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October, 2017 >>

Causes and severity of suicide in developed nations of East Asia

Sumaira Kanwal  ( Department of Biosciences, COMSATS Institute of Information Technology, Sahiwal Campus, Pakistan, and Kongju National University, Korea )

Shazia Perveen  ( Department of Zoology, The Women University, Multan )

Yaqoot Sumbla  ( COMSATS, Institute of Information Technology, Sahiwal Campus, Pakistan )


It is considered that people from poor countries get depressed which ultimately leads to suicide. It is estimated that one million people commit suicide every year worldwide. It is considered from statistics that global annual suicide fatalities could rise to 1.5 million by 2020. Economically and culturally the most influential countries of East Asia are China, Japan and South Korea. To find the underlying causes for such a high suicide rate was the basic purpose of this article. We selected 100 suicide research articles as well as World Health Organisation's statistics related to suicide in East Asian countries. Stress and insecurity, whether related to employment or in relationship, are the basic causes which ultimately take an individual to the verge of suicide. Some people also find suicide a mean to get rid of life due to some lethal diseases. Aged persons consider themselves out of life so they adopt suicide. The government has already taken serious steps to minimise the death rate caused by suicide. Stress in education institutions has to be negotiated by taking some steps in education policy. Consistent efforts should be made to cope with this problem.
Keywords: Aged, East Asia, OECD, Self-killing, Suicide.


Suicide is the act of ending one's own life deliberately. Risk factors include mental disorders such as depression, bipolar disorder, schizophrenia, personality disorders, alcoholism, or substance misuse. Others are impulsive acts due to stress such as from financial difficulties, troubles with relationships, or from bullying.1 Those who have previously attempted suicide are at higher risk for future attempts. Suicide prevention efforts include limiting access to the method of suicide, such as firearms and poisons, treating mental disorders and substance misuse, proper media reporting of suicide, and improving economic conditions.

It is generally considered that depression, anxiety, mental illness, economic burden, and unemployment are more common in developing countries. These factors lead towards suicide or suicide attempts. However, in some countries, the situation is reverse to general opinion.

East Asia, which can be defined in geographical or cultural terms, includes China, Japan, North Korea, South Korea, Mongolia and Taiwan.

But culturally and economically the most influential countries are China, Japan, and South Korea. Although there are examples of excellent achievement, the burning issue in these countries is suicide. Suicide has become a social issue in the last two decades in East Asia.

There are many socio-economical issues that compel people to think about suicide. Unemployment, poverty, injustice and illiteracy are commonly found in individuals attempting or committing in suicide.2 However, proof on the link between suicide and poverty in low-income and middle-income countries is rare.3 Similarly, psychological problems like schizophrenia, cancer, depression and migraine, etc. also influence people. Psychiatric illness is a most important cause and above 90% of suicide cases show mental sickness.4 In addition, religious perspectives cannot be denied because countries having strong beliefs that condemn suicide are saved from this evil to a great extent in the entire world and have very low suicide rate. Both at individual and societal level, religion may be defensive against suicide and this depends on the degree a religion allows suicide.5

Dynamics that upset the danger of suicide include psychological disorders, drug mismanagement, psychological states, traditional, domestic and social circumstances, and genetics.6 Psychological disorders and material misuse often coexist. Additional risk dynamics comprise requiring earlier suicide attempts, the ready accessibility of a means to take one's life, a family history of suicide, or the presence of traumatic brain injury.5,7 For example, suicide rates have been found to be greater in households with firearms than those without them.

Socio-economic problems such as unemployment, poverty, homelessness, and discrimination may trigger suicidal thoughts.8 About 15-40% of people leave a suicide note. Genetic factors appear to account for between 38% and 55% of suicidal behaviours.9 War veterans have a higher risk of suicide due in part to higher rates of mental illness such as post-traumatic stress disorder and physical health problems related to war10


Suicide toll is hard to track in China as the official data shows fewer than the actual numbers. Numerous groups have carried out studies which put the rate nearer to 30, which would place China third in the world. However, we have no alternative except to utilise the official statistics released by the Chinese government. Female suicide rates are actually higher than that of males. In fact, China has the one of the highest female suicide rates in the world though both genders experience extreme stress put on them by culture. Another major factor is the awful work conditions in numerous factories.

Suicide comprises about 3.6% of all deaths and is considered the fifth-most significant cause of death.11 The annual suicide rate in China is about 23 per 100,000 and almost 287,000 commit suicides per year; the rate is three times higher in rural areas as compared to metropolitan areas.4c,11 China has the highest female suicide rate in the world and higher rural suicide rates.11 Rural women are commonly affected due to transitions in cultural values but it is hypothesised that the migration of rural women to cities has greatly saved them from suicide by keeping her away from family clashes, easy access to pesticides and their inferior position. When people move towards cities, the people left behind are more susceptible to suicide because they are uneducated, poor and alone and do not have sufficient family support. These people have greater contact to lethal means and mostly involved in suicide attempts that sometimes bring drastic results.12

In addition, these people are not aware of mental disorders that lead to superstitions.13 Urbanisation and  advancements in technology have improved lifestyle, but people are sometimes deprived of traditional values and norms regarding dear ones.5 Suicide data shows that 35% people who commit suicide do not have a detectable mental illness. Social problems like gambling, unemployment and separation from their dear ones make people think about suicide. This thinking is further promoted if there have been cases of suicides in their own families. Furthermore, the one-child policy' in China creates pressure on young women, leading to suicide14.

Religion is an important element in nation's life and can influence every aspect of life.15 According to Durkheim, religion does not work in the Chinese society as it does in the West as it is not an important thing in the Chinese culture,16 and in many cases replaced by. Besides, there is neither any place where people perform any specific rituals nor any form of organisation so people worship individually.16-18 It is observed that countries that promote religious beliefs are quite safe from social evils, and have lower suicide rates.19


The rate of suicide is higher in Japan than any other developed country. About 90 people die every day in Japan due to suicide.20 Almost 32,845 individuals took their lives in 2009. Suicide has now become the sixth leading cause of death after the malignant neoplasms, heart disease, cerebrovascular disease, pneumonia and accidents, respectively.21 The suicide rate among males is twice than the rate among females. However, female attempted suicide rate is 2-5 times more than males. With the exception of China, male suicide rates are high than female in all countries, including countries with low economic rate.22 This rate rises with the increase in age and reaches the peak at the age of 80 years or above. On the other hand, the suicide rate among middle-aged men (50-59 years) exceeds the rate among the older age group (65 years) after the Asian financial crisis of 1997-1998.23

Rural suicide rate in Japan is higher than urban areas due to various factors like a poor financial background, the breakdown of family system, insufficient knowledge about mental disorders, problems in accessing facilities and easy availability of pesticides.24 Furthermore, a downfall of an economy has strongly affected people.24 Suicide rates increased rapidly in Japan during the Asian financial crisis in 1997. Similarly, other examples of economic crisis in Japan are Showa panic in 1930, Jinmy Boom in 1955, the second oil crisis in 1980, the asset price bubble in 1985 and the protracted economic slump in 1995. These incidents suggest a link between economical conditions and suicide16.

Different studies show that 90% of suicides are caused by one of the psychological disorders, such as depression, schizophrenia, etc., with substance abuse. There is also a strong relation between suicides and depression.

Furthermore, people who are socially isolated and hopelessness are more vulnerable to suicide. Some of the other potential signs that can be symptoms of suicide are fear of death, aggression, mental illness, hopelessness, depression, family conflicts, poor financial position, joblessness, unplanned pregnancy, etc. In Japan, job insecurity and lack of social shelter for the economically active group are associated with the high level of suicides among middle-aged men.18

South Korea

The suicide rate in South Korea was 31.7 per 100,000 people in 2011, which is 2.6 times more than the Organisation for Economic Co-operation and Development (OECD) average and showing a two-fold increase from the last decade. It is now the fourth-most important reason of death after cancer, stroke and cardiovascular disease (Korea National Statistical Office).21 The World Health Organisation (WHO) declares that in the last 45 years suicide rates have grown by 60%. Suicide is considered as the most serious social issue in South Korea and it is increasing at a shocking rate since 1997. Young Korean generation is badly affected by suicide and it has become a major cause of their death. Suicide has become the second-most common cause of death in men aged 10 to 39 years, and the third in men of 40 to 49 years.25 It is also the second-most common regular cause of death in women aged 10 to 19 years, and the first in women aged 20 to 39 years. On average, men have a suicide rate that is twice as high as women.6 However, the suicide attempt rate is higher for women than men.26 Suicide is now one of three leading causes of death among the individuals aged 15 to 44 years of both sexes. Female suicidal attempt rate is higher than males as in Japan.

Suicide is the result of different serious issues, including job loss, collapse of family set-up, poverty, changes in tradition/custom and low economical position. A great downfall has been observed after the foreign exchange crises result in increased suicides in South Korea. Various reports stated that the Korean suicide rate is the one of the highest in developed countries. Suicides rates in South Korea have exceeded from those in Japan after 2000 mostly in elder people. This increase is due to the family system crashes and growing population aging.

In 2011, the suicide rate among people in their 70s was 84.4 per 100,000 people and 116.9 per 100,000 people among those in their 80s.27 The competitive and struggling environment, joblessness and feeling of shame or guilt is the reason for suicide to be a second option. In addition, mental disorders such as depression, schizophrenia and chemical abuse account for 90% of all suicides18



Within South Korea, the suicide rate varies in different groups, primarily by age, gender, and geographic regions. While multiple factors cause South Korea's high suicidal rate. Government initiatives and policies have attempted to alleviate the issue. Physical measures are also taken to prevent suicide. The government has reduced "access to lethal means of self-harm". As mentioned above in the methods, the government has reduced access to poisoning agents, monoxide from charcoal and train platforms. This helps to decrease the impulsive suicidal behaviour. Major factors causing suicide include poverty, family disputes, and deficiencies of religion, economic crashes, mental illness and drug abuse. To improve their lifestyle different strategies should be adopted, such as awareness about psychological disorders, financial supporting steps by the government, and providing basic facilities (education, health, electricity, roads, etc.) to common people so that migration towards cities can be reduced. In Japan, official steps taken in the last few years have helped reduce the rate of suicide."

Conflict of Interest: None.
Source of Funding: None.


1. Bottino SM, Bottino CM, Regina CG, Correia AV, Ribeiro WS. Cyberbullying and adolescent mental health: systematic review. Cadernos de Saude Publica 2015; 31: 463-75.
2. Gururaj G, Isaac MK, Subbakrishna DK, Ranjani R. Risk factors for completed suicides: a case-control study from Bangalore, India. Injury Control Safety Promotion 2004; 11: 183-91 (b) Wasserman D, Cheng Q, Jiang G. Global suicide rates among young people aged 15-19. World Psychiatry 2005; 4: 114-20 (c) Tang BS, Zhao GH, Luo W,  Xia K, Cai F, Pan Q, et al. Small heat-shock protein 22 mutated in autosomal dominant Charcot-Marie-Tooth disease type 2L. Hum Genet 2005; 116: 222-4.

3. Iemmi V, Bantjes J, Coast E, Channer K, Leone T, McDaid D, et al. Suicide and poverty in low-income and middle-income countries: a systematic review. Lancet Psychiatry 2016; 3: 774-83.

4. Barraclough B, Bunch J, Nelson B, Sainsbury P. A hundred cases of suicide: clinical aspects. Br J Psychiatry 1974; 125: 355-73 (b) Dorpat TL, Ripley HS. A study of suicide in the Seattle area. Comprehensive Psychiatry 1960; 1: 349-59 (c) Cao W, Wu T, An T, Li L. [Study on the mortality of injury in Chinese population in urban and rural areas from 1990 to 1997]. Zhonghua Liu Xing Bing Xue Za Zhi 2000; 21: 327-9.

5. Vijaykumar L. Suicide and its prevention: The urgent need in India. Indian J Psychiatry 2007; 49: 81-4.

6. Hawton K, Saunders KE, O'Connor RC. Self-harm and suicide in adolescents. Lancet 2012; 379: 2373-82.

7. Scocco P, Preti A, Totaro S, Ferrari A, Toffol E. Stigma and psychological distress in suicide survivors. J Psychosom Res 2017; 94: 39-46.

8. Chang B, Gitlin D, Patel R. The depressed patient and suicidal patient in the emergency department: evidence-based management and treatment strategies. Emerg Med Pract 2011; 13: 1-23; quiz 23-4.

9. Brent DA, Melhem N. Familial transmission of suicidal behavior. Psychiatr Clin North Am 2008; 31: 157-77.

10. Rozanov V, Carli V. Suicide among war veterans. Int J Environ Res Public Health 2012; 9: 2504-19.

11. Phillips MR, Li X, Zhang Y. Suicide rates in China, 1995-99. Lancet 2002; 359: 835-40.

12. Eddleston M, Phillips MR. Self poisoning with pesticides. BMJ 2004; 328: 42-4.

13. (a) Hirsch JK. A review of the literature on rural suicide: risk and protective factors, incidence, and prevention. Crisis 2006; 27: 189-99 (b) Judd F, Cooper AM, Fraser C, Davis J. Rural suicide--people or place effects? Aust N Z J Psychiatry 2006; 40: 208-16.

14. Ji J, Kleinman A, Becker AE. Suicide in contemporary China: a review of China's distinctive suicide demographics in their sociocultural context. Harvard Rev Psychiatry 2001; 9: 1-12.

15. Wu A, Wang JY, Jia CX. Religion and Completed Suicide: a Meta-Analysis. PloS One 2015; 10: e0131715.

16. Yoshioka E, Saijo Y, Kawachi I. An analysis of secular trends in method-specific suicides in Japan, 1950-1975. Population Health Metrics 2017; 15: 14.

17. Wang Y, Tang S, Xu S, Weng S, Liu Z. Association between diabetes and risk of suicide death: A meta-analysis of 3 million participants. Comprehensive Psychiatry 2016; 71: 11-6.

18. Koyama A, Fujise N, Matsushita M, Ishikawa T, Hashimoto M, Ikeda M. Suicidal ideation and related factors among dementia patients. J Affect Disord 2015; 178: 66-70.

19. Baquero M, Martin N. Depressive symptoms in neurodegenerative diseases. World J Clin Cases 2015; 3: 682-93.

20. Kawabe K, Horiuchi F, Ochi M, Oka Y, Ueno S. Suicidal ideation in adolescents and their caregivers: a cross sectional survey in Japan. BMC Psychiatry 2016; 16: 231.

21. Kim GM, Kim JW, Kim JH. Current state of research on youth depression and suicide prevention. J Korean Med Assoc 2012; 55: 356-61.

22. Onishi K. Risk Factors and Social Background Associated with Suicide in Japan: A Review. Jpn Hosp 2015;  34: 35-50.

23. Chang SS, Gunnell D, Sterne JA, Lu TH, Cheng AT. Was the economic crisis 1997-1998 responsible for rising suicide rates in East/Southeast Asia? A time-trend analysis for Japan, Hong Kong, South Korea, Taiwan, Singapore and Thailand. Social Sci Med 2009: 68; 1322-31. (b) Kim SY, Kim MH, Kawachi I, Cho Y. Comparative epidemiology of suicide in South Korea and Japan: effects of age, gender and suicide methods. Crisis 2011; 32: 5-14.

24. Russell R, Metraux D, Tohen M. Cultural Influences on Suicide in Japan. Psychiatry Clin Neurosci 2017; 71: 2-5

25. Shin HY, Hwang HJ. Mental Health of the People with Hearing Impairment in Korea: A Population-Based Cross-Sectional Study. Korean J Fam Med 2017; 38: 57-63.

26. Khang YH, Lynch JW, Kaplan GA, Health inequalities in Korea: age- and sex-specific educational differences in the 10 leading causes of death. Int J Epidemiol 2004; 33: 299-308.

27. Lee WY, Khang YH, Noh M, Ryu JI, Son M, Hong YP. Trends in Educational Differentials in Suicide Mortality between 1993 - 2006 in Korea. Yonsei Med J 2009; 50: 482-92.



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