Exploring Drug Use and Healthcare Utilization Among Adult Suicide Attempters: A Decision Tree Approach Using National Survey Data.

Background: Korea has one of the highest suicide rates among OECD countries, ranking first for several consecutive years, with a rate of approximately 24 deaths per 100,000 population. Understanding the association between prescription drugs and suicide attempts is crucial for developing effective suicide prevention and management strategies. This study analyzed Health Insurance Review and Assessment Service data to identify medical events preceding suicide attempts and to construct a classification model of prescribed medications using decision tree analysis. Methods: This secondary data study analyzed 1264 adult suicide attempters aged 20 to 59 years who were recruited from a pilot project for postmanagement in emergency departments conducted from March 2021 to March 2023, which may limit the generalizability of the findings. Claims data from the Health Insurance Review and Assessment Service were extracted using the specific item codes, and the drug details were obtained from the Ministry of Food and Drug Safety's pharmaceutical classification table 100-890. Results: Of the total subjects, 65% were female and 35% male, with the highest proportion aged 20-29 years. Medications prescribed prior to suicide attempts were analyzed according to age-specific prescription patterns, with a focus on the types and classes of drugs prescribed. The classification model revealed age-specific patterns, with psychotropic medications emerging as major predictors across all age groups. These models included psychotropic medications, digestive ulcer drugs, antipyretic and analgesic agents, anticonvulsants, and respiratory system drugs, with respiratory medications emerging as the most crucial variable. In the 50s, psychotropic medications-particularly hypnotics and sedatives-appeared in all four pathways. Among these, zolpidem was most commonly prescribed for insomnia, underscoring the strong link between sleep disturbance and suicide risk. Of particular concern, nearly nine out of 10 suicide attempters were prescribed at least one medication carrying suicide-related warnings or contraindications, as noted by the Ministry of Food and Drug Safety and the U.S. Food and Drug Administration. Conclusion: The results highlight differences in healthcare utilization and prescribed medication patterns by age group among suicide attempters. Implications for nursing management: These results can be used as foundational data for considering suicide risk during nursing assessment and diagnosis of general and psychiatric patients and developing specialized nursing strategies and management.