Predictors of Post-Attempt Follow-up Service Utilization Among Patients Presenting to the Emergency Department after a Suicide Attempt

Background: South Korea’s suicide rate has risen to 29.1 per 100,000 in 2024, among the highest in OECD countries. Persistently high suicide rates are associated with substantial socioeconomic costs. In response, the South Korean government has implemented comprehensive suicide prevention policies since 2011 and has operated an emergency department–based post-suicide attempt follow-up service (PAFS) since 2013 to prevent suicide reattempts and improve continuity of care, ultimately contributing to the reduction of suicide mortality. However, despite more than a decade of implementation, the utilization rate of PAFS remains at approximately 50%, and the national suicide rate has not declined substantially. While follow-up services have been shown to be effective in preventing suicide reattempts, their overall impact may be constrained by limited utilization. Accordingly, this study aims to identify predictors of PAFS utilization among patients presenting to the emergency department after a suicide attempt, based on Andersen's Behavioral Model, in order to inform strategies for enhancing service uptake.

Method: A retrospective analysis was conducted using electronic medical records from the emergency department of a university hospital in Gyeonggi Province, South Korea, which participates in the emergency department–based PAFS. The medical records of 300 consecutive patients of all ages who presented after suicide attempts between January and December 2024 were reviewed.Logistic regression analysis was conducted to identify predictors of PSAFS utilization based on Andersen’s Behavioral Model, including predisposing factors (age, gender); enabling factors (disability status, insurance type, multidisciplinary approach, presence of an accompanying person); and need factors (alcohol intoxication at presentation, current suicide plan, and past suicide plan).

Results: The results indicated that enabling factors (multidisciplinary approach and presence of an accompanying person) and need factors (alcohol intoxication at presentation and past suicide plan) were significant predictors of PAFS utilization. Specifically, patients who received multidisciplinary intervention involving both a psychiatrist and a social worker were more likely to utilize PAFS than those who did not (OR = 2.19, p < .05). Likewise, patients who were accompanied by someone at the time of presentation were 3.35 times more likely to engage in follow-up services than those who presented alone (OR = 3.35, p < .05). Among need factors, patients who presented under the influence of alcohol were 2.97 times more likely to utilize PAFS (OR = 2.97, p < .05), and those with a history of suicide planning were 2.49 times more likely to utilize PAFS (OR = 2.49, p < .05).

Implication: These findings suggest that PAFS utilization is associated with readily observable need factors and enabling conditions that facilitate service linkages. In particular, visible clinical indicators (e.g., alcohol intoxication and a history of suicide plan) may signal immediate need, whereas supportive contexts, such as an accompanying person and multidisciplinary involvement, may enhance utilization. Therefore, future efforts should consider using these observable factors to support the identification and linkage of patients to PAFS while strengthening multidisciplinary approaches to improve follow-up service utilization.