Trauma Patterns and Psychiatric Profiles in Suicide Attempts at a Regional Trauma Center in South Korea: A Retrospective Single-Center Study

Abstract

Background/Objective: South Korea continues to have the highest suicide rate among the Organization for Economic Co-operation and Development (OECD) countries, with a growing number of emergency department (ED) admissions related to self-harm and suicide attempts. However, trauma-focused analyses that integrate psychiatric profiles and suicide mechanisms remain limited, hindering effective clinical care and preventive strategies. Methods: This retrospective study analyzed trauma patients who presented to the ED of Wonju Severance Christian Hospital following suicide attempts between October 2015 and December 2023. Of 305 self-harm cases, 208 survivors who underwent psychiatric evaluation were included. The variables analyzed included the mechanism, site, and severity of injury (ISS and AIS); psychiatric diagnosis and prior psychiatric history; repeated suicide attempts; alcohol use; physical pain; interpersonal conflict; and economic vulnerability. Chi-square, Fisher's exact, and Kruskal-Wallis' tests were used for statistical comparisons. Results: Stabbing/cutting (56.7%) and falling (35.6%) were the most common attempts. Mood disorders were the predominant psychiatric diagnosis (63.9%), followed by adjustment disorders (26.0%), alcohol use (25.5%), and psychotic disorders (22.1%). Among the fall-related cases, patients were typically younger and predominantly women. The median ISS was highest in fall-related cases (17) compared with stabbing/cutting (4), with 25.96% of patients with an ISS ≥16, indicating severe trauma. A psychiatric history was associated with a higher incidence of falls (44.3%), and previous suicide attempts correlated with the use of high-lethality attempts. Severe physical pain was linked to stabbing/cutting in 10 of 11 cases. Interpersonal conflict was more frequently associated with stabbing/cutting (59.6%) than with falls (31.9%). No significant association was found between alcohol use and the method of suicide attempt. Conclusions: The suicide mechanisms in patients with trauma are closely associated with psychiatric and psychosocial factors. Stabbing/cutting is often impulsive and driven by interpersonal conflict or alcohol use, while falling is more frequent in patients with psychiatric histories of repeated attempts. These findings emphasize the importance of mechanism-informed psychiatric evaluations and trauma protocols. Regionally adapted, interdisciplinary approaches and early psychiatric intervention are crucial for effective post-attempt management and suicide prevention.

Keywords: emergency department; method of self-harm; psychiatric diagnoses; suicide attempts; trauma patients.

Figure 1

Proportion of suicide mechanisms by main psychiatric diagnosis received after admission.

Figure 2

Proportion of suicide mechanisms by previous psychiatric diagnosis (p < 0.05).

Figure 3

Proportion of suicide mechanisms by severe physical pain (p = 0.0948).

Figure 4

Proportion of suicide mechanisms by previous suicide attempt (p = 0.1279).

Figure 5

Proportion of suicide mechanisms by conflict with others prior to suicidal attempt (p = 0.7869).