Long-Term Relationships Between Negative Life Events and Suicidal Ideation Specifying Agnew's General Theory of Crime and Delinquency: A 7-Year Longitudinal Mediation Analysis

The purpose of this study was to examine the longitudinal mediationa(l pathways on the link between various straining experiences and suicidal ideation and to test whether its relationship was mediated by the role of negative emotions, constraints, and motivations. Data for this study were collected as part of the Korean Welfare Panel Study, which was a longitudinal study conducted among 7,027 Korean households, surveyed annually from 2006 to 2012. The results indicated that bullying victimization had important effects on negative emotions, although bullying victimization was not significant for later suicidal ideation. Peer delinquency was significantly correlated with negative emotions and positively predicted later suicidal ideation. Also, the significant impact of bullying victimization was transmitted to suicidal ideation through negative emotions. It implies that individuals' negative life events predicted strain or stressors generating negative emotions that, in turn, led to a high risk of suicidal ideation as a possible coping skill.

Using Boosted Machine Learning to Predict Suicidal Ideation by Socioeconomic Status among Adolescents

(1) Background: This study aimed to use machine learning techniques to identify risk factors for suicidal ideation among adolescents and understand the association between these risk factors and socioeconomic status (SES); (2) Methods: Data from 54,948 participants were analyzed. Risk factors were identified by dividing groups by suicidal ideation and 3 SES levels. The influence of risk factors was confirmed using the synthetic minority over-sampling technique and XGBoost; (3) Results: Adolescents with suicidal thoughts experienced more sadness, higher stress levels, less happiness, and higher anxiety than those without. In the high SES group, academic achievement was a major risk factor for suicidal ideation; in the low SES group, only emotional factors such as stress and anxiety significantly contributed to suicidal ideation; (4) Conclusions: SES plays an important role in the mental health of adolescents. Improvements in SES in adolescence may resolve their negative emotions and reduce the risk of suicide.

Classification of Adolescent Psychiatric Patients at High Risk of Suicide Using the Personality Assessment Inventory by Machine Learning

OBJECTIVE

There are growing interests on suicide risk screening in clinical settings and classifying high-risk groups of suicide with suicidal ideation is crucial for a more effective suicide preventive intervention. Previous statistical techniques were limited because they tried to predict suicide risk using a simple algorithm. Machine learning differs from the traditional statistical techniques in that it generates the most optimal algorithm from various predictors.

METHODS

We aim to analyze the Personality Assessment Inventory (PAI) profiles of child and adolescent patients who received outpatient psychiatric care using machine learning techniques, such as logistic regression (LR), random forest (RF), artificial neural network (ANN), support vector machine (SVM), and extreme gradient boosting (XGB), to develop and validate a classification model for individuals with high suicide risk.

RESULTS

We developed prediction models using seven relevant features calculated by Boruta algorithm and subsequently tested all models using the testing dataset. The area under the ROC curve of these models were above 0.9 and the RF model exhibited the best performance.

CONCLUSION

Suicide must be assessed based on multiple aspects, and although Personality Assessment Inventory for Adolescent assess an array of domains, further research is needed for predicting high suicide risk groups.

Association between Early Spermarche and Suicide Attempts in Boys: the Korea Youth Risk Behavior Web-based Survey

BACKGROUND

Puberty is a biologically and psychologically unstable period, and pubertal changes differ by sex. However, most previous studies on pubertal timing and suicide have focused on girls. This study investigated the association between early spermarche and suicide attempts in boys.

METHODS

We analyzed a nationally representative sample of Korean adolescents (The Korea Youth Risk Behavior Web-Based Survey, KYRBS) that included approximately 35,000 boys annually from 2011 to 2015. Pubertal timing in boys was defined by spermarche. Complex sampling logistic regression analyses were performed to evaluate the odds ratios (ORs) for suicide attempts between the early and average spermarche groups.

RESULTS

The ORs for suicide attempts in boys with early spermarche were significantly higher than those in boys with average spermarche after adjustment for age, perceived stress, depressive symptoms, and suicidal ideation. The ORs from 2011 to 2015 were as follows: 1.782 (P < 0.001), 1.490 (P = 0.002), 1.693 (P < 0.001), 1.541 (P = 0.001), and 1.393 (1.024-1.895; P = 0.035), respectively.

CONCLUSION

These findings suggest that early pubertal timing is a risk factor for suicide attempts in Korean boys after adjustment for depressive symptoms, perceived stress, and suicidal ideation, which have been previously reported as risk factors for suicide attempts. Therefore, careful attention should be paid to the prevention of suicide in boys who experience early spermarche in Korea.

Does personality problems increase youth suicide risk?: A characteristic analysis study of youth who visit the emergency department following suicide attempt

BACKGROUND

Youth suicide attempts are a major risk factor for future complete suicides. However, the characteristics of suicide attempters based on the emergency department (ED) have rarely been explored, making it challenging to comprehend the characteristics of youth suicide attempters comprehensively. This study aims to investigate the characteristics of youth suicide attempters who visited the ED.

METHODS

We examined the youth (age: 12-25 years) and adult (age: 26-65 years) groups of suicide attempters who visited the ED in Wonju-si, Gangwon-do, Korea. Interviews were conducted with attempters and guardians to identify sociodemographic, clinical, and suicide-related variables. Besides, we performed bivariate logistic regression analysis with statistically adjusted gender, educational age, Socioeconomic Status(SES) level, and medical illness.

RESULTS

Youth were diagnosed more frequently with Personality disorder compared to adults. Besides, youth tended to report interpersonal or abuse as motivations for suicide, whereas adults tended to report medical illness or economic problems. Furthermore, youth attempted suicide more impulsively and repeatedly; however, medical lethality of each attempt tended to be lower than adults.

LIMITATION

We experienced difficulty in collecting complete information because of poor consciousness or cooperation of patients who visited the ED immediately after suicide attempt. Also, the study cohort was only recruited from one hospital in a region.

CONCLUSION

Youth suicide attempters are suggested to have relatively serious and persistent problems involving personality or traits than adults. Thus, this study highlights the significance of preventive strategies based on early psychopathological evaluation and treatment.

Cox regression model of prognostic factors for delayed neuropsychiatric sequelae in patients with acute carbon monoxide poisoning: A prospective observational study

OBJECTIVE

A major challenge for physicians is to identify patients with acute carbon monoxide (CO) poisoning who are likely to develop delayed neuropsychiatric sequelae (DNS). DNS is defined as neuropsychological sequelae that develops after 2-40 days of lucid interval after CO intoxication. Currently, there is no consensus on factors that predict the prognosis of CO poisoning. Thus, the purpose of this study was to identify factors predicting the development of DNS using a Cox regression model.

METHODS

This prospective observational study included 310 CO-poisoned patients admitted to an emergency department in South Korea from July 2017 to February 2020. Demographic, clinical, and laboratory data were analyzed. Kaplan-Meier curves were constructed to estimate the cumulative incidence of DNS. A multivariate Cox regression model was used to identify the main predictors of the development of DNS.

RESULTS

The incidence of DNS was 18.8 %, and the median onset time was 23.7 days (interquartile range, 14-30 days). The Kaplan-Meier survival curve showed that a serum creatine kinase (CK) level > 175.5 U/L and initial Glasgow Coma Scale (GCS) score ≤ 9 were associated with a higher cumulative incidence of DNS (log-rank test; p < 0.01 and p = 0.02, respectively). Cox regression analysis showed that a serum CK level > 175.5 U/L (hazard ratio [HR]: 2.862, 95 % confidence interval [CI]: 1.491-5.496; p < 0.01) and an initial GCS ≤ 9 (HR: 2.081, 95 % CI: 1.048-4.131; p = 0.04) were significant prognostic factors.

CONCLUSION

In acute CO poisoning, an initial GCS score ≤ 9 and serum CK level > 175.5 U/L are significant predictors of DNS development.

Association between Perceived Parenting Style and Adolescents' Attitudes toward Suicide

Objectives

Adolescent suicide, a major cause of adolescent death, is affected by various factors, including attitudes toward suicide. This study investigated the association between parenting style and adolescents’ attitudes toward suicide and the mediating role of attitude toward suicide between parenting style and suicidal ideation.

Methods

We surveyed 1,071 adolescents from eight middle schools in Incheon, Korea. The survey included sociodemographic information, attitudes toward suicide, perception of parenting style, depression severity, and suicidality.

Results

Students in the authoritarian parenting group had a more permissive attitude toward suicide compared with the democratic and permissive parenting groups. These students considered that suicide is justified in certain situations and that choosing suicide is an individual’s right. They also had a negative attitude toward talking about suicide or intervening in others’ suicide. This association remained statistically significant after adjusting for the impact of confounding factors that could affect attitudes toward suicide, except for suicidal processes and preparedness to prevent suicide. In the mediation analysis, we observed that some factors of the attitudes toward suicide mediated between authoritarian parenting attitudes and suicidal ideation, namely, suicide as a right, preventability, suicide as normal/common, preparedness to prevent suicide, and resignation.

Conclusion

This study revealed the significant impact of parenting style on children’s attitudes toward suicide. Educating parents about the appropriate parenting attitudes–sympathetic and rational–can help prevent youth suicide.

Early menarche as a risk factor for suicidal ideation in girls: The Korea youth risk behavior web-based survey

Puberty, at which point girls experience menarche, is a biologically and psychologically unstable period. This study investigated the association between early menarche and suicidal ideation in girls. This study analyzed data from approximately 35,000 girls from the Korea Youth Risk Behavior Web-Based Survey every year from 2011 to 2015. The odds ratios of suicidal ideation were compared between the early and average menarche groups. Generally, the odds ratios of suicidal ideation in girls with early menarche were significantly higher than those with average menarche.

Association between sexual behavior and suicidal ideation among South Korean middle school students

AIM

To identify the association between sexual behavior and suicidal ideation among South Korean middle school students.

METHODS

This study used raw data from the 2013 Korean Youth Risk Behavior Web-Based Survey. Among the data from 72,435 students, the data from 36,530 individuals in middle school were analyzed. The prevalence of sexual behavior and suicidal ideation, according to the participants' general characteristics, and suicidal ideation, according to sexual behaviors, were assessed by using a complex sample Chi-squared test. A complex sample logistic regression was used to examine the association between sexual behavior and suicidal ideation.

RESULTS

Overall, 3.8% of the students reported having had sexual intercourse and 17.6% of the students reported suicidal ideation during the past 12 months. Having had sexual intercourse was statistically significantly associated with suicidal ideation. The students who had had sexual intercourse usually used contraception and those who had contracted sexually transmitted diseases were more likely to report suicidal ideation in both the unadjusted and adjusted models.

CONCLUSION

This study illustrates the need to develop a prevention program that addresses the common factors between sexual behavior and suicidal ideation in order to effectively reduce both sexual behavior and suicidal ideation in middle school students.

Korean Version of Inventory of Complicated Grief Scale: Psychometric Properties in Korean Adolescents

We aimed to validate the Inventory of Complicated Grief (ICG)-Korean version among 1,138 Korean adolescents, representing a response rate of 57% of 1,997 students. Participants completed a set of questionnaires including demographic variables (age, sex, years of education, experience of grief), the ICG, the Children's Depression Inventory (CDI) and the Lifetime Incidence of Traumatic Events-Child (LITE-C). Exploratory factor analysis was performed to determine whether the ICG items indicated complicated grief in Korean adolescents. The internal consistency of the ICG-Korean version was Cronbach's α=0.87. The test-retest reliability for a randomly selected sample of 314 participants in 2 weeks was r=0.75 (P<0.001). Concurrent validity was assessed using a correlation between the ICG total scores and the CDI total scores (r=0.75, P<0.001). The criterion-related validity based on the comparison of ICG total scores between adolescents without complicated grief (1.2 ± 3.7) and adolescent with complicated grief (3.2 ± 6.6) groups was relatively high (t=5.71, P<0.001). The data acquired from the 1,138 students was acceptable for a factor analysis (Kaiser-Meyer-Olkin Measure of Sampling Adequacy=0.911; Bartlett's Test of Sphericity, χ(2)=13,144.7, P<0.001). After omission of 3 items, the value of Cronbach's α increased from 0.87 for the 19-item ICG-Korean version to 0.93 for the 16-item ICG-Korean version. These results suggest that the ICG is a useful tool in assessing for complicated grief in Korean adolescents. However, the 16-item version of the ICG appeared to be more valid compared to the 19-item version of the ICG. We suggest that the 16-item version of the ICG be used to screen for complicated grief in Korean adolescents.

Risk Factors of Discharged Against Medical Advice among Adolescents Self-inflicted Injury and Attempted Suicide in the Korean Emergency Department

Suicide is a leading cause of death among Korean adolescents. Many suicide attempting adolescents often are discharged against medical advice in the emergency department. The aim of the present study was to determine the risk factors for discharge against medical advice (DAMA) after self-inflicted injury or attempted suicide in the emergency department. We extracted data on adolescents (10-19 yr old) from the national emergency department information system; we used data from 2007 and 2011. A total of 6,394 adolescents visited EDs after self-inflicted injury or attempted suicide. Among these patients, the median age was 17 yr (Interquatile range, 15-18 yr), 83.2% were between 15-19 yr of age, and 63.3% were female. Poisoning was the most common method of attempted suicide, while hanging and fall were the most common methods of fatality. The rate of DAMA from the ED was 22.8%. Independent risk factors for DAMA included female gender (odds ratio [OR], 1.49), older age adolescents (OR, 1.96), residence in a metropolitan/large city area (OR, 1.49), and discharge at night (OR, 1.38). These risk factors should be considered in establishing management and counseling plans for patients discharged against medical advice by community services and EDs.

Trend of Suicide Rates According to Urbanity among Adolescents by Gender and Suicide Method in Korea, 1997-2012

This study aims to quantifiably evaluate the trend of the suicide rate among Korean adolescents from 1997 to 2012 according to urbanity. We used national death certificates and registration population data by administrative district for 15–19 years-old adolescents. The annual percent change (APC) and average annual percent change (AAPC) were estimated by the Joinpoint Regression Program. The suicide rate in the rural areas was higher than that in the urban areas in both genders (males (/100,000), 12.2 vs. 8.5; females (/100,000), 10.2 vs. 7.4 in 2012). However, the trend significantly increased only in the urban area (AAPC [95% CI]: males 2.6 [0.7, 4.6], females 3.3 [1.4, 5.2]). In urban areas, the suicide rate by jumping significantly increased in both genders (AAPC [95% CI]: males, 6.7 [4.3, 9.1]; females, 4.5 [3.0, 6.1]). In rural areas, the rate by self-poisoning significantly decreased by 7.9% per year for males (95% CI: −12.5, −3.0) and the rate by hanging significantly increased by 10.1% per year for females (95% CI: 2.6, 18.2). The trend and methods of suicide differ according to urbanity; therefore, a suicide prevention policy based on urbanity needs to be established for adolescents in Korea.

Relationship between socioeconomic position and suicide attempts among the Korean adolescents

This study explored the relationship of the subjective socioeconomic position (SEP) as well as the objective SEP with the rate of suicide attempts in 74,186 adolescents from the 2012 Korea Youth Risk Behavior Web-based Survey (KYRBS). The SEP was measured by the Family Affluence Scale (FAS) and the self-rated household economic status. The low perceived SEP for either the high or low FAS score was related to the elevated likelihood of suicide attempts in both genders. As compared with the adolescents in both the high level of perceived SEP and FAS score after adjusting for other confounding factors, the middle school students were more likely to attempt suicide in both low level of perceived SEP and FAS score (OR, 1.81; 95% CI, 1.18-2.78 for boys, OR, 1.46; 95% CI, 1.13-1.90 for girls). The high school students were more likely to attempt suicide in the low perceived SEP and high FAS score (OR, 1.44; 95% CI, 1.14-1.81 for boys, OR, 1.29; 95% CI, 1.07-1.56 for girls). In conclusion, the relationship of subjective SEP is important in suicide attempts as much as objective SEP and far more important in the high school students.