{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,21]],"date-time":"2026-08-21T13:15:52Z","timestamp":1787318152010,"version":"build-2736575974"},"reference-count":32,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2023,5,30]],"date-time":"2023-05-30T00:00:00Z","timestamp":1685404800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100002476","name":"Eulji University","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100002476","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Public Health"],"abstract":"<jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>This study aimed to examine whether and to what degree the suicide risk of psychiatric patients is associated with psychiatric and non-psychiatric health service utilization.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We selected incident psychiatric patients, including schizophrenia, bipolar disorders, borderline personality disorder, depressive disorders, other affective disorders, and post-traumatic stress disorder patients, in 2007\u20132010 and followed them up until 2017 based on the data linkage between the Korean National Health Insurance and National Death Registry. We analyzed the time-dependent association between suicide and four types of health service (psychiatric vs. non-psychiatric and outpatient vs. inpatient) utilization using a time-dependent Cox regression.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      The suicide risk of psychiatric patients was significantly increased with recent psychiatric and non-psychiatric admission and psychiatric outpatient visits. The adjusted suicide hazard ratios for recent outpatient visits were similar to or even higher than those for recent psychiatric admission. The adjusted suicide hazard ratios of schizophrenia patients for psychiatric admission, psychiatric outpatient visits, and non-psychiatric admission within the recent 6 months were 2.34 (95% confidence interval [CI]: 2.12\u20132.58,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&amp;lt;\u20090.001), 2.96 (95% CI: 2.65\u20133.30,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&amp;lt;\u20090.001), and 1.55 (95% CI: 1.39\u20131.74,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&amp;lt;\u20090.001), respectively. Suicide risk was not associated with recent non-psychiatric outpatient visits in patients, except for the depressive disorders group showing a negative association.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Our results highlight the priority of suicide prevention for psychiatric patients in the clinical setting. Additionally, our results warrant the precaution against increased suicide risk of psychiatric patients after psychiatric and non-psychiatric discharge.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fpubh.2023.1118135","type":"journal-article","created":{"date-parts":[[2023,5,30]],"date-time":"2023-05-30T04:53:33Z","timestamp":1685422413000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":7,"title":["Increased suicide risk of psychiatric patients following the recent utilization of health care services: results from a nationwide cohort study in South Korea"],"prefix":"10.3389","volume":"11","author":[{"given":"Ju-Mi","family":"Lee","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Junhee","family":"Lee","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jiseun","family":"Lim","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Soonjoo","family":"Park","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Myung","family":"Ki","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jiwon","family":"Kang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2023,5,30]]},"reference":[{"key":"ref1","year":""},{"key":"ref2","year":""},{"key":"ref3","year":"2020"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"8","DOI":"10.1016\/j.jad.2018.01.019","article-title":"Ten-year prediction of suicide death using cox regression and machine learning in a nationwide retrospective cohort study in South Korea","volume":"231","author":"Choi","year":"2018","journal-title":"J Affect Disord"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"90","DOI":"10.1177\/0030222817715756","article-title":"Suicide trends according to age, gender, and marital status in South Korea","volume":"79","author":"Kim","year":"2019","journal-title":"OMEGA-J Death Dying"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"258","DOI":"10.1016\/j.je.2016.06.008","article-title":"Suicide rates across income levels: retrospective cohort data on 1 million participants collected between 2003 and 2013 in South Korea","volume":"27","author":"Lee","year":"2017","journal-title":"J Epidemiol"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"16","DOI":"10.1016\/j.jad.2016.01.021","article-title":"Age\u2013period\u2013cohort analysis of the suicide rate in Korea","volume":"194","author":"Park","year":"2016","journal-title":"J Affect Disord"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"1580","DOI":"10.3390\/ijerph15081580","article-title":"Age, period, and cohort effects on suicide mortality in South Korea, 1992\u20132015","volume":"15","author":"Park","year":"2018","journal-title":"Int J Environ Res Public Health"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"835","DOI":"10.3346\/jkms.2017.32.5.835","article-title":"Mortality in schizophrenia and other psychoses: data from the South Korea national health insurance cohort, 2002\u20132013","volume":"32","author":"Kim","year":"2017","journal-title":"J Korean Med Sci"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"731","DOI":"10.1176\/appi.ajp.2010.10040589","article-title":"Rethinking the role of mental illness in suicide","volume":"167","author":"Phillips","year":"2010","journal-title":"Am Psychiatric Assoc"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"749","DOI":"10.1192\/bjp.161.6.749","article-title":"Suicide in psychiatric patients: risk and prevention","volume":"161","author":"Appleby","year":"1992","journal-title":"Br J Psychiatry"},{"key":"ref12","doi-asserted-by":"publisher","first-page":"261","DOI":"10.1192\/bjp.182.3.261","article-title":"Suicide prevention: a study of patients' views","volume":"182","author":"Eagles","year":"2003","journal-title":"Br J Psychiatry"},{"key":"ref13","doi-asserted-by":"publisher","first-page":"1119","DOI":"10.1001\/jamapsychiatry.2016.2035","article-title":"Short-term suicide risk after psychiatric hospital discharge","volume":"73","author":"Olfson","year":"2016","journal-title":"JAMA Psychiat"},{"key":"ref14","doi-asserted-by":"publisher","first-page":"377","DOI":"10.1177\/070674370805300607","article-title":"Contact of mental and nonmental health care providers prior to suicide in Taiwan: a population-based study","volume":"53","author":"Lee","year":"2008","journal-title":"Can J Psychiatry"},{"key":"ref15","doi-asserted-by":"publisher","first-page":"190","DOI":"10.1007\/s001270200014","article-title":"Association between physical illness and suicide among the elderly","volume":"37","author":"Quan","year":"2002","journal-title":"Soc Psychiatry Psychiatr Epidemiol"},{"key":"ref16","doi-asserted-by":"publisher","first-page":"265","DOI":"10.1136\/bmj.325.7358.265","article-title":"Functional somatic symptoms and syndromes","volume":"325","author":"Mayou","year":"2002","journal-title":"BMJ"},{"key":"ref17","doi-asserted-by":"publisher","first-page":"1130","DOI":"10.1097\/01.mlr.0000182534.19832.83","article-title":"Coding algorithms for defining comorbidities in ICD-9-CM and ICD-10 administrative data","volume":"43","author":"Quan","year":"2005","journal-title":"Med Care"},{"key":"ref18","doi-asserted-by":"publisher","first-page":"1357","DOI":"10.1007\/s00127-014-0860-x","article-title":"Risk of suicide according to level of psychiatric treatment: a nationwide nested case\u2013control study","volume":"49","author":"Hjorth\u00f8j","year":"2014","journal-title":"Soc Psychiatry Psychiatr Epidemiol"},{"key":"ref19","doi-asserted-by":"publisher","first-page":"694","DOI":"10.1001\/jamapsychiatry.2017.1044","article-title":"Suicide rates after discharge from psychiatric facilities: a systematic review and meta-analysis","volume":"74","author":"Chung","year":"2017","journal-title":"JAMA Psychiat"},{"key":"ref20","doi-asserted-by":"publisher","first-page":"427","DOI":"10.1001\/archpsyc.62.4.427","article-title":"Suicide risk in relation to psychiatric hospitalization: evidence based on longitudinal registers","volume":"62","author":"Qin","year":"2005","journal-title":"Arch Gen Psychiatry"},{"key":"ref21","doi-asserted-by":"publisher","first-page":"287","DOI":"10.1016\/j.jad.2019.03.079","article-title":"Suicide risk after discharge from psychiatric care in South Korea","volume":"251","author":"Choi","year":"2019","journal-title":"J Affect Disord"},{"key":"ref22","doi-asserted-by":"publisher","first-page":"20423","DOI":"10.4088\/JCP.18m12172","article-title":"Suicide immediately after discharge from psychiatric inpatient care: a cohort study of nearly 2.9 million discharges","volume":"80","author":"Haglund","year":"2019","journal-title":"J Clin Psychiatry"},{"key":"ref23","doi-asserted-by":"publisher","first-page":"1266","DOI":"10.1176\/appi.ajp.2011.10111704","article-title":"The Columbia\u2013suicide severity rating scale: initial validity and internal consistency findings from three multisite studies with adolescents and adults","volume":"168","author":"Posner","year":"2011","journal-title":"Am J Psychiatr"},{"key":"ref24","doi-asserted-by":"publisher","first-page":"347","DOI":"10.1016\/j.schres.2018.06.025","article-title":"Service utilization and suicide among people with schizophrenia spectrum disorders","volume":"202","author":"Zaheer","year":"2018","journal-title":"Schizophr Res"},{"key":"ref25","doi-asserted-by":"publisher","first-page":"105796","DOI":"10.1016\/j.ypmed.2019.105796","article-title":"Variation in patterns of health care before suicide: a population case-control study","volume":"127","author":"Ahmedani","year":"2019","journal-title":"Prev Med"},{"key":"ref26","doi-asserted-by":"publisher","first-page":"922","DOI":"10.1016\/S2215-0366(22)00232-2","article-title":"Assessment of suicide risk in mental health practice: shifting from prediction to therapeutic assessment, formulation, and risk management. The lancet","volume":"9","author":"Hawton","year":"2022","journal-title":"Psychiatry"},{"key":"ref27","doi-asserted-by":"publisher","first-page":"181","DOI":"10.1016\/j.jad.2012.09.001","article-title":"Age and gender differences in medical care utilization prior to suicide","volume":"146","author":"Cho","year":"2013","journal-title":"J Affect Disord"},{"key":"ref28","doi-asserted-by":"publisher","first-page":"480","DOI":"10.1007\/s00406-007-0751-1","article-title":"Suicide victims\u2019 contacts with physicians during the year before death","volume":"257","author":"Deisenhammer","year":"2007","journal-title":"Eur Arch Psychiatry Clin Neurosci"},{"key":"ref29","doi-asserted-by":"publisher","first-page":"226","DOI":"10.1016\/j.jpsychires.2022.02.024","article-title":"Contact with the health care system prior to suicide: a nationwide population-based analysis using linkage national death certificates and national health insurance data","volume":"149","author":"Park","year":"2022","journal-title":"J Psychiatr Res"},{"key":"ref30","doi-asserted-by":"publisher","first-page":"230","DOI":"10.1016\/j.jpsychires.2021.01.035","article-title":"Health care utilization prior to suicide in adults with drug use disorders","volume":"135","author":"Crump","year":"2021","journal-title":"J Psychiatr Res"},{"key":"ref31","doi-asserted-by":"publisher","first-page":"e0214605","DOI":"10.1371\/journal.pone.0214605","article-title":"Frequency of health care utilization in the year prior to completed suicide: a Danish nationwide matched comparative study","volume":"14","author":"Schou Pedersen","year":"2019","journal-title":"PLoS One"},{"key":"ref32","year":"2018"}],"container-title":["Frontiers in Public Health"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2023.1118135\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,5,30]],"date-time":"2023-05-30T04:53:36Z","timestamp":1685422416000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2023.1118135\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,5,30]]},"references-count":32,"alternative-id":["10.3389\/fpubh.2023.1118135"],"URL":"https:\/\/doi.org\/10.3389\/fpubh.2023.1118135","relation":{},"ISSN":["2296-2565"],"issn-type":[{"value":"2296-2565","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,5,30]]},"article-number":"1118135"}}