Limiting antidepressant prescriptions and suicide risk: Evidence from South Korea

South Korea has the highest suicide rate in the Organization for Economic Co-operation and Development (OECD). In 2002, the Ministry of Health and Welfare of South Korea implemented a policy limiting antidepressant prescriptions to 60 days in non-psychiatric clinics, aiming to prevent drug misuse. This study examines how this policy affected suicidal thoughts and attempts among patients with chronic disease. We use patients with chronic conditions, because they frequently receive antidepressants in non-psychiatric clinics, making them more vulnerable to these prescription limits. We use two approaches. First, a synthetic control method with country-level data shows a significant increase in suicide rates in South Korea following the policy compared to synthetic counterparts. Second, a difference-in-differences analysis with individual-level data shows a 0.4 percentage point increase in suicide attempts among those with chronic disease, and a 2.2 percentage point increase among those who also reported suicidal thoughts. These correspond to 36% and 51% increases relative to their pre-policy baselines. The analysis reveals that the policy's intention-to-treat effects on suicidal behaviors vary across demographic groups, with larger effects observed among divorced individuals, those with lower levels of education, and individuals in lower income quartiles. These findings point to the potential unintended consequences of restrictions on antidepressant prescriptions that can lead to adverse health outcomes among vulnerable population.