Lee Sun Young, Song Kyoung Jun, Hong Ki Jeong, Park Jeong Ho, Kim Tae Han, Jeong Joo, Choi Seul Ki, Choi Young Ho
Public Healthcare Center, Seoul National University Hospital, Seoul, Republic of Korea; Department of Human Systems Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea.
Department of Emergency Medicine, Seoul National University Boramae Medical Center.
Injury. 2025 Feb;56(2):112032. doi: 10.1016/j.injury.2024.112032. Epub 2024 Nov 22.
Suicide is a major social issue in Korea. Suicide attempt or self-harm (SA/SH)-a risk factor for suicides-is in itself a major public health problem. Investigating vulnerable populations is the first step for designing an effective prevention program. This study aimed to investigate the epidemiology and outcomes of patients with severe injuries related to suicide attempts or self-harm (SA/SH) by age groups, using a nationwide database.
This retrospective observational study was conducted in Korea between 2016 and 2020. Its participants were patients with severe injuries, who were treated by emergency medical service (EMS). From among injured patients who met the criteria for a field-based injury triage scheme or had a prehospital physiological abnormality, those with SA/SH were included. Exposure was based on age groups: adolescents (10-18 years), adults (19-64 years), and older adults (≥65 years). The study's outcomes were in-hospital mortality. Patients' characteristics and outcomes were compared by age groups and SA/SH mechanisms. Predictors of mortality were investigated using multivariable logistic regression analysis.
Among the 204,211 patients with severe injuries transferred by EMS, 43,945 (21.5 %) were SA/SH-related. Their median (interquartile) age was 48 (35-61) years, and 52.9 % were female patients. The common SA/SH mechanisms were: poisoning (67.6 %), hanging (16.3 %), and jumping (8.1 %). Overall, the mortality was 21.9 %, but it was higher for hanging (69.2 %) and jumping (62.0 %), than for common poisoning (6.5 %). Among adolescents, poisoning (46.1 %), followed by jumping (34.0 %) was common, and the mortality was 23.3 %. In the older adults, poisoning (68.6 %), followed by hanging (20.2 %) was common, and the mortality was 34.9 %. Older adults compared to adults, males compared to females, and hanging and jumping compared to poisoning, were associated with higher mortality.
More than 20 % of EMS treated patients with severe injury were SA/SH-related, and the mortality was over 20 %. Although poisoning was the most common mechanism, the high proportions of jumping and hanging with high mortality, resulted in adolescents and the older adults groups having high mortality. Therefore, designing target-specific SA/SH prevention programs based on age, sex, and common SA/SH mechanisms are necessary.
自杀是韩国的一个重大社会问题。自杀未遂或自我伤害（SA/SH）——自杀的一个风险因素——其本身就是一个重大的公共卫生问题。调查弱势群体是设计有效预防方案的第一步。本研究旨在利用全国性数据库，按年龄组调查与自杀未遂或自我伤害（SA/SH）相关的重伤患者的流行病学情况及转归。
本回顾性观察性研究于2016年至2020年在韩国进行。研究对象为接受紧急医疗服务（EMS）治疗的重伤患者。从符合基于现场的损伤分诊方案标准或院前存在生理异常的受伤患者中，纳入那些有SA/SH的患者。暴露因素基于年龄组：青少年（10 - 18岁）、成年人（19 - 64岁）和老年人（≥65岁）。研究的结局指标为住院死亡率。按年龄组和SA/SH机制比较患者的特征和结局。使用多变量逻辑回归分析调查死亡率的预测因素。
在由EMS转运的204,211例重伤患者中，43,945例（21.5%）与SA/SH相关。他们的年龄中位数（四分位间距）为48（35 - 61）岁，女性患者占52.9%。常见的SA/SH机制为：中毒（67.6%）、上吊（16.3%）和跳楼（8.1%）。总体而言，死亡率为21.9%，但上吊（69.2%）和跳楼（62.0%）的死亡率高于常见中毒（6.5%）。在青少年中，中毒（46.1%）最为常见，其次是跳楼（34.0%），死亡率为23.3%。在老年人中，中毒（68.6%）最为常见，其次是上吊（20.2%），死亡率为34.9%。与成年人相比，老年人、男性与女性相比，以及上吊和跳楼与中毒相比，死亡率更高。
超过20%接受EMS治疗的重伤患者与SA/SH相关，死亡率超过20%。尽管中毒是最常见的机制，但跳楼和上吊比例高且死亡率高，导致青少年和老年人组死亡率较高。因此，有必要根据年龄、性别和常见的SA/SH机制设计针对性的SA/SH预防方案。
