Risks of suicide among family members of suicide victims: A nationwide sample of South Korea

Jihoon Jang; Seong Yong Park; Yeon Yong Kim; Eun Ji Kim; Gusang Lee; Jihye Seo; Eun Jin Na; Jae-Young Park; Hong Jin Jeon

doi:10.3389/fpsyt.2022.995834

Risks of suicide among family members of suicide victims: A nationwide sample of South Korea

Front Psychiatry. 2022 Oct 14:13:995834. doi: 10.3389/fpsyt.2022.995834. eCollection 2022.

Authors

Jihoon Jang^{1

2

3}, Seong Yong Park^{4

5}, Yeon Yong Kim⁴, Eun Ji Kim^{1

2}, Gusang Lee², Jihye Seo², Eun Jin Na^{1

2

6}, Jae-Young Park², Hong Jin Jeon^{1

2

7

8

9}

Affiliations

¹ Department of Psychiatry, Depression Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.
² Korea Psychological Autopsy Center, Seoul, South Korea.
³ Department of Psychiatry, Keyo Hospital, Uiwang, South Korea.
⁴ Department of Big Data Management, National Health Insurance Service, Wonju, South Korea.
⁵ Department of Health Administration, Yonsei University Graduate School, Wonju, South Korea.
⁶ Department of Psychiatry, Seoul Medical Center, Seoul, South Korea.
⁷ Department of Health Sciences and Technology, Samsung Advanced Institute for Health Sciences and Technology, Sungkyunkwan University, Seoul, South Korea.
⁸ Department of Medical Device Management and Research, Samsung Advanced Institute for Health Sciences and Technology, Sungkyunkwan University, Seoul, South Korea.
⁹ Department of Clinical Research Design and Evaluation, Samsung Advanced Institute for Health Sciences and Technology, Sungkyunkwan University, Seoul, South Korea.

Abstract

Objective: Identifying the risks of completed suicide in suicide survivors is essential for policies supporting family members of suicide victims. We aimed to determine the suicide risk of suicide survivors and identify the number of suicides per 100,000 population of suicide survivors, bereaved families of traffic accident victims, and bereaved families with non-suicide deaths.

Methods: This was a nationwide population-based cohort study in South Korea. The data were taken from the Korean National Health Insurance and Korea National Statistical Office between January 2008 and December 2017. The relationship between the decedent and the bereaved family was identified using the family database of the National Health Insurance Data. Age and gender were randomly matched 1:1 among 133,386 suicide deaths and non-suicide deaths. A proportional hazard model regression analysis was conducted after confirming the cumulative hazard using Kaplan-Meier curves to obtain the hazard ratio (HR) of completed suicide in suicide survivors.

Results: Using 423,331 bereaved families of suicide victims and 420,978 bereaved families of non-suicide deaths as the control group, HR of completed suicide in suicidal survivors was found to be 2.755 [95% confidence limit (CL): 2.550-2.977]. HR for wives committing suicide after husbands' suicide was 5.096 (95% CL: 3.982-6.522), which was the highest HR among all relationships with suicide decedents. The average duration from suicide death to suicide of family members was 25.4 months. Among suicide survivors, the number of suicides per 100,000 people was 586, thrice that of people in bereaved families of traffic accident victims and in bereaved families of non-suicide deaths.

Conclusion: The risk of completed suicide was three times higher in suicide survivors than in bereaved families with non-suicide deaths, and it was highest in wives of suicide decedents. Thus, socio-environmental interventions for suicidal survivors must be expanded.

Keywords: South Korea; bereaved family; hazard model regression; risk of completed suicide; suicide survivor.