Department of Statistics, Ewha Womans University, Seoul, Korea.
School of the Environment, Yale University, New Haven, CT, USA.
BMC Public Health. 2022 Mar 1;22(1):410. doi: 10.1186/s12889-022-12843-4.
Suicide is a serious worldwide public health concern, and South Korea has shown the highest suicide rate among Organisation for Economic Co-operation and Development (OECD) countries since 2003. Nevertheless, most previous Korean studies on suicide had limitations in investigating various social environment factors using long-term nationwide data. Thus, this study examined how various social environment characteristics are related to the suicide rate at the district-level, using nationwide longitudinal data over 11 years.
We used the district-level age-standardized suicide rate and a total of 12 annual social environment characteristics that represented socioeconomic, demographic, urbanicity, general health behaviors, and other environmental characteristics from 229 administrative districts in South Korea. A Bayesian hierarchical model with integrated Laplace approximations (INLA) was used to examine the spatiotemporal association between the rate of suicide and the social environment indicators selected for the study.
In the total population, the indicators "% of population aged 65 and older eligible for the basic pension", "% vacant houses in the area", "% divorce", "% single elderly households", "% detached houses", "% current smokers", and "% of population with obesity" showed positive associations with the suicide rate. In contrast, "% of people who regularly participated in religious activities" showed negative associations with suicide rate. The associations between these social environment characteristics and suicide rate were generally more statistically significant in males and more urbanized areas, than in females and less urbanized areas; however, associations differed amongst age groups, depending on the social environment characteristic variable under study.
This study investigated the complex role of social environments on suicide rate in South Korea and revealed that higher suicide rates were associated with lower values of socioeconomic status, physical exercise, and religious activities, and with higher social isolation and smoking practice. Our results can be used in the development of targeted suicide prevention policies.
自杀是一个严重的全球公共卫生问题，自 2003 年以来，韩国的自杀率一直是经济合作与发展组织（OECD）国家中最高的。然而，大多数之前的韩国自杀研究在使用长期全国性数据调查各种社会环境因素方面存在局限性。因此，本研究使用全国性的纵向数据超过 11 年，研究了各种社会环境特征与区县级自杀率的关系。
我们使用了区县级年龄标准化自杀率和总共 12 项年度社会环境特征，这些特征代表了韩国 229 个行政区域的社会经济、人口、城市化程度、一般健康行为和其他环境特征。我们使用贝叶斯层次模型和集成拉普拉斯近似（INLA）来检查自杀率与所选研究社会环境指标之间的时空关联。
在总人口中，“有资格领取基本养老金的 65 岁及以上人口比例”、“该地区的空房比例”、“离婚率”、“单身老年家庭比例”、“独立式住宅比例”、“当前吸烟者比例”和“肥胖人口比例”与自杀率呈正相关。相比之下，“定期参加宗教活动的人口比例”与自杀率呈负相关。这些社会环境特征与自杀率之间的关联在男性和城市化程度较高的地区比在女性和城市化程度较低的地区更为显著；然而，由于所研究的社会环境特征变量的不同，关联在不同年龄组之间有所不同。
本研究调查了韩国社会环境对自杀率的复杂影响，揭示了较高的自杀率与较低的社会经济地位、体育锻炼和宗教活动、较高的社会隔离和吸烟行为有关。我们的研究结果可以用于制定有针对性的自杀预防政策。
