About this Journal


Article Abstract

Online ISSN: 1099-176X    Print ISSN: 1091-4358
The Journal of Mental Health Policy and Economics
Volume 16, Issue 3, 2013. Pages: 109-119
Published Online: 1 September 2013

Copyright © 2013 ICMPE.


 

Geographical Inequalities in Suicide Rates and Area Deprivation in South Korea

Jihyung Hong1* and Martin Knapp2

1PhD, LSE, Health and Social Care, London School of Economics, London, UK
2PhD, LSE, Health and Social Care, London School of Economics, London and King's College London, Institute of Psychiatry, London, UK

* Correspondence to: Jihyung Hong, PhD, LSE health and social care, Houghton Street, London, WC2A 2AE, UK.
Tel.: +44-20-7955 6238
Fax: +44-20-7955 6131
E-mail: jihyung.hong.kr @gmail.com

Source of Funding: None declared.

Abstract

Our study described the spatial mapping of age-standardised suicide rates and area deprivation across small areas (district level) in South Korea, and examined the relationship between the two using a spatial lag model. This spatial model was employed to take into account the spatial dependence and interactions between neighbouring districts, as indicated by Moran’s I and Geary’ C statistics. Our findings highlighted substantial geographical variation in suicide rates and the importance of area deprivation in explaining the disparities, especially for males. The level of excess suicides (i.e. 12-13 per 100,000 males) in highly deprived areas was similar to the average suicide rates of OECD countries. Prioritising development in relatively more deprived areas would potentially minimise resource barriers (e.g. job opportunities, access to amenities and services) that can impede local/regional policy actions aimed at addressing population compositional issues (i.e. individual-level targeting).

Background: Recent years have witnessed growing interest in determinants of suicide in South Korea. While much of the research has paid attention to the role of individual factors in explaining suicide mortality, another potentially important dimension of health inequality is geography.

Aims of the Study: To describe the geographical distribution of suicide rates in South Korea, and to examine to what extent the distribution is shaped by area deprivation.

Methods: Using 2004-2006 mortality data and 2005 population census data, the study first described the spatial mapping of age-standardised suicide rates and level of area deprivation across 250 districts in South Korea. A spatial lag model was also employed to examine the association between the two, taking into account the spatial dependence and interactions between neighbouring districts, as indicated by Moran's I and Geary' C statistics. In addition to level of area deprivation, population density, welfare spending, and rates of divorce, marriage and fertility at district-level were added to the model.

Results: The spatial mapping of suicide rates across 250 districts exhibited a different pattern between males and females. While the highest suicide rates tended to cluster in the north-east region of South Korea for males, no clear pattern was observed for females. On the other hand, the lowest suicide rates for both males and females were found in most districts of the capital city. The results of the spatial lag model revealed a significant association between suicide rates and area deprivation, particularly for male suicide. Compared to the least deprived area, there were about 12-13 more male suicide cases (per 100,000 males) in highly deprived areas. The association with area deprivation was less clear for females. Population density was negatively associated with suicide rates for both males and females. While suicide rates were in general positively associated with divorce rates and negatively associated with fertility rates, the coefficients of both were not significant in the model for females.

Discussion and Limitations: The study highlighted substantial geographical variation in suicide rates across South Korea. Such variation can be largely explained by level of area deprivation, especially for males. The level of excess suicides (i.e. 12-13 per 100,000 males) in highly deprived areas was similar to the average suicide rates of OECD countries. Due to the paucity of individual-level data however, the study was unable to test whether or not these associations were independent of population composition.

Implications for Health Policies: Prioritising development in relatively more deprived areas would potentially minimise resource barriers. Since such area-based approaches focus on a body with clear responsibility (i.e. local authority) and a greater relevance for local residents, programmes and services can be more effectively tailored to local needs and also more effectively delivered to local residents.

Implications for Further Research: Alternative sources of data with individual-level data should be explored to strengthen the basis of the present findings, and also to examine the exact mechanism underlying the associations between suicide rates and area deprivation.


Received 3 March 2013; accepted 3 August 2013

Copyright 2013 ICMPE