Impact of traditional Korean medicine on suicide prevention in depression: A nationwide 10-year follow-up study

초록

Background and aim: South Korea has the highest suicide rate among Organization for Economic Cooperation and Development countries, with major depressive disorder being a key predictor of suicide risk. Given the country's unique dual medical system integrating Western medicine and traditional Korean medicine (TKM), this study investigated the impact of TKM utilization on suicide rates and depression outcomes in patients with depression. Experimental procedure: We conducted a nationwide retrospective cohort study using the Korean National Health Insurance Service database, analyzing adults newly diagnosed with depression between 2007 and 2008 and followed for up to 10 years. After propensity score matching, 916 TKM users (>13 visits within 180 days of diagnosis) and 916 non-TKM users were included. Primary outcome was death by suicide; secondary outcomes included worsening depression measured by suicide, inpatient services, or tertiary hospital services. We applied the Fine-Gray model to estimate sub-distribution hazard ratios (SHR) with 95 % confidence intervals (CIs). Results and conclusion: Over 5 and 10 years, 182 (9.9 %) and 314 (17.1 %) patients showed worsening depression, with small, non-significant reductions in TKM users (5-years SHR 0.962, 95 % CI 0.727-1.27; 10-years SHR 0.869, 95 % CI 0.697-1.08). Suicide incidences were low, with no significant difference (5-years SHR 1.00, 95 % CI 0.25-4.01; 10-years SHR 0.666, 95 % CI 0.236-1.88). TKM utilization was not significantly associated with reduced suicide rates or depression worsening. These findings highlight the need for enhanced mental health training in TKM practices and integrated care approaches.

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