Epidemiology and outcomes of severe injury patients related to suicide attempt or self-harm in Korea: Nationwide community-based study, 2016–2020

Abstract

Introduction

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.

Materials and Methods

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.

Results

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.

Conclusions

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.