Epidemiologic characteristics of intentional poisoning in Korea—a retrospective analysis of the EDIIS database (2011–2020)

Background: Suicide remains a significant public health issue globally, including in South Korea. To devise effective prevention strategies, analyzing trends among individuals who have attempted suicide is essential. This study aimed to assess the epidemiologic characteristics of suicide attempts through intentional poisoning using data from 23 hospital emergency departments (EDs) across Korea. Methods: A retrospective analysis was conducted using the Emergency Department-Based Injury In-depth Surveillance (EDIIS) database over a 10-year period (2011–2020). The cases were selected based on intentional self-harm or suicide as the cause of injury and poisoning as the mechanism. Results: During the study period, 45,936 cases of intentional poisoning were identified, with 61.7% of cases being females. The mortality rate among males was 6.7%, significantly higher than the 2.1% observed in females, representing a 3.2-fold difference. Analysis of previous EDIIS data (2011–2015) indicated that suicide attempts were most frequent among females aged 40 years or older. However, the current analysis, which extended the study period to 2011–2020, demonstrated a notable increase in poisoning-related suicide attempts among females in their 20s. The substances most frequently involved in poisoning incidents differed by gender. Among males, pesticides accounted for 30.2% of cases, whereas sedative-hypnotics were the most common agents among females, comprising 36.0% of cases. Despite this variation, pesticides were the leading cause of death in both genders, contributing to 71.1% of male fatalities and 57.1%of female fatalities. Psychiatric disorders were identified as the predominant underlying cause of suicide attempts, followed by interpersonal conflicts involving family or friends. Conclusions: These findings indicate a gradual increase in the incidence of suicide attempts in the EDs of South Korea, indicating the importance of implementing patient-centered treatment strategies and developing preventive systems specifically tailored to gender and age-related factors.

Emergency department; Epidemiology; Poisoning; Suicide

[1] Ministry of Health and Welfare; Korea Foundation for Suicide Prevention. 2022 White paper on suicide prevention. 2022. Available at: https://www.korea.kr/archive/expDocView.do?docId=40007 (Accessed: 10 September 2023).

[2] Statistics Korea. Cause of death statistics in 2021. 2021. Available at: https://kostat.go.kr/board.es?mid=a10301060200&bid=218&act=view&list_no=420715 (Accessed: 10 September 2023).

[3] Statistics Korea. Cause of death statistics in 2020. 2020. Available at: https://kostat.go.kr/board.es?mid=a10301060200&bid=218&tag=&act=view&list_no=403046&ref_bid=&keyField=&keyWord=&nPage=1 (Accessed: 10 September 2023).

[4] Lim D. Trends in suicide methods in Korea; 1997–1999 and 2017–2019. Journal of Health Informatics and Statistics. 2023; 48: 76–80.

[5] Lee SY, Song KJ, Hong KJ, Park JH, Kim TH, Jeong J, et al. Epidemiology and outcomes of severe injury patients related to suicide attempt or self-harm in Korea: nationwide community-based study, 2016–2020. Injury. 2025; 56: 112032.

[6] Kim JM, Lee HJ, Ju GW, Kim SC, Jeon HJ, Park GJ, et al. Analysis of risk factors affecting a suicidal attempter exposing suicidal intensions for the development of the active intervention strategy for suicide prevention. Journal of The Korean Society of Emergency Medicine. 2019; 30: 155–165.

[7] Harmer B, Lee S, Rizvi A, Saadabadi A. Suicidal ideation. StatPearls Publishing: Treasure Island (FL). 2025.

[8] Klonsky ED, Dixon‐Luinenburg T, May AM. The critical distinction between suicidal ideation and suicide attempts. World Psychiatry. 2021; 20: 439–441.

[9] García de la Garza Á, Blanco C, Olfson M, Wall MM. Identification of suicide attempt risk factors in a national us survey using machine learning. JAMA Psychiatry. 2021; 78: 398–406.

[10] Demesmaeker A, Chazard E, Vaiva G, Amad A. Risk factors for reattempt and suicide within 6 months after an attempt in the french ALGOS cohort: a survival tree analysis. The Journal of Clinical Psychiatry. 2021; 82: 20m13589.

[11] Cai Z, Junus A, Chang Q, Yip PSF. The lethality of suicide methods: a systematic review and meta-analysis. Journal of Affective Disorders. 2022; 300: 121–129.

[12] Aguilar-Velázquez DG, González-Castro TB, Tovilla-Zárate CA, Juárez-Rojop IE, López-Narváez ML, Frésan A, et al. Gender differences of suicides in children and adolescents: analysis of 167 suicides in a Mexican population from 2003 to 2013. Psychiatry Research. 2017; 258: 83–87.

[13] Liang S, Friedman LS. Analysis of suspected suicides using poison center data. Archives of Suicide Research. 2011; 15: 185–194.

[14] Prosser JM, Perrone J, Pines JM. The epidemiology of intentional non-fatal self-harm poisoning in the United States: 2001–2004. Journal of Medical Toxicology. 2007; 3: 20–24.

[15] Cha JH, Ahn ME, Kim DW, Lee SK, Lee CH, Kim SM, et al. Clinical characteristics of intentional self-harm inpatient with lethal methods. Journal of The Korean Society of Emergency Medicine. 2019; 30: 419–427.

[16] Kuo WH, Gallo JJ. Completed suicide after a suicide attempt. American Journal of Psychiatry. 2005; 162: 633.

[17] Lange S, Jiang H, Štelemėkas M, Tran A, Cherpitel C, Giesbrecht N, et al. Evaluating the impact of alcohol policy on suicide mortality: a sex-specific time-series analysis for Lithuania. Archives of Suicide Research. 2023; 27: 339–352.

[18] Richardson C, Robb KA, O’Connor RC. A systematic review of suicidal behaviour in men: a narrative synthesis of risk factors. Social Science & Medicine. 2021; 276: 113831.

[19] Kim AR, Jeong SR, Kim ES, Lee WK. Trend of intentional self-harm methods and recovery rate including non-death in hospital discharge registry investigation in Korea 2005–2016. Journal of Health Informatics and Statistics. 2021; 46: 181–187.

[20] Lee HS, Han J, Kim JH, Kim S, Kim SH, Lee JS, et al. Epidemiologic characteristics of intentional poisoning: emergency department based injury in-depth surveillance during 2011–2015. Journal of the Korean Society of Clinical Toxicology. 2017; 15: 131–139.

[21] Health Insurance Review & Assessment Service. Depression outpatient primary appropriateness assessment. 2022. Available at: https://www.hira.or.kr/bbsDummy.do?brdBltNo=9962&brdScnBltNo=4&pgmid=HIRAA020002000100 (Accessed: 10 September 2023).

[22] Shin Y, Park S. Identifying the path from the frequency of FacetoFace and non-FacetoFace contact to Corona depression 20’s: mediating of social support. Korean Journal of Health Psychology. 2022; 27: 589–607.

[23] Burki T. The indirect impact of COVID-19 on women. The Lancet Infectious Diseases. 2020; 20: 904–905.

[24] Wenham C, Smith J, Davies SE, Feng H, Grépin KA, Harman S, et al. Women are most affected by pandemics—lessons from past outbreaks. Nature. 2020; 583: 194–198.

[25] Lee H. State and improvement policy of psychiatric emergency during COVID-19 pandemic. Journal of Korean Neuropsychiatric Association. 2021; 23–27.

[26] Xiong J, Lipsitz O, Nasri F, Lui LMW, Gill H, Phan L, et al. Impact of COVID-19 pandemic on mental health in the general population: a systematic review. Journal of Affective Disorders. 2020; 277: 55–64.

[27] Bueno-Notivol J, Gracia-García P, Olaya B, Lasheras I, López-Antón R, Santabárbara J. Prevalence of depression during the COVID-19 outbreak: a meta-analysis of community-based studies. International Journal of Clinical and Health Psychology. 2021; 21: 100196.

[28] Lee SY. Do media coverage of suicides and search frequency on suicides predict the number of tweets seeking others for a suicide pact? Frontiers in Psychiatry. 2023; 14: 1260567.

[29] Jang J, Myung W, Kim S, Han M, Yook V, Kim EJ, et al. Effect of suicide prevention law and media guidelines on copycat suicide of general population following celebrity suicides in South Korea, 2005–2017. Australian & New Zealand Journal of Psychiatry. 2022; 56: 542–550.

[30] Kim LH, Lee GM, Lee WR, Yoo KB. The Werther effect following the suicides of three korean celebrities (2017–2018): an ecological time-series study. BMC Public Health. 2023; 23: 1173.

[31] Ministry of Health and Welfare. Acta on mental health promotion and the support for welfare services for mentally ill 2016. 2016. Available at: http://elaw.klri.re.kr/kor_service/lawView.do? hseq=38925&lang=ENG (Accessed: 10 September 2023).