I HAVE READ the study by Professor Nakagawa et al.1 that was recently published in your journal. I would like to inquire about the authors' study as well as providing brief comments on the suicide and suicide-related research status in Korea.

Suicide is the fourth cause of death in South Korea as of 2007. According to the report compiled by the Korea National Statistical Office (KNSO), the suicide rate in Korea was the highest among the member countries of the Organization for Economic Cooperation and Development (OECD) in 2007.2 In detail, 26.0 (male, 33.4 vs female, 18.7) out of every 100 000 Koreans committed suicide in 2008, indicating a very sharp increase from 10.6 people (male, 14.5 vs female, 6.7) in 1995.2 The health professionals and government officials explained the reasons for the large increase in the suicide rate in the country as being due to dramatic changes in gender role in modern society, financial hardship, loosened family support (increasing elderly population living alone), hidden mental illness, and domestic violence and so on. As a whole, according to KNSO, one person committed suicide every 49 min, resulting in 34 daily deaths in 2007. Particularly steep rising rates were seen in the male population >60 years (one committed suicide every 2 h in 2007), which was threefold higher than that of women in their 30s. Since the establishment of the Korean Association of Suicide Prevention by persons working in various academic and social backgrounds in 2005, a case management project including crisis intervention has started for proper care and prevention of suicide in Korea. These activities in Korea, however, are still in the infant stage on an academic, civil and governmental basis: not well-organized, unsystematic and even fragmented.3 As indicated in the literature, several clinical factors may be implicated in suicide. According to a recent Korean study, factors such as living in urban or rural areas, low economic status, the presence of a psychiatric disorder, and cancer were statistically meaningful risk factors in suicide, which also differed according to age and gender.4 Studies also suggest a difference due to ethnicity.5

Here I have two questions relating to study on crisis intervention for suicide by Professor Nakagawa et al.1 First, which intervention model (e.g. among universal, selective and indicated interventions)6 should be the best option for the East-Asian population such as Chinese, Japanese and Korean, reflecting cultural differences ? Second, did the authors find any meaningful differences in the clinical outcome in accordance with clinical variables in their study ? In my opinion, clinical outcomes of crisis intervention may depend on a number of clinical factors that should be associated with different clinical and individual situations. Hence, types of crisis intervention, mental health professionals and other resources for the patients should be individualized for proper case management, which may eventually affect the clinical outcome.


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Dr Pae has received research grant and/or honorarium from GlaxoSmithKline Korea, GlaxoSmithKline, AstraZeneca Korea, Janssen Pharmaceuticals Korea, Eli Lilly and Company Korea, Korean Research Foundation, Otsuka Korea Pharmaceuticals, Otsuka Taiwan, Otsuka Pharmaceutical Development and Commercialization, WhanIn Pharmaceuticals, Ludbeck Korea, Wyeth Korea, Sanofi-Aventis, Novartis, Eisai Korea, Pfizer, Catholic University of Korea College of Medicine Alumni, Catholic Medical Center and Korean Institute of Science and Technology Evaluation and Planning.


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  • 1
    Nakagawa M, Yamada T, Yamada S, Natori M, Hirayasu Y, Kawanishi C. Follow-up study of suicide attempters who were given crisis intervention during hospital stay: Pilot study. Psychiatry Clin. Neurosci. 2009; 63: 122123.
  • 2
    Korea National Statistical Office. Cause of death in 2008. (cited 1 October 2009). Available from URL:
  • 3
    Jo KH. Effects of a nurse presence program on suicide prevention for elders with a chronic disease. Taehan Kanho Hakhoe Chi 2007; 37: 10271038.
  • 4
    Park JY, Moon KT, Chae YM, Jung SH. Effect of sociodemographic factors, cancer, psychiatric disorder on suicide: Gender and age-specific patterns. J. Prev. Med. Public Health 2008; 41: 5160.
  • 5
    Shiang J. Does culture make a difference? Racial/ethnic patterns of completed suicide in San Francisco, CA 1987–1996 and clinical applications. Suicide Life Threat. Behav. 1998; 28: 338354.
  • 6
    Nordentoft M. Prevention of suicide and attempted suicide in Denmark. Epidemiological studies of suicide and intervention studies in selected risk groups. Dan. Med. Bull. 2007; 54: 306369.