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Changing Trends in Suicide Rates in South Korea from 1993 to 2016: a Descriptive Study

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Open access Research BMJ Open: first published as 10.1136/bmjopen-2018-023144 on 28 September 2018. Downloaded from Changing trends in suicide rates in South Korea from 1993 to 2016: a descriptive study Sang-Uk Lee,1,2 Jong-Ik Park,3 Soojung Lee,4 In-Hwan Oh,2 Joong-Myung Choi,2 Chang-Mo Oh2 To cite: Lee S-U, Park J-I, ABSTRACT Strengths and limitations of this study Lee S, et al. Changing trends Objectives The South Korean government has recently in suicide rates in South implemented policies to prevent suicide. However, there ► Our findings show that efforts to reduce suicide at Korea from 1993 to 2016: a were few studies examining the recent changing trends descriptive study. BMJ Open the national level may lead to a decline in suicide in suicide rates. This study aims to examine the changing 2018;8:e023144. doi:10.1136/ rates especially among elderly people through nat- trends in suicide rates by time and age group. bmjopen-2018-023144 ural experiment. Design A descriptive study using nationwide mortality ► Another finding of our study is that suicide rates in ► Prepublication history for rates. men in their 30s and 40s are continuing to increase, this paper is available online. Setting Data on the nationwide cause of death from 1993 suggesting that a different suicide prevention strat- To view these files please visit to 2016 were obtained from Statistics Korea. the journal online (http:// dx. doi. egy may be necessary in South Korea. Participants People living in South Korea. org/ 10. 1136/ bmjopen- 2018- ► Because this study is a descriptive epidemiological Interventions Implementation of national suicide 023144). study, it is difficult to know exactly which policies prevention policies (first: year 2004, second: year 2009). have reduced suicide rates in which age group. Received 23 March 2018 Primary outcome measures Suicide was defined as ► Improved accuracy of statistics on the causes of Revised 30 July 2018 ‘X60-X84’ code according to the ICD-10 code. Age- death may affect to changes in suicide rates. Accepted 22 August 2018 standardised suicide rates were estimated, and a Joinpoint regression model was applied to describe the trends in suicide rate. Results From 2010 to 2016, the suicide rates in South suicide rates of each country by 10% until Korea have been decreasing by 5.5% (95% CI −10.3% 2020.2 Especially, the developed countries to −0.5%) annually. In terms of sex, the suicide rate for in East Asia have relatively high mortality http://bmjopen.bmj.com/ men had increased by 5.0% (95% CI 3.6% to 6.4%) 3 annually from 1993 to 2010. However, there has been no rates due to suicide. Among these countries, statistically significant change from 2010 to 2016. For suicide in South Korea is a serious health women, the suicide rate had increased by 7.5% (95% problem because the suicide rate in South CI 6.3% to 8.7%) annually from 1993 to 2009, but since Korea in 2013 (28.5 per 100 000 person-years) © Author(s) (or their 2009, the suicide rate has been significantly decreasing was 2.4 times higher than the average suicide employer(s)) 2018. Re-use by 6.1% (95% CI −9.1% to −3.0%) annually until 2016. In rates of other Organisation for Economic permitted under CC BY-NC. No terms of the age group, the suicide rates among women of Co-operation and Development (OECD) commercial re-use. See rights almost all age groups have been decreasing since 2010; and permissions. Published by countries and South Korea has been ranked on September 30, 2021 by guest. Protected copyright. BMJ. however, the suicide rates of men aged between 30 and top among the OECD countries in terms of 49 years showed continuously increasing trends. 4 1Department of Mental Health suicide rates in the last 10 years. In addi- Conclusion Our results showed that there were Research, National Center for tion, suicide was the most common cause of differences in the changing trends in suicide rate by sex Mental Health, Seoul, Republic death in young people aged between 10 and of Korea and age groups. Our finding suggests that there was a 2 39 years, and it was the second-most common Department of Preventive possible relationship between implementation of second Medicine, School of Medicine, national suicide prevention policies and a decline in cause of death among adults aged 40–59 years 5 Kyung Hee University, Seoul, suicide rate. in 2016 in South Korea. Republic of Korea South Korea implemented the national 3 Department of Psychiatry, suicide prevention programme in the early School of Medicine, Kangwon INTRODUCTIOn 2000s.6 This national suicide prevention National University, Chuncheon, Republic of Korea Suicide is a major public health issue, with programme includes both high-risk group-ori- 4Department of Nursing, an estimated 788 000 deaths every year ented monitoring and prevention of suicide Kyungnam University, according to the WHO statistics.1 The WHO and suicide prevention programme for Changwon, Republic of Korea established the Mental Health Action 2013– general population such as media campaign.7 Correspondence to 2020 plan to implement a national, multisec- However, there was a few studies to examine Dr Chang-Mo Oh; toral promotion and prevention programme the trends in suicide rates by sex and age kachas@ naver. com for promoting mental health and reducing group with regard to the national suicide Lee S-U, et al. BMJ Open 2018;8:e023144. doi:10.1136/bmjopen-2018-023144 1 Open access BMJ Open: first published as 10.1136/bmjopen-2018-023144 on 28 September 2018. Downloaded from prevention policies in South Korea. Therefore, this suicide by sex and age groups. To describe the changes in study aimed to describe the changing trends in suicide suicide rates by time period, the age-standardised suicide rate by sex and age group in South Korea and exploring rates of suicide were calculated. The midyear Korean the potential effects of implementation of the national population in 2005 was used as the standard population suicide prevention policies. for age-standardised suicide rates. Age-specific suicide rates were applied to the corresponding 5-year age group of the standard population. The sum of expected deaths METHOD for each 5 year age group was calculated, and the age-stan- Study participants dardised suicide rates were calculated by dividing the sum The cause of death statistics is a reliable source of data of expected deaths by the total number of standard popu- on how the causes of death have changed because of lation. We used the Joinpoint regression programme to socioeconomic changes and public health developments; know whether there were changes in trends in mortality it also provides comprehensive information to plan and rates. Joinpoint statistical software was developed by the prioritise healthcare policies. The number of deaths due National Cancer Institute in the United States. Join- to suicide and the corresponding midyear population point regression modelling was used to test the trends counts from 1993 to 2016 were obtained from Statistic in age-standardised suicide rates for suicide and detect Korea (available from http://kosis. kr/). The Statistic significant changes over time to fit a better multi-seg- Korea used the estimated population as the denominator mented model compared with a simple linear model for mortality rates before year 1993. After 1993, Statistic using a Monte Carlo permutation method.13 Further, it Korea used the midyear population based on resident could detect point where significant change in rates over registration number as the denominator for mortality time. The trends in rates were summarised as annual rates. In addition, the cause of death data before 1993 is percentage changes (APCs) and their 95% CIs. less accurate, therefore, we selected the suicide rates from P values <0.05 were considered statistically significant. 1993 to 2016. The code assigned to the cause of death due We used SPSS (V.23.0, IBM Corp, Armonk, New York, to suicide was ‘X60-X84’ according to the ICD-10 code. USA) and R software (V.3.1.1, Vienna, Austria) and Joinpoint Regression Programme software (V.4.1.1, Patient and public involvement Statistical Methodology and Applications Branch, Surveil- We did not contact with patients and our study was not lance Research Programme, National Cancer Institute, directly associated with patients, because we used the Bethesda, Maryland, USA). administrative secondary data—the cause of death data from Statistic Korea. There was no role or participation of patients in our study. RESULTS National suicide prevention programme Baseline characteristics http://bmjopen.bmj.com/ Information regarding the timing and implementa- The total number of deaths in South Korea from 1993 to tion of the national suicide prevention policy in South 2016 was 6007 678 (table 1). Of these, the total number of Korea were obtained from relevant government data and deaths due to suicide was 249 085 (4.2%). Of the deaths expert consultants. Initially, the timing and details of the due to suicide, 169 963 (68.2%) were men and 79 122 national suicide prevention policy were obtained from the (31.8%) were women. In terms of the time period, South national knowledge information system (https:// nkis. re. Korea had the highest number of deaths from suicide kr: 4445/ main. do) and publications from Korea Suicide (n=15 906) in 2011 and the highest age-standardised suicide Prevention Centre.7–10 The contents and details obtained rate from suicide (29.5 per 100 000 person-years) in 2009 on September 30, 2021 by guest. Protected copyright. from these websites were confirmed after review by the (table 2).
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