Jentashapir J Health Res. 2018 June; 9(3):e82829. Published online 2018 August 27. doi: 10.5812/jjhr.82829. Review Article Suicidal Attempts by Unusual Means and Methods: A Brief Review S.M. Yasir Arafat 1, * , Md. Hafizur Rahman Chowdhury 1 and M A Mohit 2 1 Department of Psychiatry, Bangabandhu SheikhMujib Medical University, Dhaka, Bangladesh 2 Department of Psychotherapy, National Institute of Mental Health, Dhaka, Bangladesh * Corresponding author: Department of Psychiatry, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh. Tel: +880-1713272917, Email: arafatdmc62@gmail.com Received 2018 August 01; Accepted 2018 August 12. Abstract Background: When a method is unusual, the intention is very strong and then prevention becomes a big challenge; although, suicide is a preventable public health problem. Objectives: The author aimed to look into unusual methods of suicidal attempts so that they can be considered in the formulation of prevention strategies. Methods: A search was done in PubMed, PubMed Central, Google, Google Scholar, and BanglaJOL with specific searching key words between 2000 and 2017. Eventually, 23 articles were selected purposively for review. Results: Nine suicide cases were reported as unusual poisoning, eight attempts were by violent methods, four by stabbing, and another four by unusual asphyxia. The mean age of the victims was 39.96 years, ranging from 17 to 80 years old, 68% being male. A total of 18 (72%) respondents died by the act, while 28% were saved from fatal attempts. Of the victims, 36% were found to have mental disorders, i.e. 28% had depression, 4% had schizophrenia, and 4% had bipolar 1 disorder. Seven cases had notable risk factors and two had a history of previous attempts. Conclusions: Adult males are more prone to use unusual methods. Males used violent methods more than females, whereas fe- males used more unusual poisoning methods. Asian and south Asians used more poisoning methods than those from other parts of the world. Keywords: Unusual Suicide, Unusual Mode, Unusual Method 1. Background Suicide is a preventable public health problem across the globe; however, it is still underattended by stakehold- ers (1-3). Suicide kills nearly 1 million people globally and is one of the three leading causes of death (1). If the cur- rent trend continues, it will kill approximately 1.53 million people in 2020, as stated by the World Health Organiza- tion (WHO) (1-4). Therefore, WHO focuses on suicide pre- vention and has called on countries to devise national sui- cide prevention strategies (1-4). Means restriction is one of the few promising strategies of suicide prevention, which showed effectiveness in declining the rate of suicide (5- 8). It ranges from complete restriction of lethal methods to the promotion of educational and social interventions to make apart lethal means from risky persons (6-8). The choice of method depends on availability, accessibility, and perceived lethality of the method, intensity of intent to die, and other related socio-cultural factors (1, 9, 10). When in- tention is severe, means substitution can eventually hap- pen (6-8). Unusual to very unusual means or methods have been used when intention to die is severe (6, 10). Uncom- mon methods with strong intention for suicide turn the suicides unpreventable (9, 10). The author aimed to review the reported suicide attempts with uncommon methods so that suicides by unusual modes will be paid adequate attention in suicide prevention. 2. Methods Articles were searched in PubMed, PubMed Central, Google, Google Scholar, and BanglaJOL with key search words (unusual suicide, unusual mode of suicide, unusual methods of suicide, uncommon methods of suicide) be- tween 2000 and 2017. Articles in the English language and articles focusing the suicide methods were considered as inclusion criteria. Unusual aspects of suicide other than methods, such as unusual suicidal notes, articles on topics other than suicidal topics, such as accidental death were excluded from the review. All studies identified through the search strategy were assessed by their titles and ab- stracts to help ascertain their suitability against the inclu- sion and exclusion criteria. If it was not clear from the arti- Copyright © 2018, Jentashapir Journal of Health Research. This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International License (http://creativecommons.org/licenses/by-nc/4.0/) which permits copy and redistribute the material just in noncommercial usages, provided the original work is properly cited.