JMIR Publications

ABSTRACT

Background:

Deliberate self-harm (DSH) is a well-known contributor to suicide-related deaths. South Korea has the highest suicide death rate in recent years among all Organization for Economic Co-operation and Development countries.

Objective:

We aimed to address the following questions: 1) are there significant differences in demographics, socioeconomic status, and clinical features in individuals who received psychiatric diagnosis and those who did not? 2) does receiving a psychiatric diagnosis from the department of psychiatry as opposed to other departments affect survival? and 3) which factors related to DSH contribute to deaths by suicide?

Methods:

We used the Korean National Health Insurance Service Database to design a cohort of 5640 individuals (54·4% women) who were admitted to the hospital between 2002 and 2020, after DSH (International Classification of Diseases codes X60-X84). We analyzed whether there were significant differences among groups that were classified by according to psychiatric diagnosis status, and diagnosis department status, respectively. Another outcome was completed suicide; Cox regression models yielded hazard ratios (HRs) for suicide risk. Patterns were plotted using Kaplan-Meier survival curves.

Results:

There were significant differences in all factors including demographic, health-related, socioeconomic, and survival variables between the groups that were classified by according to psychiatric diagnosis status (p < 0·001). The non-psychiatric diagnosis group had a statistically significant lowest suicide survival rate (81·5%). In comparing the five groups based on whether they received psychiatric diagnosis from psychiatry as well as other departments, there were significant differences in all features (p < 0·001). The group treated at the psychiatric clinic only had highest suicide survival rate (93·4%) significantly. These significant results were confirmed in the Kaplan-Meier survival curves (p < 0·001). The high severity of self-harm tool (HR=4·31; 95% CI, 3·55-5·26) was the most significant effects on suicide risk.

Conclusions:

Receiving psychiatric evaluation by a medical professional, especially a psychiatrist, is an important protective factor that reduces the suicide rate in the DSH population.