Changes in the Suicide Rate of Older Adults According to Gender, Age, and Region in South Korea from 2010 to 2017

Rising prevalence of subthreshold and major depressive symptom in South Korea: A trend analysis from 2014 and 2018

INTRODUCTION

Subthreshold depression and major depressive symptoms are prevalent mental health conditions that significantly impact quality of life and contribute to South Korea's high suicide rate. Despite their importance, few studies have examined temporal changes in the occurrence of these disorders in the Korean population.

OBJECTIVE

This study aimed to estimate the prevalence of subthreshold depression and MDD using a large, representative sample of the South Korean population and analyze trends over time.

METHODS

Data were obtained from 10,848 participants aged 19 and above in the Korean National Health and Nutrition Examination Survey (KNHNES) in 2014 and 2018. Depression severity was categorized using cutoff scores of 5-14 for subthreshold symptoms and ≥ 15 for severe symptoms.

RESULTS

The prevalence of subthreshold depression increased from 12.90% in 2014 to 15.20% in 2018, while MDD rose from 4.7% to 7.0% (p < 0.001). Logistic regression analysis revealed that MDD (OR = 8.1, 95% CI = 2.34-11.23), college education (OR = 7.9, 95% CI = 4.23-10.00), and age above 65 years (OR = 8.1, 95% CI = 2.58-12.58) exhibited similar risks for suicide attempts.

CONCLUSION

Since 2014, there has been a sharp and sustained increase in both subthreshold and severe depressive symptoms among the Korean population. This alarming trend underscores the critical need for targeted prevention and intervention strategies.

Suicide Risk and Associated Factors in Parkinson Disease: A Nationwide Cohort Study

BACKGROUND

Although increased mortality in patients with Parkinson disease (PD) is well documented, studies on suicide-related mortality have yielded conflicting results. Moreover, the impact of comorbidities, socioeconomic factors and health behaviours as potential risk factors for suicide remains underinvestigated. This study aimed to investigate suicide mortality risk in patients with PD and comprehensively elucidate the association between comorbidities, socioeconomic factors, health behaviours and suicide in PD.

METHODS

This nationwide population-based cohort study used Korean National Health Insurance Service data from 2009, with a longitudinal follow-up until 31 December 2021. This study included 2,732,294 (PD, n = 4132; without PD, n = 2,728,162) individuals. PD was defined by ICD-10 code (G20) and registration code (V124). Comorbidities were identified using medical history, ICD-10 codes, laboratory data and prescribed medications. Health behaviours were obtained from a self-reported National Health Screening Program questionnaire. The primary outcome was suicide mortality, determined by ICD-10 codes for intentional self-harm (X60-X84).

RESULTS

Suicide mortality in patients with PD increased by 2.71-fold. Males with PD had more than a sevenfold higher risk (HR = 7.34, 95% CI, 5.25-10.26). Low-income patients with PD had an approximately fivefold higher risk compared to high-income non-PD individuals (HR = 5.10, 95% CI, 3.07-8.46). Patients with PD concomitant with depression (HR = 5.00, 95% CI, 3.06-8.16) and alcohol consumption (HR = 3.54, 95% CI, 2.14-5.89) also showed increased suicide risk.

CONCLUSION

This study suggests that patients with PD have a higher risk of suicide, particularly males, those with lower income, depression or alcohol consumption.

Functional Limitations and Depressive Symptoms Among Older Adults in Korea: Gender Differences in the Moderating Roles of Relationship Satisfaction With Family, Friends, and Neighbors

OBJECTIVES

This study investigated the association between functional limitations and depressive symptoms among older adults in South Korea, focusing on gender differences in the moderating roles of relationship satisfaction with family, friends, and neighbors.

METHODS

Fixed-effect models were applied to five waves of data from the Korean Retirement and Income Study, encompassing 19,180 observations.

RESULTS

Increases in functional limitations were associated with higher levels of depressive symptoms, regardless of gender. However, the moderating effects of relationship satisfaction differed by gender: For older women, satisfaction with family moderated the association, whereas for older men, satisfaction with friends played a moderating role.

DISCUSSION

The findings suggest tailoring interventions to improve family relationships for women and friendships for men in mitigating depressive symptoms among functionally vulnerable older adults in Korea, where rapid population aging poses significant challenges to protect functional and mental health among older adults.

Changes in suicide inequalities in the context of an increase and a decrease in suicide mortality: The case of South Korea, 1995-2020

South Korea experienced a sharp increase until 2010 followed by a gradual decrease in suicide mortality. This study examined changes in socioeconomic inequalities in suicide over 25 years and how suicide inequalities changed in the context of both an increase and a decrease in suicide mortality. Data with five-year intervals were extracted from the Korean death registry and census data between 1995 and 2020. Using Poisson regression, four measures of suicide inequalities were calculated for the slope of inequality index (SII), relative index of inequality, rate ratios, and ratio differences. Educational inequalities in suicide were obvious across all sub-populations, measures, and periods. The widening of suicide inequalities, particularly with absolute measures, followed an increase in suicide mortality until 2010. In contrast, a decline of suicide inequalities concurred after 2010 during the period of a decline in suicide mortality. SII among the total population decreased by 35.4%, from 62.4 per 100,000 people (95% confidence interval [CI], 59.8-64.9) in 2010 to 40.3 (95% CI, 38.3-42.4) in 2020. The pattern of widening and narrowing in suicide inequalities observed in the whole population was only concordant with the older population. However, the younger and the middle-aged population showed a gradual increase or stalemate in the inequalities throughout the period. Overall, suicide inequalities narrowed in the recent decade. This decline was largely led by the older population, and was attributed to the provision of social protection. A decline of suicide inequalities can accompany a decline in suicide mortality, when the provision of social protection favored the less educated.

Impact of continuity of care on older adults diagnosed with mental and behavioural disorders at risk of death due to intentional self-harm: a retrospective Korean cohort study

OBJECTIVES

The aim of this study was to evaluate the impact of continuity of care on older adults diagnosed with mental and behavioural disorders who are at risk of death due to intentional self-harm.

STUDY DESIGN

This was a retrospective cohort study.

METHODS

Data from the Korean National Health Insurance Service-Elderly Cohort Database (2002-2013) were used. A total of 53,980 patients who had visited the outpatient clinic three or more times within the year following the initial diagnosis of mental and behavioural disorders were included. A generalised estimating equation model was generated to examine the impact of continuity of care (CoC) on the risk of death due to intentional self-harm among older adults with mental illnesses.

RESULTS

The risk of death due to intentional self-harm was significantly higher in those with poor CoC for mental and behavioural disorders than in those with good CoC. The risk ratio, adjusting for all covariates, was larger for the Usual Provider of Care index (adjusted risk ratio [aRR]: 1.63, 95% confidence interval [CI]: 1.25-2.12) than for the CoC index (aRR: 1.50, 95% CI: 1.18-1.90), indicating a stronger association with the concentration of contact with the most frequently visited provider.

CONCLUSIONS

Poor CoC among Korean older adults diagnosed with mental and behavioural disorders was identified as a significant risk factor for death due to intentional self-harm. The results of this study highlight the need for interventions that can prevent suicidal behaviour in older adults, such as institutionalising the usual providers of mental health care for older adults.