Department of Psychiatry, Chonnam National University Medical School, Gwangju, Korea.
Gwangju Metropolitan Mental Health Welfare Center, Gwangju, Korea.
J Korean Med Sci. 2024 Apr 8;39(13):e125. doi: 10.3346/jkms.2024.39.e125.
Korea has witnessed significant fluctuations in its suicide rates in recent decades, which may be related to modifications in its death registration system. This study aimed to explore the structural shifts in suicide trends, as well as accidental and ill-defined deaths in Korea, and to analyze the patterns of these changes.
We analyzed age-adjusted death rates for suicides, deaths due to transport accidents, falls, drowning, fire-related incidents, poisonings, other external causes, and ill-defined deaths in Korea from 1997 to 2021. We identified change-points using the 'breakpoints' function from the 'strucchange' package and conducted interrupted time series analyses to assess trends before and after these change-points.
Korea's suicide rates had three change-points in February 2003, September 2008, and June 2012, characterized by stair-step changes, with level jumps at the 2003 and 2008 change-points and a sharp decline at the 2012 change-point. Notably, the 2003 and 2008 spikes roughly coincided with modifications to the death ascertainment process. The trend in suicide rates showed a downward slope within the 2003-2008 and 2008-2012 periods. Furthermore, ill-defined deaths and most accidental deaths decreased rapidly through several change-points in the early and mid-2000s.
The marked fluctuations in Korea's suicide rate during the 2000s may be largely attributed to improvements in suicide classification, with potential implications beyond socio-economic factors. These findings suggest that the actual prevalence of suicides in Korea in the 2000s might have been considerably higher than officially reported.
近几十年来，韩国的自杀率出现了显著波动，这可能与死亡登记制度的修改有关。本研究旨在探讨韩国自杀趋势、意外和不明原因死亡的结构性变化，并分析这些变化的模式。
我们分析了 1997 年至 2021 年韩国自杀、交通意外、跌倒、溺水、火灾相关事件、中毒、其他外部原因和不明原因死亡的年龄调整死亡率。我们使用“strucchange”包中的“breakpoints”函数确定了变化点，并进行了中断时间序列分析，以评估变化点前后的趋势。
韩国的自杀率在 2003 年 2 月、2008 年 9 月和 2012 年 6 月出现了三个变化点，呈现出阶梯式变化，2003 年和 2008 年的变化点出现了水平跳跃，2012 年的变化点出现了急剧下降。值得注意的是，2003 年和 2008 年的峰值大致与死亡确定过程的修改相吻合。自杀率的趋势在 2003-2008 年和 2008-2012 年期间呈下降趋势。此外，2000 年代初期和中期，不明原因死亡和大多数意外死亡通过几个变化点迅速减少。
2000 年代韩国自杀率的显著波动可能主要归因于自杀分类的改善，其影响可能超出社会经济因素。这些发现表明，2000 年代韩国实际自杀率可能比官方报告的要高得多。
