Lifetime prevalence of and risk factors for suicidal ideation and suicide attempts in a Korean community sample

Psychosocial predictors of persistent suicidal ideation among Chinese adolescents: A longitudinal study

BACKGROUND

Suicide is the fourth leading cause of death among adolescents. Studies have shown that persistent suicidal ideation has a more important effect on suicidal behavior. The objective of this study was to identify predictors of persistent suicidal ideation.

METHODS

Data were collected from 4225 Chinese middle and high school students. These adolescents were assessed for suicidal ideation at baseline and the second year. We used multinomial logistic regression (n = 4171) for the predictive effect of these factors on persistent suicidal ideation. We controlled for gender, residence, clinical diagnosis, clinical diagnosis family, suicide planning, and suicide attempts.

RESULTS

Depressive symptoms are essential in predicting persistent suicidal ideation (OR = 14.0; p < 0.001). Persistent suicidal ideation was predicted by sleep disorders, such as poor sleep quality (OR = 2.3; p = 0.008), difficulty falling asleep (OR = 2.4; p = 0.005), frequently midnight awakening (OR = 1.9; p = 0.044), and frequent nightmares (OR = 2.1; p = 0.040). There was a significant association between concern with persistent ideation and parental-peer alienation (OR for father, 1.9[p = 0.024]; OR for mother, 3.1[p < 0.001]; OR for peer, 2.3[p = 0.003]).

LIMITATIONS

All measures are based on self-report rather than objective assessment or clinical diagnostic assessment.

CONCLUSIONS

Persistent suicidal ideation had a more important role in influencing suicide planning and attempt. Interventions targeting sleep disorders and attention to attachments in the home and school are particularly important in preventing persistent suicidal ideation in adolescents.

Physical disability, low self-esteem, and suicidal ideation among Chinese nursing home residents: the moderating role of resilience

OBJECTIVES

This study aimed to investigate the mediating role of self-esteem in the relationship between physical disability and suicidal ideation, and whether the mediation effect was moderated by resilience among nursing home residents.

METHODS

Participants were 538 nursing home residents recruited from 37 nursing homes in Jinan, China (mean age = 78.13 years, SD = 8.72). The Lawton and Brody Activities of Daily Living Scale, Rosenberg Self-Esteem Scale, 10-item version of the Connor-Davidson Resilience Scale, and Beck Suicidal Ideation Inventory-Chinese Version were used. Mediation and moderated mediation analyses were performed using Models 4 and 15 of the PROCESS macro for SPSS.

RESULTS

The prevalence of suicidal ideation among the nursing home residents was 14.90%. The mediation analysis showed that self-esteem partially mediated the association between physical disability and suicidal ideation. Resilience was a protective factor for suicidal ideation and moderated the relationship between physical disability and suicidal ideation, and between self-esteem and suicidal ideation.

CONCLUSION

Both physical disability and lower self-esteem are important in understanding the development of suicidal ideation among nursing home residents. Improving resilience may be crucial for suicide prevention.

Effect of Attitude Toward Suicide on Suicidal Behavior: Based on the Korea National Suicide Survey

OBJECTIVE

Suicide is a complex phenomenon; therefore, it should be approached in light of sociocultural perspectives and the general attitude toward suicide. This study aimed to extract factors from the Attitude Toward Suicide Scale (ATTS) and investigate the relationship between attitudes toward suicide and suicidal behavior (i.e., suicidal idea, plan, and attempt) by using a representative sample of Korean adults.

METHODS

Three thousand Koreans aged 19 to 75 years were surveyed cross-sectionally in 2013 and 2018. The data collected were subjected to exploratory factor analysis. Extracted attitude factors were compared using a suicidal behavior continuum. Univariate and multivariate logistic models were constructed to compare the association between attitude factors and suicidal behaviors.

RESULTS

Among the participants, 477 (15.9%) experienced suicidal idea only, 85 (2.8%) had a suicidal plan without attempt, and 58 (1.9%) attempted suicide. Four meaningful factors were extracted from the factor analysis: "permissiveness," "unjustified behavior," "preventability/readiness to help," and "loneliness." "Permissiveness," "unjustified behavior," and "loneliness" factors showed significant trends across the suicidal behavior continuum. Permissive attitude toward suicide increased the odds of suicidal idea, suicidal plan, and suicide attempt (adjusted odds ratio [aOR]=1.49, 95% confidence interval [CI]=1.25-1.79; aOR=2.79, 95% CI=1.84-4.25; aOR=2.67, 95% CI=1.65-4.33), while attitude toward suicide as unjustified behavior decreased the odds of suicidal ideation and attempt (aOR=0.79, 95% CI=0.67-0.94; aOR=0.64, 95% CI=0.42-0.99).

CONCLUSION

A significant association was found between attitude toward suicide and suicidal behaviors. Attitude toward suicide is a modifiable factor that can be used to develop prevention policies.

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.

Stratification by Sex and Hormone Level When Contrasting Men and Women in Schizophrenia Trials Will Improve Personalized Treatment

BACKGROUND

Sex and gender differences have been reported in the prevalence, expression, treatment response, and outcome of schizophrenia, but most reports are based on relatively small samples that have not been stratified for the impact of sex hormone levels. This literature review aims to show how women's hormone levels can impact the results of male/female comparisons.

METHODS

This is a narrative review of data from publications of the last decade.

RESULTS

Epidemiologic evidence, reports of the impact of hormones on cognition, results of sexually dimorphic responses to treatment, and male/female trajectories of illness over time all suggest that female hormone fluctuations exert major effects on male/female differences in schizophrenia.

CONCLUSIONS

Information on hormonal status in women participants is rarely available in clinical studies in schizophrenia, which makes male/female comparisons largely uninterpretable. These are the current challenges. Opportunities for individualized treatment are growing, however, and will undoubtedly result in improved outcomes for both women and men in the future.

Factors affecting suicidal ideation among premenopausal and postmenopausal women

WHAT IS KNOWN ON THE SUBJECT?: Pre- and postmenopausal women (PPW) experience changes in physical, psychological and social health. South-East Asia's female suicide rate is the highest compared with other countries, and the suicide rate of PPW in these countries continues to increase. The most influential factor in Asian women's suicidal ideation is family conflict; specifically, if PPW in South Korea cannot express their anger, it results in a culture-bound syndrome called "Hwa-Byung." However, there is a lack of research on Asian PPW. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: This study found differences in individual- and community-level factors affecting suicidal ideation between pre- and postmenopausal women. Individual factors that commonly affected suicidal ideation were experiencing violence, stress and depression. Individual factors that affected the suicidal ideation of premenopausal women more than postmenopausal women were religious beliefs, alcohol use and chronic disease. Community level factors affecting suicidal ideation were locational depression and locational counselling for stress in premenopausal women and locational counselling for depression in postmenopausal women. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Mental health nurses could help prevent suicide by developing and applying community-based programmes for PPW, considering the specific socio-economic and cultural context and characteristics of Asian women. Mental health nurses could help PPW participate in programmes by preparing various interventions such as case management, personal counselling, physical activity, home-based mental health services, cognitive behavioural therapy and digital interventions for self-management. Mental health nurses need to prepare various methods such as online, offline, individual and group methods to work effectively in any social situation. ABSTRACT: Introduction Pre- and postmenopausal women (PPW) experience physical and psychological changes with hormonal changes. Among Asian middle-aged women, family and culture affect suicidal ideation, and the suicide rate among this population is increasing. There are few existing research on suicidal ideation among Asian PPW. Aim We examined individual- and community-level factors that predict suicidal ideation among PPW. Method Large-scale panel data from 5,154 South Korean PPW aged 35-64 years were used in a series of multilevel logistic regression analyses to examine factors associated with suicidal ideation at individual and community levels. Results Among premenopausal women, religious beliefs, alcohol use, chronic disease, experience of violence, stress and depression were individual-level factors. Locational depression and locational counselling for stress were community-level factors. Among postmenopausal women, experience of violence, stress, depression and perceived health status were individual level factors, and locational counselling for depression was a community level factor. Discussion Suicidal ideation among PPW is affected by both individual and community level factors. Nurses must comprehensively determine what risk factors affect suicidal ideation through various intervention methods-including online, offline, individual and group methods-while considering socio-economic situations. Implications for Practice Mental health nurses should provide targeted biopsychosocial interventions targeting psychosocial and physical problems and promoting the use of community resources to reduce PPW's suicidal ideation.

Comparison of the Usefulness of the PHQ-8 and PHQ-9 for Screening for Major Depressive Disorder: Analysis of Psychiatric Outpatient Data

OBJECTIVE

This study aimed to demonstrate that the Patient Health Questionnaire (PHQ)-8 is not less useful than the PHQ-9 as a screening test for major depressive disorder (MDD).

METHODS

We performed a retrospective analysis of 567 patients in psychiatric outpatient units. The Mini International Neuropsychiatric Interview was used to diagnose MDD. We derived the validity and reliability of the PHQ-8 and PHQ-9. To evaluate the ability of the PHQ-8 and PHQ-9 to discriminate MDD, we drew receiver operating characteristic (ROC) curves and compared the areas under the curves (AUCs).

RESULTS

Of the 567 participants, 207 (36.5%) were diagnosed with MDD. Cronbach's αs for the PHQ-8 and PHQ-9 were 0.892 and 0.876, respectively. Similar to the PHQ-9, the PHQ-8 was also associated with scores on the Hamilton Depression Rating Scale in a correlation analysis. When we drew ROC curves for the PHQ-8 and PHQ-9, there was no statistically significant difference in the AUCs. With a cutoff score of 10, the PHQ-8 showed a sensitivity of 58.3%, specificity of 83.1%, positive predictive value of 53.4%, and negative predictive value of 85.7%.

CONCLUSION

In a psychiatric outpatient sample, the PHQ-8 was as useful as the PHQ-9 for MDD screening.

The association between abortion experience and postmenopausal suicidal ideation and mental health: Results from the 5th Korean National Health and Nutrition Examination Survey (KNHANES V)

OBJECTIVE

The association between abortion and postmenopausal mental health has not been clearly established in Asian women. The objective of this study was to evaluate the effect of abortion experiences on suicidal ideation and mental health in Korean postmenopausal women.

MATERIALS AND METHODS

This study included 5133 postmenopausal women registered in the Korean National Health and Nutrition Examination Survey between 2010 and 2012. Difference in suicidal ideation according to type and number of abortions was analyzed. We used survey multiple logistic regression analysis to evaluate the effect of abortion experiences on the risk for suicidal ideation expressed as adjusted odd ratios (ORs) with 95% confidence intervals (95%CIs).

RESULTS

The risk of suicidal ideation was significantly higher in women who experienced more than three abortions (27.9%). While the incidence of suicidal ideation was not significantly affected by the number of spontaneous abortions (p = 0.718), suicidal ideation was significantly more frequent in women who had undergone ≥ three abortions (p = 0.003). After adjusting for demographic confounding factors, women who underwent ≥ three induced abortions had higher risk for suicidal ideation (OR: 1.510; 95% CI: 1.189-1.919; p = 0.031). This risk remained elevated even after controlling for depression (OR: 1.391; 95% CI: 1.1086-1.871, p = 0.002). Moreover, the risk of experiencing a depressive mood in daily life was also increased with increasing number of induced abortions even after controlling for depression (OR: 1.657; 95% CI: 1.274-2.156, p = 0.002).

CONCLUSION

Undergoing three or more induced abortions during reproductive age was associated with postmenopausal suicidal ideation, stress, and depression. However, such association was not noted in those with spontaneous abortion, even in women with more miscarriages. Thus, clinicians should evaluate depression and suicidal ideation in women with multiple induced abortions.

Prevalence and characteristics of suicidal ideation among 2199 elderly inpatients with surgical or medical conditions in Taiwan

BACKGROUND

Worldwide, the elderly are at a greater risk of suicide than other age groups. There is a paucity of research exploring risk factors for suicide in hospitalized elderly patients. Therefore, a study designed to explore the prevalence and characteristic of suicidal ideation (SI), such as QOL (quality of life), a wish to die (WTD), and other factors in elderly inpatients with medical or surgical conditions in Taiwan was warranted.

METHODS

A total of 2199 hospitalized elderly patients over age 65 were enrolled. Demographic data, 5-item Brief Symptom Rating Scale (BSRS-5), and the World Health Organization Quality of Life-BREF (WHOQOL-BREF) data were collected. Logistic regression models were used to find the SI-related factors for all participants and to investigate the covariates correlated with WTD in patients with SI. Receiver operating characteristic (ROC) curve analysis was used to find the most important items of the BSRS-5 predictive of SI in this population.

RESULTS

SI was found in 3.1% (68/2199) of the elderly. The statistically significantly factors associated with SI were: BSRS-5 item 2 (depression) (odds ratio [OR] = 2.15, 95% confidence interval [CI] = 1.56-2.98), item 4 (inferiority) (OR = 1.62, 1.23-2.13), item 5 (insomnia) (OR = 1.52, 1.13-2.05), and physical domain of WHOQOL (OR = 0.84, 0.72-0.99). QOL15 (mobility) (OR = 0.64, 0.46-0.90) and QOL 16 (satisfaction with sleep) (OR = 0.62, 0.44-0.88) were also significantly associated with SI. The status of living alone (OR = 4.44, 1.24-15.87), QOL 26 (absence of negative feeling) (OR = 0.38, 0.15-0.98), and QOL 27 (being respected/accepted) (OR = 0.43, 0.20-0.92) were significantly associated with WTD among inpatients with SI. The ROC curve analysis revealed that depression, inferiority, and insomnia were the most important items in the BSRS-5 significantly associated with SI among the elderly inpatients.

CONCLUSION

To provide physical recovery and maintain mental health for physically ill elderly inpatients, setting up a multi-faceted approach targeting the aforementioned determinants of SI and WTD for reducing the risk of suicide attempt, and exploring other factors correlated with suicidal behaviors, are important topics and directions for clinical practice and further research.

Psychiatric Sequelae of Former "Comfort Women," Survivors of the Japanese Military Sexual Slavery during World War II

"Comfort women" refers to young women and girls who were forced into sexual slavery by the Imperial Japanese military during World War II. They were abducted from their homes in countries under Imperial Japanese rule, mostly from Korea, and the rest from China, Philippines, Malaysia, Taiwan, Indonesia, the Netherlands, etc. "Comfort women" endured extreme trauma involving rape, sexual torture, physical abuse, starvation, threats of death, and witnessed many others being tortured and killed. This article reviews all the studies that have investigated the psychiatric or psychosocial sequelae of the survivors of the Japanese military sexual slavery. Most importantly, a recent study which conducted a psychiatric evaluation on the former "comfort women" currently alive in South Korea is introduced. The participants' unmarried rate was relatively high and their total fertility rate was relatively low. Majority of the participants reported having no education and being the low economic status. They showed high current and lifetime prevalence of posttraumatic disorder, major depressive disorder, somatic symptom disorder, social anxiety disorder, panic disorder, and alcohol use disorder. Participants showed high suicidality and majority of the participants still reported being ashamed of being former "comfort women" after all these years. This article high-lights the fact that the trauma has affected the mental health and social functioning of former "comfort women" throughout their lives, and even to the present day.

Suicidal thoughts/acts and clinical correlates in patients with depressive disorders in Asians: results from the REAP-AD study

OBJECTIVE

Using data from the Research on Asian Psychotropic Prescription Patterns for Antidepressants (REAP-AD) study, we aimed to present the rates and clinical correlates of suicidal thoughts/acts in patients recruited from a total of 40 centres in 10 Asian countries/areas: China, Hong Kong, India, Indonesia, Japan, Korea, Malaysia, Singapore, Taiwan, and Thailand.

METHODS

Data from 1122 patients with depressive disorders in the REAP-AD study were used. The ICD-10 was employed to diagnose depressive episodes and recurrent depressive disorder. The presence or absence of suicidal thoughts/acts and profile of other depressive symptoms was established using the National Institute for Health and Clinical Excellence guidelines for depression. Country/area differences in rates of suicidal thoughts/acts were evaluated with the χ2 test. In addition, depressive symptom profiles, other clinical characteristics, and patterns of psychotropic drug prescription in depressed patients with and without suicidal thoughts/acts were compared using analysis of covariance for continuous variables and logistic regression analysis for discrete variables to adjust the effects of covariates.

RESULTS

The rates of suicidal thoughts/acts in 10 countries/areas varied from 12.8% in Japan to 36.3% in China. Patients with suicidal thoughts/acts presented more persistent sadness (adjusted odds ratio [aOR]=2.64, p<0.001), loss of interest (aOR=2.33, p<0.001), fatigue (aOR=1.58, p<0.001), insomnia (aOR=1.74, p<0.001), poor concentration (aOR=1.88, p<0.001), low self-confidence (aOR=1.78, p<0.001), poor appetite (aOR=2.27, p<0.001), guilt/self-blame (aOR=3.03, p<0.001), and use of mood stabilisers (aOR=1.79, p<0.001) than those without suicidal thoughts/acts.

CONCLUSION

Suicidal thoughts/acts can indicate greater severity of depression, and are associated with a poorer response to antidepressants and increased burden of illness. Hence, suicidal thoughts/acts can provide a clinical index reflecting the clinical status of depressive disorders in Asians.

Factors Affecting Suicidal Ideation Among Middle-Aged Korean Women in an Urban-Rural Province

PURPOSE

This study aimed to investigate the factors that affect suicidal ideation among middle-aged Korean women in an urban-rural province.

METHODS

This study used a convenience sample consisting of 196 middle-aged Korean women who live in Gyeonggi Province. Data were collected between November 2013 and January 2014.

RESULTS

There were significant correlations among social relationships (r=-.18, p=.013), previous experiences of violence (r=.15, p=.032), subjective happiness (r=-.36, p<.001), depression (r=.44, p<.001), and suicidal ideation. Economic status, subjective happiness, and depression were found to have an effect on suicidal ideation (R(2)=.26).

CONCLUSIONS

The study's results demonstrate that there needs to be greater focus on middle-aged women when considering mental health interventions in rural areas of Korea. The results may also contribute to the development of improved interventions for psychological health care.

Which deliberate self-poisoning patients are most likely to make high-lethality suicide attempts?

BACKGROUND

The risk/rescue rating scale (RRRS) assesses the lethality of a suicide attempt, which is defined as the probability of inflicting irreversible damage. We assessed the lethality of suicide attempts using the RRRS and identified the socio-demographic profiles of patients who achieved high lethality in deliberate self-poisoning (DSP).

METHODS

A retrospective study was conducted to evaluate DSP patients who visited the emergency department of a tertiary teaching hospital between 2000 and 2011. The data included socio-demographic information, clinical variables, risk factors (e.g., the method used, whether consciousness was impaired, toxicity, reversibility and whether treatment was required) and rescue factors (e.g., location, who initiated the rescue, the probability of discovery, the accessibility of rescue, and delay until discovery). The high-risk group consisted of patients with 11-15 risk points, whereas patients in the low-rescue group had 5-11 risk points. We examined the characteristics of high-lethality suicide attempts (high-risk/low-rescue group).

RESULTS

A total of 1114 patients were enrolled in this study. Pearson's correlation analysis showed that the total risk score for patients with DSP was negatively associated with the total rescue score (r = -0.201, p < 0.001). Of the total number of DSP patients, 42 were included in the high-risk/low-rescue group. The multivariate logistic regression analyses showed significant associations between high-lethality suicide attempts and male gender (OR 2.70, 95 % CI 1.41-5.18, p = 0.003), older age (OR 1.02, 95 % CI 1.01-1.04, p = 0.015), and unemployment (OR 2.98, 95 % CI 1.41-6.33, p = 0.004).

CONCLUSION

This retrospective study demonstrates that male gender, advanced age, and unemployed status were associated with high-lethality suicide attempts in DSP patients.