Why Are Suicide Rates Rising in Taiwan But Falling in South Korea? a Time Trend Analysis of Suicide Rates in Taiwan and South Korea.

BackgroundThere was a more than two-fold increase in Taiwan’s suicide rates since the early 1990s, followed by a downward trend in 2006-2014. However, Taiwan’s suicide rates turned upward from 2014 and the age-standardized rate in 2018 was 17% higher than the world average. By contrast, South Korea’s suicide rate has been the highest among Organization for Economic Co-operation and Development countries since 2003. Its suicide rates have tripled over the past 25 years. However, after reaching a peak in 2010, there was a 26% reduction in 2010-2017. However, there is a lack of systematic investigations into factors that may have contributed to the rise and decrease in suicide rates in Taiwan and South Korea, respectively.AimsThis study is aimed to investigate i) changes in long-term suicide trends by sex, age, suicide method and area (e.g. rural vs urban) over the past six decades (1959-2018) in Taiwan and 36 years (1983-2018) in South Korea; ii) the associations of suicide rates with a range of socioeconomic factors, means accessibility, alcohol consumption, rural-to-urban migration, and health care accessibility during the study period in the two countries. Specifically, we will examine the below hypotheses – i) 2008 global economic recession, recent changes in unemployment, and credit card debt contributed to recent rise in suicide rates in Taiwan; ii) the reduction in charcoal-burning suicide after Taiwan’s charcoal restriction intervention did not sustain; and iii) the paraquat ban had a longer-term impact on pesticide suicide rates in South Korea. MethodSuicide data (1959-2018) for Taiwan will be obtained from the cause-of-death mortality data files provided by the Ministry of Health and Welfare of the Executive Yuan of Taiwan. Suicide data (1983-2018) for South Korea will be obtained from registered death data provided by Statistics Korea. Data of a range of socioeconomic and other variables for both Taiwan and South Korea will be obtained from a variety of data sources.Age-standardized suicide rates as well as rates by sex, age, method, and area (rural vs urban) will be calculated. A graphic approach will be used to examine changes in suicide trends. Joinpoint regression analysis will be applied to identify the time points when there is a change in trends. To examine the correlates of suicide trends, a comprehensive investigation into the association between these variables and suicide rates will be conducted, using Pearson’s correlation, Prais-Winsten regression, and negative binomial regression.SignificanceThe research findings will provide a better understanding into recent changes in suicide trends in Taiwan and South Korea and possible reasons for these changes over long-term periods to address the limitations of previous studies such as short study period and a small set of variables investigated. Findings will be compared between Taiwan and South Korea, which have similar cultures and socioeconomic environments and face similar challenges such as the prevention of charcoal-burning suicide and pesticide suicide. Our results will have important implications for suicide prevention strategies in the two countries.