In this letter to the editor, the authors comment on an article by Miller (2006) in which a discrepancy between rates of suicide in China & rates of depression was described. Eddleston & Gunnell assert that by concentrating on fatal self-harm rather than all acts of self-harm, Miller missed an opportunity to understand the discrepancy. They note the high suicide rate in Sri Lanka & China is not due to higher levels of mental illness or rates of self-harm but to the higher lethality of self-harm acts. (5 refs.)