Epidemiology of Suicide in Korea

SPECIAL ARTICLES Epidemiology of Suicide in Korea Jin Pyo Hong, M.D.,1 Myeng Ji Bae, M.D.,1 Tongwoo Suh, M.D., DrPH.2 1Department of Psychiatry, University of Ulsan College of Medicine, Asan Medical Center, 2Korea Institute of Health and Social Affairs, Seoul, Korea Key words: Suicide, Epidemiology, Suicidal attempt. Abstract [ Psychiatry Invest 2006; 3 (2):7-14] In 2002, an estimated 877,000 lives were lost worldwide through suicide. In Korea, suicidal deaths have increased very rapidly since the economic crisis in Introduction 1997, and suicide is regarded as one of the most serious public health and social issues in Korea. This study Suicide is not only the primary emergency for the examines the current situation and trends of the recent- mental health professional, but also a major public ly increasing rates of suicidal deaths, ideas, and health problem in the world. Suicide's history goes attempts in Korea. back at least to the earliest human written records This study reanalyzed the 20-year statistics of suici- (e.g., Socrates, Seneca). The traditional or legal dal deaths recently published by the National Statistical definition of suicide was first given clarity by Office and the data of the National Health Interview Emile Durkeim, who defined suicide as "a death Survey conducted in 1995 and 1998. resulting directly or indirectly from a positive or The suicidal mortality rate in Korea is quite high negative act of the victim himself, which he knows compared to those in other OECD countries and the will produce that result".1 rate of increase is the highest. The rate of suicidal idea In 2002, an estimated 877,000 lives were lost is high among males, those in their late teens and those worldwide through suicide, representing 1.5% of in their seventies. The suicidal attempt rate is higher the global burden of disease or more than 20 mil- among females and those in their late teens. lion disability-adjusted life-years (years of healthy Suicide, one of the important causes of death in the life lost through premature death or disability).2 younger age group, has a greater socioeconomic impact The global mortality rate is estimated to be 16 per than other common causes of death in the older age 100,000; One death every 40 seconds. The WHO group. Therefore, we are in urgent need of a public men- further reports that in the last 45 years worldwide 3 tal health network to prevent suicide and to detect and suicide rates have increased by 60%. Suicide is treat early mental health problems leading to suicide. now among the three leading causes of death among those aged 15-44 (both sexes).4 Suicidal behavior has multiple causes that are broadly Correspondence: Jin Pyo Hong, M.D., Department of Psychiatry, University of Ulsan College of Medicine, Asan divided into predisposition, proximal stressors or Medical Center, 388-1 Poongnap-dong, Songpa-gu, Seoul, triggers.5 Psychiatric illness is a major contributing Korea (138-736) Tel: +82-2-3010-3421, Fax: +82-2-485-8381, factor, and more than 90% of those who commit E-mail: [email protected] suicide have a Diagnostic and Statistical Manual of 7 Suicide epidemiology Mental Disorders, Fourth Edition (DSM-IV) psy- Methods chiatric illness.6-8 Suicide results from various complex sociocultural factors and is more likely to This data is based on the population mortality sta- occur during periods of socioeconomic, family and tistics and death certificates registered between 1990 individual crisis (e.g. loss of a loved one, employ- and 2004 provided by the Korean National Statistical ment or honor). Office. The prevalence of suicidal idea and attempts Suicide attempts are up to 20 times more fre- were derived from the National Health Interview quent than completed suicides. Although suicide Surveys conducted in 1995 and 1999 by the rates have traditionally been the highest among Department of Health and Welfare and the Korea elderly males, suicide rates among young people Institute for Health and Social Affairs. The present have been increasing to such an extent that they are study presents the gender- and age-specific suicide now the group at highest risk in one third of all rates, the average annual rates of suicide per 100,000 countries. population, and the rates of suicidal ideas and In Korea, the rapid increase in the suicidal rate in attempts. recent years has meant that suicide has become a serious public health and social problem. Results Epidemiological reviews of suicide rates are valu- Serial changes of suicide rates (1990-2002) able for the delineation of trends, the prioritization of risk groups and the provision of clues to its eti- The suicide mortality rate in Korea did not show ology. The objective of this paper is to review the any evident changes until the early 1990s. However, current situation and trends of the recently increas- after 1997, the year of the IMF crisis in Korea, there ing suicidal deaths, ideas and attempts in Korea. was a sharp increase, followed by a drop in the rate FIGURE 1. Suicidal rates (per 100,000) in Korea, 1989-2004. 8 Hong JP et al. of increase which has continued ever since. In 1998, not account for the increments can also be noted by the number of suicide mortalities was 8,569, which examining the cases of suicide mortality in China, is a 42.4% increment compared to the 6,022 suicide where suicide ranks fifth (287,000 cases) in terms of mortalities in 1997. The number of suicide mortali- the total number of mortalities and over 2 million peo- ties per 100,000 persons also increased from 13.1 ple attempt suicide despite China’s soaring economic (1997) to 18.5 (1998). After 2001, the suicide mor- growth.9 tality rate increased, reaching 25.2 in 2004, the high- Gender-specific differences are also noticeable. Up to est level recorded so far. the mid 90s the difference between the genders The changes in the suicide mortality rates during the remained at a steady level, but afterwards the differ- past 20 years suggest that there is an overall relation ence between the genders increased, a shift which can between the suicide mortality rate and economy cycle. also be seen in other regions of the world.10 Compared to the 80s and early 90s, however, the sui- Changes in suicide mortality among age cide mortality rate also increased 2-fold during the groups early 90s to mid 90s and the years 2000 and 2001, during which Korea enjoyed a good economy. This Figure 2 reveals the changes in the suicide mortality implies that reasons other than the economy, such as rates among the different age groups. Until the 90s, the increases in divorce and the aging of the population, rates remained at a steady level, however since the mid have also contributed. The fact that the economy does 90s mortality rates have rapidly increased. The incre- FIGURE 2. Changes in suicide mortality rate (/100,000) among age groups between 1983-2001 9 Suicide epidemiology ment however differed among age groups. Since the TABLE 1. International suicide rates (per 100,000) and annual 1990s, a sharp increase in the mortality rate was only increase in OECD nations. observed in those over 40, while little change was Annual Country 1980-1989 1990-2004 observed amongst teenagers. The mortality rates of the Increase (%) middle-aged and elderly rapidly increased during the Korea 6.81 (1982) 25.2 (2004) 16.82 early 90s and decreased slightly after the economic Hungary 39.73 (1982) 28.44 (1995) -2.54 Finland 22.44 (1982) 24.68 (1995) 0.73 crisis of 1997, only to increase again after 2001. Denmark 26.71 (1982) 18.87 (1993) -3.11 Subsequently, the ratio between the mortality rates of Switzerland 22.68 (1982) 18.59 (1994) -1.64 the elderly (over 65) and young (aged 15-24) increased France 19.11 (1982) 17.53 (1995) -0.66 from 1.2 (1983) to 4.8 (2001). Luxemburg 19.50 (1982) 17.13 (1997) -0.86 Czech 19.72 (1986) 17.00 (1993) -2.10 Comparison of suicidal rates among OECD Austria 25.08 (1982) 16.92 (1997) -2.59 nations Belgium 19.71 (1982) 16.25 (1992) -1.91 New Zealand 11.90 (1982) 14.54 (1994) 1.68 The changes of the suicide mortality rates among Japan 17.06 (1982) 14.09 (1994) -1.58 the OECD nations including Korea are shown in Poland 11.25 (1989) 13.32 (1996) 2.44 Table 1. Korea ranked 26th among the 28 OECD Canada 14.10 (1982) 12.56 (1995) -0.89 nations in terms of the suicide mortality rates in 1982, Germany 18.76 (1982) 12.32 (1997) -2.67 but jumped to second place in 2004. Nations that Sweden 17.38 (1982) 12.26 (1996) -2.46 ranked high (Hungary, Finland, Denmark, and Norway 13.51 (1982) 11.84 (1995) -1.01 Australia 11.74 (1982) 11.50 (1995) -0.16 Switzerland) revealed decreased or steady rates, in Ireland 7.60 (1982) 11.19 (1995) 3.02 contrast to Korea which shows an annual increase of USA 11.86 (1982) 11.07 (1996) -0.49 16.8%. This rapid increase is the highest among the Iceland 9.66 (1982) 10.21 (1995) 0.43 OECD nations. The Netherlands 10.31 (1982) 8.70 (1995) -1.30 Spain 4.80 (1982) 6.91 (1995) 2.84 Rates of suicidal ideas and attempts Italia 6.78 (1982) 6.84 (1993) 0.08 Suicidal ideas United Kingdom 8.08 (1982) 6.50 (1997) -1.44 Portugal 8.32 (1982) 5.57 (1996) -2.83 According to the 1998 National Health and Nutrition Mexico 2.21 (1982) 3.78 (1995) 4.22 Survey, one fourth of the Korean population above the Greece 3.34 (1982) 2.92 (1996) -0.96 age of 10 have "thought of attempting suicide during the past 12 months" (Table 2).

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