Risks of suicide among family members of suicide victims: A nationwide sample of South Korea

Abstract

ObjectiveIdentifying the risks of completed suicide in suicide survivors is essential for policies supporting family members of suicide victims. We aimed to determine the suicide risk of suicide survivors and identify the number of suicides per 100,000 population of suicide survivors, bereaved families of traffic accident victims, and bereaved families with non-suicide deaths.MethodsThis was a nationwide population-based cohort study in South Korea. The data were taken from the Korean National Health Insurance and Korea National Statistical Office between January 2008 and December 2017. The relationship between the decedent and the bereaved family was identified using the family database of the National Health Insurance Data. Age and gender were randomly matched 1:1 among 133,386 suicide deaths and non-suicide deaths. A proportional hazard model regression analysis was conducted after confirming the cumulative hazard using Kaplan–Meier curves to obtain the hazard ratio (HR) of completed suicide in suicide survivors.ResultsUsing 423,331 bereaved families of suicide victims and 420,978 bereaved families of non-suicide deaths as the control group, HR of completed suicide in suicidal survivors was found to be 2.755 [95% confidence limit (CL): 2.550–2.977]. HR for wives committing suicide after husbands' suicide was 5.096 (95% CL: 3.982–6.522), which was the highest HR among all relationships with suicide decedents. The average duration from suicide death to suicide of family members was 25.4 months. Among suicide survivors, the number of suicides per 100,000 people was 586, thrice that of people in bereaved families of traffic accident victims and in bereaved families of non-suicide deaths.ConclusionThe risk of completed suicide was three times higher in suicide survivors than in bereaved families with non-suicide deaths, and it was highest in wives of suicide decedents. Thus, socio-environmental interventions for suicidal survivors must be expanded.

Impacts of suicide bereavement on men: a systematic review

“…Agerbo found that among suicide-bereaved individuals in Denmark, men face a suicide mortality risk three times higher than that of women ( 47 ). However, subsequent studies ( 46 , 48 , 51 , 72 ) indicate smaller gender disparities. Specifically, research from Denmark and South Korea found that men experience a smaller increase in suicide mortality risk following the suicide of a spouse or domestic partner’s suicide than women ( 46 , 72 ).…”

“…However, subsequent studies ( 46 , 48 , 51 , 72 ) indicate smaller gender disparities. Specifically, research from Denmark and South Korea found that men experience a smaller increase in suicide mortality risk following the suicide of a spouse or domestic partner’s suicide than women ( 46 , 72 ). This pattern was similarly observed in Swedish men bereaved by a sibling’s suicide compared to women ( 51 ).…”

“…All included quantitative studies ( n = 25) were non-experimental with half ( n = 13) employing a cross-sectional design that either exclusively surveyed individuals bereaved by suicide ( 42 , 52 , 54 , 59 , 60 , 62 , 64 , 77 ) or included individuals not bereaved by suicide ( 49 , 63 , 66 , 69 , 71 ). Eight quantitative studies used a cohort study design ( 46 , 50 , 51 , 55 , 65 , 68 , 70 , 72 ), with an additional two studies using a nested case–control design ( 47 , 48 ). Two quantitative studies used a case–control design ( 56 , 67 ).…”

“…Outcomes addressed by the included quantitative studies encompassed six topics related to suicide bereavement: suicidality of the bereaved ( 42 , 46–48 , 51 , 54 , 56 , 64 , 66 , 68 , 69 , 71 , 72 ), mental health and substance use ( 46 , 49 , 52 , 54 , 56 , 59 , 60 , 65–67 , 69 , 70 , 77 ), grief ( 59 , 60 , 62 , 64 , 66 , 77 ), relationships and quality of life ( 42 , 54 , 56 , 60 , 63 , 64 , 69 ), physical health ( 46 , 59 , 60 , 70 ), and employment ( 46 , 50 ). These topics are documented further in Table 3 .…”

“…Five large population registry-based cohort or nested case–control studies indicated a positive association between suicide bereavement and increased suicide mortality in men ( 46–48 , 51 , 72 ), with one indicating a stronger association for men bereaved by suicide than those bereaved by other causes ( 48 ). A smaller cohort study of adolescent and young men in the US found that participants that died by suicide had significantly higher rates of a family member’s suicide in the year prior ( 68 ).…”