The deaths of nine people in Japan in October 2004 who met via the Internet have brought the relatively rare phenomenon of suicide pacts to international attention, according to an article in the December 4th issue of the British Medical Journal.

Traditional suicide pacts account for less than 1 percent of all suicides and almost always involve people well known to each other, mostly spouses, most of them childless. About half have psychiatric disorders and a third have physical illnesses.

An increasing number of websites graphically describe suicide methods, including details of doses of medication that would be fatal in overdose. Such websites can perhaps trigger suicidal behavior in predisposed individuals, particularly adolescents, wrote the author.

The recent suicide pacts in Japan might just be isolated events in a country that has been shown to have the highest rate of suicide pacts, he said. Alternatively, the deaths might herald a new disturbing trend in suicide pacts, involving strangers meeting over the internet, becoming increasingly common.

If the latter is the case, then the epidemiology of suicide pacts is likely to change, with more young people living on their own, who may have otherwise committed suicide alone, joining with like minded suicidal persons to die together.

General practitioners and psychiatrists should continue to remain vigilant against the small but not insignificant risk of suicide pacts, concluded the article.