Factors Affecting Inpatients' Mortality through Intentional Self-Harm at In-Hospitals in South Korea

Patient safety is a global priority, and in-hospital suicides pose a significant concern. The World Health Organization (WHO) defines suicide as death resulting from suicidal behavior. Reliable estimates of in-hospital suicides are scarce, with studies indicating a substantial proportion occurring during psychiatric treatment. Methods of self-harm in hospitals include hanging, cutting, poisoning, and falls. Economic factors and chronic illnesses have been linked to increased risk. The study aims to contribute data for developing programs and strengthening policies related to patient safety in South Korean medical institutions and to reduce hospital suicides.

Existing research from various countries reveals a high prevalence of suicidal thoughts and attempts among hospitalized patients, particularly in older adults and those with specific conditions. Studies in the UK, Taiwan, and elsewhere demonstrate a correlation between age, gender, comorbidities, and suicidal ideation or attempts. These studies highlight the need for targeted interventions and improved patient safety protocols in healthcare settings. The methods of self-harm vary across studies but frequently include poisoning and hanging.

This study utilized data from the Korean National Hospital Discharge In-depth Injury Survey (2007-2019), focusing on patients (aged 9-100) who intentionally self-harmed (ICD codes X60-X84 and Y10-Y34). A total of 7235 participants were included, with 43 cases of in-hospital self-harm. The study compared characteristics of patients who self-harmed inside and outside the hospital, and survival vs. mortality rates among those who self-harmed in the hospital. Data analysis included frequency analysis, chi-square tests, Fisher's exact tests, and logistic regression analysis using STATA 15.0. Independent variables included patient characteristics (sex, age, medical benefits), comorbidities (Charlson Comorbidity Index), risk factors (mental health problems, physical illness, financial problems, family conflicts), means of self-harm (poisoning, cutting, suffocation, falling), and time from admission to self-harm attempt.

Of 7235 participants, 43 (0.59%) self-harmed in the hospital. Among in-hospital self-harm attempts, males (55.8%) were more prevalent, with an average age of 56.3 years. 20.9% received medical benefits. Common comorbidities included cerebrovascular disease (7%), renal disease (4.7%), cancer (16.3%), and metastatic cancer (7%). The most frequent risk factors were physical illness (14%) and family conflicts (7%). The primary means of self-harm were poisoning (62.8%) and falling (37.2%). Mortality rate was 27.9%. Logistic regression analysis revealed that older age, receiving medical benefits (suggesting financial difficulties), peptic ulcer disease, cancer, and financial problems increased the odds of in-hospital self-harm. Among in-hospital self-harm attempts, 31 survived and 12 died. Males comprised a larger proportion (83.3%) of the deceased. Physical illness was a more significant risk factor among those who died (33.3%), with falling (83.3%) as the predominant method. Receiving medical benefits and family conflicts were also associated with mortality. A substantial proportion (41.9%) of self-harm attempts occurred on the day of admission, with another 25.6% within one week. Poisoning as a method of self-harm was associated with reduced mortality (OR = 0.014).

The findings align with international research indicating a significant risk of suicidal ideation and attempts among hospitalized patients, particularly those with specific vulnerabilities. The high proportion of self-harm attempts on the day of admission underscores the critical need for immediate risk assessment and intervention upon hospital admission. The predominance of falling and poisoning as self-harm methods highlights the importance of environmental safety measures and potential for intervention strategies targeting methods of self-harm. The study's findings on the impact of economic factors and comorbidities emphasize the need for multifaceted interventions addressing social determinants of health. These data can inform the development of tailored preventative policies and risk assessment tools within the South Korean healthcare system.

This study provides valuable data on in-hospital self-harm and suicide in South Korea. Strengthening patient safety measures, particularly in the immediate post-admission period, is crucial. Interventions should target older male patients, individuals with financial difficulties, and those with certain comorbidities. Further research should investigate psychological factors and refine risk prediction models. The high proportion of self-harm attempts occurring soon after admission highlights the necessity for immediate and comprehensive risk assessments and targeted preventive strategies.

The study relied on data from discharged patients, potentially excluding cases resulting in death before discharge or those not hospitalized. The sample size of in-hospital self-harm attempts was relatively small. The study did not consider psychological factors (depression, stress) that might influence self-harm risk. The data were based on voluntary reporting, possibly introducing reporting bias.