Exploring the features of suicide mortality in Korea:
a descriptive study
Gil-Seong Mun
1)· Jeong-Yong Ahn
2)Abstract
Suicide has become a serious and growing public health problem in Korea. This study is to explore the features of the Korean suicide mortality. For this purpose, we explore two types of data, micro data set and the summary data set for deaths and mortality rates. First, we look at the trends of the suicide rate and the factors of suicide from a variety of perspectives. We then explore the features of the suicide based on the examination, and suggest policy implications focusing on three viewpoints to reduce the suicide rate in Korea. Data exploration results show that the suicide rates have continually increased over the last 25 years since the late 1980s in Korea, and the rates for the age group over 60 were considerably higher than the rates for other age groups since the 2000s. Especially, the rates were overwhelmingly high in the age group of 70 and over 80 in both gender. There is also a seasonality in the suicides. The suicide deaths were high during the spring season, low during the winter season, and high in the days after two main holidays. In addition, the suicides is closely related to the problems of mental/psychiatric and economics.
Key words : Suicide rates, causes of suicide, temporal trends, health policy
1. Introduction
The suicide rate in Korea has been steadily increasing for the past 25 years since the late 1980s, and has become a major social issue in the country (Kang, 2017). It increased from 7.3 per 100,000 in 1988 to 31.7 in 2011 and then decreased to 25.6 in 2016. In comparison to the organization for economic co-operation and development (OECD) countries, Korea's suicide rate has remained highest since 2003. Its suicide rate is 25.8 per 100,000 in 2016, which is about 2.2 times higher than the OECD average of 11.6 (OECD, 2018).
Suicide was the fifth most common cause of death following cancer, heart
1) Fellow, Information Strategy Division, National Pension Service, 180 Giji-Ro, Deokjin-Gu, Jeonju-Si, Jeonbuk, 54870, Korea. E-mail: gsmun@nps.or.kr
2) (Corresponding author) Professor, Dept. of Statistics(Institute of Applied Statistics), Jeonbuk National University, 567 Baekje-Daero, Deokjin-Gu, Jeonju-Si, Jeonbuk, 54896 Korea. E-mail: jyahn@jbnu.ac.kr
diseases, cerebrovascular diseases, and pneumonia in 2016. In particular, suicide deaths were overwhelmingly high from the age of 10 to 39 compared to other causes of death. The suicide rates in 10s, 20s, and 30s were 4.9, 16.4, and 24.6, respectively, per 100,000 people in 2016. On the other hand, the death rates from the second cause of death (traffic accidents in 10s and 20s, and cancer in 30s) were 3.0, 5.7, and 14.0, respectively. In addition, the suicide rates in the age group over 65 increased dramatically from 14.1 per 100,000 in 1983 to 81.9 in 2010. The rates have been gradually decreasing since 2011, but it was still the highest in the OECD by recording 53.3 in 2016. This suicide rate is more than two or three times that among those in their 20s and that among those in their 30s in 2016 (Korea National Statistical Office (NSO), 2006; NSO, 2016).
Suicide is associated with a considerable number of risk factors and with complex interactions between society and individuals (Juurlink et al., 2004; Kim et
al., 2011a; Yang et al., 2011; Kalmar, 2013). There have been many studies
associating a number of factors with suicide to account for the long-term increases in the Korean suicide (Lee et al., 2009; Park et al., 2010; Park and Lester, 2012; Jang et al., 2018). They have explained the causes in the suicide rate using the factors like gender, age, family and marital structure, education, economic status, social risk and support, residential geography, and even seasonal temperature (Kang, 2017). Although several studies have found evidence of specific causes of suicide, these views have a little short to synthetically grasp the trends of the Korean suicide.
In this study, we examine the trends of suicide in Korea from a variety of perspectives, understand the features of the suicide, and suggest policy implications to reduce the suicide rate. The objectives of this article are not to discuss specific groups or individual causes related to suicide, but explore a more general and sociological explanation for the trends and features in Korean suicide based on micro data and summary data. For this purpose, we explore the trends of Korean suicide for the last 35 years according to gender and age, and compare its suicide rates with those of OECD countries. Second, we examine the variations of suicide occurrence by month and major holidays and investigate the relationship between suicide and holidays. Lastly, we visualize suicide rates using various graphs including heat map plots, with which we can better explore and understand the relationships of the variables and secular trends, which are inherent in the data.
2. Materials and methods
To analyze and visualize suicide mortality rates, we collected two types of data from the Korean Statistical Information Service (KOSIS). One is micro data set for mortality from 2005 to 2016. The cause of death was classified based on the International Classification of Disease-10 (ICD-10). The data were based on death certificates, which are mandatory for all deaths and are usually provided by doctors. The codes X60-X84 in the data set were used to define suicide. The data set consists of about 3.5 million subjects and some indicators/variables including causes of death. About 364,000 subjects with the codes from the data set were extracted for the analysis. Another is the summary data set for deaths and mortality rates for the causes of death from 1983 to 2016. The data set can be obtained from the data service by theme of KOSIS, and has information relating to the number of deaths and mortality rates by the causes of death and age groups. In this article, we limited the scope of the data set to 2016 for comparative analysis with the World Health Organization (WHO) and OECD data.
To understand the features of suicide in Korea, we used some exploratory data analysis methods including trend lines, relative frequency, and so on. The methods are primarily used to explore the data with more quantitative traditional methods, and help us look at the overall trends of data. We also used some visualization techniques such as heat map and line plots to present suicide rates by gender, age and year. Heat maps are a popular graphical way to summarize data, observe relationships among several statistical variables (the columns in a heat map), and organize the observations from numerous participants (the rows in a heat map) all in one single graph (Moyer-Packenham et al., 2015). To explore the data, moreover, we reorganized and classified them. For example, there are two major holidays in Korea that use the lunar calendar. The dates of death of the data, however, are presented by the solar calendar. To analysis the trends in suicide around the holidays, therefore, we reconstructed the data into a holiday, the day before a holiday, and the day after a holiday.
3. Results
3.1 Trends of the suicide rates
Statistics Korea has provided the tabulation of mortality statistics for 103 and 236 causes of death recommended by WHO. The crude mortality rates for all causes of death, in deaths per 100,000, have continually decreased over the last 35 years in Korea since 1983, though they have increased slightly since 2006. However, the suicide rates, as shown in <Figure 3.1>, have been steadily
increasing during the period. They had a notable spike from 13.1 in 1997 to 18.4 in 1998, and the rate rose even higher in 2011 (31.7 per 100,000).
Temporal trends in mortality rates for suicide varied by age and by gender. <Figure 3.2> compares the trends of suicide rates from 1983 to 2016 by age groups for the rates for males and females. The rates for the age group over 60 were considerably higher than the rates for other age groups. Especially, in the age group of 70 and over 80, the rates of both gender were overwhelmingly high. In the age group of 10, the suicide rates changed from the highest 7.3 in 1996 to the lowest 3.4 in 2006 for males, and from the lowest 2.1 in 1987 to the highest 6.2 in 2009 for females, respectively.
<Figure 3.1> Age-standardized suicide rate per 100,000 population, Korea, 1983-2016
The suicide rate for males over 80 soared from 17.4 in 1984 to 222.7 in 2010, and the rate increased from 7.3 in 1987 to 95.1 in 2005 for females. In addition, the suicide rates of recent years, compared to the past, have increased in all ages. For the age group of 10, 40, and 70, for example, the rates increased about 1.4, 2.8, and 3.9-fold in 2010s compared to 1980s. On the other hand, the suicide rates for males were higher than those of females in 2010s compared to the average in the 1980s, but increasing ratios of the rates for females have overtaken those of males in all ages except for 70s.
<Table 3.1> Trend of mortality rates of the age group over 65 for the top 5 causes of death in 2016
1983(A) 1985(B) 1990(C) 1995(D) 2000(E) 2005(F) 2010(G) 2015(H) 2016(I)
B/A C/A D/A E/A F/A G/A H/A I/A
Cancer 478.9 507.7 618.3 871.2 937.3 924.5 882.4 803.0 796.2 1.1 1.3 1.8 2.0 1.9 1.8 1.7 1.7 Heart disease 470.4 431.1 408.2 381.4 363.4 331.6 344.1 351.0 357.7 0.9 0.9 0.8 0.8 0.7 0.7 0.7 0.8 Cerebrovascular disease 917.8 910.5 757.7 986.7 789.9 589.8 409.4 311.1 286.9 1.0 0.8 1.1 0.9 0.6 0.4 0.3 0.3 Pneumonia 53.3 46.7 46.8 49.0 93.2 87.3 127.6 209.1 225.1 0.9 0.9 0.9 1.7 1.6 2.4 3.9 4.2 Suicide 14.1 18.3 14.3 23.6 36.1 80.9 81.9 58.6 53.3 1.3 1.0 1.7 2.6 5.7 5.8 4.2 3.8
Compared with other causes of death, the mortality rate from suicide has been very high in older people. <Table 3.1> presents the trend of the rates of the age group over 65 for the top 5 causes of death in 2016. The rates for cancer and heart disease have changed relatively small compared to other causes between 1983 and 2016. The rate for cerebrovascular disease has decreased by more than triple. On the contrary, the rates for pneumonia and suicide have increased significantly. In 2016, compared to 1983, the mortality rate from pneumonia marked the largest increase. It is supposed that pneumonia is the most common cause in the elderly, and an early diagnosis is difficult because the respiratory symptoms of pneumonia are less obvious in the elderly (Yoon, 2014). The mortality rate from suicide increased 5.8 times in 2010, compared to 1983. The trend has been on the decline since 2010, but it has remained high ever since.
<Figure 3.3> shows an overview of suicide trends of some OECD countries from 1985 to 2015. The suicide rate of Korea ranked 23rd out of 36 OECD countries in 1985 and 28th in 1990. However, it has remained at the top since 2003 except Lithuania. The suicide rates in most countries, including Lithuania, have been gradually decreasing or increasing very slightly since 1990. Switzerland and United States have exhibited promising trends since 1995, and Latvia has also a very positive trend since 1993. On the contrary, the rate of Korea has steadily increased by 2010, and then gradually decreased.
3.2 Exploring the factors of suicide
From 1983 to 1999, the leading cause of death was circulatory diseases, but it was changed to cancer since 2000. The mortality rate for circulatory diseases decreased from 165.9 in 1983 to 118.1 in 2016, while the rates for cancer and suicide increased from 73.6 and 8.7 to 156.0 and 25.6, respectively. The rate for suicide went up about 2.9 times in 2016 compared to 1983. For men, suicide rates have increased significantly for the age group over 60, while for women, they increased largely in their 50s following the group over 80.
<Figure 3.4> presents the relative frequency of suicide deaths, calculated from the micro data set, from 2005 to 2016 by age. The total numbers of suicide deaths are high in the age groups 30s-50s and 70s. During that period, the age groups 30s-50s accounted for the largest portion of the population (about 16.5%, 17.3%, and 13.7%, respectively), while 5.2% for 70s. The relative frequency of suicide deaths in the 30s-50s were about 15.6%, 19.3%, and 18.1%, respectively, while 13.5% for 70s. Therefore, suicide deaths were relatively high in 70s.
<Figure 3.5> presents the number of monthly suicide deaths, obtained from the micro data set, from 2014 to 2016 using heat maps. In the heat maps, darkish
colors represent a high density of deaths, while lightish colors represent a low density of deaths. The heat maps show a seasonal trend that can be associated with warmer weather. Total suicide deaths were highest in March, followed in order by April and May in 2014. They were in the order of May, April and March in 2015, and March, September and May in 2016. The combined results of the three-year were in the order of March, April and May. During these three months, the proportion of male and female suicides were 29.1% and 27.9% from 2014 to 2016, 28.3% and 28.0% from 2005 to 2016, respectively, of total suicides in 12 months. This observation confirms the results from many previous studies that have investigated the association between temperature and mortality, and found a significant association (Hakko et al., 1998; Yip et al., 2000; Kim et al., 2011b; Woo
et al., 2012; Holopainen et al., 2013; Jee et al., 2016).
<Figure 3.4> The relative frequency of suicide deaths by age, 2005-2016
There are two major holidays in Korea: New Year's Day and Thanksgiving Day, both on the lunar calendar (January 1 and August 15, respectively). They are so important in Korea that the days before and after each holiday are designated, by law, to be nonworking days. <Figure 3.6> shows the trends of all suicides, calculated from the micro data set, from 2005 to 2016 around two major holidays. Annual average daily suicide was about 449 between 2005 and 2016. For New Year's Day, the daily averages were 355 and 367 in the 7 and 15 days before the holiday, and 441 and 438 after the day, respectively. The averages in both preholiday and postholiday are lower than annual average daily suicide, as mentioned above, in line with the fact that the suicide deaths was relatively low in the winter season. In contrast, the averages were 396 and 425 in the 7 and 15 days before Thanksgiving Day, and 481 and 469 after the holiday, respectively.
<Figure 3.6> Trends of suicide around major holidays, 2005-2016
In addition, there were differences in the proportion of male and female before and after the holiday depending on whether they were married or not. For two weeks on the basis of both holidays, the proportion of male among all suicides was similar (before: 67%, after: 68%). In the case of unmarried people, there was not much change in the proportion before and after the holidays (before: 71%, after: 70%). However, for married people, the proportion of male suicides increased (before: 70%, after: 74%). These are different from the results of some studies that the risk of suicide is substantially larger for unmarried than for married people (Cutright et al., 2006; Phillips et al., 2010). It is supposed to reflect the fact
that the stress of married males increases significantly due to work and family problems.
According to the suicide statistics report 2014-2018 published by Korea Suicide Prevention Center (KSPC, 2020), the trend of suicides by motive is shown in <Table 3.2>. In the past 5 years, mental/psychiatric problem has been the highest for suicide motives followed by economic and physical disease problem. The percentage of suicidal thought due to mental/psychiatric problem was the highest at 36.2% in 2016, but has been on the decline since 2017. Suicides due to economic problem continue to increase, and suicides by physical disease have been on the decline since 2015. The motives behind suicide, which increased compared to 2014, were economic and mental/psychiatric problems.
<Table 3.2> Trend of suicides for the main motives from 2014 to 2018
2014 2015 2016 2017 2018
Family problem suicides 1,211 1,285 1,162 1,100 1,043
% 8.9 9.6 8.9 8.9 7.9
Economic problem suicides 2,889 3,089 3,043 3,111 3,390
% 21.2 23.0 23.4 25.0 25.7
Physical disease suicides 2,581 2,903 2,768 2,565 2,429
% 18.9 21.6 21.3 20.6 18.4
Mental/psychiatric problem
suicides 3,916 4,228 4,713 3,939 4,171
% 28.7 31.5 36.2 31.7 31.6
Work or job duty problem suicides 552 559 514 487 487 % 4.0 4.2 3.9 3.9 3.7 Others suicides 2,509 1,372 820 1,224 1,696 % 18.3 10.1 6.3 6.3 12.7 Total suicides 13,658 13,436 13,020 12,426 13,216 % 100.0 100.0 100.0 100.0 100.0
4. Discussion and policy implications
4.1 Discussion
With the trends of the suicide rates in Korea, we can find three main features. First, there was a marked increase in the suicide rates in 1998, decreased in 1999 and 2000, and then increased steadily from 2001 to 2011 as shown in <Figure 3.1>. The spikes in suicide rates, peaked in 1998 and 2011, can largely be waken of the economic crisis on unemployment rates, income inequality, and neo-liberal restructuring (Kim et al., 2004; Khang et al., 2005). For the marked rate in 1998, especially, the economic crisis experienced in the late 1990s was one of the most
popularly cited influences on the suicide rates. At the peak of the crisis, the Korean economy shrunk to a serious level: the GDP growth rate fell from 5-10% to -6.7%, the unemployment rate increased over 300%, household income declined 6.7%, and income inequality increased from a Gini coefficient of 0.298 to 0.358 between 1996 and 2000 (Khang et al., 2005). Korea had low or negligible unemployment rates and the economic crisis pushed them up significantly, nearly tripling. These phenomena are considered to be most closely associated with the rises in suicide after the crisis as mentioned in many studies (Chang et al., 2009; Ramesh, 2009; Jeon, 2010).
<Figure 4.1> Suicide rates by gender and age groups, 2016
On the other hand, the upward trend from 2001 to 2011 is supposed to closely relate with the increase of the elderly population and the global economic crisis in 2007-2009 (Park et al., 2016; Kwon et al., 2018; Lee et al., 2018). Korea is aging faster than any other developed country. Older people aged 65 and over were only 5.3% (about 2.36 million) in 1992, but increased to 7.2% (about 3.44) in 2001, and accounted for 11.0% (about 5.53) of the population in 2011 (Jeon and Kwon, 2017). This is a substantially larger percentage than the about 7.5% worldwide in 2011. The proportions of suicides in the age group over 65 to the total number of suicides 10.8% (suicides over 65/total suicides = 392/3,628) in 1992, but increased to 21.0% (1,462/6,968) in 2001, and accounted for 27.7% (4,406/15,906) in 2011. <Figure 4.1> shows the suicide rates by gender and age groups in 2016. There was a very high suicide rate over the age of 70, and the suicide rates of male were three to four times higher than those of female in the age group over 60.
The suicide rates of the elderly in Korea were 44.4 from 65-74 and 72.4 from the age of over 75 in 2014. These were very high, compared to other countries: 16.0 and 18.3 in USA, and 23.5 and 24.2 in Japan, respectively.
Second, suicides in Korea are also associated with temperature and holidays as mentioned in many studies (Nishi et al., 2000; Preti, 2000; Qi et al., 2009; Kim et
al., 2011b; Woo et al., 2012; Baker et al., 2014; Kim et al., 2016). The suicide
deaths were high during the spring season, low during the winter season, and high in the days after holidays. The temperature and suicides during the 2005-2016 period had the same pattern, indicating that suicide in Korea may have a seasonality. In spring season (March, April, May), the number of suicides was 1.3 times higher than in winter in the period, and the highest month May was 1.4 times of the lowest December. These seasonal patterns are similar to those of previous studies that demonstrated the seasonality of suicide that warmer seasons enhance susceptibility to suicide. These results suggest that the effects of climate change are predicted to favor an increase in suicide rates (Burke et al., 2018; Ghazali et al., 2018). Therefore, it should work to improve responses to suicide associated with climate change.
Meanwhile, a dip and peak pattern of suicides around major holidays, as shown in <Figure 3.6>, has been found in Korea as in other countries (Stack, 1995; Jessen and Jessen, 1999; Sohn, 2017). There are two patterns. One is the glaring discrepancy of the suicide deaths between before and after holidays. In other words, there are low and high patterns around the two holidays. The other is the dip in suicides immediately before the holidays. The number of suicides was stable until immediately before the holidays, then plunged. The number shot up immediately after the holiday. These patterns imply that there is the broken promise effect proposed by Gabennesch (1988) in the Korean suicide. The effect is the suicidal person's affective state can be adversely influenced by circumstances which tend to promote the aspiration or expectation for feeling better. For example, it was found to support the effect for major public holidays in that there appears to be a postponement of a significant number of suicides from before a holiday until after. Another phenomenon is that there was little difference between dip and peak in the 15 days of both holidays, but the difference in the 7 days was considerable. The proportion of the differences was more pronounced for New Year's Day. It is assumed that this phenomenon is caused by warmer weather, because there are more suicides in the warm season.
The third feature is that Korea's suicide rate is abnormally high, compared to other countries. Korea's suicide rate has remained highest among OECD members since 2003, and Korea still maintains a suicide rate 2-3 times higher than the OECD average. There are various factors affecting suicides in Korea, but the most
common motivation for suicide, as shown in <Table 3.2>, is mental/psychiatric issues (Korean National Police Agency (KNPA), 2018). According to a report from Ministry of Health and Welfare (MOHW, 2016), one in four Koreans, 25.4%, suffers from mental illness and only one out of every 10 Koreans, 9.6%, receives professional help in 2016. The proportion of treatment is considerably lower than that of some OECD countries (Mcmanus et al., 2016). One way to improve this problem is to support accessible mental health services. The services in Korea are mainly concentrated in hospital settings, and support for receiving community care is ineffective or insufficient. In addition, hospital care is used to treat disorders that other countries usually manage in a community setting, such as alcohol addiction disorder. Therefore, efforts are needed to find the right balance between hospital and community-based health care for people with mental illness.
4.2 Policy implications
First, it is observed that the upward trend of suicide rate in Korea is closely related to the rapid aging of the population (aged 65 and over: 14.9% in 2019) and the increase in the suicide rate of the elderly as shown in <Figure 3.2> and <Table 3.1>. In order to reduce the suicide rate in Korea, therefore, we believe that it is necessary to prevent suicides of the elderly. For example, poisoning overall is a very common suicide method among elderly in Korea (Park et al., 2016). In the early 2010s, the government's efforts to ban Paraguat, a pesticide often used in suicide attempts, helped reduce suicides across the country. There are many reasons for the increase in the suicide rate among elderly, but they can be divided into social and environmental factors such as family dissolution and aging, and personal factors such as family relations and health conditions (NSO, 2007; Lee and Lee, 2009; Kim et al., 2012). The government, therefore, needs to come up with more fundamental and proper policies to alleviate these problems. A short-term task is the realization of policy issues that can contribute to the immediate reduction of suicide rate by establishing a response system to the suicide crisis. In this context, the most urgent task is to develop screening tools for the group of senior citizens at risk of suicide. Unlike other age groups, suicide in older people is not impulsive and tends to be caused by multiple factors (Lee, 2007). Thus, signs of suicide of an elderly person at risk of suicide can be detected in advance through a variety of channels, and the development of screening tools can be an important preventative mechanism before a hazard occurs. The long-term task for preventing suicides of the elderly is to improve the quality of aged life. It requires both the basic suicide prevention infrastructure and the community health infrastructure. Therefore, it should establish suicide
prevention projects for the elderly connected with the health service projects such as economic support, social job creation, expansion of primary care services, role-making in the community, and the development of programs to promote leisure activities of the elderly.
Second, suicides in Korea have a seasonality with a peak in Spring and after two main holidays. The exact reason for the seasonality of suicidal behavior is far from clear, but it is widely known that the seasonality is associated with depression (Kim et al., 2011b; Law and Leo, 2013; Jee et al., 2016). Depression is a common disease, affecting at least 300 million people around world (WHO, 2017), and about 60% of all suicides are estimated to stem from depression and other mood disorder (Kim et al., 2003; Dumais et al., 2005). According to the report of the 2013 Community Health Survey, approximately 5.8% of Koreans are affected by depressive symptoms, but only 16% of those depressed receive mental health consultation for their depression symptoms. Despite the fact that mental health consultation is an effective treatment for depression, it is a real problem that people with depressive symptoms do not receive a mental health consultation. Therefore, we need to expand mental health consultation program for treatment of depression. The Ministry of Health and Welfare in Korea included a "depression" item in health examination for people aged 40 and older from 2014. This is accounted as a very positive policy to prevent suicide, and it is necessary to expand the scope of the examination.
Third, the problem of mental illness is closely related to the suicide of Koreans as shown in <Table 3.2>, and early detection of the disorder is an important part of suicide prevention along with effective support and treatment (Link et al., 1999; Angermeyer and Matschinger, 2005; Cho et al., 2009). Mental illness, however, is still a taboo subject that Koreans seem reluctant to address. Koreans tend to avoid making their mental health problems known to other people, and they with mental disorders perceived more prejudice against emotional or mental problems than people without mental disorders (Seo and Kim, 2006). The stigma not only makes it difficult to detect early the disorder, but also acts as a barrier to access to mental health services (Park and Jeon, 2016). Therefore, it is very important to develop social system to reduce the stigma and for early detection (Matsubayashi and Ueda, 2011; Hogan and Grumet, 2016; Arensman, 2017). In this vein, the ongoing policies in Korea - for example, primary screening test conducted by local clinic to detect mental illness during the health examination, and a psychological autopsy system for verifying the cause of suicide - are very meaningful efforts, and it is necessary to establish a more systematic and long-term strategies to support the treatment of mental illnesses.
5. Conclusion
The suicide rate in Korea has steadily increased since the late 1980s and peaked in 2011. The trend has been decreasing since then, but it is still higher than that of other OECD countries. Suicide is complex, multi-causal phenomenon, which is a result of an interaction of biological, psychological, sociocultural and other factors (Maris, 2002; Voros, 2010; Kalmar, 2013). To understand suicide, therefore, it needs multi-causal approach for the factors, as well as to investigate the specific groups or individual causes related to suicide.
In this study, we explored the trends and features of the Korean suicide and suggested policy implications from some points of view. This approach can offer a more sociological explanation for the trends and patterns in suicide, and a clue to the overall policymaking to prevent suicide, although it may not be sufficient to specific factors. In summary, we can understand the followings from the results of the data exploration: First, the rates increased considerably in the old age group compared to the rates of other age groups in both gender. For the age group over 65, the mortality rate from suicide increased 3.8 times in 2016, compared to 1983. Second, there is a seasonality in Spring and two main holidays to suicide in Korea. Third, suicides is closely related to the problems of mental/psychiatric and economics. In order to reduce suicides in Korea, as a result, there need to be expanding financial support for the elderly and the poor, developing scaled-up primary care and community-based care system, and fostering effective prevention strategies including early detection of mental illness.
Acknowledgement
This work was supported by National University Development Project in 2019.
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