospitals in 2010 using the Illinois hospital database. Age-adjusted incidence rates were calculated. RESULTS: In Illinois, 425,491 patients were treated in hospitals for poisoning in 2010, of whom 222,339 were inpatients. The age-adjusted incidence rate was 3,189 per 100,000 persons, with an average length of stay among inpatients of 5.5 days. The cumulative hospital charges were $7.9 billion. DISCUSSION AND CONCLUSION: The definitions used in national surveys miss 60-90% of poisoning cases. Poisoning is the leading cause of fatal injuries in the U.S., but as this study shows broadening the definition for poisoning may provide a more accurate representation of the direct and indirect effects of poisoning in the US.

What is Known About Health and Morbidity in the Pediatric Population of Muslim Bedouins in Southern Israel: A Descriptive Review of the Literature from the Past Two Decades.

The Bedouins comprise one of the ethnic groups in Israeli society. They are Muslims, most of who live in the Negev desert region of southern Israel and live by their unique traditions and customs. At the present they are going through a period of "society in transition", a unique condition that has ramifications for health and morbidity. In recent years the number of publications on the health of Bedouins in the Negev has increased. Recognition of unique socio-economic features, characteristics of health and diseases can help the medical team treat various health problems in this population as well as other populations with similar characteristics. In the present paper we survey and discuss publications on the health of Bedouin children over the past 20 years.

Drug-poisoning Deaths Involving Opioid Analgesics: United States, 1999-2011.

KEY FINDINGS: Data from the National Vital Statistics System, Mortality File. The age-adjusted rate for opioid-analgesic poisoning deaths nearly quadrupled from 1.4 per 100,000 in 1999 to 5.4 per 100,000 in 2011. Although the opioid-analgesic poisoning death rates increased each year from 1999 through 2011, the rate of increase has slowed since 2006. Natural and semisynthetic opioid analgesics, such as hydrocodone, morphine, and oxycodone, were involved in 11,693 drug-poisoning deaths in 2011, up from 2,749 deaths in 1999. Benzodiazepines were involved in 31% of the opioid-analgesic poisoning deaths in 2011, up from 13% of the opioid-analgesic poisoning deaths in 1999. During the past decade, adults aged 55-64 and non-Hispanic white persons experienced the greatest increase in the rates of opioid-analgesic poisoning deaths. Poisoning is the leading cause of injury death in the United States (1). Drugs-both illicit and pharmaceutical-are the major cause of poisoning deaths, accounting for 90% of poisoning deaths in 2011. Misuse or abuse of prescription drugs, including opioid-analgesic pain relievers, is responsible for much of the recent increase in drug-poisoning deaths (2). This report highlights trends in drug-poisoning deaths involving opioid analgesics (referred to as opioid-analgesic poisoning deaths) and updates previous Data Briefs on this topic.

Hospitalizations for unintentional injuries among Canadian adults in areas with a high percentage of Aboriginal-identity residents.

INTRODUCTION: Injuries are a leading cause of death and morbidity. While individual Aboriginal identifiers are not routinely available on national administrative databases, this study examines unintentional injury hospitalization, by cause, in areas with a high percentage of Aboriginal-identity residents. METHODS: Age-standardized hospitalization rates (ASHRs) and rate ratios were calculated based on 2004/2005-2009/2010 data from the Discharge Abstract Database. RESULTS: Falls were the most frequent cause of injury. For both sexes, ASHRs were highest in high-percentage First Nations-identity areas; high-percentage Métis-identity areas presented the highest overall ASHR among men aged 20-29 years, and high-percentage Inuit-identity areas presented the lowest ASHRs among men of all age groups. Some causes, such as falls, presented a high ASHR but a rate ratio similar to that for all causes combined; other causes, such as firearm injuries among men in high-percentage First Nations-identity areas, presented a relatively low ASHR but a high rate ratio. Residents of high-percentage Aboriginal-identity areas have a higher ASHR for hospitalization for injuries than residents of low-percentage Aboriginal-identity areas. CONCLUSION: Residents of high-percentage Aboriginal-identity areas also live in areas of lower socio-economic conditions, suggesting that the causes for rate differences among areas require further investigation.

TITRE: Hospitalisations pour blessures non intentionnelles chez les adultes au Canada, dans les régions ayant un fort pourcentage de résidents d'identité autochtone. INTRODUCTION: Les blessures constituent une cause importante de décès et de morbidité. Bien qu'aucun indicateur d'identité autochtone ne soit directement disponible dans les bases de données administratives nationales, cette étude porte sur les hospitalisations pour blessure non intentionnelle, selon la cause, dans les régions ayant un fort pourcentage de résidents d'identité autochtone. MÉTHODOLOGIE: Nous avons calculé les taux d'hospitalisation normalisés selon l'âge (THNA) et les rapports de taux pour 2004-2005 à 2009-2010, à partir de la Base de données sur les congés des patients. RÉSULTATS: Les chutes étaient la cause principale de blessure. Les THNA étaient plus élevés pour les hommes comme pour les femmes dans les régions ayant un fort pourcentage de membres des Premières nations; dans les régions ayant un fort pourcentage de Métis, c'est chez les hommes de 20 à 29 ans que le THNA global était le plus élevé, tandis qu'il était le plus bas chez les hommes de tous les groupes d'âge dans les régions à fort pourcentage d'Inuits. Certaines causes, telles que les chutes, étaient associées à un THNA élevé mais avec un rapport de taux semblable à celui observé pour toutes causes confondues; d'autres causes, comme les blessures par arme à feu chez les hommes dans les régions à fort pourcentage de membres des Premières nations, présentaient un THNA relativement faible mais un rapport de taux élevé. Les résidents des régions à fort pourcentage d'Autochtones présentaient un THNA pour blessure plus élevé que ceux des régions à faible pourcentage d'Autochtones. CONCLUSION: Les résidents des régions à fort pourcentage d'Autochtones vivent dans des régions dont le statut socioéconomique était faible, ce qui invite à une recherche plus approfondie à propos des différences de taux entre régions.

Poisoning and suicide by cyanide jewelry cleaner in the US Hmong community: a case series.

Over 200 000 persons of Hmong ethnicity live in the United States. The majority of this Southeast Asian ethnic group live in California, Minnesota and Wisconsin. Tradition plays a strong role in the Hmong population, and difficulty in assimilation into "Western ways" has been reported to result in depression and suicide attempts. Some products sold at Southeast Asian ethnic markets are well-known within the Hmong community to be lethal but are essentially unknown to the outside community. We describe eight cases in which cyanide-containing products were ingested by Hmong patients. Seven cases were suicide attempts involving the ingestion of a locally-purchased substance intended for cleaning metal, coins, or jewelry. One case involved the fatal ingestion of a cyanide-containing "herbal" cure. In the majority of the cases, cyanide was not initially suspected, and treatment was delayed due to lack of information regarding the product ingested. In the two patients who survived, the cyanide antidote kit (sodium nitrite, amyl nitrite, and sodium thiosulfate) was administered early. Clinicians should be aware that unusual and potentially lethal products are easily available at ethnic markets. Cyanide toxicity should be suspected, and empiric antidote therapy initiated early, in patients of Hmong or Southeast Asian descent who present with sudden and unexplained cardiovascular collapse and metabolic acidosis, especially in the setting of a suspected suicidal ingestion.

Of poisoners, tanners and the British Raj: redefining Chamar identity in colonial North India, 1850­90.

This article explores colonial representations of the crime of cattle poisoning and uses it as a starting point to investigate questions related to the formation of Chamar identity. Starting from the 1850s, it looks at the process whereby the caste group was imbued with certain undesirable traits of character. Simultaneously, it also explores the larger trend towards fixing the caste with certain occupational traits, so that it began to be identified completely with leather work by late nineteenth century. The role of new specialisms such as ethnography, toxicology and medical jurisprudence in the formation of new definitions about Chamars is also highlighted. The overall aim of the article is to reveal the complexities involved in the formation of colonial discourse about caste and caste groups.

[The challenges of the ethics of personalism to clinical toxicology]. / Etyka personalistyczna wobec wyzwan toksykologii klinicznej.

The fields of philosophical anthropology and the ethics of personalism overlap in the area of many difficult personal situations involving clinical toxicology. These therapeutic situations need an integral, multidimensional, and personal approach for both the patient and the toxicologist. This means that man is treated not only as a physical (biological) being but also there is an appreciation for the mental sphere, which includes rational, emotional, and spiritual elements while not forgetting that the human person is also part of the human community. Studying such an individual's personal decision as suicide, we must realize that it's not just physiological or biochemical poisons but also includes the poisoning of the psyche, as well as poisoning relationships with loved ones (family), poisoning social relations (in school or the workplace) and poisoning the spirit, in other words, there is no meaning in life itself, nor the meaning of God's existence, nor the meaning of faith, hope and love. Not only is there a greater "variety of poisons" than before, they are much more extensive and deep. For example, we can name environmental pollution, industrial poisons, chemical waste, genetic modification, powerful medications, or even the toxic social environment of evil ideas, malicious manipulation of the human mind (destructive religious sects). In approaching the challenges of clinical toxicology, the doctor must not only be a specialist in chemistry, biochemistry and pharmacology. What then is of future of toxicology because of this human dimension (anthropological, ethical and spiritual) of this teaching? As today marks the occasion of the 45th anniversary of the Clinic of Toxicology CM UJ, should we shape the ethos of young doctors who want to deal with toxicology seriously?

Acculturation in Hispanics and childhood poisoning: are medicines and household cleaners stored properly?

BACKGROUND: Unintentional poisonings are a major public health issue in the United States (US). With the increasing number of Hispanics in the US, childhood poisoning is a salient public health issue to address within this population. There is a paucity of research examining the relationship between acculturation in Hispanics and the safe storage of medicines and cleaners. The purpose of the study was to determine if demographic variables, such as acculturation in Hispanics, age, gender and education, were predictive of incorrectly storing medicines and household cleaners. METHODS: We conducted a study among parents/guardians of small children at two pediatric primary care clinics in the Dallas/Fort Worth (DFW) Metropolitan area. We enrolled 201 parents to identify where they stored medicines and household cleaners, and measured acculturation with the Short Acculturation Scale for Hispanics. RESULTS: Of Hispanic participants, 49% were categorized as less acculturated (n = 99) while 21% were more acculturated (n = 42). Less acculturated participants were over 4 times more likely to store medicines incorrectly, and participants with a high school education or less were over 3 times more likely to improperly store cleaners. With each additional child in the household, the risk for improper storage of cleaners increased by 44%. CONCLUSION: The fact that children of less acculturated families are at greater risk for poisoning and have lower levels of education demonstrates the need for readable educational materials on this salient topic. Because social networks are integral in Hispanic culture, especially among new immigrants, poison prevention messages should be disseminated by interpersonal communications.

Drug poisoning deaths in the United States, 1980-2008.

In 2008, the number of poisoning deaths exceeded the number of motor vehicle traffic deaths and was the leading cause of injury death for the fi rst time since at least 1980. During the past three decades, the poisoning death rate nearly tripled, while the motor vehicle traffic death rate decreased by one-half. During this period, the percentage of poisoning deaths that were caused by drugs increased from about 60% to about 90%. The population groups with the highest drug poisoning death rates in 2008 were males, people aged 45­54 years, and non-Hispanic white and American Indian or Alaska Native persons. The vast majority of drug poisoning deaths are unintentional (see Appendix table). Opioid analgesics were involved in more drug poisoning deaths than other specified drugs, including heroin and cocaine. Opioid analgesics were involved in nearly 15,000 deaths in 2008, while cocaine was involved in about 5,100 deaths and heroin was involved in about 3,000 deaths (data not shown). Deaths involving opioid analgesics may involve other drugs as well, including benzodiazepines (2). In addition to an increase in the number of deaths caused by drug poisoning, increases in drug use, abuse, misuse, and nonfatal health outcomes have been observed. In the past two decades, there has been an increase in the distribution and medical use of prescription drugs, including opioid analgesics (3). From 1999 to 2008, the use of prescription medications increased (4). In 2007­2008, 48% of Americans used at least one prescription drug in the past month and 11% of Americans used five or more prescriptions in the past month. Analgesics for pain relief were among the common drugs taken by adults aged 20­59 years (4). In 2009­2010, over 5 million Americans reported using prescription pain relievers nonmedically in the past month (that is, without a doctor's prescription or only for the experience or feeling they caused), and the majority of people using prescription pain relievers nonmedically reported getting the drugs from friends or family (5,6). From 2004 to 2008, the estimated rate of emergency department visits involving nonmedical use of opioid analgesics doubled from 49 per 100,000 to 101 per 100,000 (7). Government agencies and other organizations joined together to achieve great reductions in the number of deaths from motor vehicle crashes in the past three decades (8,9). A comprehensive approach, including improvements in the safety of vehicles; improvements in roadways; increased use of restraint systems, such as seat belts and child safety seats; reductions in speed; and also efforts to reduce driving under the influence of alcohol and drugs, contributed to the decline in motor vehicle related deaths (8,9). Using a comprehensive, multifaceted approach, it may be possible to reverse the trend in drug poisoning mortality.

Deliberate self-harm in the emergency department: experience from Karachi, Pakistan.

BACKGROUND: Suicidal behavior is an understudied subject in Pakistan, a South-Asian developing country with a predominantly Muslim population. AIMS: This study examined the characteristics and management of patients presenting with Deliberate Self-Harm (DSH) to the Emergency Department (ED) of a tertiary care teaching hospital in Karachi, Pakistan. METHODS: A retrospective chart review of all patients (n = 98), over a period of 12 months was carried out. The demographic details of patients; method of DSH and, if drugs were used, their type, route, and quantity; reason for DSH; past psychiatric history; and outcome were recorded. RESULTS: The mean age of subjects was 23.5 years. The majority of patients were female; most had used drugs for DSH. After initial treatment in the ED, 34 patients were admitted to medical wards for further treatment, 12 were discharged from ED, while 52 patients left against medical advice. The main reasons for leaving against medical advice were financial constraints and fear of legal issues. Seven patients had at least one previous episode of DSH. CONCLUSIONS: Patients who left the ED without psychosocial assessment are at increased risk for repetition of DSH as well as suicide.

Characteristics of suicidal behavior in a Turkish sample.

BACKGROUND: Suicidal behavior is one of the most important problems in psychiatric clinics. Several sociodemographic and clinical characteristics may have different effects on suicidal behavior. AIMS: To examine the sociodemographic and clinical characteristics of a sample of 144 suicide attempters admitted to a Turkish emergency clinic for a suicide attempt. METHODS: All subjects were interviewed by a consultant psychiatrist. For all individuals, data on DSM-IV psychiatric diagnoses, sociodemographic data, Beck's Hopelessness Scale (BHS), Becks's Suicidal Ideation Scale (SIS), and Beck's Suicidal Intention Scale (BSIS) were collected. RESULTS: The majority of suicide attempters were females characterized by low educational status and low religious orientation. Drug overdose was the most common method of suicide attempt and conflict within the family was the most frequent psychological stress factor. Three-quarters of attempters (74.6%) met DSM-IV criteria for at least one psychiatric diagnosis. Of these, 28.5% met criteria for major depressive disorder. Suicide attempters with depression tended to be immigrant, urban dwellers with high scores on the suicide intent scale. CONCLUSIONS: In the present study, the findings are useful in showing the risk factors related to suicidal behavior.

Impulsive but fatal self-poisoning with pesticides among South Asians in Nickerie, Suriname.

BACKGROUND: Intentional self-poisoning with pesticides is a serious problem in many developing countries. It is a commonly used method among South Asians all over the world. AIMS: To describe the circumstances and characteristics of suicides in Nickerie, e, in order to gain insight into why South Asians commonly use self-poisoning. METHODS: An exploratory psychological autopsy study was conducted among 19 survivors of 13 suicides in the Nickerie district in Suriname. RESULTS: Impulsivity plays an important role in self-poisonings, as well as aggression and easy accessibility of pesticides. CONCLUSIONS: Possible answers to the question why South Asians often use self-poisoning as a method for suicide may be found in culture, upbringing, styles of communication and genetics. However, more research is needed to further explore these hypotheses.