DOI QR코드

DOI QR Code

Factors Associated With Suicidal Attempt among Suicidal Ideators of Korean Adults

한국 성인 자살관념자의 자살시도 연관 요인

  • Yuncheol, Choi (Department of Psychiatry, Kosin University Gospel Hospital) ;
  • Hyunseuk, Kim (Department of Psychiatry, Kosin University Gospel Hospital) ;
  • Sang-Shin, Lee (Department of Psychiatry, Kosin University Gospel Hospital)
  • 최윤철 (고신대학교 복음병원 정신건강의학과) ;
  • 김현석 (고신대학교 복음병원 정신건강의학과) ;
  • 이상신 (고신대학교 복음병원 정신건강의학과)
  • Received : 2022.06.23
  • Accepted : 2022.08.30
  • Published : 2022.12.31

Abstract

Objectives : The study aimed to identify factors associated with suicidal attempt in Korean adults experiencing thoughts of suicide. Methods : This study analyzed outcomes of suicidal behavior in the Korea National Health and Nutrition Examination Survey (KNHANES) 2015, 2017, and 2019. This survey was administered by the Korea Centers for Disease Control and Prevention (KCDC). The suicidal idea group was divided into individuals who had attempted suicide (n=92) and those who had not (n=831). Complex samples crosstabs analysis was conducted to compare the two groups' sociodemographic, psychiatric, and clinical characteristics. In addition, factors related to attempted suicide were investigated using complex samples logistic regression analysis. Results : The attempted suicide group had significantly higher rates of depression, recent psychiatric counseling, and suicidal plan (p<0.001) than the non-attempting group. In addition, the groups differed significantly in the frequency of binge drinking and smoking (p<0.05). Adjusted multivariate analysis revealed that the presence of a suicidal plan (Odds ratio [OR]=8.46, 95% Confidential Intervals [CI]=4.72-15.00), daily binge drinking (OR=3.14, 95% CI=1.26-7.84), psychiatric counseling within the past year (OR=3.03, 95% CI=1.75-5.23), low income level (OR=2.89, 95% CI=1.17-7.10), and history of depression (OR=2.39, 95% CI=1.29-4.42) were significantly associated with suicidal attempt. Conclusions : Factors associated with suicidal attempt among suicidal ideators in the general Korean population were identified across all sociodemographic, psychiatric, and clinical variables. Assessment of and intervention in suicidal plan, binge drinking, income level, and depression might prevent progression to suicidal attempt among those contemplating suicide.

연구목적 자살관념이 있는 한국성인에서 자살시도와 연관된 요인을 규명하고자 하였다. 방 법 질병관리청에서 매년 실시하는 국민건강영양조사 중 자살행동을 조사한 2015, 2017, 2019년도 결과를 분석하였고, 만 19세 이상 성인을 대상으로 하였다. 자살관념자를 자살시도군(n=92)과 비자살시도군(n=831)으로 나누었고, 복합표본 교차분석으로 두 군의 사회인구학적, 정신의학적, 임상적 특성을 비교하였다. 복합표본 로지스틱 회귀분석으로 자살관념자에서 자살시도와 연관된 인자를 조사하였다. 결 과 자살관념자 중 자살시도군에서는 비자살시도군에 비해 우울증 진단 병력, 자살시도 전 정신의학적 상담 경험, 자살계획이 유의하게 많았다(p<0.001). 또한 두 군은 소득 수준, 폭음 빈도, 흡연 빈도에서 유의한 차이를 보였다(p<0.05). 다변량 분석 모형(Adjusted model)에서 자살계획이 있는 경우(Odds ratio [OR]=8.46, 95% Confidential Intervals [CI]=4.72-15.00), 매일 폭음을 하는 경우(OR=3.14, 95% CI=1.26-7.84), 최근 1년 동안 정신의학적 상담 경험이 있는 경우(OR=3.03, 95% CI=1.75-5.23), 소득 수준이 낮은 경우(OR=2.89, 95% CI=1.17-7.10), 평생 우울증을 진단받은 적이 있는 경우(OR=2.39, 95% CI=1.29-4.42)가 자살시도와 통계적으로 유의한 연관성이 있었다. 결 론 우리나라 일반인구의 자살관념자에서 사회인구학적, 정신의학적, 임상적 변수 모두에 걸쳐서 자살시도의 위험요인이 나타났다. 자살관념이 있는 환자들에서 자살계획, 문제음주, 소득수준, 우울증 병력 등을 평가하고 개입하는 것이 자살시도로의 이환을 방지해 줄 가능성이 있다.

Keywords

References

  1. Korea Statistics. Causes of death statistics 2020. Available from: https://kostat.go.kr/portal/korea/kor_nw/1/6/2/index.board?bmode=read&bSeq=&aSeq=403046&pageNo=1&rowNum=10&navCount=10&currPg=&searchInfo=&sTarget=title&sTxt=. 
  2. Organization for Economic Co-operation and Development. Health Statistics 2021. Available from: https://www.oecd.org/health/health-data.htm. 
  3. Maris RW. Suicidology: a comprehensive biopsychosocial perspective. Br J Psychiatry 2019;217:3-18. 
  4. Sveticic J, De Leo D. The hypothesis of a continuum in suicidality: a discussion on its validity and practical implications. Ment Illn. Published online 2012. 
  5. Mikawa JK. An alternative to current analyses of suicidal behavior. Psychol Rep 1973;32:323-330.  https://doi.org/10.2466/pr0.1973.32.1.323
  6. Paykel ES, Myers JK, Lindenthal JJ, Tanner J. Suicidal feelings in the general population: a prevalence study. Br J Psychiatry 1974;124:460-469.  https://doi.org/10.1192/bjp.124.5.460
  7. Mundt JC, Greist JH, Jefferson JW, Federico M, Mann JJ, Posner K. Prediction of suicidal behavior in clinical research by lifetime suicidal ideation and behavior ascertained by the electronic Columbia-Suicide Severity Rating Scale. J Clin Psychiatry 2013;74:15045. 
  8. Millner AJ, Lee MD, Nock MK. Describing and measuring the pathway to suicide attempts: a preliminary study. Suicide Life Threat Behav 2017;47:353-369.  https://doi.org/10.1111/sltb.12284
  9. Mann JJ, Apter A, Bertolote J, Beautrais A, Currier D, Haas A, Hegerl U, Lonnqvist J, Malone K, Marusic A, Mehlum L, Patton G, Phillips M, Rutz W, Rihmer Z, Schmidtke A, Shaffer D, Silverman M, Takahashi Y, Varnik A, Wasserman D, Yip P, Hendin H. Suicide prevention strategies: a systematic review. JAMA 2005;294:2064.  https://doi.org/10.1001/jama.294.16.2064
  10. Chung CE. Complex sample design effects and inference for Korea National Health and Nutrition Examination Survey data. Korean J Nutr 2012;45:600-612.  https://doi.org/10.4163/kjn.2012.45.6.600
  11. Korea Disease Control and Prevention Agency. Instruction manual for the Korea National Health and Nutrition Examination Survey Raw Data. Available from: https://knhanes.kdca.go.kr/knhanes/sub03/sub03_06_02.do. 
  12. Chung JH, Moon K, Kim DH, Min JW, Kim TH, Hwang HJ. Suicidal ideation and suicide attempts among diabetes mellitus: The Korea National Health and Nutrition Examination Survey (KNHANES IV, V) from 2007 to 2012. J Psychosom Res 2014;77:457-461.  https://doi.org/10.1016/j.jpsychores.2014.08.008
  13. Chung JH, Han CH, Park SC, Kim CJ. Suicidal ideation and suicide attempts in chronic obstructive pulmonary disease: The Korea National Health and Nutrition Examination Survey (KNHANES IV, V) from 2007-2012. NPJ Prim Care Respir Med 2014;24:1-5. 
  14. Lee JY, Park YK, Cho KH, Kim SM, Choi YS, Kim DH, Nam GE, Han KD, Kim YH. Suicidal ideation among post-menopausal women on hormone replacement therapy: The Korean National Health and Nutrition Examination Survey (KNHANES V) from 2010 to 2012. J Affect Disord 2016;189:214-219.  https://doi.org/10.1016/j.jad.2015.09.068
  15. Choi J, Lee M, Ki M, Lee JY, Song YJ, Kim M, Lee S, Park S, Lim J. Risk factors for feelings of sadness and suicide attempts among cancer survivors in South Korea: findings from nationwide cross-sectional study (KNHANES IV-VI). BMJ Open 2017;7:e016130.  https://doi.org/10.1136/bmjopen-2017-016130
  16. Song HB, Lee SA. Socioeconomic and lifestyle factors as risks for suicidal behavior among Korean adults. J Affect Disord 2016;197:21-28.  https://doi.org/10.1016/j.jad.2016.02.035
  17. Oh J, Kim TS. Serum lipid levels in depression and suicidality: The Korea National Health and Nutrition Examination Survey (KNHANES) 2014. J Affect Disord 2017;213:51-58.  https://doi.org/10.1016/j.jad.2017.02.002
  18. Lee H, Jo M, Choi S, Kim Y, Oh K. Development and psychometric evaluation of measurement instrument for Korean health-related quality of life. PUBLIC Health Wkly Rep 2016;9:447-454. 
  19. Maris RW. Suicidology: a comprehensive biopsychosocial perspective. Br J Psychiatry 2019;217:65-77. 
  20. Han B, Compton WM, Gfroerer J, McKeon R. Prevalence and Correlates of past 12-month suicide attempt among adults with past-year suicidal ideation in the United States. J Clin Psychiatry 2015;76:295-302.  https://doi.org/10.4088/JCP.14m09287
  21. Nock MK, Borges G, Bromet EJ, Alonso J, Angermeyer M, Beautrais A, Bruffaerts R, Chiu WT, Girolamo G, Gluzman S, Graaf R, Gureje O, Haro JM, Huang Y, Karam E, Kessler RC, Lepine JP, Levinson D, Medina-Mora ME, Ono Y, Posada-Villa J, Williams D. Cross-national prevalence and risk factors for suicidal ideation, plans and attempts. Br J Psychiatry 2008;192:98-105.  https://doi.org/10.1192/bjp.bp.107.040113
  22. Suominen K, Isometsa E, Ostamo A, Lonnqvist J. Level of suicidal intent predicts overall mortality and suicide after attempted suicide: a 12-year follow-up study. BMC Psychiatry 2004;4:11.  https://doi.org/10.1186/1471-244X-4-11
  23. Borges G, Angst J, Nock MK, Ruscio AM, Walters EE, Kessler RC. A risk index for 12-month suicide attempts in the National Comorbidity Survey Replication (NCS-R). Psychol Med 2006;36:1747-1757.  https://doi.org/10.1017/s0033291706008786
  24. Posner K, Oquendo MA, Gould M, Stanley B, Davies M. Columbia Classification Algorithm of Suicide Assessment (CCASA): classification of suicidal events in the FDA's pediatric suicidal risk analysis of antidepressants. Am J Psychiatry 2007;164:1035-1043.  https://doi.org/10.1176/appi.ajp.164.7.1035
  25. Simon RI, Hales RE. The American psychiatric publishing textbook of suicide assessment and management. American Psychiatric Pub;2012. 
  26. Sher L. Alcohol consumption and suicide. Qjm 2006;99:57-61.  https://doi.org/10.1093/qjmed/hci146
  27. Abroms BD, Fillmore MT, Marczinski CA. Alcohol-induced impairment of behavioral control: effects on the alteration and suppression of prepotent responses. J Stud Alcohol 2003;64:687-695.  https://doi.org/10.15288/jsa.2003.64.687
  28. Ratsma JE. Neurochemical markers of alcoholism vulnerability in humans. Alcohol Alcohol 2002;37:522-533.  https://doi.org/10.1093/alcalc/37.6.522
  29. Badawy AAB. Alcohol, aggression and serotonin: metabolic aspects. Alcohol Alcohol 1998;33:66-72.  https://doi.org/10.1093/oxfordjournals.alcalc.a008350
  30. Vinson DC, Borges G, Cherpitel CJ. The risk of intentional injury with acute and chronic alcohol exposures: a case-control and case-crossover study. J Stud Alcohol 2003;64:350-357.  https://doi.org/10.15288/jsa.2003.64.350
  31. Glasheen C, Pemberton MR, Lipari R, Copello EA, Mattson ME. Binge drinking and the risk of suicidal thoughts, plans, and attempts. Addict Behav 2015;43:42-49.  https://doi.org/10.1016/j.addbeh.2014.12.005
  32. Xuan Z, Naimi TS, Kaplan MS, Bagge CL, Few LR, Maisto S, Saitz R, Freeman R. Alcohol policies and suicide: a review of the literature. Alcohol Clin Exp Res 2016;40:2043-2055.  https://doi.org/10.1111/acer.13203
  33. Raschke N, Mohsenpour A, Aschentrup L, Fischer F, Wrona KJ. Socioeconomic factors associated with suicidal behaviors in South Korea: systematic review on the current state of evidence. BMC Public Health 2022;22:129.  https://doi.org/10.1186/s12889-022-12498-1
  34. Burrows S, Auger N, Gamache P, St-Laurent D, Hamel D. Influence of social and material individual and area deprivation on suicide mortality among 2.7 million Canadians: a prospective study. BMC Public Health 2011;11:1-11.  https://doi.org/10.1186/1471-2458-11-1
  35. Park EO, Lee HY. Factors influencing suicidal ideation among Korean adults by age: results of the 2010-2011 Korean health and nutrition examination survey. Community Ment Health J 2015;51:987-993.  https://doi.org/10.1007/s10597-015-9863-7
  36. Walby FA, Myhre MO, Kildahl AT. Contact with mental health services prior to suicide: a systematic review and meta-analysis. Psychiatr Serv 2018;69:751-759.  https://doi.org/10.1176/appi.ps.201700475
  37. Stene-Larsen K, Reneflot A. Contact with primary and mental health care prior to suicide: a systematic review of the literature from 2000 to 2017. Scand J Public Health 2019;47:9-17.  https://doi.org/10.1177/1403494817746274
  38. Andersen RM, Davidson PL, Baumeister SE. Improving access to care in America. Chang US Health Care Syst Key Issues Health Serv Policy Manag 3a Ed San Franc Jossey-Bass. Published online 2007:3-31. 
  39. Subramaniam M, Abdin E, Seow EL, Picco L, Vaingankar JA, Chong SA. Suicidal ideation, suicidal plan and suicidal attempts among those with major depressive disorder. Ann Acad Med Singap 2014;43:412-421.  https://doi.org/10.47102/annals-acadmedsg.V43N8p412
  40. Han B, Compton WM, Gfroerer J, McKeon R. Mental health treatment patterns among adults with recent suicide attempts in the United States. Am J Public Health 2014;104:2359-2368.  https://doi.org/10.2105/AJPH.2014.302163
  41. Urbanoski KA, Cairney J, Bassani DG, Rush BR. Perceived unmet need for mental health care for Canadians with co-occurring mental and substance use disorders. Psychiatr Serv 2008;59:283-289.  https://doi.org/10.1176/ps.2008.59.3.283
  42. Berg SH, Rortveit K, Aase K. Suicidal patients' experiences regarding their safety during psychiatric in-patient care: a systematic review of qualitative studies. BMC Health Serv Res 2017;17:1-13.  https://doi.org/10.1186/s12913-016-1943-z
  43. Cavanagh JTO, Carson AJ, Sharpe M, Lawrie SM. Psychological autopsy studies of suicide: a systematic review. Psychol Med 2003;33:395-405.  https://doi.org/10.1017/S0033291702006943
  44. Harwood D, Hawton K, Hope T, Jacoby R. Psychiatric disorder and personality factors associated with suicide in older people: a descriptive and case-control study. Int J Geriatr Psychiatry 2001;16:155-165.  https://doi.org/10.1002/1099-1166(200102)16:2<155::AID-GPS289>3.0.CO;2-0
  45. Jeon HJ, Lee JY, Lee YM, Hong JP, Won SH, Cho SJ, Kim JY, Chang SM, Lee HW, Cho MJ. Unplanned versus planned suicide attempters, precipitants, methods, and an association with mental disorders in a Korea-based community sample. J Affect Disord 2010;127:274-280.  https://doi.org/10.1016/j.jad.2010.05.027
  46. Sokero TP, Melartin TK, Rytsala HJ, Leskela US, Isometsa ET. Suicidal ideation and attempts among psychiatric patients with major depressive disorder. J Clin Psychiatry 2003;64:20288. 
  47. Nordentoft M, Mortensen PB, Pedersen CB. Absolute risk of suicide after first hospital contact in mental disorder. Arch Gen Psychiatry 2011;68:1058-1064.  https://doi.org/10.1001/archgenpsychiatry.2011.113
  48. Melhem NM, Porta G, Oquendo MA, Zelazny J, Keilp JG, Iyengar S, Burke A, Birmaher B, Stanley B, Mann JJ, Brent DA. Severity and variability of depression symptoms predicting suicide attempt in high-risk individuals. JAMA Psychiatry 2019;76:603-613.  https://doi.org/10.1001/jamapsychiatry.2018.4513
  49. Pfeiffer PN, Ganoczy D, Ilgen M, Zivin K, Valenstein M. Comorbid anxiety as a suicide risk factor among depressed veterans. Depress Anxiety 2009;26:752-757.  https://doi.org/10.1002/da.20583
  50. Min JY, Min KB. Suicide behaviors and health-related quality of life: results from the Korean community health survey of 393,073 adults. Afr J Psychiatry 2015;18:214. 
  51. Kim M, Oh GJ, Lee YH. Gender-specific factors associated with suicide attempts among the community-dwelling general population with suicidal ideation: the 2013 Korean community health survey. J Korean Med Sci 2016;31:2010.  https://doi.org/10.3346/jkms.2016.31.12.2010
  52. Chen YL, Kuo PH. Effects of perceived stress and resilience on suicidal behaviors in early adolescents. Eur Child Adolesc Psychiatry 2020;29:861-870.  https://doi.org/10.1007/s00787-019-01401-w
  53. Maris RW. Suicidology: a comprehensive biopsychosocial perspective. Br J Psychiatry 2019;217:432-449. 
  54. Simon RI, Hales RE. The American psychiatric publishing textbook of suicide assessment and management. American Psychiatric Pub;2012. p.57-72.