By Lee Kyung-min
The government plans to expand analyses of psychological autopsies, a research process that attempts to determine the complex mental conditions preceding suicides, in continued efforts to shed a negative image associated with Korea. The country has had the highest suicide rate among 34 OECD member nations for the past decade. The initiative was one of President Moon Jae-in's major campaign pledges, with the objective of reducing the rate to 20 for every 100,000 people, from the current 25.6. According to Statistics Korea, 13,092 people committed suicide in 2016, about 40 people per day. Korea's suicide rate is over twice the average rate among OECD nations which stood at 12.1.
The measure undertaken by the Ministry of Health and Welfare and the Korea Psychological Autopsy Center involves collecting all available information on the deceased including interviews with family members, relatives, close friends and health care providers that attended to them. The ministry set up the center in April 2014 to trace and analyze the process in the lead-up to suicide to determine causes and factors, and provide the bereaved with comprehensive psychological consultation for emotional trauma.
The process is available for people who lost loved ones at least three months ago and no more than three years, with referrals from hospitals, clinics, government-affiliated healthcare institutions or police. Those seeking consultations can visit without any restrictions. The criteria are based on a determination that those who experienced a traumatic event less than three months ago are emotionally volatile and therefore not considered ready to process a wide range of emotions, and those who did over three years ago may have unclear, or less accurate recollections.
Up to two individuals can be interviewed for one suicide case, but at least one of them should have maintained a deep, personal relationship with the deceased. Two interviewers from the center will visit a location comfortable for the interviewee to conduct up to a three-hour session using the Korea Psychological Autopsy Checklist (K-PAC) which uses questionnaires to ask about family background, early childhood and family relationships, among many possible stressors. Four hundred and forty-six people took part in the process between 2014 and 2017.
Some of the bereaved said the in-depth session helped them break out of the overwhelming and overpowering sense of death that entailed suicidal thoughts among other measures to “put an end” to the pain. “I began to think about myself, who is survived by my loved one as well as my children,” one comment from an interview read. Sharing and letting out bottled-up rage, disappointment, depression and guilt gradually subsided, other respondents said, helping them “better understand” the deceased, which in turn stopped the obsession over asking “Why?” Concerns remain, however, the center said, as some of them continued to blame themselves for failing to see and understand _ or simply be there when they were needed. Further and continued consultation is required with mental health centers in such cases.
9 in 10 showed warning signs before suicide
The efforts came amid high numbers of possibly “preventable deaths.” The ministry data unveiled early this month on psychological autopsies of 289 cases between 2015 and last year showed one out 10 people showed verbal or behavioral indicators of possible suicide. Over 92 percent of them frequently mentioned words “suicide,” “murder” and “death” and said they had physical discomfort without any clear medical diagnosis. Many of them expressed self-demeaning thoughts and asked around about ways to commit suicide. Insomnia, a difficulty falling and/or staying asleep, as well as hypersomnia, excessive sleepiness were experienced by the group. Extreme mood swings were observed as well as behaviors of an aggressive, hypersensitive, introspective nature or a lack of interest in general. In other cases, they behaved in an anguished or restless way, claiming to be at a “dead end” or feeling “unbearable” pain. Some of them either ate too much or refused to eat at all and stopped caring about their appearance. They gave objects that they valued most to close friends as present.
However, only 21.4 percent of their family members noticed such “different and unusual” changes and less than a third of them asked them whether they had had suicidal thoughts or consulted relevant mental healthcare organizations. When multiple answers were allowed, nearly 40 percent said they became worried but did not think their loved ones would actually commit suicide. About a third said they tried to help but to no avail and 20 percent said they did not take the situation seriously. Of the total, 80 percent of the bereaved said they suffered from depression, 27 percent of whom were feared in serious condition in need of immediate help.
According to a study conducted by Seoul National University commissioned by the Ministry of Health and Welfare of 72 family members of people who have committed suicide, 75 percent said they were depressed and had no interest in life, when multiple answers were allowed. They suffered from insomnia (69 percent), anxiety attacks (65 percent), rage (65 percent) and difficulty concentrating (60 percent). Of the total, 11 people were hospitalized due to psychological distress. They also suffered physical manifestations of distress including heart palpitations or shortness of breath, headaches, fatigue, muscle cramps or back pain. Of the total, 31 respondents said they seriously considered committing suicide, and 21 among them had actually attempted to commit suicide. Sixteen had planned it out in detail.
Learning from Finnish model
The ministry seeks to learn from Finland, whose 10-year project identified seven keys to suicide prevention and reduced the suicide rate to 16.4 per 100,000 people in 2011. According to 2013 OECD data, the suicide rate in Finland fell by 25.8 percent from 2000 to 2011 compared to the OECD average reduction of seven percent over the same period, while Korea remained the only country that saw the rate increase by 0.6 percent in the same period.
Finland conducted a national psychological autopsy study of all 1,397 suicides in the country, under the project “Suicide in Finland 1987,” a five-year project that ended in data-based recommendations for suicide prevention. This was followed by another five-year implementation phase where a target- and action-specific strategy for suicide prevention was established in 1993. Internal and external, international evaluations were carried out until 1999.
The analysis concluded seven keys were vital to preventing suicide including developing support and treatment for those who have attempted suicide, improving care for depressive disorder, and learning to prevent alcohol use as a substitute for problem-solving. Also crucial were enhancing social and psychological support in the treatment of physical conditions, promoting mutual and professional support in life crises. Preventing alienation of young citizens is also vital which could be further achieved by giving them creative opportunities, circumstances and options for coping with life, followed by rewarding experiences. Encouraging more belief and enthusiasm in life, as well as self-assurance, perseverance and mutual support are other important aspects.
According to the National Institute for Health and Welfare, an independent expert agency working under the Ministry of Social Affairs and Health in Finland, the most important aspect is early diagnosis of depression, followed by support and efficient and comprehensive treatment. Mental and social support, it added, must also be included in the treatment of physical illnesses. The educational and cultural atmosphere must move away from one that makes people feel guilty and stigmatized to one that instills faith in life and provides mutual support.