Landscape of Elderly Suicide in South Korea: Its Trend According to Age,Gender,and Educational Attainment

Abstract

South Korea has one of the highest suicide rates in the world, and the most alarming suicide rate is among its elders. This study aims to understand the social, historical, and cultural context of the Korean older adults and examine suicide trends based on that understanding. The results show that the suicide risk increases with age, the male suicide rate outweighs that of females, and the suicide rate decreases with educational attainment. In addition, several suggestions for reducing elderly suicide rate are addressed, including differentiating the existing social services for elders by age and expanding suicide prevention programs beyond schools to communities so that all people in need can access them.

Keywords

elderly suicide in South Korea suicide trend Suicide educational attainment Korean tradition

South Korea had the highest suicide rate among Organisation for Economic Cooperation and Development (OECD, 2014) member countries between 2002 and 2012. South Korea’s suicide rate in 2012 was about 29.1, which is about 2.4 times the OECD average of 12.1. Because the suicide rates of most countries have been gradually declining while South Korea’s suicide rate has not, the phenomenon demands investigation.

The most alarming suicide rate in South Korea is among its elders. This rate exceeded 64.2 in 2012, which is about 2.26 times that of Korea’s other age groups (Statistics Korea, 2013). Furthermore, according to OECD (2009) social indicators, elderly suicide is a leading factor in South Korea’s rank as the highest among the OECD member countries. For example, in 2005, the overall Korean suicide rate was the highest, but that was not the case for people younger than 55 years. Although the suicide rates of those aged 15 to 54 years were higher than the OECD average, Belgium and Japan had higher rates in that age-group (except for ages 15–19 years), and Hungary had a higher rate. However, among those aged 55 or older, Korea’s suicide rate is extremely high. Within that age-group, the suicide rate of those between 55 and 64 years was 42.7. Hungary had the second highest suicide rate, which was remarkably lower, at 27.2. Elders older than 75 years had a seriously high rate of 160.4, about 42 times that of the United Kingdom (3.8; the lowest rate) and 4.4 times that of Hungary (36.1; the second highest).

An additional concern is the aging of the South Korean population. The pace of population aging in South Korea is globally unmatched. In 2000, the proportion of the elderly population was 7.2%, which qualified South Korea as an aging society (7%–14% of the population are 65 years or older). That proportion is expected to rise sharply, and South Korea is expected to be an aged society (14%–21% of the population are 65 years or older) in 2017 and a super high-aged society (21% or more of the population are 65 years or older) in 2026 (Statistics Korea, 2011). It is expected that the number and proportion of elderly suicides will increase apace. Elderly suicide, therefore, is an exigent social and national issue that must be addressed. Although a number of previous studies have dealt with this issue, it is necessary to understand what makes the Korean older adults differ from other countries’ older adults. In this study, therefore, we aimed to understand the social, historical, and cultural context of Korean older adults and examine the suicide trend based on that understanding.

Traditionally, South Korea has been affected by Confucianism. Korea is reported as one of the countries in East Asia most influenced by Confucian tradition (Ryu, 2007). The influences of Confucianism could stem from the Joseon Dynasty. Joseon, which was a Korean dynasty from the late 14th century to the 19th century, encouraged the entrenchment of Chinese Confucian ideals and doctrines in Korean society. Although the dynasty ended more than a century ago, legacies of the long history of approximately 500 years still remain, whether they are good or not.

Familism and son preference are emphasized (Kent & Larson, 1982; Ryu, 2007). Familism is a notion that a family is the most basic unit of society, and family value is most important in familism (Shin, 1998). In this ideology, one’s personal success is based on the glory of his or her family. In the Joseon Dynasty, status elevation was possible by passing the state employment examination, and one’s elevation meant elevation of his or her family. Therefore, Korean society prioritized education, a concept that still exists today. In fact, South Korea is known throughout the world for its sometimes-excessive emphasis on education (J. K. Lee, 2006; Sorensen, 1994). At the same time, son preference was a distinct phenomenon in Joseon. Only males had a right to apply for the state employment examination. Education, therefore, used to be emphasized only among males. At least among the Korean older adults , however, this situation still remains: The elderly males’ educational attainments are much higher than females’ educational attainments.

Many previous studies have examined the relationship between educational attainment and suicide rate. In South Korea, however, the meaning and reason of it may differ due to these cultural traditions, which are weakening over time. This study, therefore, examines elderly suicide trends according to age, gender, and educational attainment.

Age

Although elderly suicide rates have declined in recent years in some countries, such as England and Wales, Shah and De (1998) pointed out that suicide rates tend to increase with age. They observed that suicide rates in the old-old (individuals older than 80 years) were higher than in young-old (aged 65 to 79 years) in many developed countries. South Korea is also experiencing this phenomenon. S. Y. Kim (2004) reported that the rate of increase in elderly suicide exceeded the rates of increase in the elderly population and total suicide between 1983 and 2002. Thus, elderly suicide is such an issue because the elderly suicide rate proportionally exceeds those of other age groups despite the aging of the South Korean population due to prolonged life expectancy and declining fertility (Shah, Bhat, McKenzie, & Koen, 2007).

Gender

We usually identify someone as a male or a female. That has biological aspect (sex) as well as social aspect (gender). Therefore, gender difference related to psychiatric problems such as suicides has not only personal and biological factors but also sociocultural differences, which males and females experience in social lives (Andermann, 2010). Many societies have differences in their elderly suicide rates by gender. Innamorati et al. (2010) suggested that the gender gap in overall suicide rates between elderly men and women is larger in the older than in the newer European Union (EU) members. Among all EU members, elderly men tend to have higher risks of suicide. In Austria, one of the earlier EU countries, the male-to-female ratio of suicide has gradually increased since 1970.

Agbayewa, Marion, and Wiggins (1998) explained the gender difference as caused by modernization. They suggested that women’s increasing autonomy and power could negatively influence the number of female suicides and increase the number of male suicides. A study on sex differences in elderly suicide rates found that elderly female suicides related to stress and the stability of the social environment, whereas elderly male suicides related to financial and social status (Coren & Hewitt, 1999). However, S. Han, Kang, Yoo, and Phee’s (2009) study of suicidal ideation among elders in South Korea found that more elderly females than males have had suicidal ideations. Kring, Johnson, Davison, and Neale (2009) argued that men tend to attempt suicide using more reliable lethal methods, such as firearms or hanging, whereas women tend to choose less lethal and less reliable methods, such as drug overdosing.

Most Korean older adults were born in the period of Japanese colonial rule (from 1910 to 1945) or soon after liberation from it. They have experienced dramatic events such as the Korean War and rapid industrialization process. In the meantime, they have maintained traditional gender roles and patriarchal norms in the context of Confucian values. At this period, males entered the war and participated in economic activities, while females focused on domestic chores and activities to earn the family’s living. These distinct gender roles and the difference in the male and female experience have affected elderly suicide ideation as well (Kim, June, & Kim, 2013). In fact, it is suggested by several previous studies (Kim et al., 2013; Koo, Kim, & Yu, 2014; Park, Moon, Chae, & Jung, 2008) that some factors, such as economic status or education attainment, do not significantly affect female suicide rate (suicide ideation) but are very significant in male suicide rates. In South Korea where traditional gender roles have been deeply rooted, males (more than females) have been burdened with financial responsibilities in life. Thus, elderly males are more sensitive to economic hardship postretirement than females. Although the emphasis on these gender roles has been weakening, it is possible that this phenomenon affects suicide.

Educational Attainment

Most Korean older adults suffered from hunger during the Korean War and that condition lingered even after the war. They were eager not to pass the poverty on to their children and promoted education as an alternative. They believed education could make them (or their children) escape from the poverty, leading to higher socioeconomic status (SES). There is a Korean proverb that compares “a man risen from a humble family” to “a dragon risen from a shallow stream” (Heffner, 2015). This term shows Koreans’ strong enthusiasm for education. Could this passion for education create a relationship between educational attainment and suicide rate?

Durkheim (1951) suggested that suicide is affected far more by social factors such as educational attainment and religion than by any type of innate inclination toward suicide. It was reported that, among these social factors, educational attainment has a positive relationship with suicide rate. Several previous studies have supported this positive correlation (Kowalski, Faupel, & Starr, 1987; Lester, 2003; Voracek, 2004). On the contrary, other studies suggested negative correlation between education attainment and suicide rate (Gunnell, Magnusson, & Rasmussen, 2005; Kowalski et al., 1987; Shah & Chatterjee, 2008).

Scholars explain the relationship between higher educational attainment and lower suicide rates as follows: Individuals with high educational attainment tend to have some particular psychological characteristics such as strong self-regulation and numerous social resources and networks (Saegert et al., 2007). When exposed to suicidal ideation, individuals with more education can psychologically cope with it and rely on their large, accessible social resources (Shah & Chatterjee, 2008).

Although a previous study suggested that one response to suicide would be to strengthen public education (Mann et al., 2005), the fundamental problem is that people with low educational attainment tend to have few opportunities for public education. Lorant, Kunst, Huisman, Costa, and Mackenbach (2005) found that educational status correlates with suicide mortality. According to their European comparative study, the relationship of educational attainment to suicide risk differed by marital status. In most of the countries, lower educational attainment among the nonmarried related to a higher risk of suicide mortality than among their married counterparts. Moreover, low educational attainment was associated with increased suicide risk for elderly females (Agbayewa et al., 1998).

Methods

Data

This study employed two data sets from the Statistical Korean Bureau: The first data set, Korean Standard Classification of Diseases, which was created by the Korea National Statistical Office, comprises the total number and causes of death statistics from 2000 through 2015, and it provides information on gender, age, and educational attainment. To understand the elderly suicide trends in South Korea, the annual suicide rates among the older adults and in the overall population were assessed. The other data set was the Korea Population Census, which exclusively provides information about age and gender. Although this data set is reported annually, the information regarding educational attainment is collected and provided every 5 years.

By merging these data sets, this study provides an understanding of the elderly suicide trend in South Korea through observations of elderly suicide rates in South Korea. This has an advantage of allowing us to understand accurately and analyze the trends, although it has limitations in regard to determining causal relationships. Data on gender, age, and educational attainment of individuals who committed suicide were analyzed.

Analytical Method

People aged 65 years or older are generally considered elders. However, the age cutoff is not consistent. Sometimes, it begins at the age of 50 or 60 years (McIntosh, 1992). To define the parameters of this age-group, it is necessary to consider social and cultural characteristics. In this study, the term “elders” signifies individuals aged 60 years or older. There are several reasons we chose this age cutoff. First, South Korea’s National Pension Act requires an old-age pension for people starting at the age of 60 years. Second, according to the Welfare of the Aged Act, the age at which an individual qualifies for elderly welfare housing is 60 years. Last, in South Korea, there is a special tradition regarding commemoration of the 60th birthday (I. S. Lee, 1999; Kim, 2008).¹ Age was categorized into five groups of years: 60 to 64 (reference group), 65 to 69, 70 to 74, 75 to 79, and older than 79.

In terms of gender, female group was a reference group. There were four categories of educational attainment: (a) elementary school and under, (b) middle school, (c) high school, and (d) university and over.

STATA 13.0 was used to analyze the data. The suicide death ratio (per 100,000) by educational attainment and logit analysis are presented as the results. First, an adjacent-categories logit model estimated log odds ratios of the effects of gender, age, and educational attainment on suicide rate. The logit model was as follows:
$logit (π) {=α+β}_{a}^{A} + β_{g}^{G} + β_{e}^{E}$
where; α means a constant and βs mean variables (A is age, G is gender and E is educational attainment).

Then, the suicide rate by educational attainment, including age and gender, was analyzed to examine the relationship in more detail. The bar chart and second graph (Figure 4) are categorized to group 5-year spans (2000, 2005, 2010, and 2015) and to distinguish by gender. The figures show the suicide rates by age-group in each educational attainment category.

Results

Figure 1 presents the suicide rates of elders compared with the total population of South Korea from 2000 through 2015. The elderly suicide rate clearly exceeded the total. The elderly male suicide rate was more than twice that of all the males in every year, ranging from 2.05 times (in 2014) to 3.32 times (in 2005). The elderly female rate was about twice that of the total female rate, and the gap was smaller than for the males. The gap ranged from 1.74 times (in 2014) to 2.83 times (in 2002). The elderly suicide rate was consistently higher than the overall suicide rate.

Figure 1.
Elderly and overall suicide rates in South Korea between 2000 and 2015 by gender.

There was also a gender gap among elders. In every year, the male rate was more than twice that of the females. The gap was largest in 2015 (about 2.95 times) and smallest in 2002 (about 2.31 times). Although the trend in the gender gap varies, it is clear that elderly males were more likely to commit suicide than elderly females.

The elderly male suicide rate generally increased between 2000 and 2015, although a few years indicate decreases. Compared with its previous year, 2003 had the steepest increase; the suicide rate in 2003 was 1.32 times that of 2002. Despite the decline between 2007 and 2008, male and female suicide rates increased in 2009. These two periods were times of economic hardship. In 2003, South Korea experienced a credit card crisis, and, in 2008, the U.S. economic recession instigated a global financial crisis. This trend is consistent with Coren and Hewitt’s (1999) finding that male suicide is associated with economic factors. This trend of the association between economic crises and suicide rate was found by a past study, which demonstrated the suicidal trend of individuals over 25 years in South Korea (Kim et al., 2017). Figure 1 shows that elderly men, most of whom are unemployed, also have the same association. In addition, female suicide rate dramatically increased in 2003 (1.27 times that of 2002) and 2009 (1.19 times that of 2008).

Figure 2 illustrates the number of elderly suicides by educational attainment. Suicide in each educational attainment category increased across time, except for the elementary school and lower group between 2010 and 2015, which was 3,495 in 2010 and 2,573 in 2015. Among elderly individuals with no more than middle school education, there were 172 suicides in 2000, 563 in 2005, 762 in 2010, and 805 in 2015. Suicides among high school-educated South Korean elders were 162 in 2000, 530 in 2005, 781 in 2010, and 942 in 2015. Suicides among those with university and over educations were 58 in 2000, 203 in 2005, 295 in 2010, and 359 in 2015. The increases across time show that suicides among those with educational attainment less than middle school were the highest. Suicides among those who had no more than elementary school accounted for 75.9% of all elderly suicides in 2000, 70.0% of all elderly suicides in 2005, 65.5% of all elderly suicides in 2010, and 54.99% of all elderly suicides in 2015.

Figure 2.
Total number of elderly suicides, including educational attainment statistics.

Although the number of suicides in the elementary and lower education group of South Koreans decreased in 2015, when the total population of this group in South Koreans is considered, it is not clear that their risk of suicide actually declined. Korea Institute for Health and Social Affairs (2014) pointed out that the percentages of individuals with educational level beyond high school increase as the age groups get younger. For example, among elders aged 60 to 69 years, individuals whose educational attainments were elementary schools or lower accounted for 47.1%, while these attainments in individuals over 85 years were about 86.4%; people aged 65 to 69 years whose educational attainment was higher than high school accounted for 10.3%, whereas people aged over 85 years accounted for 3.9%. Although Figure 2 helps us to understand elderly suicide trends using the actual numbers, it does not provide much information on the relative suicide risk of each group because it does not compare to the overall population. The suicide rate, measured as suicides per 100,000 individuals in the population, clarifies the suicide risk.

Figure 3 shows the odds ratios using the elderly suicide rate by gender, age, and educational attainment. In terms of gender, the result supports those of previous studies that found the suicide risk of elderly males as more than twice that of female elders. Specifically, the elderly male rate exceeded the elderly female rate by 2.94 times in 2000, 3.32 times in 2005, 3.43 times in 2010, and 4.71 times in 2015. The elderly male suicide rate has been consistently higher. Moreover, the gender gap has been increasing over time. This trend indicates that suicide risk of the elderly males has been increasing, especially compared with elderly females whose suicide rates are internationally high.

Figure 3.
Elderly suicide odds ratios by gender, age, and educational attainment.

The results regarding the suicide odds ratios by age were consistent with those of previous studies that found that suicide rate is associated with age. By and large, suicide risk increased with age in this study. In 2005, for example, the suicide risk of the group aged 65 to 69 years was 1.20 times that of the reference group (aged 60–64 years), the suicide risk of those aged 70 to 74 years was 1.32 times, the suicide risk of those aged 75 to 79 years was 1.64 times, and the suicide risk of those aged over 80 years was 2.51 times that of the reference group. Although in 2000 and 2015, there were some exception (the 65–69 group had lower risk than 60–64 group), this pattern is also evident for 2010.

The results regarding educational attainment were consistent with past studies. The general result of previous studies on the relationship of SES to suicide was negative, such that suicide risk decreases as educational attainment increases (Agbayewa et al., 1998; Lorant et al., 2005). This study found that elderly people with high educational attainment had a lower risk of suicide. The group with a university education or higher (the reference group) had the lowest risk. In 2015, for instance, the suicide risk of the elementary school and lower group was 2.80 times higher, the group with no more than middle school education was 1.93 times higher, and those with high school education were 1.54 times higher than the reference group.

Figure 4 provides an additional information on differences in suicide rates by educational attainment across age and gender. Elderly males’ suicide rates negatively relate to educational attainment in 2000, 2005, 2010, and 2015 for all educational groups. Moreover, every educational group evidences a trend in which the suicide rate increases with age. The lowest education attainment group shows higher suicide risk than the other educational attainment categories. The group aged over 80 years had the highest suicide rate.

Figure 4.
Male and female elderly suicide rates by age and educational attainment in 2000, 2005, 2010, and 2015.

Elderly females had a similar trend, in which the suicide risk of elderly females whose educational attainments were elementary or lower were generally higher than that of any other categories. Similar to elderly males, the elderly female suicide rate was, by and large, related to age in every educational attainment group.

One difference from the males was with respect to those who had university educations. Among female elders whose educational attainment was university or more, a particular trend with age could not be found. A possible explanation for this is that university-educated women were relatively rare in the past. As a result of familism and son preference, women previously were not targeted for public education, especially higher education. Korean females, rather, used to achieve self-fulfillment by helping their son (or sons) achieve high educational attainment (J. S. Han, 1998). Thus, it is established that elderly women with high educational attainment were much more likely to be in high SES. Perhaps females’ suicide rates became more similar to males’ rates, as the proportion of university-educated women increased along with other social changes.

In sum, elders with elementary school or lower educational attainment had the highest suicide risk for males and females. The trends that suicide rates generally increase with age and decrease with education attainment were clearly found among the elderly male. The male elderly suicide rate in South Korea negatively associated with educational attainment across four points covering 20 years. However, such trends had some exceptions among the elderly female. In particular, female elders whose education attainments are university or more did not show the suicide trend with age.

Discussion

While adolescents tend to impulsively attempt suicide, and these attempts could be interpreted as calls for help, elders tend to commit suicide after long consideration, preparation, and planning (Conwell, 2001). Their suicide attempts, therefore, are more likely to succeed. For example, Parkin and Stengel (1965) reported that 1 person per 200 nonelderly people who attempted to commit suicide succeeded, whereas 1 person per 4 elderly people did. Furthermore, the reasons that elders commit suicide are more varied and complex than nonelders’ reasons. Elderly suicide is influenced by complex factors such as age, gender, marital status, a sense of alienation, role loss due to retirement, and economic instability (Choi, 2008). In South Korea, economic instability seems to be a particularly important factor for committing suicide based on this study’s finding that the elderly suicide rate markedly increased during periods of economic hardship. This study focused on South Korean suicide trends by age, gender, and educational attainment. We suggest the following implications of the major findings:

First, the male suicide rate was higher than the female suicide rate from 2000 to 2015 in the overall population and among the subpopulation of elders aged 60 or older. Elderly males’ rates were consistently higher than females’ rates, and they sharply increased during periods of economic recession. It is alarming that the elderly male and female suicide rates were consistently higher than those of the overall population and that the gender gap within the population of elders was widening over time. These findings suggest that it is important to understand the ways that elderly suicide differs from suicide among younger people and to establish suicide prevention policies focused on elders’ distinct characteristics and gender differences. For example, the risk of suicide would likely decrease in response to effective measures to alleviate the financial difficulties of those elders who are financially unstable and to relieve elders’ sense of loneliness.

Second, this study found suicide and age to be positively related, which supports previous studies on the topic. When elders were defined as individuals aged 60 or older in light of the Korean social context, the eldest group had the highest suicide rate and risk of suicide, whereas the youngest group had the lowest rate and risk. These findings suggest that the existing social services for elders should be differentiated by age.

Third, the results regarding the relation of suicide rate to educational attainment was consistent with many previous studies, which reported that suicide rates were negatively associated with educational attainment. However, the suicide trends among female elders were irregular. The reason for this finding could be related to the decreasing number of low-educated people in the population. As females’ educational attainments are getting higher over time, females who graduated from university as not as rare as before and their SES are changing. It supports this deduction that there have been no “0” suicide rate since 2010. However, in this study, educational attainment was the only measure of SES, and future studies on suicide trends in South Korea should consider the effects of other SES measures. It would also be informative to examine the social resources, networks, and coping methods of individuals who are uneducated to identify the reasons for their low suicide rates.

Relatively higher suicide rates and a trend of increase among people with low educational attainment (Figure 4) suggest that existing suicide prevention policies in South Korea are having limited success. Most suicide preventive education programs in South Korea are offered in schools, meaning that uneducated individuals as well as those with low education attainment are out of the policy’s target range. These analytical results, therefore, imply that suicide preventive policies should enlarge educational programs beyond schools to communities so that people who need them can access them.

Footnotes

Acknowledgments

The authors extend their gratitude to the Statistical Korean Bureau for providing data.

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) received no financial support for the research, authorship, and/or publication of this article.

Note

Author Biographies

J. W. Kim is a professor in the Department of Social Welfare at Sungkyunkwan University (SKKU). He obtained his master’s degree from London School of Economics and PhD from the University of Texas at Austin. His research interests focus on mortality and social services for the disabled and the older adults.

H. Y. Jung is an adjunct professor in the Department of Social Welfare and a senior researcher at the Research Institute of Social Welfare at SKKU. She obtained her PhD from SKKU. Her research interests include mortality and differential stratification.

D. Y. Won is a doctoral student in the Department of Social Welfare at SKKU. He obtained his master’s degree in social work from SKKU in 2014. His research interests focus on mortality and well-being of the older adults.

Y. S. Shin is currently a senior researcher at the Research Institute of Social Welfare at SKKU. He obtained his PhD from SKKU. His research interests include social work research methods, mortality, and social services for the older adults.

J. H. Noh is a doctoral student in the Department of Social Welfare at SKKU and currently serves as a part-time instructor at Baekseok University. His research interests focus on mortality, program evaluation, and life satisfaction of the older adults.

T. I. Kang serves as the chief of Choong Hyun Community Welfare Center and also as an adjunct professor in the Department of Social Welfare at Daelim University. He obtained his PhD from SKKU. His research interests focus on people with developmental disabilities, overseas adoption, and welfare for the aged.

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