INTRODUCTION
Since its liberation in 1945, Korea has overcome political turmoil and the Korean War, achieving economic, social, and cultural growth that has propelled it into the ranks of developed nations. However, after a period of rapid economic growth in a short time, social inequality and economic bipolarization worsened, elderly poverty increased, and the number of irregular and insecure workers and single-person households rose. The 1997 IMF economic crisis dealt a severe blow, leading to a sharp increase in the suicide rate. This trend persisted with the economic downturns caused by the 2003 domestic credit card loan crisis and the 2008 global financial crisis [1]. eISSN 1976-3026 OPEN ACCESS Since 2003, Korea has had the highest suicide rate among Organisation for Economic Co-operation and Development (OECD) countries. In response to this pressing issue, the central and local governments with non-governmental organizations have been working collaboratively to implement various suicide prevention programs. For example, the government established a National Suicide Prevention Action Plan in 2004 and has developed subsequent plans every five years. Major policy achievements are including the enactment of the Suicide Prevention Act in 2011, the launch of the National Assembly Suicide Prevention Forum in 2018, and the formation of the Suicide Prevention Policy Committee under the Prime Minister’s Office in 2019. In 2023, the government introduced the 5th Action Plan, aiming to reduce the suicide rate by 30% by 2027 through various strategies [2].
This paper analyzes suicide prevention research, policies, and programs in Korea. It first presents the data currently being collected by the Ministry of Health and Welfare (MOHW) and the Korea Foundation for Suicide Prevention (KFSP) for evidence-based suicide prevention, diagnose the current state of suicide mortality in the country, review the trends and changes in the Action Plan, and explain the Suicide Prevention Act enacted in 2011. Additionally, this paper introduces the public suicide prevention service delivery system and highlights a major recent initiative: early detection and intervention programs for depression.
COLLECTION AND ANALYSIS OF OFFICIAL GOVERNMENT DATA OF SUICIDE
In the public sector of Korea, a variety of data on suicide deaths is collected and analyzed to implement evidence-based suicide prevention policies. The data on suicide deaths includes mortality statistics from Statistics Korea [3], psychological autopsies [4] and comprehensive investigation of suicide deaths among police records from the KFSP, and criminal justice information from the National Police Agency [5]. Data on suicide attempts is gathered from the National Emergency Department Information System (NEDIS) and from the Emergency Room based Clinic Intervention Center for Suicide Attempts (ERC) [6]. Additionally, data on suicidal thoughts and attitudes among Koreans is collected through various sources, including the National Health and Nutrition Examination Survey, the Youth Risk Behavior Survey, the Mental Health Survey, the Korea Welfare Panel Study, and the National Survey on Suicide [7]. The government is leading the generation of suicide mortality and related data. The KFSP collects some of this data or analyzes the collected data and makes it available for use by local government and suicide prevention professionals. This section will introduce some of the data on suicide deaths and attempts collected in Korea and briefly review the analysis results. Among the introduced data, the analysis results using psychological autopsy and comprehensive investigation of suicide deaths by the police, linked with health insurance data, were the first trial in the KFSP of Korea.
Mortality statistics
Since 1980, Statistics Korea has annually published statistics on deaths caused by intentional self-harm or suicide from the previous year. Figure 1 shows the suicide rates in Korea over the past 30 years [3], along with GDP per capita and real growth rates [8,9]. The suicide rate in Korea increased sharply following the 1997 IMF economic crisis, the 2003 credit card loan crisis, and the 2008 global financial crisis, corresponding with a decline in real economic growth rates. In 2011, when the suicide rate reached a peak of 31.7 per 100,000 people, the government enacted the Suicide Prevention Act and began serious efforts to prevent suicides [2]. While the overall suicide rate in Korea has been on a decline, the suicide rate among people in their 20s has been increasing. This issue is not limited to Korea but is recognized as an international social problem. According to a recent study that compared age-standardized suicide rates among 10-24-year-olds between 1990 and 2020 using the World Health Organization (WHO) mortality database, there has been an increasing trend in countries such as the United Kingdom, Brazil, the United States, Australia, and Korea [10]. The researchers attributed the increase to factors such as the rise in mood disorders including depression, the increase in substance abuse such as illegal opioid use, and the expanded use of social media. Thus, while Korea has succeeded in reducing the overall suicide rate through various efforts, the impact of COVID-19 and the post-pandemic era has contributed to the increasing suicide rate among the younger population. This trend highlights the need for new countermeasures [2].
Statistics on suicide attempts
Since 2013, Korea has used data from the NEDIS to understand the status of self-harm and suicide attempt patients who visit emergency room (ER) [6]. The age distribution of these patients (Figure 2) shows a significant increase of suicidal attempts among those under 20, unlike those in their 30s and older. The number of female attempts has also gradually increased, with the female-to-male ratio rising from 1.2 in 2018 to 1.7 in 2022 [11,12]. Furthermore, a review of responses regarding suicidal ideation among individuals aged 20-40 in the 2021 Mental Health Survey revealed that the proportion of females reporting suicidal ideation was higher than that of males across all age groups, with the highest response rate observed among those in their 20s [13]. This indicates a rising trend of suicidal thoughts and attempts among young individuals, particularly those under 20 and females, in Korea. Therefore, there is a need for mental health management, employment and economic support for these populations.
Psychological autopsies of suicide deaths
The mortality statistics from Statistics Korea provide only basic demographic information such as gender and age of suicide deaths. Since 2015, the KFSP has been accumulating information through psychological autopsies that estimate the circumstances and reasons for suicides. Figure 3 presents the top 10 warning signs displayed by suicide deaths based on 956 cases collected over the past eight years (2015-2022) [4]. The most common warning signs were changes in emotional state (66.0%), changes in sleep patterns (62.3%), mentioning suicide (54.9%), hopelessness and loss of interest (52.7%), changes in eating habits (52.2%), and physical discomfort (43.4%). In 2024, the KFSP conducted an analysis of suicide deaths among single-person households using data collected over nine years through psychological autopsies. It was found that suicide decedents in single-person households exhibited higher employment instability, lower income, a higher history of suicide attempts, and a greater proportion of acquaintances as the first discoverers compared to those in multi-person households [14]. The Korean government is utilizing these analytical results to enhance the identification of individuals at mental health risk. Additionally, the analysis of information derived from psychological autopsies is intended to be used in educational materials for mandatory suicide prevention education, which commenced in July 2024.
Comprehensive investigation of suicide deaths
Since psychological autopsies rely on voluntary participation by bereaved families, the number of cases collected each year represents only about 1% of all suicide deaths. To gather more information on suicide deaths, the government investigated whole suicide deaths among police records from 2013 to 2020 [15]. The collected data were analyzed to identify and provide locations of suicide hotspots and areas with high concentrations of suicides. This enabled the implementation of community-based suicide prevention programs. Additionally, the KFSP analyzed data from this investigation for five years (2016-2020) and combined it with health insurance data of the deceased [5]. The analysis showed that a decline in income level, indicated by a drop in health insurance premium payment brackets, was associated with higher suicide rates. Further analysis of mental illness diagnoses among suicide deaths (Figure 4) revealed that, the most common diagnoses were depression, insomnia, alcohol dependence, schizophrenia, and bipolar disorder. When looking at the suicide rate per 100,000 people with these mental illnesses, the highest rates were found among those with bipolar disorder, schizophrenia, alcohol dependence, insomnia, and depression, in that order.
The analysis results revealed several key findings. First, suicide rate of Korea has been increasing since the late 1990s, peaked in 2011, and has since declined, but the recent increase in suicide rates among those in their 20s needs attention. Second, the proportion of suicide attempts is also rising among young people under 20, particularly among females. Third, psychological autopsies have identified the suicide risk of single-person households and the common warning signs among suicide deaths of Korea, which should be actively used to identify high-risk individuals. Fourth, the comprehensive investigation of suicide deaths and health insurance data analysis showed that economic difficulties and a drop in income levels were linked to higher suicide rates, and many suicide deaths had been diagnosed and treated for mental illnesses such as depression. Therefore, early detection and intervention for economic problems and depression are crucial.
SUICIDE PREVENTION POLICIES AND LAWS IN KOREA
As previously discussed, Korea’s suicide prevention efforts are evidence-based approach by data analysis on suicide deaths and attempts, suicide rate trends, and risk factor analysis. These analyses establish the direction of policy implementation and inform the necessary service contents. This section will explore the Action Plan and the Suicide Prevention Act, which serves as the foundation for data-driven suicide prevention programs.
National suicide prevention action plans
The MOHW has established a five-year Action Plan aimed at reducing suicide rates. The 1st Action Plan (2004-2008) was the first comprehensive national initiative led by the government, which aimed to create suicide prevention measures across the lifespan and create a culture of respect for life [16]. However, the 1st Action Plan focused only on individual mental health problems and lacked social discourse and public-private cooperation strategies for suicide prevention services [17]. The 2nd Action Plan (2009-2013) identified 10 major tasks for suicide prevention, promoted systematic implementation of these tasks, and sought to strengthen public-private cooperation by establishing the Korea Suicide Prevention Center and the Korea Psychological Autopsy Center and enacting the Suicide Prevention Act [18]. In 2013, the ERC was established to provide emotional stability and necessary treatment and counseling services to suicide attempters visiting ER. However, the 2nd Action Plan merely added suicide prevention programs without additional budget and manpower, and it proceeded without prioritizing the programs [17].
The 3rd Action Plan (2016-2020) outlined three major suicide prevention strategies, namely “creating a pan-societal environment,” “customized services,” and “strengthening policies” and sought to build a regional customized delivery system [19,20]. In January 2020, the “Notification of Hazardous Suicide Means” was enacted to regulate items frequently used or at risk of being used for suicide. The 4th Action Plan (2018-2022) further detailed the whole of governmental efforts for suicide prevention [21]. The MOHW established the Division of Suicide Prevention Policy, the National Assembly launched the Suicide Prevention Forum by 59 congressmen, and the Prime Minister operated the Suicide Prevention Policy Committee. Additionally, in 2021, the KFSP, which integrated the Korea Psychological Autopsy Center and the Korea Suicide Prevention Center, was launched to enhance support for the operation of suicide prevention programs [22]. Major programs under the 4th Action Plan included training one million gatekeepers, operating the 1393 hotline counseling service, establishing a Korean psychological autopsy system, and conducting comprehensive investigation of suicide deaths. The investigation involved reviewing data stored at police stations nationwide, and over eight years (2013-2020), data on approximately 100,000 suicide deaths were collected as a long-term national project [21].
Suicide rate is still high in Korea despite various suicide prevention policies, action plans, and services in the community. This is attributed to a combination of many factors, such as insufficient communication and collaboration between central and local governments, a lack of suicide prevention professionals and infrastructure, societal attitudes that perpetuate misconceptions about suicide, insufficient public awareness campaigns, and a lack of evidence-based policies based on comprehensive investigation of suicide deaths and psychological autopsy. Additionally, previous plans have primarily been driven by central government initiatives, with local governments not effectively executing suicide prevention programs. These plans have also been limited by their focus on post-incident responses rather than proactive interventions for suicide risks [23].
The 5th Action Plan (2023-2027) aims to reduce the suicide death rate by 30% to 18.2 per 100,000 people by 2027, by strengthening community-based suicide prevention policies and support for high-risk groups [2,23]. This plan is structured around five major strategies and 15 key tasks (Table 1). Firstly, in relation to the strategy of building the Life Safety Network, which refers to the provision of community-driven, resident-tailored services, the 5th Action Plan proposes expanding community-based suicide prevention programs and mental health screenings, mandating suicide prevention education, and introducing the Suicide Zero Town as a new project. The Suicide Zero Town project aims to implement communityspecific suicide prevention programs by integrating various prevention activities, including the identification, treatment, and connection of high-risk individuals across five key sectors—healthcare, education, welfare, community, and public institutions—as well as awareness campaigns, gatekeeper training, customized services for high-risk groups, and restricting access to means of suicide.
The second strategy is to reduce risk factors, which includes expanding psychiatric treatment fee support for suicide attempters and high-risk groups, establishing a real-time monitoring system for suicide-inducing information. The third strategy is to strengthen follow-up management, which consists of enhancing the management of suicide attempters, expanding one-stop services for suicide survivors. The fourth strategy is to prevent suicide tailored to the different groups, which includes suicide prevention approach by life-cycle and economic crises or mental health vulnerable groups. In addition, the fifth strategy is to strengthen the foundation for efficient suicide prevention, which consists of publishing suicide death analysis reports using psychological autopsy and comprehensive investigation of suicide deaths, restructuring the suicide prevention service delivery system between central and local governments, expanding 109 hotline infrastructure, and empowering the suicide prevention professionals [2].
Suicide Prevention Act
The Suicide Prevention Act was enacted in March 2011 to support the Action Plan [24]. This act emphasizes the responsibilities of the central and local governments for suicide prevention (Article 1, Article 4; “Article” refers to a provision in a law) and focuses on prevention and awareness improvement (Article 2). To this end, the MOHW establishes Action Plan every five years (Article 7), and the central and local governments implement and evaluate annual suicide prevention plans (Article 8). The central and local governments also performs the implementation of suicide surveys and psychological autopsies (Article 11), integrate and manage suicide-related data (Article 12), and establish and operate the KFSP and Suicide Prevention Centers to perform counseling, education, and crisis intervention tasks (Article 12-4, Article 13). The Suicide Prevention Act has been amended several times to reflect the latest suicide prevention programs and policies. The amendment in February 2022 included provisions for the provision of information on suicide attempt survivors from the police and fire departments to community mental health and welfare centers (CMHC). The amendment in July 2023 incorporated measures for mandatory suicide prevention education for all citizens.
SUICIDE PREVENTION SERVICE DELIVERY SYSTEM AND PROGRAM
Korea is refining its laws and systems for suicide prevention and enhancing delivery systems and tailored programs to provide practical services. This section aims to describe the community-based suicide prevention service delivery system and highlight recent key suicide prevention programs, such as the early detection and intervention of depression.
Community-based suicide prevention service delivery system
The community-based mental health and suicide prevention service delivery system can be divided into the MOHW, regional and local areas (Figure 5). Local governments operate CMHC and suicide prevention centers to prevent high-risk suicide cases and manage them.
The MOHW’s Mental Health Policy Bureau, which consists of three divisions, oversees suicide prevention and mental health policies. Furthermore, The National Center for Mental Health, under the MOHW, provides operational support for regional and local CMHC, alcohol and drug abuse treatment centers, community rehabilitation facilities, and psychiatric asylums. The KFSP, under the MOHW, supports the operation of regional and local suicide prevention centers and CMHC’s suicide prevention programs. To enhance the effectiveness of these services, the KFSP also conducts evaluations of the suicide prevention programs carried out by local governments [25,26].
Currently, there are currently 17 regional and 246 local CMHC in operation [25,27]. The main services of CMHC commonly perform tasks such as early detection and case management for people with severe mental illness, psychiatric treatment fee support, crisis hotline, and mental health promotion programs for the general public. Suicide prevention centers, of which there are 6 independent and 48 affiliated to the CMHC, offer direct and indirect services related to screening high-risk suicide groups, training and managing gatekeepers, conducting crisis intervention and case management for suicide attempters, providing post-management and psychological autopsy for suicide attempters and survivors, and offering psychiatric treatment fee support. However, the suicide prevention programs still lack a robust delivery system, and due to insufficient infrastructure, most suicide prevention centers cannot operate diverse programs for the community. In this context, some experts propose to increase the number of local independent suicide prevention centers and strengthen cooperation between the central and local governments.
Community-based suicide prevention programs
Analysis of domestic suicide deaths revealed that many suffered from mental illnesses such as depression at the time of death, highlighting the importance of early detection and treatment of depression for suicide prevention. The role of detect-ing individuals with mental health issues early and linking them to treatment institutions is crucial, as suicide completers are more likely to have visited general practitioners at primary medical institutions than mental health professionals before their death [28-30]. This section introduces two recent initiatives aimed at early detection and intervention for depression, as outlined in the 5th Action Plan (2023-2027) [2].
Expanded mental health screening
The government has been striving to identify depression patients within the community. In a proactive approach to address mental health problems, the mental health screening system has been restructured since January 2025. Key changes include shortening the screening interval for adults aged 20 to 70 (from 10 years to 2 years), identifying disorders closely related to suicide (adding schizophrenia and bipolar disorder to the existing depression screening), and ensuring those identified at risk of suicide through screening are refered to psychiatric clinics or CMHC. Currently, children and adolescents (in grades 1, 4, 7, and 10) undergo evaluations for key emotional and behavioral characteristics such as personality issues, ADHD, depression, anxiety, bullying victimization, and suicide risk every three years [31]. The government plans to provide revised evaluation questionnaires for children and adolescents. Through nationwide mental health screenings, the government aims to identify and intervene with high-risk groups for depression and suicide early.
Pilot Project for Mental Health Care Linkage in Primary Health Clinics
As mentioned earlier, primary medical institutions play a critical role in identifying and intervening with high-risk suicide groups [32-35]. Based on previous research [36], the MOHW has been implementing the Pilot Project for Mental Health Care Linkage in Primary Health Clinics since 2022 [37,38]. The project’s goal is to refer individuals assessed by primary care physicians as being at risk of depression or suicide to CMHC, suicide prevention centers, or psychiatric clinics for counseling and treatment. Additionally, the government plans to expand professional psychological counseling services to all citizens experiencing psychological difficulties such as depression and anxiety since July 2024. The support involves offering 60-minute sessions of professional psychological counseling up to eight times per individual through vouchers, with services provided by certified psychological service professionals [31].
DISCUSSION
Due to rapid social development and changes unlike any other nation in the world, many citizens in Korea have struggled to properly cope with psychological, economic, and social stress, leading to serious mental health issues such as depression. Since the economic crisis in 1997, the Korean government has established plans to cope with the surge in suicide rates, responded to social changes, and improved laws and policies. Also, it has been striving to establish an effective suicide prevention delivery system and implement community-led policies under the central government’s directions [1].
The main achievements of the comprehensive measures for suicide prevention are as follows. First, an analysis of data on suicide deaths and attempts provides insights into the severity and characteristics of suicide in Korea. Also, it has identified suicide risk factors that reflect recent social issues, such as young adults in their 20s and 30s, women, single-person households, economic problems, and mental illnesses. Second, the Suicide Prevention Act and the Action Plan served as the foundation for the development of evidence-based suicide prevention programs. Specifically, the government achieved measures such as strengthened management through regulations to the hazardous means for suicide-related materials such as carbon monoxide and pesticides, expanded the ERC, and trained over 7 million gatekeepers through suicide prevention education as of 2022 [39]. Furthermore, it is fortunate that in 2018, the MOHW established the Division of Suicide Prevention Policy and the National Assembly launched the Suicide Prevention Forum by 59 congressmen, followed by the launch of the Suicide Prevention Policy Committee under the Prime Minister’s Office in 2019, and the establishment of the KFSP in 2021 [2]. Third, based on previous studies, early detection and intervention programs for depression are being improved. Programs such as the expansion of mental health screenings and Pilot Project for Mental Health Care Linkage in Primary Health Clinics are expected to serve as practical measures to reduce the number of patients with depression and those at high risk of suicide. Sustaining existing psychiatric treatments, stigma reduction campaigns, and nationwide psychological therapy support while expanding new mental health programs can foster a virtuous cycle, increasing depression treatment rates and help-seeking behaviors while reducing suicide rates within the biopsychosocial model.
However, there are still some problems with suicide prevention efforts of Korea. For example, it is imperative to sensitively detect and promptly respond to recent social changes and fluctuations in suicide rates. Until now, suicide prevention in Korea has tended to focus mainly on individual mental health problems. The suicide issue is highly complex, and changes in overall socio-cultural perceptions and institutions should be supported to prepare for this issue.
Specifically, the young individuals in their 20s and 30s in Korea were born around the time of the IMF crisis and have been continuously exposed to competition, with a tendency to attribute failure to a lack of personal effort. The intergenerational transmission of inequality exacerbates the sense of helplessness among youth, as they feel that their lives are determined by their parents’ socioeconomic status. Moreover, the impact of COVID-19 has led to a global economic downturn, further exacerbating the instability experienced by the younger generation. This sense of despair is further intensified among young people who have not yet established a stable position in society, as they are likely to experience heightened levels of depression, anxiety, and suicidal thoughts due to the impact of COVID-19 [40,41]. In addition, the increase in female suicide rates has been observed both domestically and internationally after COVID-19,42-44 and in the case of Korea, women face unstable jobs, imbalances in caring work, and difficulties in work-family balance. They tend to be forced into low-wage part-time jobs due to the genderized dual structure in the labor market and even the role of children care [45-48]. In other words, Korean women lack opportunities to demonstrate their professional competence, experience difficulties in work-family balance, and problems with depression and burnout could be significant. Therefore, in addition to strengthening mental health management for young people and women, improving social and economic foundations, such as welfare systems, social safety nets, and the labor market, is equally essential.
In the above context, suicide-related data collection methods should be further advanced to incorporate recent social issues. For example, the KFSP is establishing a system to respond to regions with a surge in suicides based on suiciderelated data (e.g., the Comprehensive Investigation of Suicide Deaths), selects suicide surge areas through provisional values for the tally of suicide deaths, and seeks ways to reduce suicide rates in the area. The predictive power of suicide risk factors could be enhanced by analyzing combined data on suiciderelated information and the socioeconomic background of the deceased, such as records of health and employment insurance payments, history of psychiatric services. However, in Korea, it is currently impossible to utilize the socioeconomic data of deceased individuals due to restrictions imposed by relevant laws and regulations. If a comprehensive suicide prevention data system incorporating the socioeconomic data of suicide deaths is established following legal revisions, the government would be able to promptly intervene in response to changes in suicide rates and proactively address regions experiencing a surge in suicides.
Finally, it is crucial to assess the effectiveness of current suicide prevention policies, including central government planning and budget allocation, as well as the collaborative system with local governments in implementation. Even with existing laws and regulations, without adequate manpower, systems, and funding, their effectiveness may not meet expectations. In particular, many local governments face challenges due to insufficient professional personnel, limited financial resources, and inadequate infrastructure for mental health services. Strengthening local capacities by establishing dedicated suicide prevention teams, expanding mental health infrastructure, and enhancing inter-agency collaboration is essential.
Rather than a centrally driven, supply-oriented policy, services that are locally driven and focused on people’s needs should be provided to establish a robust safety net, enabling the implementation of suicide prevention policies that address the underlying causes of suicide [1,23,49]. To achieve this, it is necessary to allocate resources more equitably across regions, provide customized support based on local characteristics, and create a structured cooperation framework between national and local entities. Furthermore, in addition to establishing a well-structured suicide prevention plan, it is also crucial to evaluate the effectiveness of these policies. Currently, the MOHW and the KFSP are responsible for developing and assessing suicide prevention plans across 17 provinces in Korea. To enhance the effectiveness of plan development and evaluation, a study was completed in 2024 [50]. The findings from this study will be applied starting with the 2025 local government suicide prevention plans, and efforts will be made to refine the evaluation of local suicide prevention initiatives and incorporate them into policy. Additionally, these issues and improvements should be reflected in the 6th Action Plan in the future.
In summary, this paper has examined the current status and issues of national suicide prevention policies along with domestic suicide rate trends, and identified key tasks that need to be prioritized in the future. Suicide is not a problem that can be solved quickly due to its complex causes and variability depending on social and environmental changes. There must be consensus on national policy priorities to secure broad societal, governmental, and civic capabilities, as well as policies and funding, so that all citizens can live with hope in a safe, happy society without suicide.
PDF Links
PubReader
ePub Link
XML Download
Full text via DOI
Download Citation
Print
