Nationwide Patterns and Predictors of In-Hospital Suicide and Self-Harm in Korea: A Registry-Based Study Using the Korea Patient Safety Reporting and Learning System.

Background: Suicide and self-harm in hospitals are critical yet under-recognized threats to patient safety. Previous studies have focused on psychiatric inpatients, leaving a knowledge gap regarding suicide risk in the general medical population. The present study compared in-hospital suicide and self-harm incidents reported on the Korea Patient Safety Reporting and Learning System (KOPS), focusing on differences within the category of intentional self-injury, to identify distinct clinical and environmental predictors. Methods: We analyzed 447 in-hospital suicide and self-harm cases reported to the KOPS between 2016 and 2020. Demographic, clinical, temporal, and environmental characteristics were compared using chi-squared tests. Multivariate logistic regression analysis identified the predictors that distinguished suicide from self-harm. Results: Among the 447 cases, 147 were suicides and 300 were self-harm incidents. Absence of a psychiatric diagnosis (odds ratio [OR] 5.12, 95% confidence interval [CI]: 3.01-8.71), time of incident (evening: OR 2.22, 95% CI: 1.17-4.19; nighttime: OR 2.27, 95% CI: 1.12-4.63), and location (inpatient room: OR 4.06, 95% CI: 1.61-10.30) distinguished suicide from self-harm. Patients without a psychiatric diagnosis were at a higher risk of suicide, and suicides were significantly more likely to occur during the evening and nighttime hours and in private spaces, such as hospital rooms. These patterns persist across diverse hospital types, including general and long-term care facilities. Conclusion: There is a substantial risk of in-hospital suicide among patients without formal psychiatric diagnoses during off-hours in private spaces. Universal suicide risk screening, enhanced monitoring during high-risk periods, and environmental safety interventions are necessary in all hospitals.