Document Type : Original Article


1 Department of Regional Emergency Medicine, Fukushima Medical University, Fukushima, Japan[Department of Emergency and Critical Care Medicine, Yamagata University School of Medicine, Yamagata, Japan ]

2 Department of Emergency and Critical Care Medicine, Yamagata University School of Medicine, Yamagata, Japan [Department of Anatomy and Cell Biology, Yamagata University School of Medicine, Yamagata, Japan]

3 Department of Emergency and Critical Care Medicine, Fukushima Medical University, School of Medicine, Fukushima, Japan

4 Department of Forensic Medicine, Yamagata University School of Medicine, Yamagata, Japan


Background: In Japan, hydrogen sulfide (H2S) suicides have been a serious issue in recent years. We previously studied H2S suicides using hospital-based data. However, most cases did not involve ambulance transfer to the hospital because the victims of H2S suicide were usually found dead at the scene. H2S suicide-related data elucidating an overview of the patients were therefore not available. To clarify the mechanism of poisoning, we obtained H2S suicide victim data from the Yamagata prefectural police office.
Methods: We analyzed all H2S suicide-related data available from the Yamagata prefectural police office.
Results: In this study, a total of 41 cases (29 men and 12 women) were included for analysis. We found that the number of H2S suicides reached a peak in April 2008, with 14 cases being reported, followed by 10 in 2009, 10 in 2010, 3 in 2011, and 4 in 2012. The mean age of the victims was 31.8 ± 12.2 years (range: 18–77 years), and the median age was 28 years. Sources of H2S gas included cars (22 cases; 54%), rooms (6 cases; 15%), and bathrooms (5 cases; 12%). We also identified several cases of a novel suicide method, wherein H2S was generated in a plastic garbage bag, after which the victim would put their head or body into the bag.
Conclusion: Most cases of H2S poisoning are not registered at hospital, therefore,the data on these victims need to analysis from police office data. H2S-related suicides are known to occur in confined places, such as those in cars or toilets; however a new form of H2S suicide using a sealed plastic bag is in the increase, possibly due to widespread sharing on the internet.


  1. Ruder JB, Ward JG, Taylor S, Giles K, Higgins T, Haan JM.. Hydrogen sulfide suicide: a new trend and threat to healthcare providers. J Burn Care Res. 2015; 36:e23-5. doi: 10.1097/BCR.0000000000000065.
  2. Fujita Y, Fujino Y, Onodera M, Kikuchi S, Kikkawa T, Inoue Y et al. A fatal case of acute hydrogen sulfide poisoning caused by hydrogen sulfide: hydroxocobalamin therapy for acute hydrogen sulfide poisoning. J Anal Toxicol. 2011 Mar; 35(2):119-23.
  3. Iseki K, Ozawa A, Seino K, Goto K, Tase C. The Suicide Pandemic of Hydrogen Sulfide Poisoning in Japan. Asia Pac J Med
  4. Toxicol 2013;3:13-7.Kamijo Y, Takai M, Fujita Y, Hirose Y, Iwasaki Y, Ishihara S.. A multicenter retrospective survey on a suicide trend using hydrogen sulfide in Japan. Clin Toxicol (Phila). 2013 Jun;51(5):425-8. doi: 10.3109/15563650.2013.799676.
  5. Iseki K. Hydrogen sulfide poisoning and the internet. Chudoku Kenkyu. 2009 Dec; 22(4):315-9.
  6. Morii D, Miyagatani Y, Nakamae N, Murao M, Taniyama K.. Japanese experience of hydrogen sulfide: the suicide craze in 2008. J Occup Med Toxicol. 2010 Sep 29;5:28. doi: 10.1186/1745-6673-5-28.
  7. Hagihara A, Abe T, Omagari M, Motoi M, Nabeshima Y.. The impact of newspaper reporting of hydrogen sulfide suicide on imitative suicide attempts in Japan. Soc Psychiatry Psychiatr Epidemiol. 2014 Feb;49(2):221-9. doi: 10.1007/s00127-013-0741-8. Epub 2013 Jul 14.
  8. Nakamura M, Yasunaga H, Toda AA, Sugihara T, Imamura T.. The impact of media reports on the 2008 outbreak of hydrogen sulfide suicides in Japan. Int J Psychiatry Med. 2012; 44(2):133-40.
  9. Maebashi K1, Iwadate K, Sakai K, Takatsu A, Fukui K, Aoyagi M et al. Toxicological analysis of 17 autopsy cases of hydrogen sulfide poisoning resulting from the inhalation of intentionally generated hydrogen sulfide gas. Forensic Sci Int. 2011 Apr 15;207(1-3):91-5. doi: 10.1016/j.forsciint.2010.09.008.
  10. Orui M, Kawakami N, Iwata N, Takeshima T, Fukao A.. Lifetime prevalence of mental disorders and its relationship to suicidal ideation in a Japanese rural community with high suicide and alcohol consumption rates. Environ Health Prev Med. 2011 Nov;16(6):384-9. doi: 10.1007/s12199-011-0209-y.
  11. Iseki K, Hayashida A, Shikama Y, Goto K, Tase Ch.. An Outbreak of Carbon Monoxide Poisoning in Yamagata Prefecture Following the Great East Japan Earthquake. Asia Pac J of Med Toxicol. 2013;2(2):37-41.
  12. Reedy SJ, Schwartz MD, Morgan BW. Suicide fads: frequency and characteristics of hydrogen sulfide suicides in the United States. West J Emerg Med. 2011 Jul;12(3):300-4.
  13. Cantrell L, Lucas J. Suicide by non-pharmaceutical poisons in San Diego County. Clin Toxicol (Phila). 2014 Mar;52(3):171-5. doi: 10.3109/15563650.2014.888734.
  14. Sams RN, Carver HW 2nd, Catanese C, Gilson T.. Suicide with hydrogen sulfide. Am J Forensic Med Pathol. 2013 Jun;34(2):81-2. doi: 10.1097/PAF.0b013e3182886d35.
  15. Gunnell D, Coope C, Fearn V, Wells C, Chang SS, Hawton K et al. Suicide by gases in England and Wales 2001-2011: evidence of the emergence of new methods of suicide. J Affect Disord. 2015 Jan 1;170:190-5. doi: 10.1016/j.jad.2014.08.055 2015; 170:190-5.
  16. Bott E, Dodd M. Suicide by hydrogen sulfide inhalation. Am J Forensic Med Pathol. 2013 Mar;34(1):23-5. doi: 10.1097/PAF.0b013e31827ab5ad.
  17. Värnik P. Suicide in the world. Int J Environ Res Public Health. 2012 Mar;9(3):760-71. doi: 10.3390/ijerph9030760.
  18. Hee Ahn M, Park S, Ha K, Choi SH, Hong JP.. Gender ratio comparisons of the suicide rates and methods in Korea, Japan, Australia, and the United States. J Affect Disord. 2012 Dec 15;142(1-3):161-5. doi: 10.1016/j.jad.2012.05.008.
  19. Shiho Y, Tohru T, Shinji S, Manabu T, Yuka T, Eriko T et al. Suicide in Japan: present condition and prevention measures. Crisis 2005; 26:12-9.
  20. Yamamura T, Kinoshita H, Nishiguchi M, Hishida S.. A perspective in epidemiology of suicide in Japan. Vojnosanit Pregl. 2006 Jun;63(6):575-83.
  21. Austin A, Winskog C, van den Heuvel C, Byard RW.. Recent trends in suicides utilizing helium. J Forensic Sci. 2011 May;56(3):649-51. doi: 10.1111/j.1556-4029.2011.01723.x.
  22. Gallagher KE, Smith DM, Mellen PF. Suicidal asphyxiation by using pure helium gas: case report, review, and discussion of the influence of the internet. Am J Forensic Med Pathol. 2003 Dec;24(4):361-3.
  23. Auwaerter V, Perdekamp MG, Kempf J, Schmidt U, Weinmann W, Pollak S.. Toxicological analysis after asphyxial suicide with helium and a plastic bag. Forensic Sci Int. 2007 Aug; 170(2-3):139-41.
  24. Schön CA, Ketterer T. Asphyxial suicide by inhalation of helium inside a plastic bag. Am J Forensic Med Pathol. 2007 Dec;28(4):364-7.