National Trends and Directions for Suicide Prevention Research in South Korea: A Narrative Review

Literature search and selection

A literature review was conducted on suicide prevention in South Korea. Four databases were searched: MEDLINE via PubMed, PsycINFO, Embase, and RISS. During a preliminary exploration of the literature, PubMed, Embase, and RISS were searched using the keywords “Suicide” and “South Korea.” In PubMed, the filters “Meta-Analysis, Review, and Systematic Review” were applied, while in Embase, the filters “human,” “English or Korean,” and “review” were used. In RISS, the filters “Suicide Prevention, Policy, Review, and Effectiveness” were applied. All articles published through 2024 were included. Records were screened by title and abstract to select studies related to suicide in South Korea. No publication date restrictions were applied. A total of 10,952 papers with abstracts in English were extracted, and studies relevant to the research purpose were included in the review (Figure 1).

Figure 1.

Review process.

Effectiveness of suicide prevention policies

These efforts include studies conducted to improve the environment for suicide prevention nationwide. A prime example of such efforts is enhancing control over suicide means (e.g., accessibility restrictions to control carbon monoxide [CO] exposure, restricting the sale of pesticides, and installing screen doors on subway platforms). In South Korea, CO poisoning was historically not a common method of suicide; however, it became increasingly prevalent, rising 30-fold between 2006 and 2012 following the suicide of a famous actor in 2008 [9]. Since then, CO poisoning has remained a significant suicide method, with 35%–44% of cases attributed to intentional poisoning [9]. A study on the prevalence of CO poisoning in South Korea, using claims data from the Health Insurance Review and Assessment Service (HIRA), reported a prevalence of 8.64/10,000 patients, demonstrating a gradual increase between 2010–2019 with a total of 44,361 patients with CO poisoning [10]. To prevent suicide by CO poisoning, a nationwide policy has been implemented to restrict the process of selling charcoal and reduce the toxicity of charcoal burning [11]. Prior to November 2011, approximately 1-in-5 suicides involved the intake of pesticides—mainly paraquat—a virulent herbicide. After a ban on the sale of paraquat was implemented, the suicide mortality rate from pesticide poisoning decreased by half from 5.26 to 2.67 per 100,000 people between 2011 and 2013, establishing a good precedent for practical preventive efforts by restricting suicide means [12].

Another study on the impact of paraquat bans on national suicide rates and suicide methods in South Korea found that the estimated suicide rate decreased by 10.0% for total suicides and by 46.1% for suicides involving herbicide or disinfectant poisoning between 2005 and 2013. Following the restriction of paraquat sales in 2011, suicide mortality from pesticide poisoning decreased from 5.26 to 2.67 per 100,000 people between 2011 and 2013.

The Seoul Metro Subway installed Platform Screen Doors (PSDs) at 121 locations between 2005 and 2009 at a cost of approximately $190 million. A study of these 121 subway stations in the Seoul metropolitan area from 2003 to 2012 found that PSD installation reduced fatal suicides by 89%, from approximately 100 cases to 11. The study also found that half-height PSDs were less effective than full-height PSDs; consequently, full-height PSDs are currently used [13]. Meanwhile, suicides by CO poisoning increased from 0.5 per 100,000 people in 2008 to 3.9 per 100,000 in 2019, making it the third most common suicide method in Korea after hanging and falling. However, the rise in suicides by CO poisoning did not surpass the overall reduction in suicides caused by herbicide or disinfectant poisoning, despite evidence of a method-substitution effect following the paraquat bans [14].

Effectiveness of gatekeeper training in suicide prevention

Gatekeeper training is another effective strategy for suicide prevention [15]. “Suicide CARE” (Standardized Suicide Prevention Program for Gatekeeper Intervention in Korea), which allows early recognition of suicide warning signs, was developed in 2011 and has been updated and developed in various versions for different audiences, including office workers, soldiers, students, firefighters, and North Korean defectors [16]. Certain occupational and demographic groups have been prioritized as gatekeepers because of their heightened exposure to suicide risk factors and their potential to intervene effectively. The program was revised in 2019 based on findings from psychological autopsy studies in South Korea and international literature reviews. It incorporates different suicide prevention approaches tailored to various age groups, including general adults; middle and high school students; and young, middle-aged, and older adults. This structure enables the cultivation of life guards who understand the unique characteristics of each life stage. “Suicide Care” is provided free of charge by instructors who have completed 16 hours of training over two days. These instructors must have at least two years of experience in suicide prevention. The program ensures standardization and quality management of instructor training, including mandatory annual refresher courses. To date, more than 7 million people have completed this training (Table 1) [8,17].

Table 1.

Number of participants completing suicide prevention gatekeeper education program by year (including “Suicide CARE”)

Studies have demonstrated the effectiveness of the Suicide CARE. One study found that trained gatekeepers exhibited enhanced intervention skills and greater confidence in suicide prevention [18]. Another study indicated that while participants retained suicide prevention knowledge up to at least 3 months, ongoing reinforcement was needed for sustained effectiveness [19]. However, further research is required to evaluate the program’s long-term impact on suicide reduction rather than just improvements in awareness and intervention skills [18].

Effectiveness of media guidelines in suicide prevention

In South Korea, numerous high-profile celebrities have died by suicide. When each incident occurred, the risk of suicide increased significantly during the affected period, most likely due to the copycat effect (i.e., “Werther effect”) among subjects that identify themselves with celebrities. Experts agreed that measures were needed to ensure accurate media coverage contributing to reducing suicide rates and minimizing excessive reporting on celebrity suicides [20]. The Korea Foundation for Suicide Prevention enacted suicide reporting guidelines for the media in 2004. Following the enactment of the Suicide Prevention Act in March 2011, the Korean government revised these guidelines in September 2013 to prevent imitation suicides after celebrity suicides. The suicide reporting guidelines in South Korea have been continuously updated to strengthen responsible media practices and mitigate the Werther effect. The guidelines emphasize avoiding detailed descriptions of suicide methods and locations, prohibiting sensationalized headlines and emotional framing, providing crisis helplines in suicide-related articles, encouraging balanced reporting by highlighting recovery stories, and monitoring online and social media content to prevent harmful discussions. Since their initial introduction in 2004, the guidelines have undergone multiple revisions to enhance their effectiveness. Version 1.0 (2004) discouraged explicit suicide reporting and recommended including helpline information. Version 2.0 (2013) introduced stricter measures against sensationalism, incorporated social media reporting guidelines, and addressed the responsible coverage of celebrity suicides. Currently, the suicide reporting guidelines for the media have been updated to version 3.0. Version 3.0 (2018–present) expanded social media monitoring, mandated journalist training, and implemented legal enforcement measures to ensure compliance. These updates reflect the Korean government’s commitment to ethical media reporting and suicide prevention in an evolving digital landscape [20].

A 2015 study using data from the Korea National Statistical Office examined the relationship between media coverage and suicide rates in South Korea. The results of a Pearson correlation analysis showed a significant positive correlation between the number of suicide reports in daily newspapers and broadcasts and the monthly suicide rate across all media. The study found that a decrease in media suicide reports contributed to a decline in the suicide rate [20]. Another study analyzed the impact of media coverage of 24 Korean celebrity suicides on the general population. It found that in the 30 days following a celebrity suicide, total suicides increased by an average of 6.27 per day. During this period, the number of suicide deaths among the general population increased by 13%. After the implementation of media reporting guidelines in 2013, the suicide rate declined by 13% (95% confidence interval [CI]: 8.2–17.5), confirming the effectiveness of these guidelines in reducing suicide deaths. However, as the media environment has diversified, controlling suicide-related content on various social media platforms poses another challenge [21].

Suicide risk factors

The impact of suicide extends beyond the victim, significantly affecting bereaved family members, exacerbating their risk of mental health issues and suicidal behaviors [22]. In South Korea, the “Sewol ferry disaster,” which killed 304 passengers on April 16, 2014, served as an opportunity to improve awareness of disaster mental health. As a result, the National Center for Disaster and Trauma was established in April 2018, and disaster mental health guidelines were developed. These movements led to the recognition that suicide prevention activities are needed in disaster situations and that early intervention in suicide prevention is necessary [23]. Under this process, during the COVID-19 outbreak, the Korean government strengthened its response system for suicide prevention by expanding the number of suicide prevention telephone counselors and strengthening non-face-to-face psychological support. Non-face-to-face psychological support includes crisis hotlines, AI-based chatbot counseling, and remote telepsychiatry sessions. The number of suicide prevention counselors increased from 250 in 2019 to 680 in 2023. In the private sector, a multidisciplinary team of mental health experts systematically organized psychosocial support [24].

Korea’s 5th Basic Plan for Suicide Prevention, established in 2023, proposes expanding the treatment and management of individuals with mental health conditions and mitigating suicide risk factors [25]. In Korea, a national database study is being conducted to examine suicide risk factors among individuals with low socioeconomic status and people with mental illness or disabilities. This study utilizes suicide-related cohort studies, public enterprise claims data, as well as data from the HIRA and the National Health Insurance Service (NHIS).

A nationwide cohort study of 95,855 individuals with psychiatric conditions found that restricting access to pesticides significantly reduced suicide mortality among high-risk patients [26]. A cohort study analyzing self-harm behaviors in South Korea found that such behaviors were more prevalent in individuals aged 50 and older, particularly among those with chronic illnesses [26]. Risk factors for suicidal ideation were analyzed from a life-stage perspective using data from 5,935 individuals from the Korea National Health and Nutrition Examination Survey conducted in 2015. In that study, various risk factors for suicidal ideation were identified across different age groups: activity limitations for individuals aged 12–19 years, education level and subjective health status for those aged 20–39 years, education level, activity limitations, and quality of life for individuals aged 40–64 years, and inadequate sleep duration for those aged 65 years and older. These findings highlight the need for individualized suicide prevention strategies and targeted government policies that address the specific risk factors associated with each stage of life [27]. In a study that investigated deaths by suicide among mentally ill patients using a retrospective population-based cohort of 95,855 Koreans and National Health Insurance claims data, 2,408 people died of suicide and 15,192 people died of other causes. Furthermore, the healthcare utilization rate one year before suicide was 95.0%, and the utilization rate one week before suicide was 43.5% [28]. These findings are consistent with those of previous studies showing the importance of gatekeeper training for healthcare providers to prevent suicide in patients with mental illness [15]. To understand the risk faced by suicide loss survivors, a nationwide population-based cohort study was conducted, analyzing 423,331 bereaved families of suicide victims and 420,978 bereaved families of non-suicide deaths as a control group. The study merged data from National Health Insurance claims between 2008 and 2017 with data from Statistics Korea. Among suicide loss survivors, the suicide rate was 586 per 100,000 people, three times higher than that of bereaved families of traffic accident victims and non-suicide deaths. For wives whose husbands died by suicide, the hazard ratio for suicide death was 5.096 (95% CI: 3.982–6.522). The average duration from the death of a family member to the suicide was 25.4 months [29]. A psychological autopsy study also found that adolescent survivors who lost a parent to suicide experienced clinically significant suicidal thoughts, depression, and insomnia [30]. Based on these studies, the Korean government has been operating one-stop services such as onsite visits, psychological counseling, and support for treatment costs for suicide survivors since 2019 [25]. In another psychological autopsy study conducted in South Korea, which involved a comprehensive investigation of suicide deaths by the National Police Agency from 2013 to 2017, 3,147 out of 5,228 cases (60.2%) were first-time suicide attempts that resulted in death. Those who died on the first attempt were more likely to die on the first attempt if they were male, over 65 years old, employed, and married/widowed; those who died on the first attempt were more likely to have never been diagnosed with a mental illness, and those who died after repeat attempts were more likely to have been diagnosed with a mood disorder [31].

Management of suicide high-risk groups

Individuals with a history of suicide attempts and patients discharged from psychiatric hospitals are recognized as high-risk groups for suicide. Studies indicate that individuals who have previously attempted suicide are highly likely to reattempt within 24 months and have a significantly higher risk of suicide mortality compared to the general population [32]. Similarly, psychiatric patients have an approximately 20 times higher risk of suicide than those hospitalized for non-mental illnesses [33]. Among high-risk groups, suicide attempters and psychiatric patients face unique vulnerabilities. Individuals who have attempted suicide require immediate intervention to prevent reattempts, while patients with psychiatric disorders, including substance use disorders, schizophrenia, bipolar disorder, and depression, are at an elevated risk, particularly in the period immediately following discharge [34].

To address the needs of suicide attempters, the Ministry of Health and Welfare in South Korea has been providing psychological treatment and social welfare services in collaboration with community mental health and welfare centers since 2011. This initiative involves case management teams of two to three professionals per hospital who support suicide attempters receiving care in emergency departments [35]. As of 2023, 75 medical institutions have implemented post-suicide attempt case management programs [35]. A study evaluating this program found that individuals who received four weeks of case management had a significantly longer time to reattempt suicide compared to the control group within the first 24 weeks after their initial attempt [36]. Another observational study of 439 suicide attempters reported that 277 (63.1%) completed the case management program, and those who completed the program had a significantly lower suicide risk compared to non-completers (65.3% vs. 46.9%, adjusted odds ratio: 2.13 [1.42–3.20]) [37].

Given the high suicide risk among recently discharged psychiatric patients, South Korea developed a hospital-based case management model to provide continued post-discharge support. This model was introduced as a pilot project in January 2020 to ensure ongoing treatment and crisis intervention [38]. As of March 2022, 21 hospitals are participating in this hospital-based case management program [38]. A reimbursement structure has been established to cover services such as discharge planning, education counseling, home visits, and patient monitoring, with these services available for up to 6 months post-discharge [38]. A recent study in Korea demonstrated that early outpatient follow-up after psychiatric hospital discharge significantly reduces suicide risk in patients with substance use disorders, schizophrenia, bipolar disorder, and depression [34].

Efforts to provide structured post-crisis intervention through case management programs in emergency departments and psychiatric hospitals reflect South Korea’s commitment to reducing suicide rates among high-risk groups [39]. However, further research and evaluation are required to assess the long-term effectiveness of these interventions in preventing suicide mortality.

Trends in digital mental health interventions

The remarkable development of digital technology can provide opportunities to understand, predict, and prevent suicidal behavior. Ecological momentary assessment (EMA) or machine learning technology can be utilized, and early identification and intervention based on digital technology can be implemented [40].

South Korea is a highly technologically advanced country with a smartphone penetration rate of 95% in 2021 and thus has great potential to utilize mobile applications for health care [41]. A systematic review of the use of mobile apps for mental health management in South Korea has shown that such apps target various mental health symptoms such as depression, anxiety, panic attacks, and attention deficits, but few are related to suicide prevention. Several studies have developed mobile applications for creating safety plans that include coping strategies that adolescent suicide attempters can immediately access and use in crisis situations [42]. In a cross-sectional study on suicide screening using smartphone applications [43], mobile messenger counseling for self-harm and suicide attempters discharged from the emergency department demonstrated a positive impact on post-discharge case management outcomes, including connections to outpatient clinics and community mental health and welfare centers [44]. Further mobile-based research is needed to help prevent suicides [45].

There have also been limited studies utilizing machine learning to predict suicide risk. Some research has explored blood-derived multi-omics data to identify biological markers associated with suicide risk. Additionally, machine learning models have been applied to analyze the relationship between suicidal ideation risk factors and the socioeconomic status of adolescents, providing insights into how economic disparities influence mental health and suicidal behavior [46,47].

Furthermore, only a limited number of preliminary studies in Korea have examined suicide risk assessment using EMA, highlighting the need for expanded research in this area [48].

Future directions for suicide prevention and mental health policy innovation

In this review, we describe the national trends in suicide prevention research in South Korea, with an emphasis on the national suicide prevention action plans. However, the suicide problem in South Korea has yet to be resolved. In Korea, suicide prevention efforts have been continuously expanding in recognition of the significant social burden of suicide. In accordance with the National Action Plan for Suicide Prevention, the Department of Suicide Prevention Policy and the National Assembly Suicide Prevention Forum were established in 2018, providing an opportunity to take Korea’s suicide prevention to the next level. The suicide prevention budget approximately doubled in 2018 compared to 2017, and has increased every year, with the 2023 budget increasing 6.7 times to 48.9 billion won (approximately 37.5 million USD). However, Korea’s annual suicide prevention budget is still extremely low compared to that of other nations, approximately 1/20 of Japan [49].

In December 2023, the Korean government announced a Mental Health Policy Innovation Plan aimed at providing mental health counseling to 1 million people by 2027 and reducing the suicide rate by 50% within 10 years. Suicide prevention education became mandatory for 16 million people, emergency calls for suicide prevention counseling were integrated into a three-digit number (i.e., 109), and counseling via social media platforms has been introduced. In the future, the Presidential Mental Health Policy Innovation Committee will discuss long-term and complex tasks and prepare detailed implementation plans [50].

In the future, Korea’s suicide prevention research must be further tailored to support different life stages, high-risk groups with mental health conditions, and financially vulnerable individuals, ultimately reducing suicide rates. Research should focus on evidence-based policies to strengthen prevention strategies while addressing gaps in mental health care accessibility.

Key areas for further research include personalized interventions for at-risk populations such as adolescents, the elderly, individuals with psychiatric disorders, and socioeconomically disadvantaged groups. Longitudinal studies on early intervention effectiveness and the impact of socioeconomic factors on suicide risk would provide valuable insights. Additionally, digital mental health interventions such as AI-driven counseling, mobile-based suicide prevention, and telepsychiatry require further investigation to enhance prevention efforts [51,52].

Evaluating regional disparities in mental health services and developing models for integrating community-based mental health care with existing suicide prevention efforts are also necessary. Studying effective psychiatric reimbursement models from other countries could inform policy improvements to ensure high-risk individuals receive adequate care.

In the current research and clinical environment, there are limitations to early detection and effective intervention in high-risk groups with repeated suicide attempts. There are difficulties in evaluating the effectiveness of individual elements of suicide prevention strategies at the national level. However, in countries where suicide prevention projects are well-implemented, there have been investments in evidence-based innovation, such as the National Suicide Prevention Clinics, a large suicide research center, hospital-based intervention management, and the introduction of psychological autopsy policies [15,53]. Denmark has been operating 20 National Suicide Prevention Clinics nationwide since 2007, and is developing and operating the Danish Internet Psychiatry Clinic by actively introducing digital psychiatry [54-56]. In 2020, the U.S. National Institute of Mental Health launched a practice-based suicide prevention research center based on a research center program model for adolescents and adults with mental illness. The center aims to develop an effective and scalable approach to reduce the suicide rate; develop, improve, and test models for rapid introduction into actual treatment sites; and support research that could not be achieved with existing research funds. Seven centers have been designated and operated to focus on crisis detection, suicide risk screening, and intervention in high-risk groups, with the aim of reducing the suicide rate by 20% [57]. In Japan, an intensive case management program for suicide attempters, which has been proven effective through a randomized controlled multicenter trial of the post-suicide attempt case management for the prevention of further attempts in Japan (ACTION-J) program, has been covered by medical insurance and implemented in clinical settings since 2016. This program has contributed to reducing the suicide rate, lowering suicide attempts by 24% (95% CI: 18–30). Similarly, Denmark’s suicide prevention clinics achieved a 22% reduction over five years [58]. Sweden established the National Center for Suicide Research and Prevention in 1993, which has operated under the Karolinska Institute since 2007. This center collaborates with various government agencies, parliament, and volunteer organizations to implement suicide prevention strategies through the medical system. Since the 1970s, Sweden has experienced a general decline in suicide rates. Over the past 15 years, the suicide rate has decreased by approximately 20%, aligning with the EU average [59,60].

In South Korea, there is an urgent need to introduce an innovative hospital-based suicide and self-harm clinical research center that integrates the U.S. Practice-Based Suicide Prevention Research Center model with Denmark’s National Suicide Prevention Clinic model. It is necessary to develop successful technologies nationwide to prevent suicide, such as the sharing of a suicide prevention database system based on artificial intelligence, the expansion of a standardized model of intensive case management of high-risk groups based on hospital-based suicide risk management, the prediction of suicide risk based on digital mental health services and interventions in high-risk groups, and the introduction of short-term treatment programs for suicide attempters to solve the problem of self-injurious behavior that goes beyond research. South Korea is well-known for its robust National Health Insurance and hospital systems. Building on these solid foundations, the development of cutting-edge science and new medical technologies for preventing suicide and self-injurious behavior can be rapidly introduced and integrated into clinical practice. Furthermore, such research will contribute to establishing an innovative clinical research center model and supporting policy measures to mitigate suicide in Korea. As a limitation of this study, related studies were identified and their main contents and results reviewed; however, a quality evaluation based on the level of evidence was not conducted. Additionally, the study selection process focused on English-language publications, which may have excluded relevant Korean studies. Finally, while key studies were reviewed, the methodological quality of each study was not formally assessed, which may have affected the interpretation of the findings.

In conclusion, there are ongoing efforts at the national level to reduce Korea’s consistently high suicide rate. With the enactment of the Suicide Prevention Act and the Basic Plan for Suicide Prevention, improvements are being made in various areas, such as establishing a life safety net, strengthening follow-up management, and building a foundation for efficient suicide prevention. Further, suicide prevention research has been actively conducted in various areas, and major suicide prevention studies in South Korea are presented in this paper. However, bold investment and innovation in early detection and intervention systems for suicide risk groups using cutting-edge science and technology are urgently needed. Drastic changes must be made to ensure that effective suicide prevention measures are implemented in line with new mental health innovation policies. To this end, we propose the establishment of national suicide clinical research centers that integrate technological development and clinical practice to achieve the national goal of reducing the suicide rate by 50% in 10 years.