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

Decreased odds of depressive symptoms and suicidal ideation with higher education, depending on sex and employment status

BACKGROUND

Higher education is associated with reduced depressive symptoms and requires investment without guaranteed employment. It remains unclear how sex and employment status together contribute to the association between mental health and educational attainment. This study investigated the role of sex and employment status together in the associations of 1) depressive symptoms and 2) suicidal ideation with education.

METHODS

Using 2005-2018 National Health and Nutrition Examination Survey data, cross-sectional analyses were conducted on individuals ≥20 years who completed the depression questionnaire and reported their employment status and highest level of education. Survey-weighted multivariable logistic regression models were used to explore how depressive symptoms and suicidal ideation are associated with educational attainment in an analysis stratified by sex and employment status. To account for multiple testing, a significance level of a < 0.01 was used.

RESULTS

Participants (n = 23,669) had a weighted mean age of 43.25 (SD = 13.97) years and 47% were female. Employed females (aOR = 0.47, 95% CI 0.32, 0.69), unemployed females (aOR = 0.47, 95% CI 0.29, 0.75), and unemployed males (aOR = 0.31, 95% CI 0.17, 0.56) with college education had reduced odds of depressive symptoms compared to those with high school education. Employed females with college education also had reduced suicidal ideation odds compared to those with high school education (aOR = 0.41, 95% CI 0.22, 0.76).

CONCLUSIONS

Females demonstrated significant associations between depressive symptoms and education, regardless of employment status, whereas males demonstrated an association only if unemployed. Employed females, in particular, demonstrated a significant association between suicidal ideation and education. These findings may inform future research investigating the underlying mechanisms and etiology of these sex-employment status differences in the association between mental health and education.

Psychosocial risk factors of youth suicide in the Western Pacific: a scoping review

INTRODUCTION

 The Western Pacific region accounts for 25% of global suicide rates globally. In the last decade, however, there is a rising concern over the rate of youth suicides in the region. In line with the regional vision of reducing the rate of non-communicable diseases by 2025, the study contributes to the literature by utilizing a scoping review approach to identify psychosocial risk factors associated with youth suicide in the region.

METHOD

Publications on youth suicide in the Western Pacific region between 2010 and 2021 were reviewed. A total of 43 publications met the inclusion criteria and were read in full.

RESULTS

Psychosocial risk factors associated with suicide in each publication were identified and thematically classified into five themes: interpersonal factors, history of abuse, academic factors, work factors, and minority status.

DISCUSSION

Findings showed discrepancies in youth suicide research across member nations in the Western Pacific. Implications for regional policies on suicide prevention and future research were discussed.

Psychological Effects Of Unemployment Across The Lifespan: A Synthesis Of Relevant Literature

Amid ongoing global economic uncertainty and long-standing efforts to tackle age discrimination and increase older workers' labor force engagement, it is pertinent to consider age differences in the individual effects of joblessness. This is paramount for informing support services, policy formulation, and research. This article is based on a literature review of international peer reviewed quantitative research that has examined the relationship between age, psychological wellbeing and unemployment. Two hundred and twenty-six studies were screened and 36 were included. No relevant qualitative studies were identified. Among the studies, there was a broad consensus that there are age differences in terms of the psychological consequences of unemployment. However, they showed mixed evidence, and critical conceptual and methodological deficiencies were identified. We conclude that the body of evidence is weak and that drawing from it for the development of practice and policy in support of jobless individuals is to be cautioned against.

Temporal Trends and Characteristics of Adult Patients in Emergency Department Related to Suicide Attempt or Self-Harm in Korea, 2016-2020

BACKGROUND

The implementation of an effective suicide prevention program requires the identification and monitoring of subpopulations with elevated risks for suicide in consideration of demographic characteristics, to facilitate the development of tailored countermeasures for tackling the risk factors of suicide. We examined the annual trends in emergency department (ED) visits for suicide attempts (SAs) or self-harm and investigated the sex- and age-specific characteristics of individuals who visited the ED for SA and self-harm.

METHODS

Data on ED visits for SAs or self-harm in Korea from 2016 to 2020 were extracted from the National Emergency Department Information System and assessed. We evaluated the age-standardized incidence rate of ED visits for SAs or self-harm, and hospital mortality among individuals who visited the ED for SAs or self-harm. In addition, the characteristics of the individuals were compared according to sex and age.

RESULTS

We identified 145,963 ED visits for SAs or self-harm (0.42% of the total ED visits) during the study period. The rate of ED visits increased in the youngest age group (19-29 years old), and was more prominent among women (increased by an annual average of 22.5%), despite the coronavirus disease pandemic. The middle-aged group (45-64 years old) had a higher rate of mortality than other age groups, and the highest proportion of individuals on Medical Aid.

CONCLUSION

It is necessary to plan age- and gender-specific suicide prevention programs that focus on improving the limited public mental health resources for the vulnerable populations.

Machine learning prediction of suicidal ideation, planning, and attempt among Korean adults: A population-based study

Background

Suicide remains the leading cause of premature death in South Korea. This study aims to develop machine learning algorithms for screening Korean adults at risk for suicidal ideation and suicide planning or attempt.

Methods

Two sets of balanced data for Korean adults aged 19–64 years were drawn from the 2012–2019 waves of the Korea Welfare Panel Study using the random down-sampling method (N = 3292 for the prediction of suicidal ideation, N = 488 for the prediction of suicide planning or attempt). Demographic, socioeconomic, and psychosocial characteristics were used to predict suicidal ideation and suicide planning or attempt. Four machine-learning classifiers (logistic regression, random forest, support vector machine, and extreme gradient boosting) were tuned and cross-validated.

Results

All four algorithms demonstrated satisfactory classification performance in predicting suicidal ideation (sensitivity 0.808–0.853, accuracy 0.843–0.863) and suicide planning or attempt (sensitivity 0.814–0.861, accuracy 0.864–0.884). Extreme gradient boosting was the best-performing algorithm for predicting both suicidal outcomes. The most important predictors were depressive symptoms, self-esteem, income, consumption, and life satisfaction. The algorithms trained with the top two predictors, depressive symptoms and self-esteem, showed comparable classification performance in predicting suicidal ideation (sensitivity 0.801–0.839, accuracy 0.841–0.846) and suicide planning or attempt (sensitivity 0.814–0.837, accuracy 0.874–0.884).

Limitations

Suicidal ideation and behaviors may be under-reported due to social desirability bias. Causality is not established.

Discussion

More than 80% of individuals at risk for suicidal ideation and suicide planning or attempt could be predicted by a number of mental and socioeconomic characteristics of respondents. This finding suggests the potential of developing a quick screening tool based on the known risk factors and applying it to primary care or community settings for early intervention.

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This study develops machine learning models to predict suicidal ideation and behaviors.

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Logistic regression, random forest, support vector machine, and extreme gradient boosting are used.

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The algorithms correctly identifyed 80–90% of suicidal cases.

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The algorithms with the top two predictors (depressive symptoms and self-esteem) could achieve comparable accuracy.

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Our findings can be used to design a quick screening tool for use in primary care or community settings.

[Effects of Fear of Coronavirus Disease 2019 and Social Distancing on Women's Suicidal Ideation: Mediating Effect of Depression]

PURPOSE

This study aimed to identify the mediating effects of depression amid the influence of fear and social distancing arising from Coronavirus disease 2019 (COVID-19) in Korean women's suicidal ideation.

METHODS

A descriptive correlation study was conducted. Study participants, recruited by Hankook Research from March 2 to March 5, 2021, included 300 women aged 19 to 49 living in South Korea, and 100 people were randomly allocated and enlisted for each age group out of 700,000 Hankook Research Panels recruited in advance from 17 cities and provinces nationwide. Data were collected through a self-reported questionnaire and analyzed using Pearson's correlation coefficient and Hayes' Process Macro Model 4 with 95% bias-corrected bootstrap confidence interval via SPSS statistics 27.0.

RESULTS

Suicidal ideation was significantly correlated with fear of COVID-19 (r = .16, p = .006) and depression (r = .65, p < .001). The mediation effect of depression in the relationship between the fear of COVID-19 and suicidal ideation was found to be significant (B = 0.40, boot 95% CI: 0.21~0.61). However, social distancing did not significantly affect suicidal ideation via depression (B = -0.79, boot 95% CI: -1.94~0.26).

CONCLUSION

It is necessary to develop and apply interventions to prevent depression and suicidal behaviors by continuously observing and reducing the negative psychological responses caused by COVID-19.

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.

Impact of the COVID-19 pandemic on mental health service use among psychiatric outpatients in a tertiary hospital

BACKGROUND

The aim was to explore the impact of the COVID-19 pandemic on mental health service use according to mental disorder diagnosis among psychiatric outpatients.

METHODS

Psychiatric outpatient visits and patient diagnostic information were extracted from the EHR(electronic health records) of a Korean tertiary hospital during 3 months of the COVID-19 pandemic and 3 months before the COVID-19 outbreak. Visit rates of psychiatric outpatients according to primary psychiatric diagnosis category before and after the COVID-19 pandemic were compared using an over-dispersed Poisson regression model. The temporal associations between the number of daily outpatient visits and the daily number of newly confirmed cases were examined by time-series analysis within each diagnosis category.

RESULTS

Total daily outpatient visit rate was significantly reduced during the pandemic. Among the nine most prevalent diagnosis categories, the daily visit rates for anxiety disorders, depressive disorders, and schizophrenia-spectrum disorders were significantly reduced by about 29.8%, 14.8%, and 13.3% respectively. Time-series analysis showed significant temporal correlations between the daily number of newly confirmed cases and the daily visit rates for anxiety disorders and depressive disorders, whereas patients with schizophrenia-spectrum disorders showed no significant temporal association.

LIMITATIONS

Potential confounding factors unrelated to the pandemic might have influenced the results.

CONCLUSIONS

The present findings suggest that patients with anxiety or depressive disorders may have concerns regarding the spread of COVID-19, and may be more reluctant to visit psychiatry outpatient clinics. Delivery strategies for mental healthcare services, such as telepsychiatry, would be helpful to enhance continuity of care during the pandemic.

Demographic, Social, and Economic Factors of Internalizing Problems in Referred and Non-Referred Adolescents

Depressive symptoms and suicidal ideation are common internalizing problems during adolescence. Numerous studies have explored the role of certain demographic, social, and economic factors in their development in referred or non-referred adolescents, but not simultaneously in both groups. In this study, we examined the association between age, gender, parents’ educational level, and socioeconomic status (SES) and depressive symptoms and suicidal ideation in a referred group (n = 211) and a non-referred (n = 1401) group of adolescents. We also examined the moderating role that these factors play in the relationships between both internalizing problems. The results showed: higher levels of depressive symptoms and suicidal ideation in the referred group; an increase in both problems during early-to-middle adolescence in the non-referred group; an association between low SES and suicidal ideation in both groups; an association between low father’s education level and depressive symptoms in the non-referred group; and no gender differences in either of these two internalizing problems. The moderation analyses showed that age, in referred adolescents, and SES, in non-referred adolescents, moderated the relationship between depressive symptoms and suicidal ideation. This study contributes to the identification of groups of vulnerable adolescents that could constitute the target populations of preventive programs.

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.