Suicidal ideation and suicide attempts in chronic obstructive pulmonary disease: The Korea National Health and Nutrition Examination Survey (KNHANES IV, V) from 2007–2012

There is good evidence for an association between chronic obstructive pulmonary disease (COPD) and depression, but there are few studies on the relationship between COPD and suicidal ideation/suicidal attempts. To evaluate the mental health of patients with COPD in Korea and to compare it with that of the general population. We analysed data of 15,718 subjects (age ⩾40 years) who participated in the 2007–2012 Korea National Health and Nutrition Examination Survey. COPD was defined according to the Global Initiative for Chronic Obstructive Lung Disease (GOLD) criteria for people aged ⩾40 years. We compared the mental health outcomes of 2,506 patients with COPD (2,355 GOLD stages I and II; 151 GOLD stages III and IV) with those of 13,212 controls. Suicidal thoughts were reported by 16.0% of patients in stages I and II, by 23.8% of those in stages III and IV and by 15.7% of controls (P=0.023). Suicidal attempts were reported by 0.6% of patients in stages I and II, by 2.6% of those in stages III and IV and by 1.0% of controls (P=0.019). The crude odds ratio (OR) for suicidal ideation in those in stages III and IV was 1.68 (95% confidence interval (CI), 1.16–2.46), and the OR for suicidal attempts in stages III and IV was 2.83 (95% CI, 1.03–7.75). In multivariate analysis, the OR for suicidal ideation in stages III and IV was 1.67 (95% CI, 1.12–2.49) and that for suicidal attempts was 2.94 (95% CI, 1.03–8.31). GOLD stages III and IV COPD were associated with a marked increase in suicidal behaviour. Korean researchers have reported that severe chronic obstructive pulmonary disease (COPD) is associated with increased suicidal behavior. Previous studies have consistently shown links between COPD and depression, which is the strongest risk factor for suicide. A team led by Chang Hoon Han at the National Health Insurance Service Islan Hospital, used data from the 2007–2012 Korea National Health and Nutrition Examination Survey to explore the relationship between COPD and suicidal behavior in 2,506 patients with COPD and 13,212 control subjects. In mental health assessment surveys, 23.8% of patients with severe COPD reported having suicidal thoughts and 2.6% reported suicide attempts, compared with 15.7% and 1% of controls, respectively. These data indicate that patients with severe COPD are at a significantly higher risk of suicide than the general population of South Korea.