Factors Influencing Suicidal Ideation Among Korean Adults by Age: Results of the 2010-2011 Korean Health and Nutrition Examination Survey

Effects of metabolic syndrome and obesity on suicidality in individuals with bipolar disorder

BACKGROUND

The prevalence of metabolic syndrome and overweight/obesity is increased in bipolar disorder (BD) compared to the general population and is related to suicidality. The aim of this study was to examine the association between both the rate of suicidal ideation and suicide attempts and metabolic variables in individuals with BD.

METHODS

Anthropometric measures, socio-demographic data, suicide history and serum lipid levels were measured in 215 individuals with BD. Individuals were divided into normal weight, overweight and obese according to their body mass index (BMI), and metabolic syndrome was assessed using "The International Diabetes Federation"-criteria.

RESULTS

Of the 215 individuals studied, 80.9% reported suicidal ideation, 35.3% reported at least one suicide attempt and 30.7% were diagnosed with metabolic syndrome. Both metabolic syndrome and BMI were not related to suicide attempts. However, individuals with normal weight had more suicidal ideation than overweight individuals, while obese individuals did not differ from either group. Furthermore, there was no association between suicide attempts or suicidal ideation and serum lipid levels.

LIMITATIONS

The cross-sectional design of the study, a non-standardized questionnaire for suicidality, and not controlling the medication intake are limiting factors.

CONCLUSION

Contrary to expectations, a difference was found in the BMI categories and suicidal ideation, but not suicide attempts. Serum lipid levels were found to be unsuitable as possible biomarkers for suicidality in individuals with BD. Special attention should be paid to suicidal ideation and BMI rather than metabolic syndrome or lipid values when treating suicidal individuals with BD.

Factors Related to Suicidal Ideation and Prediction of High-Risk Groups among Youngest-Old Adults in South Korea

(1) Background: The suicide of older adults shows different factors between the youngest-old adults and the old-old adults. This study aimed to identify factors predicting suicidal ideation among youngest-old adults (ages 65 to 74 years) and predict high-risk groups’ characteristics. (2) Methods: The subjects of this study were 970 youngest-old adults who participated in the Korean National Health and Nutrition Examination Survey (KNHANES VIII Year 1, 2019). Logistic regression analysis identified factors related to suicidal ideation, and decision tree analysis identified combined characteristics among high-risk groups. Data were analyzed using SPSS 27.0. (3) Results: Suicidal ideation became more common among those with relatively lower income levels (OR = 1.48, 95% CI = 1.04−2.12), those whom had experienced depression (OR = 9.28, 95% CI = 4.57−18.84), those with relatively higher stress levels (OR = 2.42, 95% CI = 1.11−5.28), and those reporting a relatively worse perceived health (OR = 1.88, 95% CI = 1.23−3.11). Complex characteristics that combined depression, low personal income level, and low perceived health predicted a high risk of suicidal ideation (64.6%, p < 0.05). (4) Conclusions: The findings indicate that this high-risk group should be prioritized when developing suicide prevention strategies.

Socioeconomic factors associated with suicidal behaviors in South Korea: systematic review on the current state of evidence

Background

The economic and human costs of suicide to individuals, families, communities, and society make suicide a major public health problem around the world. Suicide rates in South Korea are among the highest in the world. This paper is the first systematic review investigating socioeconomic risk factors for suicidal behaviors (suicidal ideation, attempted suicides, and completed suicides) in South Korea.

Methods

We performed a systematic review in Medline and Web of Science. Empirical studies and peer-reviewed articles on the association between individual socioeconomic factors and suicidal behaviors have been included. A total of 53 studies were included in a descriptive synthesis.

Results

Overall, 35 studies focused on the association between individual socioeconomic factors and suicidal ideation, 16 were related to suicide attempts, while 10 addressed completed suicides. Low income, unemployment, and financial difficulties were identified as risk factors for all suicidal behaviors. Working in precarious conditions, long working hours, self-employment, changes in employment status, shift work/night-time work, and occupational stress were associated with an increased risk for suicidal ideation. Low educational attainment appears to increase the risk for suicide attempts and completed suicide, but the significance of educational attainment on the reporting of suicidal ideation could not be verified. The primary studies were unable to ascertain whether the place of residence impacts on suicidal behaviors.

Conclusions

The results highlight the relevance of socioeconomic factors for suicidal behaviors in South Korea. Governmental social spending must be increased and redirected more efficiently so that the economically most vulnerable groups are financially protected and income inequality does not widen. Furthermore, comprehensive prevention strategies at the community level are needed. Future research needs to focus on identifying vulnerable groups for whom the effects of low socioeconomic status may have particularly serious consequences with regard to suicidal behaviors.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-022-12498-1.

Psychological Strain and Suicidal Behaviors Among Medical Students in Northwest, China: The Mediating Effect of Psychological Distress and Hopelessness

ABSTRACT

Although most studies have shown the psychological strains associated with increased risk of suicidal behaviors, how psychological strains are linked to suicidal behaviors is still unclear. The current study examines the possible mediation effect of psychological distress and hopelessness on the relationship between psychological strains and suicidal behaviors among Chinese medical college students. A cross-sectional survey was conducted from November 2017 to March 2018 involving 5703 medical college students, and the 12-month prevalence of suicidal behaviors was 12.89%. Psychological strains significantly associated with suicidal behaviors, and psychological distress and hopelessness partially explained this relationship. A positive psychological intervention program is needed to buffer the psychological strains, which is a crucial predictor for suicidal behaviors among Chinese medical college students.

Childhood adversity predicted suicidal ideation in older age: Results from a National Survey in Korea

Objectives: Suicide is a major mental health concern in South Korea, where a rapid increase in suicide rates among older adults is evident. This study aims to understand the association of childhood adversity with suicidal ideation in later life, and whether gender differences in the effects of childhood adversity exist.Method: The sample consisted of older adults aged 60 years and more in six waves of the Korea Welfare Panel Study from 2012 to 2017 (N = 4,105). A mixed effect logistic regression with random intercept was used to test the effects of childhood adversity on the risk of 12-month suicidal ideation.Results: After controlling for socioeconomic status, psychosocial resources, and health conditions, the mixed effect models using longitudinal data indicated that parental death predicted an increased risk of suicidal ideation and that a greater number of childhood adversities predicted a higher likelihood of suicidal ideation. No gender differences were found in the effects of childhood adversity on suicidal thoughts.Conclusion: These findings support a life course perspective, highlighting the importance of assessing early life disadvantages to understand suicidal ideation among older adults. The findings suggest that interventions targeting older adults who experienced parental death in childhood or multiple adversities may be effective in preventing suicidal ideation.

Demoralization and Its Relationship with Depression and Hopelessness in Suicidal Patients Attending an Emergency Department

Emergency departments (EDs) play an increasingly crucial role in the management of patients with suicidal behavior (SB). Demoralization has been associated with SB in various populations and conditions, but little is known about the effect of this construct in SB patients who attend an ED. Therefore, a more inclusive SB assessment which considers the demoralization construct could be useful in clinical practice. The main aim of this study was to assess the presence and severity of demoralization in patients visiting EDs for SB. Secondly, the maintenance of the relationship between demoralization and SB after controlling for depression and the proportion of variance which accounted for hopelessness was investigated. A cross-sectional study of patients (N = 199) visiting an ED for SB was performed, which examined the role of demoralization, hopelessness, and depression on suicidal ideation (SI) and suicide attempts (SAs). Demoralization was strongly and positively correlated with SI. Demoralization was related to major depressive episodes, but it was confirmed to be a different and, probably, more sensitive construct for SB, validating its specificity in relation to depression. Hopelessness accounted for a small portion of the variance in SI, compared to demoralization. Formal support for the association of demoralization with SI was provided. Demoralization can improve SB assessment in EDs, particularly among patients whose suicide risk can be unnoticed. Furthermore, demoralization represents a clinically useful concept to increase comprehension of the suffering of the suicidal patient and a possible target for psychotherapeutic interventions.

Characteristics of the "young-old" and "old-old" community-dwelling suicidal Ideators: A longitudinal 6-month follow-up study

BACKGROUND

Despite heterogeneity of older people in suicidal behavior, research identifying characteristics by age groups is scarce. We examined baseline features of older community-dwelling suicidal ideators by dichotomized age groups and the 6-month trajectory of their suicidal ideation along with its related psychopathology. Predictors of suicidal ideation within each group were investigated.

METHODS

Older community-dwelling suicidal ideators enrolled in the Korean Cohort for the Model Predicting a Suicide and Suicide-related Behavior study were subdivided into the "young-old (65-74 years)" and "old-old (≥75 years)" group. Baseline, 1-, and 6-month assessments were compared. Within each group, multiple regression analysis using rating scales (Patient Health Questionnaire-9, Beck Anxiety Inventory, Alcohol Use Disorders Identification Test, Stress Questionnaire for Korean National Health and Nutrition Examination Survey-Short Form, and Social Relationships Scale) was conducted to identify predictors of suicidal ideation measured with the intensity subscale of the Columbia-Suicide Severity Rating Scale. Two-way repeated-measures analysis of variance (RM-ANOVA) was used to compare changes in suicidal ideation, depression, anxiety between age groups over time, and one-way RM-ANOVA to examine changes within each age group.

RESULTS

Among 29 "young-old" and 53 "old-old" ideators, the latter were less likely to be receiving psychiatric treatment (odds ratio [OR] = 4.065) and make suicide attempts (OR = 2.874), whereas the former revealed greater levels of anxiety and stress. Baseline depression and stress in the "young-old" group and the "old-old" group, respectively, predicted the intensity of suicidal ideation at both baseline and 1-month assessments. No significant age group x time interactions on suicidal ideation and depression were found. However, within each age group, both suicidal ideation and depression significantly decreased only during the first month with no further improvement.

CONCLUSION

We speculate cautiously that more attention may need to be paid to the "old-old" ideators in the evaluation of psychiatric issues and for referral to psychiatrists. To decrease suicidal ideation, tailored approaches involving proactive, timely management of depression in the "young-old" and interventions focusing on stress reduction in the "old-old," would be helpful.

Association between socioeconomic attainments and suicidal ideation by age groups in Korea

BACKGROUND:

Suicidal ideation is a strong antecedent of suicidal behavior, associated with increased likelihood of suicide. Thus, suicidal ideation serves to identify which groups are at more risk of suicide and has policy implications for targeting groups to prevent suicide.

AIMS:

A substantial body of research has addressed potential determinants of suicide ideation in Korea. Little attention has been paid, however, to analyzing the extent to which socioeconomic attainments (education, household income, and employment status) are associated with risk of suicidal ideation, drawing on nationally representative data.

METHODS:

Data were drawn from the 2012 Korea Welfare Panel Study (KOWEPS). Among the 12,606 respondents, the findings are based on 1,500 young adults (age 18-35) and 3,469 middle-aged adults (age 36-55) who answered a question about suicidal ideation.

RESULTS:

For young adults, respondents from 2-year and 4-year colleges and higher had lower probabilities of suicidal ideation compared with respondents from high school. People out of the labor force also exhibited an elevated risk of suicidal ideation compared with those in waged employment. Middle-aged adults displayed different patterns. Middle-aged respondents from 4-year colleges or higher had an increased likelihood of suicidal ideation. The likelihood of reporting suicidal ideation was predicted to decrease as household income increased only for middle-aged adults.

CONCLUSIONS:

The information about suicidal ideation was obtained from only one question of self-response, which limits the validity of the suicidal ideation measurement. The cross-sectional setting of the data prevents us from estimating causal relationships. Nevertheless, the findings imply that age-specific policy should be implemented to ameliorate differential risk for suicidal ideation and benefit public mental health in the long run.

The Function of Personality in Suicidal Ideation from the Perspective of the Interpersonal-Psychological Theory of Suicide

The Interpersonal-Psychological Theory of Suicide (IPTS) has been increasingly studied over the last years, responding to the demand for a valid framework addressing suicidality. Yet, only a few studies have explored the function of personality in the IPTS and none with clinical patients. We aimed to contribute to fill this gap in investigating the relationship between personality as conceptualized by the Five-Factor Model, the IPTS constructs, and a dimensional measure of current suicidal ideation. We conducted correlation, multiple linear regression, and path analyses based on a trait-interpersonal framework in a sample of 201 individuals visiting the psychiatric emergency room of a general hospital with current suicidal ideation. Neuroticism (positively) and openness (negatively) predicted perceived burdensomeness, while neuroticism (positively) and extraversion (negatively) predicted thwarted belongingness. Higher conscientiousness and lower extraversion were both predictors of the acquired capability for suicide. However, none of the models involving path analyses with IPTS variables as mediators of the relationship between personality traits and suicidal ideation was adequately adjusted to the data. Thus, it appears that personality plays a significant albeit modest role in suicidality when considered from an IPTS perspective. As personality is frequently assessed in the clinical routine, health professionals should consider it as complementary to detect individuals at risk of or presenting suicidal ideation.

Resilience Protected against Suicidal Behavior for Men But Not Women in a Community Sample of Older Adults in Korea

Suicide prevention efforts in reducing risk factors have been found to be more beneficial to older women than men, suggesting potential gender differences in effective prevention. The study aimed to examine gender difference in resilience for suicidal behavior in a community sample of older adults in Korea. A community-based survey was conducted to investigate resilience and risk factors of suicidal behavior using the Suicidal Behaviors Questionnaire-Revised, Connor-Davidson Resilience Scale, Center for Epidemiologic Studies Depression Scale (CES-D), as well as questions regarding physical illness and depression history. After accounting for well-known risk factors, resilience was inversely associated with suicidal behavior, but this protective role of resilience was applicable to men only. The findings of this study indicated gender difference in resilience against suicidal behavior in the elderly population. Gender-specific preventive intervention strategies need to be developed for community-based suicide prevention for older adults.

The application of the interpersonal-psychological theory of suicide to a sample of Swiss patients attending a psychiatric emergency department for a non-lethal suicidal event

BACKGROUND

Visits to emergency departments (EDs) for suicidal ideation or a suicide attempt have increased in the past decades. Yet comprehensive models of suicide are scarce, potentially enhancing misunderstandings from health professionals. This study aimed to investigate the applicability of the interpersonal-psychological theory of suicide (IPTS) in a population visiting EDs for suicide-related issues.

METHODS

Three major hypotheses formulated by the IPTS were tested in a sample of 167 individuals visiting EDs for suicidal ideation or a suicide attempt.

RESULTS

As predicted by the IPTS, greater levels of perceived burdensomeness (PB) were associated with presence of current suicidal ideation. However, contrary to the theory assumptions, thwarted belongingness (TB) was not predictive of current suicidal ideation (Hypothesis 1). Similarly, the interaction between PB, TB and hopelessness did not account for the transition from passive to active suicidal ideation (Hypothesis 2). The interaction between active suicidal ideation and fearlessness of death did not either predict the transition from active suicidal ideation to suicidal intent (Hypothesis 3).

LIMITATIONS

The cross-sectional design limited the interpretation of causal hypotheses. Patients visiting EDs during nights and weekends were underrepresented. A general measure of hopelessness was considered, not a measure of hopelessness specifically related to PB and TB.

CONCLUSIONS

Although the three hypotheses were only partially verified, health professionals might consider the IPTS as useful for the management of patient with suicide-related issues. Clinical intervention based on perceived burdensomeness could notably be proposed shortly after ED admission.