Skip Navigation
Skip to contents

JPMPH : Journal of Preventive Medicine and Public Health


Author index

Page Path
HOME > Browse Articles > Author index
Changsoo Kim 5 Articles
Effect of Burnout on Post-traumatic Stress Disorder Symptoms Among Firefighters in Korea: Data From the Firefighter Research on Enhancement of Safety & Health (FRESH)
Woojin Kim, Munjoo Bae, Sei-Jin Chang, Jin-Ha Yoon, Da Yee Jeong, Dae-Sung Hyun, Hye-Yoon Ryu, Ki-Soo Park, Mi-Ji Kim, Changsoo Kim
J Prev Med Public Health. 2019;52(6):345-354.   Published online October 24, 2019
  • 9,054 View
  • 237 Download
  • 18 Crossref
AbstractAbstract AbstractSummary PDFSupplementary Material
It is well-known that post-traumatic stress disorder (PTSD) among firefighters contributes to their job-related stress. However, the relationship between burnout and PTSD in firefighters has rarely been studied. This study therefore explored the association between burnout and its related factors, such as trauma and violence, and PTSD symptoms among firefighters in Korea.
A total of 535 firefighters participated in the Firefighter Research on Enhancement of Safety & Health study at 3 university hospitals from 2016 to 2017. The 535 participants received a baseline health examination, including questionnaires assessing their mental health. A Web-based survey was also conducted to collect data on job-related stress, history of exposure to violence, burnout, and trauma experience. The associations among burnout, its related factors, and PTSD symptoms were investigated using structural equation modeling.
Job demands (β=0.411, p<0.001) and effort-reward balance (β=-0.290, p<0.001) were significantly related to burnout. Burnout (β=0.237, p<0.001) and violence (β=0.123, p=0.014) were significantly related to PTSD risk. Trauma (β=0.131, p=0.001) was significantly related to burnout; however, trauma was not directly associated with PTSD scores (β=0.085, p=0.081).
Our results show that burnout and psychological, sexual, and physical violence at the hands of clients directly affected participants’ PTSD symptoms. Burnout mediated the relationship between trauma experience and PTSD.
Korean summary
535명의 현직소방관을 대상으로 소방공무원에서 업무관련스트레스, 폭력노출, 외상노출, 소진(번아웃), 외상후 스트레스 장애(PTSD) 증상 설문을 시행하였고, 구조방정식 통해 업무스트레스에 의한 소진이 PTSD에 주는 영향과 다른 요인간의 연관성을 분석하였다. 그 결과, 업무 환경에서의 높은 직무요구수준과 낮은 노력-보상 균형은 소진을 증가시키며, 업무스트레스에 의한 소진과 근무 중 겪게 되는 폭력노출 경험은 PTSD 점수와 양의 연관관계를 보였다. 반면, 업무 도중 외상사건 경험은 PTSD 점수와 직접적으로 유의한 연관관계를 보이지 않았으나, 소진을 통한 간접적으로 영향을 주는 것을 확인하였다.


Citations to this article as recorded by  
  • Association between burnout and post‐traumatic stress disorder among frontline nurse during COVID‐19 pandemic: A moderated mediation analysis
    Leilei Liang, Yuanchao Hu, Junsong Fei, Tongshuang Yuan, Ren Gao, Jingyi Yue, Qianqian Song, Xixi Zhao, Songli Mei
    Journal of Clinical Nursing.2024; 33(3): 1076.     CrossRef
  • Post-Traumatic Stress Disorder Symptoms among Pediatric Healthcare Workers
    Nikolaos Rigas, Zacharias Kyritsis, Maria Dagla, Alexandra Soldatou, Eirini Orovou, Maria Tzitiridou-Chatzopoulou, Panagiotis Eskitzis, Evangelia Antoniou
    Nursing Reports.2024; 14(1): 115.     CrossRef
  • Moderating effect of work fatigue on the association between resilience and posttraumatic stress symptoms: a cross-sectional multi-country study among pharmacists during the COVID-19 pandemic
    Samar Younes, Souheil Hallit, Irfan Mohammed, Sarah El Khatib, Anna Brytek-Matera, Shadrach Chinecherem Eze, Kenneth Egwu, Rawshan Jabeen, Nebojša Pavlović, Pascale Salameh, Michelle Cherfane, Marwan Akel, Chadia Haddad, Randa Choueiry, Feten Fekih-Romdha
    BioPsychoSocial Medicine.2024;[Epub]     CrossRef
  • Post-traumatic stress disorder in international surgeons undertaking trauma electives in a South African trauma centre
    V Thirayan, VY Kong, H Uchino, DL Clarke
    South African Journal of Surgery.2024; 62(1): 14.     CrossRef
  • Firefighters and Spouses: Hostility, Satisfaction, and Conflict
    Romana Pasca, Shannon L. Wagner
    Journal of Family Issues.2023; 44(4): 1074.     CrossRef
  • Psychological Variables Associated With Post-Traumatic Stress Disorder in Firefighters: A Systematic Review
    Elena R. Serrano-Ibáñez, Tania Corrás, Mirtha del Prado, Javier Diz, Carmen Varela
    Trauma, Violence, & Abuse.2023; 24(4): 2049.     CrossRef
  • Burnout and post-traumatic stress disorder symptoms among medical staff two years after the COVID-19 pandemic in Wuhan, China: Social support and resilience as mediators
    Yifang Liu, Li Zou, Shijiao Yan, Pu Zhang, Jun Zhang, Jing Wen, Jing Mao, Longti Li, Ying Wang, Wenning Fu
    Journal of Affective Disorders.2023; 321: 126.     CrossRef
  • Compassion Fatigue and Perceived Social Support among Polish Nurses
    Paulina Pergol-Metko, Anna Staniszewska, Sebastian Metko, Zofia Sienkiewicz, Lukasz Czyzewski
    Healthcare.2023; 11(5): 706.     CrossRef
  • Occupational Stress and Burnout in the Fire Service: Examining the Complex Role and Impact of Sleep Health
    Mari-Amanda A. Dyal, Todd D. Smith, David M. DeJoy, Brian A. Moore
    Behavior Modification.2022; 46(2): 374.     CrossRef
  • Student Burnout and PTSD Symptoms: The Role of Existential Anxiety and Academic Fears on Students during the COVID 19 Pandemic
    Katarzyna Tomaszek, Agnieszka Muchacka-Cymerman, Giovanni Galeoto
    Depression Research and Treatment.2022; 2022: 1.     CrossRef
  • The short form effort−reward imbalance: Measure of occupational stress for firefighters
    Dal Lae Chin, MinJung Kyung, Jian Li, Stephanie Phelps, OiSaeng Hong
    American Journal of Industrial Medicine.2022; 65(6): 492.     CrossRef
  • Emergency nurses' burnout levels as the mediator of the relationship between stress and posttraumatic stress disorder symptoms during COVID‐19 pandemic
    Bey‐Jing Yang, Ching‐Wei Yen, Shou‐Ju Lin, Chien‐Hua Huang, Jhong‐Lin Wu, Yih‐Ru Cheng, Chia‐Chen Hsieh, Fei‐Hsiu Hsiao
    Journal of Advanced Nursing.2022; 78(9): 2861.     CrossRef
  • Workplace stressors and PTSD among psychiatric workers: The mediating role of burnout
    Elke Ham, Michael C. Seto, Nicole C. Rodrigues, N. Zoe Hilton
    International Journal of Mental Health Nursing.2022; 31(5): 1151.     CrossRef
  • Testosterone and occupational burnout in professional male firefighters
    Denis Vinnikov, Zhanna Romanova, Gulnara Kapanova, Aizhan Raushanova, Sundetgali Kalmakhanov, Alexander Zhigalin
    BMC Public Health.2021;[Epub]     CrossRef
  • Doctors and Nurses: A Systematic Review of the Risk and Protective Factors in Workplace Violence and Burnout
    Jose Miguel Giménez Lozano, Juan Pedro Martínez Ramón, Francisco Manuel Morales Rodríguez
    International Journal of Environmental Research and Public Health.2021; 18(6): 3280.     CrossRef
  • A Relational Model for Stress: A Systematic Review of the Risk and Protective Factors for Stress-Related Diseases in Firefighters
    Joana Proença Becker, Rui Paixão, Manuel João Quartilho
    Psych.2020; 2(1): 74.     CrossRef
  • PTSD symptoms among health workers and public service providers during the COVID-19 outbreak
    Sverre Urnes Johnson, Omid V. Ebrahimi, Asle Hoffart, Kristin Vickers
    PLOS ONE.2020; 15(10): e0241032.     CrossRef
  • A Systematic Review and Meta-analysis on the Factors Related to Post-traumatic Growth of Fire Officials
    Myung-Gwan Kim, Seung-Woo Han
    Journal of Health Informatics and Statistics.2020; 45(4): 373.     CrossRef
Short-term Effect of Ambient Air Pollution on Emergency Department Visits for Diabetic Coma in Seoul, Korea
Hyunmee Kim, Woojin Kim, Jee eun Choi, Changsoo Kim, Jungwoo Sohn
J Prev Med Public Health. 2018;51(6):265-274.   Published online October 29, 2018
  • 6,063 View
  • 233 Download
  • 6 Crossref
AbstractAbstract AbstractSummary PDFSupplementary Material
A positive association between air pollution and both the incidence and prevalence of diabetes mellitus (DM) has been reported in some epidemiologic and animal studies, but little research has evaluated the relationship between air pollution and diabetic coma. Diabetic coma is an acute complication of DM caused by diabetic ketoacidosis or hyperosmolar hyperglycemic state, which is characterized by extreme hyperglycemia accompanied by coma. We conducted a time-series study with a generalized additive model using a distributed-lag non-linear model to assess the association between ambient air pollution (particulate matter less than 10 μm in aerodynamic diameter, nitrogen dioxide [NO2], sulfur dioxide, carbon monoxide, and ozone) and emergency department (ED) visits for DM with coma in Seoul, Korea from 2005 to 2009.
The ED data and medical records from the 3 years previous to each diabetic coma event were obtained from the Health Insurance Review and Assessment Service to examine the relationship with air pollutants.
Overall, the adjusted relative risks (RRs) for an interquartile range (IQR) increment of NO2 was statistically significant at lag 1 (RR, 1.125; 95% confidence interval [CI], 1.039 to 1.219) in a single-lag model and both lag 0-1 (RR, 1.120; 95% CI, 1.028 to 1.219) and lag 0-3 (RR, 1.092; 95% CI, 1.005 to 1.186) in a cumulative-lag model. In a subgroup analysis, significant positive RRs were found for females for per-IQR increments of NO2 at cumulative lag 0-3 (RR, 1.149; 95% CI, 1.022 to 1.291).
The results of our study suggest that ambient air pollution, specifically NO2, is associated with ED visits for diabetic coma.
Korean summary
본 연구에서는 대기오염물질의 단기적인 영향을 확인하기 위하여 당뇨병성 혼수로 인한 응급실 내원을 시계열적으로 분석하였다. 분석 결과 이산화질소 상승이 노출 1일 후의 응급실 방문을 1.25% 상승시켰다(RR, 1.125; 95% CI 1.039-1.219). 또한, 노출 3일 후까지 누적 결과도 유의한 상관관계를 보였다(RR 1.092; 95% CI, 1.005-1.186).


Citations to this article as recorded by  
  • Criteria air pollutants and diabetes mortality classified by different subtypes and complications: A nationwide, case-crossover study
    Peng Yin, Huihuan Luo, Ya Gao, Wei Liu, Su Shi, Xinyue Li, Xia Meng, Haidong Kan, Maigeng Zhou, Guanglin Li, Renjie Chen
    Journal of Hazardous Materials.2023; 460: 132412.     CrossRef
  • Comparison of different hybrid modeling methods to estimate intraurban NO2 concentrations
    Inbo Oh, Mi-Kyoung Hwang, Jin-Hee Bang, Wonho Yang, Soontae Kim, Kiyoung Lee, SungChul Seo, Jiho Lee, Yangho Kim
    Atmospheric Environment.2021; 244: 117907.     CrossRef
  • Short-term effect of NO2 on outpatient visits for dermatologic diseases in Xinxiang, China: a time-series study
    Ling Chao, Mengxue Lu, Zhen An, Juan Li, Yuchun Li, Qian Zhao, Yinbiao Wang, Yue Liu, Weidong Wu, Jie Song
    Environmental Geochemistry and Health.2021; 43(9): 1.     CrossRef
  • Assessing short-term effects of ambient air pollution on respiratory diseases in Guwahati, India with the application of the generalized additive model
    Abhishek Dutta, Wanida Jinsart
    Human and Ecological Risk Assessment: An International Journal.2021; 27(7): 1786.     CrossRef
  • Does ozone inhalation cause adverse metabolic effects in humans? A systematic review
    Judy S. LaKind, Carol J. Burns, Lynn H. Pottenger, Daniel Q. Naiman, Julie E. Goodman, Satori A. Marchitti
    Critical Reviews in Toxicology.2021; 51(6): 467.     CrossRef
  • Joint effect of heatwaves and air quality on emergency department attendances for vulnerable population in Perth, Western Australia, 2006 to 2015
    Dimpalben Patel, Le Jian, Jianguo Xiao, Janis Jansz, Grace Yun, Andrew Robertson
    Environmental Research.2019; 174: 80.     CrossRef
Short-term Effects of Ambient Air Pollution on Emergency Department Visits for Asthma: An Assessment of Effect Modification by Prior Allergic Disease History
Juhwan Noh, Jungwoo Sohn, Jaelim Cho, Seong-Kyung Cho, Yoon Jung Choi, Changsoo Kim, Dong Chun Shin
J Prev Med Public Health. 2016;49(5):329-341.   Published online September 8, 2016
  • 9,553 View
  • 242 Download
  • 29 Crossref
AbstractAbstract PDFSupplementary Material
The goal of this study was to investigate the short-term effect of ambient air pollution on emergency department (ED) visits in Seoul for asthma according to patients’ prior history of allergic diseases.
Data on ED visits from 2005 to 2009 were obtained from the Health Insurance Review and Assessment Service. To evaluate the risk of ED visits for asthma related to ambient air pollutants (carbon monoxide [CO], nitrogen dioxide [NO2], ozone [O3], sulfur dioxide [SO2], and particulate matter with an aerodynamic diameter <10 μm [PM10]), a generalized additive model with a Poisson distribution was used; a single-lag model and a cumulative-effect model (average concentration over the previous 1-7 days) were also explored. The percent increase and 95% confidence interval (CI) were calculated for each interquartile range (IQR) increment in the concentration of each air pollutant. Subgroup analyses were done by age, gender, the presence of allergic disease, and season.
A total of 33 751 asthma attack cases were observed during the study period. The strongest association was a 9.6% increase (95% CI, 6.9% to 12.3%) in the risk of ED visits for asthma per IQR increase in O3 concentration. IQR changes in NO2 and PM10 concentrations were also significantly associated with ED visits in the cumulative lag 7 model. Among patients with a prior history of allergic rhinitis or atopic dermatitis, the risk of ED visits for asthma per IQR increase in PM10 concentration was higher (3.9%; 95% CI, 1.2% to 6.7%) than in patients with no such history.
Ambient air pollutants were positively associated with ED visits for asthma, especially among subjects with a prior history of allergic rhinitis or atopic dermatitis.


Citations to this article as recorded by  
  • Causal relationship between asthma outpatient visits and air pollution with instrumental variable approach
    Su Hwan Kim, Seong Pyo Kim, Jae‐In Song, Zio Kim, Jin Youp Kim, Hyung‐Jin Yoon
    Allergy.2023; 78(11): 3007.     CrossRef
  • Defining the Relationship between Daily Exposure to Particulate Matter and Hospital Visits by Psoriasis Patients
    Eun Hye Lee, Daesick Ryu, Nam-Soo Hong, Jun Young Kim, Kyung Duck Park, Weon Ju Lee, Seok-Jong Lee, Sang-Hyun Kim, Younghae Do, Yong Hyun Jang
    Annals of Dermatology.2022; 34(1): 40.     CrossRef
  • Review of Ground-Level Ozone Impact in Respiratory Health Deterioration for the Past Two Decades
    Angelo Roldão Soares, Carla Silva
    Atmosphere.2022; 13(3): 434.     CrossRef
  • Role of ambient air pollution in asthma spread among various population groups of Lahore City: a case study
    Rabia Aslam, Faiza Sharif, Mujtaba Baqar, Abdul-Sattar Nizami, Uzma Ashraf
    Environmental Science and Pollution Research.2022; 30(4): 8682.     CrossRef
  • Associations between Daily Ambient Air Pollution and Pulmonary Function, Asthma Symptom Occurrence, and Quick-Relief Inhaler Use among Asthma Patients
    Monika Ścibor, Bartosz Balcerzak, Andrzej Galbarczyk, Grazyna Jasienska
    International Journal of Environmental Research and Public Health.2022; 19(8): 4852.     CrossRef
  • Spatial autocorrelation may bias the risk estimation: An application of eigenvector spatial filtering on the risk of air pollutant on asthma
    Yujin Park, Su Hwan Kim, Seong Pyo Kim, Jiwon Ryu, Jinyeong Yi, Jin Youp Kim, Hyung-Jin Yoon
    Science of The Total Environment.2022; 843: 157053.     CrossRef
  • Associations between ambient air pollution and medical care visits for atopic dermatitis
    Jin-Ok Baek, Jaelim Cho, Joo-Young Roh
    Environmental Research.2021; 195: 110153.     CrossRef
  • Effects of ambient air pollution on childhood asthma exacerbation in the Philadelphia metropolitan Region, 2011–2014
    Wanyu Huang, Leah H. Schinasi, Chén C. Kenyon, Kari Moore, Steven Melly, Rebecca A. Hubbard, Yuzhe Zhao, Ana V. Diez Roux, Christopher B. Forrest, Mitchell Maltenfort, Anneclaire J. De Roos
    Environmental Research.2021; 197: 110955.     CrossRef
  • Glutathione S-transferases and their implications in the lung diseases asthma and chronic obstructive pulmonary disease: Early life susceptibility?
    Cheryl van de Wetering, Evan Elko, Marijn Berg, Caspar H.J. Schiffers, Vasili Stylianidis, Maarten van den Berge, Martijn C. Nawijn, Emiel F.M. Wouters, Yvonne M.W. Janssen-Heininger, Niki L. Reynaert
    Redox Biology.2021; 43: 101995.     CrossRef
  • Effects of Particulate Matter on Healthy Skin: A Comparative Study between High- and Low-Particulate Matter Periods
    Se Jin Oh, Dokyoung Yoon, Ji-Hye Park, Jong Hee Lee
    Annals of Dermatology.2021; 33(3): 263.     CrossRef
  • Association with Ambient Air Pollutants and School Absence Due to Sickness in Schoolchildren: A Case-Crossover Study in a Provincial Town of Japan
    Masanari Watanabe, Hisashi Noma, Jun Kurai, Kazuhiro Kato, Hiroyuki Sano
    International Journal of Environmental Research and Public Health.2021; 18(12): 6631.     CrossRef
  • A traditional herbal formula, Deng-Shi-Qing-Mai-Tang, regulates TLR4/NF-κB signaling pathway to reduce inflammatory response in PM2.5-induced lung injury
    You Zhou, Jianbo Liu, Cheng Jiang, Jiaming Chen, Xilian Feng, Weiyan Chen, Jiechun Zhang, Hongzhen Dong, Wei Zhang
    Phytomedicine.2021; 91: 153665.     CrossRef
  • Long-term exposure to air pollution and the risk of non-lung cancer: a meta-analysis of observational studies
    H-B Kim, J-Y Shim, B Park, Y-J Lee
    Perspectives in Public Health.2020; 140(4): 222.     CrossRef
  • Predicting Asthma Attacks: Effects of Indoor PM Concentrations on Peak Expiratory Flow Rates of Asthmatic Children
    Dohyeong Kim, Sunghwan Cho, Lakshman Tamil, Dae Jin Song, Sungchul Seo
    IEEE Access.2020; 8: 8791.     CrossRef
  • Acute associations between PM2.5 and ozone concentrations and asthma exacerbations among patients with and without allergic comorbidities
    Natalie A. Rosenquist, William J. Metcalf, So Young Ryu, Aida Rutledge, Max J. Coppes, Joe J. Grzymski, Matthew J. Strickland, Lyndsey A. Darrow
    Journal of Exposure Science & Environmental Epidemiology.2020; 30(5): 795.     CrossRef
  • The short-term effects of air pollution on respiratory disease hospitalizations in 5 cities in Poland: comparison of time-series and case-crossover analyses
    Alessandro Slama, Andrzej Śliwczyński, Jolanta Woźnica-Pyzikiewicz, Maciej Zdrolik, Bartłomiej Wiśnicki, Jakub Kubajek, Olga Turżańska-Wieczorek, Marcin Studnicki, Waldemar Wierzba, Edward Franek
    Environmental Science and Pollution Research.2020; 27(19): 24582.     CrossRef
  • Association between air pollutants and outpatient and emergency hospital visits for childhood asthma in Shenyang city of China
    Qing Chang, Shu Liu, Zongjiao Chen, Biao Zu, Hehua Zhang
    International Journal of Biometeorology.2020; 64(9): 1539.     CrossRef
  • Effect of particulate matter exposure on patients with COPD and risk reduction through behavioural interventions: the protocol of a prospective panel study
    Shinhee Park, Seung Won Ra, Sung Yoon Kang, Hwan-Cheol Kim, Sei Won Lee
    BMJ Open.2020; 10(11): e039394.     CrossRef
  • The Respiratory Risks of Ambient/Outdoor Air Pollution
    Gary Adamkiewicz, Jahred Liddie, Jonathan M. Gaffin
    Clinics in Chest Medicine.2020; 41(4): 809.     CrossRef
    N. M. Agarkov, A. V. Poshibailova, V. A. Ivanov
    Ekologiya cheloveka (Human Ecology).2020; 27(5): 45.     CrossRef
  • The Effects of Air Pollutants on the Prevalence of Common Ear, Nose, and Throat Diseases in South Korea: A National Population-Based Study
    Mina Park, Ji Sung Lee, Moo Kyun Park
    Clinical and Experimental Otorhinolaryngology.2019; 12(3): 294.     CrossRef
  • Air Pollutants and Frailty in Older Adults: A Geriatrician’s Perspective
    Heayon Lee, Eunju Lee, Il-Young Jang
    Annals of Geriatric Medicine and Research.2019; 23(4): 212.     CrossRef
  • Assessing the impact of air pollution on childhood asthma morbidity: how, when, and what to do
    Allison J. Burbank, David B. Peden
    Current Opinion in Allergy & Clinical Immunology.2018; 18(2): 124.     CrossRef
  • The relationship between fine particulate matter (PM2.5) and schizophrenia severity
    Rika Eguchi, Daisuke Onozuka, Kouji Ikeda, Kenji Kuroda, Ichiro Ieiri, Akihito Hagihara
    International Archives of Occupational and Environmental Health.2018; 91(5): 613.     CrossRef
  • Metal(loid) bioaccessibility and inhalation risk assessment: A comparison between an urban and an industrial area
    A. Hernández-Pellón, W. Nischkauer, A. Limbeck, I. Fernández-Olmo
    Environmental Research.2018; 165: 140.     CrossRef
  • Air pollution influences the incidence of otitis media in children: A national population-based study
    Mina Park, Jiyeon Han, Myoung-jin Jang, Myung-Whan Suh, Jun Ho Lee, Seung Ha Oh, Moo Kyun Park, Alexander Larcombe
    PLOS ONE.2018; 13(6): e0199296.     CrossRef
  • Impact of Air Pollutants on Outpatient Visits for Acute Respiratory Outcomes
    Ran Li, Ning Jiang, Qichen Liu, Jing Huang, Xinbiao Guo, Fan Liu, Zhancheng Gao
    International Journal of Environmental Research and Public Health.2017; 14(1): 47.     CrossRef
  • Relationship between emergency care utilization, ambient temperature, and the pollution standard index in Taiwan
    Ching-hui Tseng, Li-Chin Lu, Shao-Hwan Lan, Yen-Ping Hsieh, Shou-Jen Lan
    International Journal of Environmental Health Research.2017; 27(5): 344.     CrossRef
  • Systematic Review and Meta-Analysis of Human Skin Diseases Due to Particulate Matter
    Le Ngoc, Duckshin Park, Yongil Lee, Young-Chul Lee
    International Journal of Environmental Research and Public Health.2017; 14(12): 1458.     CrossRef
Medical Care Expenditure in Suicides From Non-illness-related Causes
Jungwoo Sohn, Jaelim Cho, Ki Tae Moon, Mina Suh, Kyoung Hwa Ha, Changsoo Kim, Dong Chun Shin, Sang Hyuk Jung
J Prev Med Public Health. 2014;47(6):327-335.   Published online November 4, 2014
  • 9,186 View
  • 91 Download
  • 2 Crossref
AbstractAbstract PDF
Several epidemiological studies on medical care utilization prior to suicide have considered the motivation of suicide, but focused on the influence of physical illnesses. Medical care expenditure in suicide completers with non-illness-related causes has not been investigated.
Suicides motivated by non-illness-related factors were identified using the investigator’s note from the National Police Agency, which was then linked to the Health Insurance Review and Assessment data. We investigated the medical care expenditures of cases one year prior to committing suicide and conducted a case-control study using conditional logistic regression analysis after adjusting for age, gender, area of residence, and socioeconomic status.
Among the 4515 suicides motivated by non-illness-related causes, medical care expenditures increased in only the last 3 months prior to suicide in the adolescent group. In the younger group, the proportion of total medical expenditure for external injuries was higher than that in the older groups. Conditional logistic regression analysis showed significant associations with being a suicide completer and having a rural residence, low socioeconomic status, and high medical care expenditure. After stratification into the four age groups, a significant positive association with medical care expenditures and being a suicide completer was found in the adolescent and young adult groups, but no significant results were found in the elderly groups for both men and women.
Younger adults who committed suicide motivated by non-illness-related causes had a higher proportion of external injuries and more medical care expenditures than their controls did. This reinforces the notion that suicide prevention strategies for young people with suicidal risk factors are needed.


Citations to this article as recorded by  
  • Socioeconomic factors associated with suicidal behaviors in South Korea: systematic review on the current state of evidence
    Nicolas Raschke, Amir Mohsenpour, Leona Aschentrup, Florian Fischer, Kamil J. Wrona
    BMC Public Health.2022;[Epub]     CrossRef
  • Impact of intergenerational support and medical expenditures on depression: Evidence from rural older adults in China
    Congrong Li, Qing Han, Jinrong Hu, Zeyu Han, Hongjuan Yang
    Frontiers in Public Health.2022;[Epub]     CrossRef
Medical Care Utilization During 1 Year Prior to Death in Suicides Motivated by Physical Illnesses
Jaelim Cho, Won Joon Lee, Ki Tae Moon, Mina Suh, Jungwoo Sohn, Kyoung Hwa Ha, Changsoo Kim, Dong Chun Shin, Sang Hyuk Jung
J Prev Med Public Health. 2013;46(3):147-154.   Published online May 31, 2013
  • 9,271 View
  • 95 Download
  • 19 Crossref
AbstractAbstract PDF

Many epidemiological studies have suggested that a variety of medical illnesses are associated with suicide. Investigating the time-varying pattern of medical care utilization prior to death in suicides motivated by physical illnesses would be helpful for developing suicide prevention programs for patients with physical illnesses.


Suicides motivated by physical illnesses were identified by the investigator's note from the National Police Agency, which was linked to the data from the Health Insurance Review and Assessment. We investigated the time-varying patterns of medical care utilization during 1 year prior to suicide using repeated-measures data analysis after adjustment for age, gender, area of residence, and socioeconomic status.


Among 1994 suicides for physical illness, 1893 (94.9%) suicides contacted any medical care services and 445 (22.3%) suicides contacted mental health care during 1 year prior to suicide. The number of medical care visits and individual medical expenditures increased as the date of suicide approached (p<0.001). The number of medical care visits for psychiatric disorders prior to suicide significantly increased only in 40- to 64-year-old men (p=0.002), women <40 years old (p=0.011) and women 40 to 64 years old (p=0.021) after adjustment for residence, socioeconomic status, and morbidity.


Most of the suicides motivated by physical illnesses contacted medical care during 1 year prior to suicide, but many of them did not undergo psychiatric evaluation. This underscores the need for programs to provide psychosocial support to patients with physical illnesses.



Citations to this article as recorded by  
  • Suicide risk of chronic diseases and comorbidities: A Korean case-control study
    Areum Song, Emily Jiali Koh, Weon-Young Lee, Shusen Chang, Jiseun Lim, Minjae Choi, Myung Ki
    Journal of Affective Disorders.2024; 349: 431.     CrossRef
  • Variations in healthcare utilization for mental health problems prior to suicide by socioeconomic status: a Norwegian register-based population study
    Carine Øien-Ødegaard, Solveig Tobie Glestad Christiansen, Lars Johan Hauge, Kim Stene-Larsen, Sissel Marguerite Bélanger, Espen Bjertness, Anne Reneflot
    BMC Health Services Research.2024;[Epub]     CrossRef
  • Late-life suicide in an aging world
    Diego De Leo
    Nature Aging.2022; 2(1): 7.     CrossRef
  • Risk factors for suicidal behavior in older adults
    D.P. Ponomareva, M.S. Artemieva M.S. Artemieva
    Vestnik nevrologii, psihiatrii i nejrohirurgii (Bulletin of Neurology, Psychiatry and Neurosurgery).2022; (1): 18.     CrossRef
  • Innovating Technology-Enhanced Interventions for Youth Suicide: Insights for Measuring Implementation Outcomes
    Hannah S. Szlyk, Jia Tan, Rebecca Lengnick-Hall
    Frontiers in Psychology.2021;[Epub]     CrossRef
  • Suicide prevention in older adults
    Carlos Augusto de Mendonça Lima, Diego De Leo, Gabriel Ivbijaro, Igor Svab
    Asia-Pacific Psychiatry.2021;[Epub]     CrossRef
  • Suicide in late life: A viewpoint
    Diego De Leo, Andrea Viecelli Giannotti
    Preventive Medicine.2021; 152: 106735.     CrossRef
  • Understanding the impact of clinical characteristics and healthcare utilizations on suicide among cancer sufferers: a case-control study in Hong Kong
    Yu Vera Men, Tai-Chung Lam, Cheuk Yui Yeung, Paul Siu Fai Yip
    The Lancet Regional Health - Western Pacific.2021; 17: 100298.     CrossRef
  • Risk Factors for Suicide in a National Sample of Veterans With Multiple Sclerosis
    Quinn D. Kellerman, Narineh Hartoonian, Megan L. Beier, Steven L. Leipertz, Charles Maynard, Trisha A. Hostetter, Jodie K. Haselkorn, Aaron P. Turner
    Archives of Physical Medicine and Rehabilitation.2020; 101(7): 1138.     CrossRef
  • Wearing a happy mask: mother’s expressions of suicidality with postpartum depression
    Regina Praetorius, December Maxwell, Komal Alam
    Social Work in Mental Health.2020; 18(4): 429.     CrossRef
  • Adaptation of evidence‐based suicide prevention strategies during and after the COVID‐19 pandemic
    Danuta Wasserman, Miriam Iosue, Anika Wuestefeld, Vladimir Carli
    World Psychiatry.2020; 19(3): 294.     CrossRef
  • Contact with primary and mental health care prior to suicide: A systematic review of the literature from 2000 to 2017
    Kim Stene-Larsen, Anne Reneflot
    Scandinavian Journal of Public Health.2019; 47(1): 9.     CrossRef
  • Use of prescription medication prior to suicide in Norway
    Anne Reneflot, Silje L. Kaspersen, Lars Johan Hauge, Jorid Kalseth
    BMC Health Services Research.2019;[Epub]     CrossRef
  • Use of primary healthcare services prior to suicide in Norway: a descriptive comparison of immigrants and the majority population
    Carine Øien-Ødegaard, Anne Reneflot, Lars Johan Hauge
    BMC Health Services Research.2019;[Epub]     CrossRef
  • Clinical epidemiology of long-term suicide risk in a nationwide population-based cohort study in South Korea
    Hyewon Lee, Woojae Myung, Chunsoo Lee, Junbae Choi, Ho Kim, Bernard J. Carroll, Doh Kwan Kim
    Journal of Psychiatric Research.2018; 100: 47.     CrossRef
  • Areas of uncertainties and unmet needs in bipolar disorders: clinical and research perspectives
    Michael Bauer, Ole A Andreassen, John R Geddes, Lars Vedel Kessing, Ute Lewitzka, Thomas G Schulze, Eduard Vieta
    The Lancet Psychiatry.2018; 5(11): 930.     CrossRef
  • A study of people who attempted suicide referred to the emergency ward of Ali Ibn Abi Taleb hospital, Rafsanjan, Iran (2016)
    Alireza Taherifard, Hassan Ahmadinia, Reza Vazirinejad, Zahra Javadi, Seyed Zia Tabatabaei, Mohsen Rezaeian
    Journal of Occupational Health and Epidemiology.2018; 7(4): 201.     CrossRef
  • Towards Actualizing the Value Potential of Korea Health Insurance Review and Assessment (HIRA) Data as a Resource for Health Research: Strengths, Limitations, Applications, and Strategies for Optimal Use of HIRA Data
    Jee-Ae Kim, Seokjun Yoon, Log-Young Kim, Dong-Sook Kim
    Journal of Korean Medical Science.2017; 32(5): 718.     CrossRef
  • Effectiveness of Nursing Preventive Interventions in Suicide re- Attempts
    B Ghanbari, SK Malakouti, M Nojomi, K Alavi, SH Khaleghparast, A Sohrabzadeh
    Iran Journal of Nursing.2016; 29(99): 34.     CrossRef

JPMPH : Journal of Preventive Medicine and Public Health