Risk Factors for Suicidal Ideation among Middle Class Korean: Focusing on Psychosocial Comparison - An Analysis of a Nationwide Survey of the 8th Korea Health Panel Data

Ahra Jo; Bora Kang; Youngju Seo; Eunha Gil; Heeyoung Oh

doi:10.12799/jkachn.2018.29.1.1

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Jo, Kang, Seo, Gil, and Oh: Risk Factors for Suicidal Ideation among Middle Class Korean: Focusing on Psychosocial Comparison - An Analysis of a Nationwide Survey of the 8th Korea Health Panel Data

Original Article

J Korean Acad Community Health Nurs 2018;29(1):1-10.

Published online: 12 March 2018

DOI: https://doi.org/10.12799/jkachn.2018.29.1.1

Risk Factors for Suicidal Ideation among Middle Class Korean: Focusing on Psychosocial Comparison - An Analysis of a Nationwide Survey of the 8th Korea Health Panel Data

Ahra Jo¹, Bora Kang², Youngju Seo², Eunha Gil³, Heeyoung Oh⁴

¹Graduate School of Nursing, Eulji University, Daejeon, Korea

²Hospital of Eulji University, Daejeon, Korea

³Department of Nursing, Institute of Science and Technology, Daejeon, Korea

⁴College of Nursing, Eulji University, Daejeon, Korea

Corresponding author: Oh, Heeyoung College of Nursing, Eulji University, 77 Gyeryoung-ro, 771 beon-gil, Jung-gu, Daejeon 34824, Korea. Tel: +82-42-259-1713, Fax: +82-42-259-1709, E-mail: hoh123@eulji.ac.kr

Received 12 April 2017 Revised 26 November 2017 Accepted 26 January 2018

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0), which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

The purpose of this study was to examine the prevalence and risk factors of suicidal ideation among middle class Korean.

Methods

Cross sectional study was designed for secondary data analysis. From the 8th Korea Health Panel survey (2008~2013), a total of 6,037 data was drawn and analyzed by developmental stage using descriptive statistics including frequency, percentage, x² test, and logistic regression analysis.

Results

Across all age groups, high physical-mental stress, frustration, anxiety about the future and low self-perceived health status or social class were found to be the risk factors of suicidal ideation. Peer-compared subjective health status and frustration significantly influenced the adolescents. The young adults‘suicidal ideation was mainly influenced by physical and mental stress, frustration and absence of economic activity. For the middle-aged, physical and mental stress, frustration, future anxiety, low peer-compared subjective health status were found to be the major influencing factors. The predominant risk factors for the elderly were frustration and low peer-compared subjective health status.

Conclusion

Making comparisons to others significantly influence suicidal ideation throughout all life cycles. Improvement of mental health and suicide prevention can be enhanced by avoiding negative comparison to others.

Keywords: Suicidal ideation, Suicide, Risk factors, Mental health, Social class

References

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Table 1.

Comparison of Suicidal Ideation Rate by Demographic Factors among Middle-class Korean Adolescents, Young Adults, Middle-aged and the Elderly who able doing Independent Activities of Daily Living

Variables	Adolescent (＜20 years)			Young adult (20~39 years)			Middle aged (40~64 years)			Elderly (≥65 years)
	Total n=1,468	SI (yes) n=66	x² (p)	Total n=1,363	SI (yes) n=59	x² (p)	Total n=2,206	SI (Yes) n=98	x² (p)	Total n=1,000	SI (Yes) n=65	x² (p)
	n (%)	n (%)	x² (p)	n (%)	n (%)	x² (p)	n (%)	n (%)	x² (p)	n (%)	n (%)	x² (p)
Gender
Male	733 (49.9)	25 (3.4)	4.02	654 (48.0)	29 (4.4)	0.03	1,091 (49.5)	49 (4.5)	0.01	483 (48.3)	34 (7.0)	0.45
Female	735 (50.1)	41 (5.6)	(.045)	709 (52.0)	30 (4.2)	(.854)	1,115 (50.5)	49 (4.4)	(.912)	517 (51.7)	31 (6.0)	(.504)
Spouse
Yes	0 (0.0)	0 (0.0)	-	540 (39.6)	29 (5.4)	2.34	1,939 (87.9)	86 (4.4)	0.01	724 (72.4)	45 (6.2)	0.35
No	1,468 (100.0)	66 (4.5)		823 (60.4)	30 (3.6)	(.126)	267 (12.1)	12 (4.5)	(.965)	276 (27.6)	20 (7.2)	(.554)
Education level
≤Middle school	1,100 (74.9)	46 (4.2)	4.51	21 (1.5)	3 (14.3)	6.36	618 (28.0)	24 (3.9)	0.63	682 (68.2)	46 (6.7)	0.66
High school	295 (20.1)	19 (6.4)	(.105)	344 (25.2)	18 (5.2)	(.042)	1,005 (45.6)	47 (4.7)	(.728)	229 (22.9)	15 (6.6)	(.720)
≥College	73 (5.0)	1 (1.4)		998 (73.3)	38 (3.8)		583 (26.4)	27 (4.6)		89 (8.9)	4 (4.5)
Economic activity
Yes	9 (0.6)	66 (4.5)	0.43*	729 (53.5)	40 (5.5)	5.08	1.664 (75.4)	80 (4.8)	2.13	362 (36.2)	21 (5.8)	0.46
No	1,459 (99.4)	66 (4.5)	(.660)	634 (46.5)	19 (3.0)	(.024)	542 (24.6)	18 (3.3)	(.145)	638 (63.8)	44 (6.9)	(.499)
Chronic illness
Yes	478 (32.6)	21 (4.4)	0.02	381 (28.0)	19 (5.0)	0.55	1.430 (64.8)	58 (4.1)	1.43	945 (94.5)	60 (6.3)	0.64*
No	990 (67.4)	45 (4.5)	(.895)	982 (72.0)	40 (4.1)	(.457)	776 (35.2)	40 (5.2)	(.232)	55 (5.5)	5 (9.1)	(.396)

^† Fisher's exact test; SI=suicidal ideation.

Table 2.

Comparison of Suicidal Ideation Rate by Psychosocial Factors among Middle-class Korean Adolescents, Young Adults, Middle-aged and the Elderly who able doing Independent Activities of Daily Living

Variables	Adolescent (＜20 years)			Young adult (20~39 years)			Middle aged (40~64 years)			Elderly (≥65 years)
	Total n=1,468	SI (yes) n=66	x² (p)	Total n=1,363	SI (yes) n=59	x² (p)	Total n=2,206	SI (yes) n=98	x² (p)	Total n=1,000	SI (yes) n=65	x² (p)
	n (%)	n (%)	x² (p)	n (%)	n (%)	x² (p)	n (%)	n (%)	x² (p)	n (%)	n (%)	x² (p)
Stress-mental/physical
Yes	800 (54.5)	58 (7.3)	31.06	735 (53.9)	56 (7.6)	41.70	1,215 (55.1)	89 (7.3)	52.94	560 (56.0)	58(10.4)	31.16
No	668 (45.5)	8 (1.2)	(＜.001)	628 (46.1)	3 (0.5)	(＜.001)	991 (44.9)	9 (0.9)	(＜.001)	440 (44.0)	7(1.6)	(＜.001)
Frustration
Yes	463 (31.5)	57 (12.3)	96.20	440 (32.3)	50 (11.4)	77.65	735 (33.3)	78 (10.6)	98.84	360 (36.0)	52(14.4)	58.42
No	1,005 (68.5)	9 (0.9)	(＜.001)	923 (67.7)	9 (1.0)	(＜.001)	1,471 (66.7)	20 (1.4)	(＜.001)	640 (64.0)	13(2.0)	(＜.001)
Anxiety about the future
Yes	818 (55.7)	59 (7.2)	31.76	767 (56.3)	53 (6.9)	28.22	1,223 (55.4)	87 (7.1)	46.13	594 (59.4)	55(9.3)	18.33
No	650 (44.3)	7 (1.1)	(＜.001)	596 (43.7)	6 (1.0)	(＜.001)	983 (44.6)	11 (1.1)	(＜.001)	406 (40.6)	10(2.5)	(＜.001)
Strain from excessive work
Yes	435 (29.6)	34 (7.8)	15.87	423 (31.0)	35 (8.3)	23.06	636 (28.8)	46 (7.2)	16.39	326 (32.6)	28(8.6)	3.47
No	1,033 (70.4)	32 (3.1)	(＜.001)	940 (69.0)	24 (2.6)	(＜.001)	1,570 (71.2)	52 (3.3)	(＜.001)	674 (67.4)	37(5.5)	(.062)
Subjective health status compared with peers
Better	639 (43.6)	14 (2.2)	17.62	572 (42.0)	15 (2.6)	9.88	959 (43.5)	17 (1.8)	45.50	422 (42.2)	10(2.4)	53.62
Same	676 (46.0)	38 (5.6)	(＜.001)	644 (47.2)	32 (5.0)	(.007)	1,012 (45.9)	54 (5.3)	(＜.001)	467 (46.7)	31(6.6)	(＜.001)
Worse	153 (10.4)	14 (9.2)		147 (10.8)	12 (8.2)		235 (10.6)	27 (11.5)		111 (11.1)	24(21.6)
Have a chance to succeed when make the effort
Yes	900 (61.3)	29 (3.2)	8.79	843 (61.8)	23 (2.7)	13.67	1,365 (61.9)	43 (3.2)	14.09	648 (64.8)	37(5.7)	1.89
No	568 (38.7)	37 (6.5)	(.003)	520 (38.2)	36 (6.9)	(＜.001)	841 (38.1)	55 (6.5)	(＜.001)	352 (35.2)	28(8.0)	(.169)
Gap between the rich and the poor is getting bigger
Yes	1,406 (95.8)	65 (4.6)	1.25*	1,305 (95.7)	56 (4.3)	0.10*	2,120 (96.1)	94 (4.4)	0.01*	958 (95.8)	61(6.4)	0.66*
No	62 (4.2)	1 (1.6)	(.523)	58 (4.3)	3 (5.2)	(.736)	75 (3.9)	4 (4.7)	(.791)	42 (4.2)	4(9.5)	(.345)
Perceived social class of own High (7~10) Middle (4~6) Low(1~3)
High (7~10)	97 (6.6)	2 (2.1)	19.29	77 (5.6)	4 (5.2)	27.11	117 (5.3)	4 (3.4)	14.40	69 (6.9)	3(4.3)	11.82
Middle (4~6)	907 (61.8)	27 (3.0)	(＜.001)	861 (63.2)	19 (2.2)	(＜.001)	1,373 (62.2)	45 (3.3)	(.001)	628 (62.8)	30(4.8)	(.003)
Low(1~3)	464 (31.6)	37 (8.0)		425 (31.2)	36 (8.5)		716 (32.5)	49 (6.8)		303 (30.3)	32(10.6)

^† Fisher's exact test; SI=suicidal ideation.

Table 3.

Factors Influencing Suicidal Ideation among Middle-class Korean Adolescents, Young Adults, Middle-aged and the Elderly who able doing Independent Activities of Daily Living

Variables	Adolescent (＜20 years) n=1,468			Young adult (20~39 years) n=1,363			Middle aged (40~64 years) n=2,206			Elderly (≥65 years) n=1,000
	SI (yes) n=66		p	SI (yes) n=59		p	SI (yes) n=98		p	SI (yes) n=65		p
	OR	95% CI	p	OR	95% CI	p	OR	95% CI	p	OR	95% CI	p
Stress-mental/physical
Yes	1.27	0.53~3.04	.589	4.74	1.37~16.44	.014	2.61	1.22~5.58	.013	2.21	0.90~5.42	.084
No	1.00			1.00			1.00			1.00
Frustration
Yes	8.87	3.91~20.09	＜.001	4.78	2.16~10.56	＜.001	3.78	2.15~6.65	＜.001	4.56	2.24~9.29	＜.001
No	1.00			1.00			1.00			1.00
Anxiety about the future
Yes	1.87	0.77~4.50	.165	2.01	0.78~5.20	.148	2.09	1.04~4.19	.038	1.45	0.67~3.12	.346
No	1.00			1.00			1.00			1.00
Strain from excessive work
Yes No	1.44	0.84~2.46	.180	1.64	0.90~2.96	.104	1.17	0.75~1.83	.488	-	-	-
No	1.00			1.00			1.00			-	-	-
Subjective health status compared with peers
Better	1.00			1.00			1.00			1.00
Same	2.01	1.05~3.87	.036	1.49	0.76~2.93	.248	2.40	1.36~4.22	.002	2.26	1.08~4.77	.032
Worse	2.55	1.12~5.79	.026	1.83	0.79~4.28	.161	4.45	2.32~8.57	＜.001	7.81	3.43~17.77	＜.001
Have a chance to succeed when make the effort
Yes	1.00			1.00			1.00			-	-	-
No	1.24	0.73~2.13	.427	1.68	0.94~3.03	.082	1.41	0.91~2.17	.127	-	-	-
Perceived social class of own
High (7~10)	1.00			1.00			1.00			1.00
Middle (4~6)	0.88	0.20~3.94	.865	0.30	0.09~1.01	.051	0.64	0.21~1.92	.421	0.91	0.26~3.22	.878
Low (1~3)	1.83	0.41~8.25	.431	1.05	0.32~3.50	.934	0.86	0.28~2.60	.785	1.40	0.39~5.04	.607
Gender
Male	1.65	0.97~2.83	.067	-	-	-	-	-	-	-	-	-
Female	1.00			-	-	-	-	-	-	-	-	-
Education level
≤Middle school	-	-	-	2.33	0.60~9.12	.224	-	-	-	-	-	-
High School	-	-	-	1.41	0.75~2.68	.284	-	-	-	-	-	-
≥College	-	-	-	1.00			-	-	-	-	-	-
Economic activity
Yes	-	-	-	1.93	1.06~3.52	.032	-	-	-	-	-	-
No	-	-	-	1.00			-	-	-	-	-	-

SI=suicidal ideation; OR=odds ratio; CI=confidence interval.

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