We investigated the relationship between social environment characteristics, suicide rate, and Korea’s 229 districts over 11 years (2008-2018). This was done using nationwide longitudinal data that covered all 229 of these areas. 1) Poor socioeconomic conditions and isolation (higher % of the population aged 65 and over eligible for the basic pension, higher % vacant houses in an area, and higher % divorce) were associated higher suicide rates. 2) Higher levels of religious activity and greater accessibility to recreational opportunities (access to parks) were linked to lower suicide rates. And 3) higher rates smoking were associated higher suicide rates. These associations with social environment characteristics differed by age. In general, older people had higher suicide rates due to their higher socioeconomic status and more severe health behaviors. However, younger people had higher suicide rates because of their higher isolation and fewer recreational opportunities.
As a major risk factor for suicide, a lower socioeconomic status has been suggested. Economic depressions led to an increase in suicide rates [15, 16]Globally, higher suicide rates for people with lower incomes and less education have been consistently reported. [1, 11]. This study also revealed that poor socioeconomic conditions were associated with higher suicides rates at the district level. The % of residents aged 65 and over who are eligible for basic pensions and the % vacant homes in the area showed a positive correlation with suicide rate. We also found that the relationship between the basic pension eligibility rate and the suicide rate was highest for those aged 60 and older (Table 3) Previous studies have also shown that poor physical and mental health are major factors in suicide among seniors. [6]. This result has important implications for suicide prevention policies and programs in Korea, due to the significantly higher suicide rate among the elderly than in other age groups.
Additionally, the association between suicide rates and % basic retirement was more evident in high-density and mid-density than in low-density locations, even though the % of eligible population for the basic pension who were 65 or older was highest in low–density places. This result could be related to a greater relative deprivation in high- and mid-density areas. However, this study did not provide sufficient epidemiological evidence to support this hypothesis. Further investigations are needed to determine regional differences in economic status of the population 65 years and older.
Another risk factor for suicide is social isolation and lower socioeconomic status. [17,18,19]. This finding was confirmed by our study, which found a positive correlation between suicide rate and divorce rate and detached house percentages. We also found that suicide rates were higher in males than females due to poor socioeconomic status and isolation. This gender difference may be a reason why Korean men are more active in economic activity. According to Korea National Statistics Office in 2019, the labor force was comprised of 53.5% women and 73.5% men. These results may also be explained in part by the gender differences between men and women in their social relationships. Previous research has shown that males are more vulnerable to social isolation than their female counterparts. [20, 21]Females tend to have larger social networks and receive more social support than males. They also engage in more social relationships than their male counterparts. [22,23,24]. Although further studies are required, our results suggest the need for gender-differentiated suicide prevention policies that focus on different social vulnerability factors.
This study also found that physical activity and availability of parks can have a significant impact on suicide rates. Numerous studies have shown that physical exercise can lead to a decrease in stress and depression, which may be linked to suicide. [25, 26]. Even though the results are mixed, a systematic review has revealed a statistically significant negative association of physical activity and suicidal thoughts. [27]. A Korean study also found that teens who exercise more often have fewer suicide attempts and thoughts. [28]. Additionally, studies in the past have shown positive effects of green space and parks on suicidal behavior (suicide death, suicide ideation, and attempts to commit suicide). [29,30,31]You can improve your health and well-being by engaging in physical and other social activities. [32, 33]. In this study, the effects of physical exercise on suicide rate were greater in the youngest group (aged 1039), than in other older age groups. This could be related to the outdoor activity patterns of younger people. Young people may be more likely to engage with outdoor and physical activities than older adults, and so the average time spent in parks and sports facilities may be higher among the former. Future research should explore the effects of physical exercise and park usage on suicide rates in relation to age. Such findings could be helpful in establishing effective suicide prevention programs for the young generation.
The study also showed a positive correlation between current smoking and suicide rates. Previous studies have identified smoking as a major risk factor for suicide. [34]It was found that smoking levels are significantly linked to suicide attempts, planning, and suicidal thoughts. [35]. We did not find a significant positive relationship between suicide rate at the district-level and the % of people who were high-risk drinkers. The male population also showed a negative association between suicide and high-risk drinking (Table 3). Numerous studies have repeatedly shown that drinking can lead to suicidal behavior. [36, 37]This study’s results should be carefully considered. This result could be related to Korean socioeconomic cultures. Korean men, particularly young men, tend to build their social capital primarily through work and economic activities. [38]A group dinner after work is a big part of Korean drinking culture. This suggests that there may be a benefit to increased alcohol consumption at group meals. This could help to build social networks and reduce isolation, which could lead to an increase suicide risk. Second, the results were based on aggregated data and are therefore only estimates at the district-level. Future studies should investigate this association more closely.
This study also found that the relationship between suicide rate and social environment characteristics varied by region. The relationships between suicide rate and social environment characteristics were generally stronger in high-density areas (i.e. More urbanized areas than other areas (i.e. There are less urbanized areas. Research has shown that rapid urbanization is closely linked with social exclusion. It affects social capital as well as income inequalities in urban areas, especially among socioeconomically poor classes. [39,40,41]. We speculate that higher socioeconomic inequality and social isolation in urban areas might be associated to stronger associations between suicide rate and social environments.
There were several limitations to the study. First, the study results are limited in their ability to interpret individual-level associations between suicide and social environment characteristics. The Korea National Statistics Office mortality data does NOT include individuals socioeconomic standing and residential addresses. Therefore, we were not able to examine the specific effects on individual-level socioeconomic stats and individual-level environmental exposure data. Therefore, our study results reflect aggregated community-level results. Second, because these variables were derived from the Korean Community Health Survey, (KCHS), we could not collect certain social environment characteristics variables (% people who regularly engage in religious activities and % current smokers, % individuals exhibiting high-risk alcohol consumption, % number of people with known stress and % number of obese people) as self-report. [8]. Although studies in the past have shown good quality self-reported data and quality control assessments have also been conducted for KCHS. [42]There could be underlying problems with recall bias or misclassifications. These possible flaws warrant that our study be complemented with data from future cohort studies at the individual level.
Our study does have some strengths, however, that can offset its weaknesses. First, the study looked at a large, nationwide database of suicide deaths in Korea. It included more than 154.866 cases across 11 years. We were able statistically to show a strong and stable spatiotemporal relationship between suicide rate, social environmental factors and a large longitudinal dataset that covers an extended period (11years). We also collected data for 12 annual indicators of the social environment at regional and local levels. These indicators included socioeconomic, demographic and urbanicity characteristics as well as other environmental characteristics. Then, we used advanced statistical methods to analyze the relationships between these variables and suicide rates. We also found distinct roles for these social environment characteristics in decreasing or increasing suicide rates across sex, age, and densification. These results can help to create targeted suicide prevention strategies for each sub-population based on evidence. This is the largest investigation to date into the complex effects of socio-environmental factors on suicide rates in Korea.