title: Paraquat prohibition and change in the suicide rate and methods in South Korea.
abstract: The annual suicide rate in South Korea is the highest among the developed countries. Paraquat is a highly lethal herbicide, commonly used in South Korea as a means for suicide. We have studied the effect of the 2011 paraquat prohibition on the national suicide rate and method of suicide in South Korea. We obtained the monthly suicide rate from 2005 to 2013 in South Korea. In our analyses, we adjusted for the effects of celebrity suicides, and economic, meteorological, and seasonal factors on suicide rate. We employed change point analysis to determine the effect of paraquat prohibition on suicide rate over time, and the results were verified by structural change analysis, an alternative statistical method. After the paraquat prohibition period in South Korea, there was a significant reduction in the total suicide rate and suicide rate by poisoning with herbicides or fungicides in all age groups and in both genders. The estimated suicide rates during this period decreased by 10.0% and 46.1% for total suicides and suicides by poisoning of herbicides or fungicides, respectively. In addition, method substitution effect of paraquat prohibition was found in suicide by poisoning by carbon monoxide, which did not exceed the reduction in the suicide rate of poisoning with herbicides or fungicides. In South Korea, paraquat prohibition led to a lower rate of suicide by paraquat poisoning, as well as a reduction in the overall suicide rate. Paraquat prohibition should be considered as a national suicide prevention strategy in developing and developed countries alongside careful observation for method substitution effects.
authors.affiliation: Department of Psychiatry, Depression Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea; Department of Information Statistics, Korea National Open University, Seoul, Korea; Samsung Biomedical Research Institute, Samsung Medical Center, Seoul, Korea.
authors.forename: Woojae
authors.initials: W
authors.lastname: Myung
authors.affiliation: Department of Information Statistics, Korea National Open University, Seoul, Korea.
authors.forename: Geung-Hee
authors.initials: GH
authors.lastname: Lee
authors.affiliation: Samsung Biomedical Research Institute, Samsung Medical Center, Seoul, Korea.
authors.forename: Hong-Hee
authors.initials: HH
authors.lastname: Won
authors.affiliation: Depression Clinical and Research Program, Massachusetts General Hospital, Harvard Medical School, Boston, United States of America.
authors.forename: Maurizio
authors.initials: M
authors.lastname: Fava
authors.affiliation: Depression Clinical and Research Program, Massachusetts General Hospital, Harvard Medical School, Boston, United States of America.
authors.forename: David
authors.initials: D
authors.lastname: Mischoulon
authors.affiliation: Depression Clinical and Research Program, Massachusetts General Hospital, Harvard Medical School, Boston, United States of America.
authors.forename: Maren
authors.initials: M
authors.lastname: Nyer
authors.affiliation: Department of Psychiatry, Depression Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
authors.forename: Doh Kwan
authors.initials: DK
authors.lastname: Kim
authors.affiliation: Department of Psychiatry, Depression Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
authors.forename: Jung-Yoon
authors.initials: JY
authors.lastname: Heo
authors.affiliation: Department of Psychiatry, Depression Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea; Depression Clinical and Research Program, Massachusetts General Hospital, Harvard Medical School, Boston, United States of America; Department of Clinical Research Design and Evaluation and Department of Medical Device Management and Research, Samsung Advanced Institute for Health Sciences & Technology (SAIHST), Seoul, Korea.
authors.forename: Hong Jin
authors.initials: HJ
authors.lastname: Jeon
mesh_terms: D033161:Government Regulation; D006540:Herbicides / Q000506:poisoning*; D006801:Humans; D010269:Paraquat / Q000506:poisoning*; D056910:Republic of Korea / Q000453:epidemiology; D013405:Suicide / Q000706:statistics & numerical data*
chemical_list: D006540:Herbicides; D010269:Paraquat