Wyatt Knight, who starred in the 1980s “Porky’s” films, died from a self-inflicted gunshot wound in Kula, Maui, on Oct. 25, 2011.

Knight was 56, and several years earlier had undergone radiation treatments and a bone-marrow transplant for stage 4 non-Hodgkin’s lymphoma, which left him in “physical and emotional pain,” according to a family statement issued at the time.

“He was tired of the pain, and after much contemplation, chose to end his life in a beautiful and a serene place,” his wife, Silvina, said in the statement.

He wasn’t alone in that regard. Suicides make up more than one-tenth of injury-related non-resident deaths in Hawaii. They are the second-leading cause of injury-related deaths for out-of-towners — after drowning — according to the state Department of Health.

In the last five years, at least 43 visitors have committed suicide in Hawaii.

Some people travel far from their homes to end their lives in well-known places, a phenomenon one expert calls “suicide tourism.”

Many people with depression may think going to Hawaii will make them feel happier.

“I think a lot of people might make decisions based on what they think about a place,” said Kenneth Tardiff, who has studied suicide in New York extensively. “Hawaii is a really impressive place to think about, and so is New York City.”

Non-residents made up more than 10 percent of Manhattan suicides since 1990, according to The Journal of Urban Health.

Tardiff is a professor of psychiatry at Cornell Medical College and co-authored the New York study. He found that people from outside of the Big Apple were more likely to choose landmarks like the Empire State Building and the Washington Bridge to die by suicide.

“Suicide can be a very emotional thing,” Tardiff told Civil Beat. “If you’re thinking, ‘I’m going to kill myself’ … where would you go?”

The Golden Gate Bridge in San Francisco, which is known as the world’s leading suicide location, is another example of the phenomenon. So is Niagara Falls, where approximately 20 people die by suicide each year, the study said.

“I think the principles seem to be the same, but the geographies seem to be much different,” Tardiff said.

Atmosphere of Aloha is Not a Cure-All

Untreated depression is the leading cause of suicide, and not all visitors to Hawaii who kill themselves show up with that intent, experts say.

Many people with depression may think going to Hawaii will make them feel happier, said Robert Collesano, director of Mental Health America of Maui.

But that might not happen.

Also, people who have a manic-depressive disorder might board the plane to Hawaii feeling happy. But once they get to Hawaii, they crash, he said.

“People come here and they think that Maui is this paradise, and (things will) change by coming to Hawaii, but everything stays the same,” Collesano said.

In the last five years, the deaths of 12 non-residents were deemed “undetermined intent,” which means that officials weren’t able to decide whether the deaths were accidental or intentional, according to the DOH. Those are in addition to the 43 suicides recorded by officials.

Train Staff to Spot the Signs?

Of the visitors who commit suicide in Hawaii, many jump from hotel balconies, said Jessica Rich, president of Hawaii Visitor Aloha Society. Her organization helps to counsel families who have lost loved ones while visiting the islands.

Police officers sometimes call her after a tourist has died by suicide, she said.

She gives moral support to the families and tries to help them decide what to do after the death of a loved one far from home.

On Maui, Prakash Mackay, a bereavement counselor at Hospice, has counseled hotel staff members who witnessed a suicide. In one case, a man jumped from a hotel balcony in sight of  hotel guests and employees in a ground-floor atrium area.

The man had been to Maui a few times before, and had come to the island with the intent to end his life, Mackay said.

Educating hotel staff about mental health conditions could help prevent suicide, Collesano said.

His organization offered a training session for management and human resources personnel at hotels. The eight-hour program, Mental Health First Aid, teaches attendees how to help people who might be experiencing a mental health crisis. One lesson deals with how substance abuse affects mental health.

He thinks all hotel employees should be trained to recognize the signs of someone who is suicidal.

Marya Grambs, the executive director of Mental Health America of Hawaii, said public awareness is key to preventing suicides. Knowing risk factors and what questions to ask someone who might be suicidal could help a loved one know when to intervene.

“We need to reach out when we think someone might be really depressed,” Grambs said.

Suicide is the nation’s 10th leading cause of death, and accounted for 41,149 deaths in 2013, according to the U.S. Centers for Disease Control and Prevention.