S. Y. Kimet al.: Epidemiology of Suicide in Sout h Korea and Japan Crisis 2011; Vol.

32(1):514 2011 Hogrefe Publishing

Research Trends
Comparative Epidemiology of Suicide
in South Korea and Japan: Effects of
Age, Gender and Suicide Methods
Seong Yi Kim
1
, Myoung-Hee Kim
2
, Ichiro Kawachi
3
, and Youngtae Cho
4
1
Graduate School of Public Health, Seoul National University, South Korea,
2
Peoples Health Institute,
Seoul, South Korea,
3
Department of Society, Human Development and Health at the Harvard School of
Public Health, Boston, MA, USA,
4
Department of Health Demography, Seoul National University, School
of Public Health, Seoul, South Korea
Abstract. Background: Suicide is one of the leading causes of mortality in both South Korea and Japan. Aims: The study aims to compare
the descriptive epidemiology of suicide over the last two decades (19852006) and to explore the conditions associated with the different
distribution of suicides in both countries. Methods: Age-standardized suicide rates were obtained from the OECD Health Data 2009.
Age-specific suicide rates for the age groups were calculated from the WHO Mortality Database. Suicide methods were identified based
on ICD-10. Results: Through 19802000, Japan showed consistently higher suicide rates compared to Korea. However, from the mid-
1990s, Korea showed an acute increase of suicides and finally surpassed Japan; the age-standardized suicide rate of Korea increased from
10.2 (per 100,000) in 1985 to 21.5 in 2006, while it slightly increased from 18.4 to 19.1 in Japan. The highest age-specific suicide rate
was observed among Japanese men aged 4564 years and Korean men aged over 64 years. The increase of elderly suicides among Korean
women was notable. The gender ratio increased in Japan and decreased in Korea, respectively. The preferred suicide methods were
hanging and pesticide poisoning in Korea and hanging in Japan. Because of the limited number of observations, hypothesis testing of
specific risk factors was not possible. Conclusions: Age and gender distribution of suicide rates differed considerably between the two
countries. Welfare protection throughout the life course in both countries, and pesticide regulation in Korea would be helpful in reducing
the burden of suicide mortality in both countries, even if the social values could not be changed in a short time.
Keywords: Korea, Japan, suicide epidemiology, suicide methods, pesticide
Background
Contrary to the overall decrease in suicides among indus-
trialized countries over the last decade, South Korea (here-
after, Korea) and Japan experienced increases in suicides.
Between 1995 and 2006, Korea recorded the highest degree
of suicide increase among the OECD countries, from 11.2
deaths per 100,000 to 21.5 (Organization for Economic Co-
operation and Development [OECD], 2009b) and now
ranks at the top with a rate of 33.4 for men and 18.7 for
women in 2008 (Korea National Statistical Office [KNSO],
2009). Meanwhile, the total number of suicide deaths in
Japan has exceeded 30,000 since 1998 (Japan Ministry of
Health, Labor and Welfare [JMHLW], 2009), although the
extent of increase was not as sharp as in Korea. According-
ly, suicide is one of the major public health threats in both
countries.
Korea and Japan are neighboring countries separated by
the East Sea, and Japan has heavily influenced Korea in
contemporary history.
Japan experienced radical modernization through the
Meiji Revolution around the 1860s, and rapidly developed
imperialistic capitalism. It forcefully occupied Korea in the
early twentieth century (then the Chosun Dynasty) and main-
tained its colonial rule for 36 years till its defeat in the Second
World War, which plunged the majority of Japanese people
into destitution. However, Japan gained the momentum for
economic development after the Korean War (19501953),
and became one of the most affluent countries in the 1990s
(Kwon, 2005). Meanwhile, Korea successfully recovered
from the destitution caused by colonial exploitation and the
Korean War in a generation, through state-driven industrial-
ization and foreign aid. Economic development at an unprec-
edented speed contributed to the dramatic improvement of
material conditions and, without doubt, brought about con-
siderable changes in social values and traditions. Throughout
the course of economic development and modernization in
Korea, Japan was seen as a role model to catch up with, al-
though the emotional antipathy of Korean people was con-
siderable because of the past history of Japanese coloniza-
DOI: 10.1027/0227-5910/a000046
2011 Hogrefe Publishing Crisis 2011; Vol. 32(1):514
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tion. In addition, Japanhas precededKorea in terms of demo-
graphic transitions such as population aging and lowfertility,
and has stood as a benchmark for the evolution of welfare
programs such as a public pension systemand long-termcare
insurance for the elderly. Nowthere are considerable similar-
ities between the two countries in industrial structure, the
educational system, and judicial and political institutions
(Goodman & Peng, 1996). Also, the two countries share cul-
tural characteristics and social values; they both have been
classified as Confucian countries (Ronald Inglehart, 2000)
and as examples of the Far Eastern variety of capitalism; their
societies and institutions are uniquely organized, and in spite
of the high level of material prosperity, their populations are
relatively unhappy (Bergheim, 2007). Around mid-1997, a
series of financial crises struck East Asia including Korea and
Japan, which caused extremely negative effects such as a
sharp decline of foreign exchange rates and stock prices, a
drastic loss of foreign exchange reserves, the sudden drop of
GDP growth (Brimmer, 1998) as well bankruptcy of many
companies and massive layoffs (Hashimoto, 2005; Korea La-
bor Institute [KLI], 2001). As a result, considerable attention
was paid to its social consequences such as unemployment
and suicides (Abe et al., 2004; Chang, Gunnell, Sterne, Lu,
& Cheng, 2009; Chen, Choi, & Sawada, 2009; Inoue, 2006;
Khang, Lynch, & Kaplan, 2005; Kim, Song, Yi, Chung, &
Nam, 2004; Yamasaki, Sakai, & Shirakawa, 2005).
In general, both countries would be expected to share
similar patterns of suicides because of their shared charac-
teristics. However, it is also plausible that country-specific
contexts and time-lag in modernization between the two
countries could lead to divergent patterns of suicide epide-
miology. At first, Japan recorded the highest suicide rates
in late 1950s immediately after the Second World War. The
suggested causes included poverty, family problems (i.e.,
loss of parents and authoritative patriarchy), failure in so-
cial roles (i.e., failure in university entrance examination,
especially, of sons), and cultural conflicts (i.e., unapproved
marriage of daughters) (Iga, Yamamoto, Noguchi, & Ko-
shinaga, 1978). However, as Japan rapidly recovered its
economy with an average annual growth rate of 8.06%
from 1950 to 1973 (Maddison, 2004), suicide rates contin-
ued to decline until the present, in spite of apparent fluctu-
ations at some points. Yet, it is true that Japan still has one
of the highest suicide rates in the world. Meanwhile, as far
as mortality statistics are available, suicide rates in Korea
seemed to be stable at fairly low rates until the early 1990s.
However, suicides began to increase in the mid-1990s, and
an acute surge around economic crisis was notable.
This study aimed to compare the descriptive epidemiol-
ogy of suicide over the last two decades (19852006) at the
population level and to explore the conditions associated
with different distribution of suicides, if any, between Ko-
rea and Japan. In particular, attention was paid to identify-
ing vulnerable populations at higher risk for suicide. Our
comparative approach could yield useful clues for popula-
tion-based strategies to reduce suicides, in spite of its lim-
ited ability to identify specific causes of individual cases
(Rose, 1992).
Data and Methods
Age-standardized suicide rates (per 100,000) of both coun-
tries for the years from 1985 to 2006 were obtained from
the OECD Health Data 2009. Age-specific suicide rates for
the age groups of 1524, 2544, 4564, and 65 + years
were calculated by using the number of suicide deaths and
population denominators from the WHO Mortality Data-
base. Within each age group, age was still standardized by
a direct method, using the 20002005 World Standard Pop-
ulation as the standard (World Health Organization
[WHO], 2009).
Suicide methods were identified from the WHO Mor-
tality Database according to the International Classifica-
tion of Disease system version 10 (ICD-10). The infor-
mation was available from 1995, and therefore, compar-
ison of suicidal means was done for 19952006. They
were categorized into six groups: poisoning other than by
pesticide ingestion, pesticide poisoning, hanging, drown-
ing, jumping from a high place, and others. As pesticide
ingestion is one of the most widely used suicide methods
in Korea, we separated it from poisoning by other sub-
stances.
Table 1. Variables and the source of data
Variable Unit Source(s) Observation
Annual growth of GDP/capita % OECD Health Data 2009 22
Unemployment rate % of total labor force 22
Public social expenditure % of GDP Korea(16), Japan(21)
Life expectancy at birth Years 22
Fertility rate Number of children per women 1549 22
Female labor participation rate % females in labor force 22
Divorce rate Per 1,000 population World Bank 2007 22
Equal contribution to family economy Agree% World value surveys
1st4th
4
Male priority for job opportunity Agree% 4
6 S. Y. Kim et al.: Epidemiology of Suicide in South Korea and Japan
Crisis 2011; Vol. 32(1):514 2011 Hogrefe Publishing
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We compared descriptive statistics and examined the so-
cial correlates by examining socioeconomic contexts, in
particular, institutions.
In order to explore the social correlates based on the
limited data, we adopted bivariate correlation analysis;
economic indicators included annual GDP/capita growth
rate and unemployment rate, which represents the eco-
nomic cycle and is known to be associated with suicides
(Blakely, Collings, & Atkinson, 2003; Wasserman,
1984). Social variables included life expectancy at birth
for overall health status, fertility rate and divorce rate
(which represents the level of social integration), total
social expenditure (% of GDP) for level of social protec-
tion, and female labor force participation for gender re-
lations (Gunnell, Middleton, Whitley, Dorling, & Fran-
kel, 2003; Stack, 1998; Yang, Lester, & Yang, 1992).
Then Pearson correlation coefficients were estimated. In
addition, from the World Values Surveys (World Values
Survey, 2008), information about attitudes toward gender
role was obtained. The proportion agreeing with the
statement When jobs are scarce, men should have more
right to a job than women and husband and wife should
both contribute to income was compared between the
two countries over time, using sample weights. Table 1
shows the variables and the source of data.
Result
Age and Gender Distribution of Suicides
Total number of suicides increased from 3,656 to 10,688
between 1985 and 2006 in Korea, which translates into
age-standardized suicide rates of 10.2 (per 100,000 pop-
ulation) and 21.5, respectively. Over the same period, Ja-
pan also experienced an increase of suicides from 23,172
cases to 29,921, with age-standardized rates of 18.4 and
19.1, respectively. From the beginning of the 1990s, male
and female suicide rates in Korea were growing fast. In
1998, immediately after the economic crisis, male suicide
rates quickly rose by 38.2% in Korea and 42.8% in Japan
compared to the previous year. Since then, the increasing
tendency has continued to varying degrees in both coun-
tries (Figure 1).
Figure 2 shows age-specific suicide rates by gender
over time. In Korea, all age groups in both genders, ex-
cept for the male group aged 1524 years, showed an in-
crease in the suicide rate. In particular, a clearly increas-
ing tendency began to be observed around the mid-1990s
in the elderly aged over 64 years, resulting in the highest
rates of all age groups. Meanwhile, after a steady decline,
male suicide rates increased again in Japan by the early
1990s; most prominent in the middle-aged population
with the highest rates among all age groups. Suicide rates
of Japanese women maintained relatively constant, and
the elderly group of both genders showed a steady de-
cline of suicides except for a small peak centered around
the economic crisis (Figure 2).
In both countries, male suicide rates were higher than
0
5
10
15
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25
30
35
40
1985 1987 1989 1991 1993 1995 1997 1999 2001 2003 2005
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Japan, women Japan, men Korea, women Korea, men
Economic crisis
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1985 1987 1989 1991 1993 1995 1997 1999 2001 2003 2005
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Japan, women Japan, men Korea, women Korea, men
Economic crisis
Figure 1. Annual trends of age-stan-
dardized suicide rates (per 100,000)
by gender, 19852006, Korea and Ja-
pan.
Table 2. Gender differences in suicide rates, 1985 and 2006,
Korea and Japan
Country Age group
(years)
Absolute difference
(M-F difference)
Relative difference
(M:F ratio)
1985 2006 1985 2006
Korea 1524 8.2 0.9 2.2 1.1
2544 12.1 10.3 2.9 1.8
4564 18.2 37.2 4.0 3.5
65+ 18.0 73.2 2.7 2.6
Total 10.4 18.8 2.9 2.4
Japan 15~24 7.3 8.2 2.2 1.9
2544 16.1 21.0 2.5 2.6
4564 28.2 38.8 2.6 3.7
65+ 16.6 22.8 1.4 2.2
Total 13.4 17.7 2.1 2.7
S. Y. Kim et al.: Epidemiology of Suicide in South Korea and Japan 7
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those of females throughout the observation period. Over
the 20 years, the average annual change of gender ratio
(i.e., slope) in age-standardized suicide rates was 0.0151
for Korea and 0.062 for Japan, respectively. Both were
different from zero at a significance level of 0.05 based
on a one-sided test. Between 1985 and 2006, the absolute
difference increased in both countries, from 10.4 to 18.8
in Korea, and from 13.4 to 17.7 in Japan, while the rela-
tive difference (male to female ratio) increased from 2.1
to 2.7 in Japan and decreased from 2.9 to 2.4 in Korea.
The male to female ratio was most prominent among
those aged 4564 years in both countries (Table 2).
Suicide Methods
From the latest information available (in 2006), the most
frequently used method for suicide was hanging in both
countries, followed by poisoning in Korea. Suicides by
jumping from a high place have increased in Korea, and
they were more commonly reported for women in both
countries. Suicides by using firearms were very rare in both
countries (0.0~0.2%).
Poisoning was commonly used in Korea, and a consid-
erable number of cases were attributable to pesticide inges-
tion, i.e., 25.7% of total suicides in 2006, which was rarely
0
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120
140
160
1985 1987 1989 1991 1993 1995 1997 1999 2001 2003 2005
S
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(
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1985 1987 1989 1991 1993 1995 1997 1999 2001 2003 2005
S
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s
(
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Korea 15-24 Korea 25-44 Korea 45-64 Korea 65+
Japan 15-24 Japan 25-44 Japan 45-64 Japan 65+
Men
Women
0
20
40
60
80
100
120
140
160
1985 1987 1989 1991 1993 1995 1997 1999 2001 2003 2005
S
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1985 1987 1989 1991 1993 1995 1997 1999 2001 2003 2005
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(
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Korea 15-24 Korea 25-44 Korea 45-64 Korea 65+
Japan 15-24 Japan 25-44 Japan 45-64 Japan 65+
Men
Women
Figure 2. Annual trends of age-specif-
ic suicide rates (per 100,000) by gen-
der, 19852006, Korea and Japan.
Men Women Women Men
Korea Japan
0%
20%
40%
60%
80%
100%
1995 2006 1995 2006 1995 2006 1995 2006
Jumping
Drowning
Hanging
Pesticide poisoning
Other poisoning
Others
Men Women Women Men
Korea Japan
0%
20%
40%
60%
80%
100%
1995 2006 1995 2006 1995 2006 1995 2006
Jumping
Drowning
Hanging
Pesticide poisoning
Other poisoning
Others
Figure 3. Distribution of suicide
methods by gender, 1995 and 2006,
Korea and Japan.
8 S. Y. Kim et al.: Epidemiology of Suicide in South Korea and Japan
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used in Japan (1.6~3.8%). Recently, Japan also experi-
enced an increase of suicides by poisoning, but it was main-
ly from gas inhalation (11.8% of total suicides in 2006),
which was rarely used in Korea (0.1~0.6%) (Figure 3).
Correlation Between Socioeconomic Factors
and Suicide Rates
Table 3 presents the bivariate correlation of socioeconomic
variables with suicide rates during 19852006. Annual
growth rate of GDP/capita was negatively associated with
suicides, among men and women in Korea and Japanese
men aged 4564 years, while unemployment rate was sig-
nificantly associated with higher suicide rates in Korean
and Japanese men. Positive correlation between suicides
and social disintegration (i.e., lower fertility and higher di-
vorce rate) was observed as expected. Social expenditure
showed a positive association with suicides in both coun-
tries except for Japanese elderly women. As for attitudes
toward gender role, those supporting equal contribution of
husband and wife to household economy were far more
common in Korea (all p values < .001 by test), and the
proportion increased over time. By contrast, those who sup-
port male priority for job opportunity are more common in
Korea (all p values < .001 by test; Figure 4).
Discussion
In contemporary history, different patterns of suicide epi-
demiology have evolved in Korea and Japan. Although an
acute surge of suicides was observed immediately after the
financial crisis in 1997/98, the rising tendency began early
in the 1990s and continued even after recovering from the
economic crisis in the year 2000. So, although it is true that
the economic crisis had a dramatic impact on suicides in
Korea, the underlying factors determining suicide trends
seemed to have existed over decades. Our major findings
can be summarized as follows: (1) consistently higher rates
in Japan and subsequently exceeded in Korea in 2000, (2)
divergent pattern of elderly suicides between the two coun-
tries, (3) uniquely high rates of suicides among middle-
aged men in Japan, (4) narrowing gender gap in Korea, and
(5) different distribution of suicide methods in the two
countries.
Divergent Pattern of Elderly Suicides
In most industrialized countries, the highest suicide rates
tend to be observed in the elderly group (Marris, Berman,
& Silverman, 2000; OConnell, Chin, Cunningham, &
Lawlor, 2004), which have been explained by various fac-
tors including chronic health conditions, financial distress,
family problems, sense of anomie, and social isolation (Du-
berstein, Conwell, Conner, Eberly, & Caine, 2004; Fushi-
Table 3. Pearson correlation coefficients between socioeco-
nomic variables and age-standardized suicide
rates, 19852006
Korea Japan
Men Women Men Women
Annual GDP/capita growth 0.62** 0.57** 0.39 0.35
Unemployment rate 0.46* 0.36 0.84*** 0.14
Life expectancy 0.88*** 0.92*** 0.61** 0.44*
Fertility rate 0.91*** 0.91*** 0.47* 0.59**
Divorce rate 0.62** 0.69*** 0.08 0.80***
Female labor-force partici-
pation rate
0.91*** 0.90*** 0.76*** 0.30
Total social expenditure 0.90*** 0.89*** 0.73*** 0.32
Note. ***p < .001, **p < .01, *p < .05.
Figure 4. Social values on the gender
role, Korea and Japan.
S. Y. Kim et al.: Epidemiology of Suicide in South Korea and Japan 9
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mi, Sugawara, & Shimizu, 2005; Heisel, 2006; Inoue,
Tanii, Kaiya, Okazaki, & Fukunaga, 2008; Yip, 2008).
However, it is also true that over the last two decades, most
OECD countries have witnessed a steady decline of elderly
suicides. In Japan, elderly suicides are still greater com-
pared to the rest of OECD countries, however, they have
decreased over time in both genders (Chen et al., 2009). By
contrast, Korean elderly suicides sharply increased in both
genders. What could explain these differences?
First, unprepared population aging might be one of
important contributing factors. Since 1970, when the elder-
ly accounted for 7%of the total population, Japan has faced
rapid population aging. In 2006, the population share of the
elderly reached 20% (so-called postaged society). From
the early 1970s, Japan has developed and expanded a set
of social welfare systems for the elderly (Shogo, 1999);
free healthcare service for the elderly was introduced in
1973 and the Gold Plan for elderly health and welfare in
1989. Public pension through the social insurance system
has continuously expanded since the 1960s; its income re-
placement rate was 59.1% in 2005 (OECD, 2005), and
61.2% of pensioners live on public pension only (Cho,
2006). In total, public social expenditure for the elderly
amounted to 8.6% of GDP in 2005 (OECD, 2009b). In the
case of Korea, although the population share of the elderly
is smaller, i.e., 9.1% of total population in 2005, its growth
is even faster compared to Japan; it is estimated to have
taken 18 years for Korea to transit from aging society into
aged-society, while it took 24 years for Japan (KNSO,
2006). Such rapid population aging in Korea made it diffi-
cult to properly cope with the problem; the countrys social
welfare system has failed to evolve in tandem with its rate
of population aging, while the traditional family support
system has quickly broken down. Public social expenditure
for the elderly accounted for only 1.5% of GDP in 2005
(OECD, 2009b); the share of public transfer out of total
income among the elderly amounts to only 13.9% (Chang
et al., 2008), and income replacement rate of pensions was
44.3% in 2005. Accordingly, relative poverty was more
prevalent among the elderly compared to the general pop-
ulation (45.1%vs.14.6%) and poverty of the elderly record-
ed was the highest rate among the OECD countries in mid-
2000 (vs. Japan, 22.0%; OECD, 2009c). Indeed, economi-
cally active individuals are more likely to be influenced by
economic downturns or unemployment, and it seems rea-
sonable that the effects of the economic cycle on suicide
rates of the elderly or women are less clear than in the case
of Japan and other industrialized countries (Chen et al.,
2009). However, under weak welfare protections, the elder-
ly were more likely to become the victims of economic
recession and widening social inequalities in Korea.
The reason why these two countries show a different
impact of population aging on suicide might be explained
with competing theories for cohort size and cohorts social
well-being positive effect from greater voting power vs.
negative effect fromharsh competition for scarce resources
(Easterlin, 1987; Preston, 1984). However, the direction of
cohort effects seems to depend on the historical/institution-
al context and the developmental stage of individual socie-
ties (Pampel & Willamson, 2001; Stockard & OBrien,
2002). In the case of Japan, the former argument seems to
be appropriate. The elderly population grew rapidly while
the Japanese economy was in full bloom from 1960 to
1990. Important welfare policies (i.e., free healthcare ser-
vice and the Gold Plan) for the elderly seemed to be intro-
duced partly because of the considerable voting power of
the growing elderly population as well as the improving
national economy. However, in Korea, the population share
of the elderly reached 7% in 2000, when the national econ-
omy was in the aftermath of an unprecedented financial
crisis, and failing to meet the needs of the population. When
the aging society (more than 7% of the population aged
65 years or above) began in Korea (2000) and Japan (1970),
social expenditure for old age pensions out of GDP was
1.3% in 2000 vs. 3.1% in 1980, respectively (OECD,
2009b). In summary, it could be said that population aging
influenced the welfare policies for the elderly, and conse-
quently, influenced well-being and suicides among them,
of which the extent and direction varied according to the
speed of aging and the context of the national economy.
Second, social integration factors should be considered.
The speed of urbanization and breakdown of traditional ex-
tended families was greater in Korea; population share of
urban residents increased from 31.7% in 1970 to 47.3% in
1985, while the same change took 40 years in Japan (World
Bank, 2007). Nuclear families are more common in Korea
compared to Japan (65.0% vs. 57.9%) (Japan Statistics Bu-
reau, 2009; Joo & Lee, 2009). Also, Korea had higher di-
vorce rates compared to Japan (2.6 vs. 2.0 per 1,000 pop-
ulation in 2006) and recorded the lowest fertility rate
among the OECDcountries (1.13 in 2006) (OECD, 2009b).
Coupled with insufficient social protection, a rapid break-
up of traditional families and shift in social norms might
play an important role in making the elderly population
more vulnerable to suicide risks in Korea.
Highest Suicide Rates Among Middle-Aged
Men in Japan
The highest suicide rates of middle-aged men among all
age groups in Japan is unique, considering that the greatest
risk for suicides tends to be observed among the elderly in
most industrialized countries. In general, men are more
likely to suffer from loss of opportunity and failure in the
traditional male gender role (Cutright & Fernquist, 2001;
Moller-Leimkuhler, 2003). A previous study (Araki & Mu-
rata, 1987) argued that male suicide rates in Japan had fluc-
tuated according to the economic cycle for the three de-
cades of postwar period; oil crisis (first in 1973 and second
in 19801983), bubble economy (19861990), and
19971998 economic crisis, which suggests a strong rela-
tionship between socioeconomic factors and suicides of
10 S. Y. Kim et al.: Epidemiology of Suicide in South Korea and Japan
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middle-aged men (Abe et al., 2004; Araki & Murata, 1987;
Chang et al., 2009; Chen, et al., 2009; Otsu, Araki, Sakai,
Yokoyama, & Voorhees, 2004). Contrary to the well-devel-
oped welfare programs for the elderly, social protection for
the economically active population is relatively weak in
Japan; active labor market programs and unemployment
benefits are not sufficient (0.6% of GDP in 2005) (OECD,
2009b) and corporate welfare rather than the public system
has played an important role (Shogo, 1999). A high level
of employment security under corporate paternalism and
strong commitment of workers to their jobs have supported
such a system (Shinkawa, 1993). Very long working hours
for middle-aged men (OECD, 2009a), workers loyalty to
their company (Ogura & Fujimoto, 2004), and a strong cul-
tural orientation to emphasize masculinity (Hofstede,
2000) in Japan are well-known. Accordingly, when the eco-
nomic crisis hit Japan and job security could no longer be
guaranteed, middle-aged men appeared to disproportion-
ately suffer. They seemed not only to lose the tangible
means of family subsistence, but also to suffer from an
identity crisis. In fact, all of these are also true for Korean
men, and a suicide surge was also observed among the mid-
dle-aged Korean men, which was, however, not easily not-
ed because of the much more marked increase of elderly
suicides. Moreover, the high level of suicides of middle-
aged men in both countries even in the recovering economy
might reflect the current labor market conditions i.e., neo-
liberal restructuring of the corporate sectors based on the
destruction of the lifetime employment guarantee in the
name of labor flexibility (Ee-Hwan Jung, 2007).
Narrowing Gender Gaps in Korea
In comparison to the widening gender gap in Japan, because
of a disproportionate decrease of female suicides, among el-
derly women in particular,, Korea experienced a narrowing
gender gap. This could be attributable to the comparable in-
crease of suicides in both genders. There are several factors
that might explain such divergent phenomenon.
First, female participation in the labor market is compa-
rable in both countries (Korea 42% and Japan 41%, 2005)
(OECD, 2007). Women in both countries have disadvan-
tages in employment conditions and wage/benefits com-
pared to men; they are disproportionately employed in part-
time jobs and there is a considerable gender wage gap (i.e.,
Korea: 52%of male workers income, Japan: 45%) (United
New Democratic Party [UNDP], 2009). However, there are
also differences. In Japan, the tax and compensation struc-
ture creates a significant financial incentive for married
women to work part-time and earn less than the income
threshold for tax deductions and social security contribu-
tions (Houseman & Osawa, 2003). Womens social rights
are set based on the entitlement as a dependent or sec-
ondary earner under the strong male breadwinner model,
which makes it less likely that the economic cycle directly
impacts on womens psychosocial well-being. In Korea,
women are more likely to work full-time, but at contingent
jobs (women 65.6% vs. men 41.8%) (Kim, 2009). Such
jobs are characterized by instability, lower income, and less
provision of social insurance (Hadden, Muntaner, Benach,
Gimeno, & Benavides, 2007). Feminization of poverty
is more visible (17% women vs. 6.6% men in Korea)
(Sung, 2009). This is, in part, why female suicides are more
sensitive to the economic cycle in Korea.
Second, there is no doubt that gender equality has been
improving for decades in both countries, but the world rank
in the Gender Empowerment Measure is relatively low at
61th for Korea and 57th for Japan, respectively, as compared
to their rank at 26th and 10th in Human Development Index
(UNDP, 2009). However, there are still some differences in
social values. Koreans more frequently expect equal respon-
sibility of women for the household economy than Japanese,
while admitting male priority for job opportunities. This con-
flicting situation, coupled with disadvantages in the labor
market and weak social welfare programs, seems to have
more negative impact on Korean women.
Prevalent Use of Pesticide Poisoning in Korea
Both countries have labor intensive agricultural systems as
a means for family subsistence. The agricultural popula-
tion, which has easy access to pesticides, is greater in Japan
(7.9 millions in 2006) than in Korea (3.3 millions) (Minis-
try of Agriculture, Forestry and Fisheries [MAFF], 2008;
Ministry of Food, Agriculture, Forestry and Fisheries [MI-
FAFF], 2007) and the amount and kinds of pesticides used
are much greater in Japan (Korean Rural Development Ad-
ministration [KNAAS], 1998). However, suicides by pes-
ticide are more common in Korea, which could be ex-
plained by the high lethality of pesticides and an inadequate
pesticide control system. In fact, paraquat dicholoride, a
highly lethal chemical with no adequate treatment, is wide-
ly used in Korea, although many European countries pro-
hibit themor set strict regulations (Berne Declaration [BD],
2009). A similar situation occurs where the amount of pes-
ticide consumption per capita is greater in the EU than in
Indonesia but the related mortalities are much higher in the
latter (Gunnell, Eddleston, Phillips, & Konradsen, 2007).
Prevalent use of pesticides implies that many suicide
cases are impulsive in Korea. Thus, improved storage of
pesticides and requirement of a prescription for purchase
(Bowles, 1995; Mann et al., 2005), regulation on the tox-
icity, and other safety measures, as well as the emergency
medical system would have an influence on pesticide poi-
soning and its consequences in Korea (WHO, 2008). How-
ever, it should be noted that interventions exclusively fo-
cused on suicidal means would be of limited value (Sloan,
Rivara, Reay, Ferris, & Kellermann, 1990; Varnik et al.,
2009). As observed in Japan, restriction of specific suicidal
means such as pesticides and drugs resulted in an increase
in deaths by other means such as hanging.
Meanwhile, it is notable that suicides by firearms are
S. Y. Kim et al.: Epidemiology of Suicide in South Korea and Japan 11
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very rare in both countries, which resulted from strict reg-
ulation to restrict ownership of firearms (i.e., rigorous li-
censing process) (Ministry of Government Legislation
[MGL], 2009; Ministry of Internal Affairs and Communi-
cations [MIAC], 2009). It also supports the significance of
control of suicide methods.
Limitations and Implications
This study has some limitations. As Korea only began to
report official mortality statistics in 1985 and some social
statistics in 1990, it was impossible to compare long-term
trends with that of Japan. Also, because of the limitednumber
of observations, hypothesis testing for specific risk factors
based on statistical models could not be made. However, de-
scriptive epidemiology has its own merits to the extent that
they generate potential hypotheses about etiology. Although
caution is warranted, we could draw the following observa-
tions. Korea and Japanshare some aspects of suicide statistics
that are distinct fromother OECDcountries; namely, a steady
rise over the last two decades and an acute surge immediately
after the economic crises of the late 1990s. However, the age
and gender distributionof suicides is quite different in the two
countries, which we attribute to differences in the social wel-
fare systems and labor institutions as well as social norms.
While the latter factor is not easy to modify in a short time,
the former factors could be remedied for suicide prevention.
In order to halt the suicide epidemic among the elderly pop-
ulation in Korea, welfare protection should be strengthened
as in Japan. In addition, economic restructuring exclusively
based on labor flexibility without concomitant development
of social protection should be suspended in both countries. In
particular, the welfare systembasedon a family support mod-
el that gives primacy to the strict and traditional gender divi-
sion of labor (i.e., male breadwinner ideology) and weak la-
bor programs needs to be reformed in both countries. In ad-
dition, control of suicide methods, at least pesticides in
Korea, is strongly required.
Acknowledgments
This work was partly supported by the Health Promotion
Fund (200599) and the Korea Research Foundation Grant
funded by the Korean Government (MOEHRD) (KRF-
2007313-E00179).
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About the authors
Seong Yi Kim, MA (Art), MPh (Public Health), is a PhD course-
work student in the Graduate School of Public Health, Seoul Na-
tional University. Her main interest is the consequence of histor-
ical and cultural context on population and gender health.
Myoung-Hee Kim, MD, MPH, PhD, works at the Peoples Health
Institute, a nonprofit civic research center in South Korea. Her
research interest lies mainly in social determinants of health.
Ichiro Kawachi, is Professor of Social Epidemiology and Chair
of the Department of Society, Human Development and Health at
the Harvard School of Public Health. He has published widely on
the social and economic determinants of population health. His
research focuses on the investigation of the origins of health dis-
parities, such as the impact of neighborhood contexts on health
behaviors and outcomes.
Youngtae Cho is Associate Professor of Health Demography at
the Seoul National University School of Public Health. His re-
search interest includes social disparities in health and mortality,
low fertility issues in Korea, and the interactive effect of biology
and social characteristics on health.
Received July 9, 2009
Revision received May 17, 2010
Accepted May 18, 2010
Published online February 28, 2011
Myoung-Hee Kim
Peoples Health Institute
Bangbae-dong 899-3
Insan BD #302
Seocho-gu
Seoul 137-841
South Korea
Tel. +82 70 8658-1848
Fax +82 2 581-0339
Email mhkim1871@gmail.com
14 S. Y. Kim et al.: Epidemiology of Suicide in South Korea and Japan
Crisis 2011; Vol. 32(1):514 2011 Hogrefe Publishing
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