Chan Chee Hon, Caine Eric D, Chang Shu Sen, Lee Won Jin, Cha Eun Shil, Yip Paul Siu Fai
Department of Social Work and Social Administration, The University of Hong Kong, Hong Kong Special Administrative Region, China; The Hong Kong Jockey Club Centre for Suicide Research and Prevention, The University of Hong Kong, Hong Kong Special Administrative Region, China.
The Injury Control Research Center for Suicide Prevention, Department of Psychiatry, University of Rochester Medical Center, Rochester, United States of America.
PLoS One. 2015 May 20;10(5):e0125730. doi: 10.1371/journal.pone.0125730. eCollection 2015.
The suicide rate of South Korea has increased dramatically during the past decades, as opposed to steadily decreasing trends in Japan and Hong Kong. Although the recent increase of suicide in South Korea may be related to changing socioeconomic conditions and other contextual factors, it may also reflect, in part, a reduction of misidentified suicide cases due to improving classification of manner of death.
We compared the annual proportional change of suicide, undetermined death, and accidental death from South Korea with those of Japan and Hong Kong from 1992 to 2011; a greater proportional change of the manner-of-death categories during the period is indicative of a relatively less stable registration and hence a greater potential for misclassification bias on reported suicide trends. Subgroup analyses stratifying the deaths by methods were also conducted. To estimate the impact, the age-standardized rates of these three death categories in each site were calculated.
We found that, during the 20-year observation period, the proportional change of suicide, undetermined death, and accidental death in South Korea was significantly greater than Japan and Hong Kong. Similar observations were made in subgroup analyses. While death rates of the three manners in Japan and Hong Kong generally moved in a parallel fashion, the increase of suicide in South Korea occurred concomitantly with a significant reduction of its accidental death rate. 43% of the increase in suicides could be attributed to the decrease in accidental deaths, while 57% of the increase could be due to fundamental causes.
Our data suggest that, during the mid-1990s and after, the increasing burden of suicide in South Korea initially was masked, in part, by misclassification. Thus, the later apparently rapid increase of suicides reflected steadily improving classification of manner of death, as well as a more fundamental increase in the suicide rate.
在过去几十年中，韩国的自杀率急剧上升，而日本和香港则呈稳步下降趋势。尽管韩国近期自杀率的上升可能与社会经济状况变化及其他背景因素有关，但这也可能部分反映出由于死亡方式分类的改进，误判自杀案件有所减少。
我们比较了1992年至2011年韩国与日本和香港自杀、死因不明死亡及意外死亡的年度比例变化；在此期间，死亡方式类别比例变化较大表明登记相对不稳定，因此报告的自杀趋势存在更大的误分类偏差可能性。我们还按方法对死亡进行了亚组分析。为评估影响，计算了各地区这三类死亡的年龄标准化率。
我们发现，在20年观察期内，韩国自杀、死因不明死亡及意外死亡的比例变化显著大于日本和香港。亚组分析也有类似发现。日本和香港这三种死亡方式的死亡率总体呈平行变化，而韩国自杀率上升的同时意外死亡率显著下降。自杀率上升的43%可归因于意外死亡的减少，57%的上升可能是由根本原因导致。
我们的数据表明，在20世纪90年代中期及之后，韩国自杀负担的增加最初部分被误分类掩盖。因此，后来自杀率看似快速上升反映出死亡方式分类不断改进，以及自杀率更根本的上升。
