title: Impact of macro-level socio-economic factors on rising suicide rates in South Korea: panel-data analysis in East Asia.
abstract: BACKGROUND
  The rapid increase in suicide rates in South Korea, particularly in the aftermath of the Asian economic crisis in the late 1990s, compares with the declining suicide rates observed in most other OECD countries over the same period.
  
  
  OBJECTIVE
  This study aimed to examine an array of macro-level societal factors that might have contributed to the rising suicide trend in South Korea.
  
  
  METHODS
  We first investigated whether this trend was unique to South Korea, or ubiquitous across five Asian countries/areas that are geographically and culturally similar (South Korea, Hong Kong, Japan, Singapore, and Taiwan), using WHO mortality data and national statistics (1980-2009). Age-standardised suicide rates (per 100,000 population) were calculated for each gender and age group (15-24, 25-44, 45-64, and 65+) for each country. Both panel data and country-specific time-series analyses were employed to investigate the impact of economic change and social integration/regulation on suicide.
  
  
  RESULTS
  Despite similarities in geography and culture, the rising trend of suicide rates was unique to South Korea. This atypical trend was most apparent for people aged 65 and over, which was in sharp contrast to the decreasing suicide trends observed in the other four Asian countries. The results of the panel data analyses generally pointed to a negative relationship between economic growth and suicide rates, particularly for working-aged people. The results of the time-series analyses further suggested that low levels of social integration, as indicated by rising divorce rates, may also have a role in rising suicide rates in South Korea, particularly for older people. Furthermore, the association between suicide rates and economic adversity (unemployment and economic downturn) was most salient among middle-aged men in South Korea.
  
  
  CONCLUSIONS
  Compared to four other East Asian countries/areas (Hong Kong, Japan, Singapore, and Taiwan), South Korea has uniquely experienced a rising trend of suicide rates over the past three decades, particularly among older people. The findings highlight the differential associations between social changes and suicide rates at various stages over a person's life course. Low levels of social integration and economic adversity may in part explain the atypical suicide trend in South Korea, especially for older people and middle-aged men, respectively. Data constraints, however, limit the scope for explanation in light of the complex and multifactorial causes of suicide.
  Different age groups within the population require different policy interventions to curb the unprecedented rise in suicide rates in South Korea. Particularly for older people, there is a great need to strengthen methods of assisting family support as well as formulating models of social care that are financially-sustainable and culturally sensitive. More investment is also needed to strengthen labour market protection and/or expand social safety net for the unemployed.
  
  
  CONCLUSIONS
  The link between social integration and suicide rates deserves further empirical investigation, so that mediating factors that are amenable to policy actions can be better identified.
authors.affiliation: LSE health and social care, Houghton Street, London, WC2A 2AE, UK, jihyung.hong.kr@gmail.com.
authors.forename: Jihyung
authors.initials: J
authors.lastname: Hong
authors.forename: Martin
authors.initials: M
authors.lastname: Knapp
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D001208:Asia / Q000453:epidemiology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D018803:Models, Economic; D056910:Republic of Korea / Q000453:epidemiology; D012737:Sex Factors; D064890:Social Determinants of Health / Q000706:statistics & numerical data*; D012959:Socioeconomic Factors; D013405:Suicide / Q000706:statistics & numerical data*; D055815:Young Adult