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Twelve-month prevalence and predictors of self-reported suicidal ideation and

suicide attempt among Korean adolescents in a web-based nationwide survey
Article in Australian and New Zealand Journal of Psychiatry · August 2014

DOI: 10.1177/0004867414540752 · Source: PubMed
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Australian and New Zealand Journal of Psychiatry
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Twelve-month Prevalence and Predictors of Self-reported
Suicidal Ideation and Suicide Attempt Among Korean
Adolescents in a Web-based Nationwide Survey
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Journal: Australian and New Zealand Journal of Psychiatry
Manuscript ID: ANP-2013-00528.R1
Manuscript Type: Research

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Date Submitted by the Author: 31-Mar-2014

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Complete List of Authors: Kang, Eun-Ho; Samsung Medical Center, Sungkyunkwan University,
Psychiatry
Hyun, Min Kyung; National Evidence-based Healthcare Collaborating
Agency,
Choi, Seong Mi; National Evidence-based Healthcare Collaborating Agency,
Kim, Ji-Min; National Evidence-based Healthcare Collaborating Agency,
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Kim, Gyung-Mee; Haeundae Paik Hospital, Inje University School of

Medicine, Psychiatry
Woo, Jong-Min; Seoul Paik Hospital, Inje University School of Medicine,
Psychiatry
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Keywords: Adolescent, Korea, Prevalence, Risk factor, Suicide
Editorial Office Contact: journal.assist@sydney.edu.au

Page 1 of 33 Australian and New Zealand Journal of Psychiatry
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4 Response to reviewers
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8 Reviewers' comments to Authors:
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11 Reviewer: 1
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14 Comments to the Author
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16 This manuscript reports the findings from a cross-sectional online survey exploring the prevalence of
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suicidal thoughts and suicide attempts over the past 12 months. Overall, the manuscript is well written
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19 and reports on a methodologically simple study. A few minor points:
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21 → We appreciate the reviewer 1’s valuable comments.
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24
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25 ABSTRACT:
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27 Well-written for the most part. The authors should spell out fully any acronyms which appear in the
28 abstract (e.g. OECD).
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31 → We revised it as the reviewer’s comment.
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35 INTRODUCTION:
36 Also well-written, good use of references. I was surprised to read the authors state that previous
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38 research about suicidal behaviours is now ‘out-of-date’, despite them being published in 2009, 2010
39 and 2013. Are these studies really no longer relevant?
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42 → We apologize for the confusion we have made. As the reviewer’s comment, we revised
43 the text as well as the references as follows:
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46 (P3; L9-11) However, only a few studies have reported about the prevalence and
47 predictors of suicidal behaviors (i.e., suicidal ideation and attempt) among adolescents
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49 in South Korea (An et al., 2010; Han et al., 2009). Although a few studies have reported
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51 about suicidal behaviors in adolescents, most of those results are out of date and limited
52 due to small sample sizes or narrow age ranges of the subjects (An et al., 2010; Han et
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54 al., 2009; park et al., 2013; Woo et al., 2010).
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Australian and New Zealand Journal of Psychiatry Page 2 of 33
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4 METHOD:
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Although simple in design, it was encouraging to read that the authors had used a stratified multi-
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7 stage cluster approach to obtain a more representative sample.
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9 I wonder whether the authors have considered the impact of measuring only ‘perceived’ SES and
10 academic performance – what are the implications for inaccurate perceptions?
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→ We agree with the reviewer’s comment. It would have been good to measure
14 objective SES and academic performances as well. It is the limitation in our study only
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16 to measure perceived SES and academic performances not to measure objective ones.
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18 (P10;L15−
−P11;L9) Perceived SES is considered to be a kind of identity type akin to
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19 gender identity (Ostrove et al., 1999) and has been used to explore the health outcomes
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21 and health inequalities. Recent studies have repeatedly shown that while perceived SES
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23 were influenced by objective SES, perceived SES independently predicted physical or

24 mental health (Demakakos et al., 2008; Goodman et al., 2007). On the other hands, little
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26 is known about the effect of perceived SES on suicidal behaviors. Thus, our study might
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28 shed light on the exploration of the relationship between them. Further studies
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29 comparing the roles of objective and perceived SES on suicidal behaviors are warranted.
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31 In terms of academic performance, several studies reported that perceived academic
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33 performance was associated with suicidal behavior in adolescents (Richardson et al.,
34 2005; Martin et al., 2005). In addition, perception of failure in academic performance
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36 was shown to be an independent indicator of risk of attempted suicide in young
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38 adolescents (Richardson et al., 2005). Our results are consistent with the previous
39 reports and suggest that measuring perceived academic performance as well as
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41 perceived SES would be easy and simple way for teachers to assess the adolescents in
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43 the school context. We added this point to the limitation.
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47 Also, although it is too late to address this, it would have been good to measure (or at least comment
48 on) use of mental health services by people who did not attempt suicide – i.e. did they seek help? Also,
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50 did those who did attempt suicide seek help before their attempt or only after?
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52 → We agree with the reviewer’s comment that it would have been good to measure use
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54 of mental health services by people who did not attempt suicide. The data were all about
55 adolescents who sought help and received mental health services only after the suicide
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57 attempts.
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RESULTS:
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7 A good succinct summary of findings.
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10 DISCUSSION:
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12 It is inaccurate to state “the age of peak incidence of suicide attempt in female adolescents was 12 and
13 13 years” as it cannot be both. Rather, the exact figure should be provided.
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16 → We agree with the reviewer’s comment. We revised the text and added the data label
17 in the figure as follows:
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20 (P7; L20) “the age of peak incidence of suicide attempt in female adolescents was 13
21 years”
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Some references should be used to support the statement: “It is well known that mental disorders such
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48 as depression are closely related with suicidal behaviour”.
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→ We added references as the reviewer’s comment (P8; L22).
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54 Although there was a brief mention of the study’s limitations, it would be good to see these
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56 acknowledged and discussed more fully and openly. Acknowledging them is the first step, but
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hypothesising on their likely impact on the findings is the next logical step.
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4 → We agree with the reviewer’s comment and discussed more about the limitation of
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6 the present study as follows:
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8 (P10;L7−
−P11;L14) Several limitations should be mentioned. First, the question about
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10 suicide attempt was asked only to adolescents who had reported suicidal ideation. In the
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12 present survey, we did not assess self-injurious behaviours in adolescents who denied
13 history of suicidal ideation. However, several studies have shown that non-suicidal self-
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15 injury such as cutting is closely related with suicide attempts (Whitlock and Knox, 2007).
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17 Thus, there is possibility that the rates of suicidal attempts in our study were
18 underestimated. Second, because of the self-reporting and cross-sectional design, there
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20 is potential for recall bias. Third, we used perceived SES and academic performance
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22 only rather than objective ones. Perceived SES is considered to be a kind of identity
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23 type akin to gender identity (Ostrove et al., 1999) and has been used to explore the
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25 health outcomes and health inequalities. Recent studies have repeatedly shown that
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27 while perceived SES were influenced by objective SES, perceived SES independently
28 predicted physical or mental health (Demakakos et al., 2008; Goodman et al., 2007). On
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30 the other hands, little is known about the effect of perceived SES on suicidal behaviors.
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32 Thus, our study might shed light on the exploration of the relationship between them.
33 Further studies comparing the roles of objective and perceived SES on suicidal
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35 behaviors are warranted. In terms of academic performance, several studies reported
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that perceived academic performance was associated with suicidal behavior in
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38 adolescents (Richardson et al., 2005; Martin et al., 2005). In addition, perception of
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40 failure in academic performance was shown to be an independent indicator of risk of
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42 attempted suicide in young adolescents (Richardson et al., 2005). Our results are
43 consistent with the previous reports and suggest that measuring perceived academic
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45 performance as well as perceived SES would be easy and simple way for teachers to
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47 assess the adolescents in the school context. Fourth, we assessed subjective feelings of
48 depression rather than a formal diagnosis of major depression. Although major
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50 depression is well known predictor of suicide, subjective feelings of depression is not
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52 confined to major depression. However, it would be amenable and practical way for
53 teachers to assess the suicidal risk of their students. Finally, our data on the use of
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55 mental health services was limited to those who attempted suicide attempters who
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57 sought mental health services only after the attempts.
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Finally, I was hoping to read some more in-depth discussion about the potential implications of the
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7 study’s findings and of what the next step might be for these data / authors.
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→ We agree with the reviewer’s comment. We added the potential implication in the
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11 discussion as follows: (P11;L17−
−P12;L6) The most important implications of our study
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13 were that suicide prevention methods in adolescents in South Korea should be different
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15 from those of other countries at least in terms of demographic data including age and
16 sex. First, the most urgent attention should be paid on younger female adolescents
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18 compared to other countries in which adolescents under 15 years show low prevalence
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20 of suicidal behaviors. In addition, suicide prevention should be made for all age ranges
21 of adolescents. Second, our results suggest that screening and treatment system for
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23 mental disorders including depression is warranted. Third, it would be possible to

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educate teachers to assess suicide risk of their students by several simple questions in
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26 the school. Finally, the causes of the unique patterns as well as high prevalences of
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28 suicidal behaviours in Korean adolescents are unclear. Our study suggests that multi-
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30 disciplinary efforts and studies including psychiatric, familial, social aspects are urgent
31 to solve the problem.
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35 I trust this feedback is of use and I wish the authors the best of luck in their future endeavours.
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38 → We deeply appreciate with the reviewer 1’s feedback.
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44 Reviewer: 2
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47 Comments to the Author
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49 This is a useful paper in that it surveys a group outside the usual Anglo-American, European surveys.
50 The survey is also large and the findings of interest to readers. However there are a number of issues I
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52 would like to see verified.
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54 → We appreciate the reviewer 2’s valuable comments.
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4 First, the authors say the survey was a cross-sectional, stratified, multistage cluster method used to
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select a nationwide representative sample of 74,980 adolescents. Is there any reference as to the
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7 sampling method and was the survey confined to the few questions which are discussed in the paper?
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9 → We added the reference.
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12 And the survey consisted of the questions about 15 domains with 134 questionnaires including
13 physical activities, eating habits, personal hygiene habits, health inequalities, physical and
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15 mental health, etc. From the big data, we drew demographic and mental health data. The
16 mental health data was confined to the few questions that were discussed in our paper.
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19 It is not clear, at least to me, how many adolescents were eligible. It says 74,980 adolescents
20 responded to a web-based self-reported survey but what number did not respond? The authors then
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22 state that after the survey was fully explained, only participants who provided informed consent
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23 completed the online self-report questionnaires. A total of 72,623 samples were used for analysis (I
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25 calculate this as 97% is that correct). I felt the study would benefit from a CONSORT diagram with
26 numbers who were eligible, numbers who responded, numbers who consented, and numbers used for
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28 analysis.
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30 → We appreciate the reviewer’s comment. There were some errors and we corrected the
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32 number. We also added the CONSORT diagram as the Fig. 1.

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58 For a study that is focused on youth risk behaviour, was there really only one question on suicidal
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4 ideation and suicide attempts in the survey? Similarly was there only one question(“Have you ever
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been depressed or down, most of the day, nearly every day, at least for 2 weeks in the past 12
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7 months?”) for depression. It might be useful to attach an appendix of the survey.
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9 → Done. Same as the above.
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13 The results are interesting and, as the authors note, have a high reported rate of suicidal ideation and
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15 suicide attempts. Interestingly female rates were considerably higher, particularly young females.
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18 The predictors are of interest but I think the authors need to discuss more the relative importance of
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19 individual predictors. For example, being depressed had an odds ratio of 9.2 while nearly all the other
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21 odds ratios are between 1 and 2. We also have no idea of what percentage of variance the selected
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predictors added up to. I think the authors need to look at other statistical analyses to help readers
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24 regarding the clinical relevance of the predictors they have found.
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26 → In terms of the relative importance of being depressed, we discussed more in the response to
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28 reviewer 1. We used multiple logistic regression analysis to examine each factor predict
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29 independently suicidal behaviours. Using multiple logistic regression analysis, we could see the
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31 relative importance of each predictors. Especially, we suggest that we could educate school
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teachers to use some simple questions in our paper assessing the suicide risk of their students.
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Overall, this is a very large survey on an under-surveyed group.
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40 References)
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43 An H, Ahn JH and Bhang SY. (2010) The association of psychosocial and familial factors with
44 adolescent suicidal ideation: A population-based study. Psychiatry Res 177: 318-322.
45
Demakakos P, Nazroo J, Breeze E, et al. (2008) Socioeconomic status and health: the role of
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47 subjective social status. Soc Sci Med 67: 330-340.
48 Goodman E, Huang B, Schafer-Kalkhoff T, et al. (2007) Perceived socioeconomic status: a new type
49
50 of identity that influences adolescents' self-rated health. J Adolesc Health 41: 479-487.
51 Han MA, Kim KS, Ryu SY, et al. (2009) Associations between smoking and alcohol drinking and
52
suicidal behavior in Korean adolescents: Korea Youth Behavioral Risk Factor Surveillance,
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54 2006. Prev Med 49: 248-252.
55 Martin G, Richardson AS, Bergen HA, et al. (2005) Perceived academic performance, self-esteem
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57 and locus of control as indicators of need for assessment of adolescent suicide risk:
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4 implications for teachers. J Adolesc 28: 75-87.
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6 Ostrove JM, Feldman P and Adler NE. (1999) Relations among Socioeconomic Status Indicators and
7 Health for African-Americans and Whites. J Health Psychol 4: 451-463.
8
Richardson AS, Bergen HA, Martin G, et al. (2005) Perceived academic performance as an indicator
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10 of risk of attempted suicide in young adolescents. Arch Suicide Res 9: 163-176.
11 Whitlock J and Knox KL. (2007) The relationship between self-injurious behavior and suicide in a
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13 young adult population. Archives of General Psychiatry 161: 634-640.
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4 1 Title page
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7 2 Title: Twelve-month Prevalence and Predictors of Self-reported Suicidal
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10 3 Ideation and Suicide Attempt Among Korean Adolescents in a Web-based
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4 Nationwide Survey
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50 16 Gyung-Mee Kim, M.D., Ph.D.2,3
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4 1 Jong-Min Woo, M.D., M.P.H., Ph.D.2,4
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10 3 Department of Psychiatry, Samsung Medical Center, Sungkyunkwan University School of
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12 4 Medicine, Seoul, Korea
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National Evidence-based Healthcare Collaborating Agency, Seoul, Korea
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Department of Psychiatry, Seoul Paik Hospital, Inje University School of Medicine, Seoul ,
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34 12 Seoul Paik Hospital, Inje University School of Medicine, Marreunnae street 9, Jung-gu, Seoul,
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36 13 100-032, Korea (Phone +822 2270 0063 Fax. +822 2270 0344 Email jongmin.woo
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4 1 Twelve-month Prevalence and Predictors of Self-reported Suicidal Ideation
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7 2 and Suicide Attempt Among Korean Adolescents in a Web-based
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3 Nationwide Survey
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16 5 Abstract
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19 Objective: The suicide rate in South Korea was the highest among the Organisation for
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21 7 Economic Co-operation and Development (OECD) countries in 2011. Although the suicide
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28 10 determine the prevalence, pattern, and predictors of suicidal ideation and attempt in the past
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30 11 12 months.
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33 12 Methods: A total sample of 72,623 adolescents aged 12 to 18 years who responded to a web-
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35 13 based anonymous self-reported survey between September and October 2010 was used for
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40 15 Results: The suicidal ideation and suicide attempt rates were 19.1 % and 4.9%, respectively.
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16 Being female, having a poor perceived socioeconomic status and a poor perceived academic
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45 17 performance, subjective feeling of depression, cigarette smoking, alcohol use, perceived
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47 18 general medical health, and experiences of any involvement with sexual intercourse were the
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49 19 contributing factors that predicted elevated risks for suicidal ideation and suicide attempt. In
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20 contrast to previous reports in other countries, the suicide attempt rate in Korean female
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4 1 adolescents peaked in the age 13 years, and there were no differences in suicidal ideation in
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6 2 females by age. There were no differences in both suicidal ideation and attempt rates in males
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3 by age.
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4 Conclusion: A multi-disciplinary approach that takes into consideration the characteristics of
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14 5 Korean adolescents with suicidal ideation or attempt is warranted for developing prevention
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22 8 Keywords: Adolescent, Korea, Prevalence, Risk factor, Suicide
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4 1 Introduction
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7 2 The suicide rate has been rapidly rising in South Korea, with up to 31.7 deaths per 100,000 in
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9 3 2011, which was the highest rate among the OECD (Organisation for Economic Co-operation
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4 and Development) countries (Office, 2011a). Although the suicide rate in adolescents is lower
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14 5 than that of adults and has been reported to be decreasing in young males in some countries
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16 6 (Bridge et al., 2006), it has consistently been increasing in recent years in South Korea. In
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18 7 South Korea, suicide is the most common cause of deaths under 40 years of age (Office,
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8 2011b). The suicide rate in people aged 12-18 years was 5.3 per 100,000 in 2011, which was
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25 and predictors of suicidal behaviors (i.e., suicidal ideation and attempt) among adolescents in
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27 11 South Korea (An et al., 2010; Han et al., 2009). In addition, suicide rates are known to vary
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29 12 region to region and country to country (Hawton and van Heeringen, 2009). It has been
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13 known that many other factors such as age, sex, ethnicity, psychiatric problems including
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34 14 depression and alcohol misuse, sexual abuse are associated with suicidal behaviors. For
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36 15 example, in the United States, during the course of 12 months, a total of 4.2% of adolescents
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38 16 aged 13 to 18 years old reported experiencing suicidal ideation and 1.9% attempted suicide
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17 (Husky et al., 2012). Whereas the rate of suicidal ideation was higher in adolescents aged 16-
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43 18 18 than their younger counterparts, the suicidal attempt rate was the reverse of this. On the
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45 19 other hand, the suicidal attempt rate (7.8%) in New Zealand adolescent students in the last 12
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47 20 months was reported to be much higher than the reported result according to Husky et al.
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49 21 (2012). Another important issue in suicidal behavior is the use of mental health services. Less
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22 than one third of suicidal adolescents were reported to receive mental health services during
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4 1 the past 12 months (Pirkis et al., 2003; Borges et al., 2008). However, there is no known data
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6 2 about mental health services, especially about the data after suicide attempts in Korea despite
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3 the impact and seriousness of such suicidal behaviors.
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4 Thus, a comprehensive survey on suicidal behavior among Korean adolescents is urgent and
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14 5 would be helpful to extend our understanding of the problem and for the planning and
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16 6 development of intervention programs for suicidal adolescents. We aimed to examine the
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18 7 rates of adolescent suicidal ideation and attempts and the use of mental health services after a
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8 suicide attempt in the past year among a large nationwide sample using a web-based survey.
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10 Methods
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11 Samples
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12 The data are from “The Sixth Korea Youth Risk Behavior Web-based Survey, 2010, Ministry
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35 13 of Education, Science and Technology, Ministry of Health and Welfare, Korea Centers for
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37 14 Disease Control and Prevention”. A cross-sectional, stratified multistage cluster method

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39 15 according to urbanicity, sex, and school type was used to select a nationwide representative
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16 sample of 75,643 adolescents aged 12 to 18 years (middle and high school students) who
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44 17 responded to a web-based anonymous self-reported survey between September and October
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46 18 2010 (Prevention, 2010). After the survey was fully explained, only participants who
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48 19 provided informed consent completed the online self-report questionnaires in a school
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50 20 computer room. Finally, a total of 72,623 samples were used for analysis. Fig.1. shows the
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21 CONSORT diagram for the flow. The Ethics Committee of National Evidence-based
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4 1 Healthcare Collaborating Agency (NECA) South Korea approved the survey.
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3 Measures
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4 The sociodemographic factors examined included age, sex, perceived socioeconomic status
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14 5 (SES), and perceived academic performance. Health-related factors were subjective feeling of
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16 6 depression (“Have you ever been depressed or down, most of the day, nearly every day, at
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18 7 least for 2 weeks in the past 12 months?”), cigarette smoking, alcohol drinking, perceived
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8 general medical condition, and experiences of sexual intercourse. Suicidal ideation was
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23 assessed by asking “Have you ever seriously thought about committing suicide in the past 12
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25 months?” and suicide attempt was assessed by asking “Have you ever attempted suicide in
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27 11 the past 12 months?” Suicide attempt was assessed only in respondents who said ‘Yes’ to the
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38 15 Statistical analyses
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41 16 Simple logistic regressions were employed to determine odds ratios (ORs) and associated
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43 17 confidence intervals (CIs) for suicidal ideation and suicide attempt. Multiple logistic
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45 18 regressions were used to explore the demographic and clinical correlates that independently
46
47 19 predict suicidal ideation and suicide attempt. Statistical significance was set at p < 0.05 on
48
49
20 two-sided tests. All statistical analyses were conducted using SAS version 9.2.
50
51
52
21
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54 5
55
56
57
58
59
60
1
2
3
4 1 Results
5
6
7 2 In the past 12 months, 19.1% of adolescents reported experiencing suicidal ideation and the
8
9 3 reported suicide attempt rate was 4.9% (Table 1). Female sex was a strong sociodemographic
10
11
4 factor predicting suicidal ideation and suicide attempt after controlling for all
12
13
14 5 sociodemographic data. As a total group, adolescents aged 12 to 15 years were significantly
15
16 6 associated with an increased prevalence of suicidal ideation and attempts. However, when
17
18 7 examined separately by sex, the age curve showed that there were no significant differences
Fo
19
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8 in suicidal ideation according to age (Fig. 2A). In addition, age curve showed that suicide
21
22
9
r
23 attempt rate decreased continuously by age in females only with no age differences in males
24
10
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25 (Fig. 2B). Multiple logistic regression revealed that the prevalence rate of suicide attempt in
26
27 11 females started to fall significantly at 16 (age 16: adjusted OR = 0.66, CI = 0.55 − 0.80; age
28
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29
12 17: adjusted OR = 0.58, CI = 0.47 − 0.71; age 18: adjusted OR = 0.47, CI = 0.37 − 0.59; all
30
31
ew
32 13 p’s < 0.001). Perceived poor SES was significantly associated with both highest suicidal
33
34 14 ideation and suicide attempt rates (Table 1). Perceived fair or poor academic performance
35
36 15 also independently predicted increased prevalence of suicidal ideation and suicide attempt.
On
37
38
39 16 Both suicidal ideation and suicide attempts were strongly associated with a history of
40
41
ly
17 subjective feelings of depression (Table 2). Ever-smoker and ever-alcohol user showed higher
42
43
44 18 12-month prevalence rates in both suicidal ideation and suicide attempt than their respective
45
46 19 counterparts. Average or lower perceived overall general medical health was significantly
47
48 20 associated with increased rates of suicidal ideation and suicide attempt compared to excellent
49
50
21 or good general medical health. Having had sexual intercourse with the opposite or same sex
51
52
53 22 all increased both suicidal ideation and suicide attempt rates.
54 6
55
56
57
58
59
60
1
2
3
4 1 Of the 3,529 suicide attempters, 11.6 % (N = 410) of adolescents received mental health
5
6 2 services after the attempt.
7
8
9 3
10
11
12 4
13
14
15 5 Discussion
16
17
18 6 Self-reported 12-month prevalences of suicidal ideation and suicide attempt among Korean
Fo
19
20
21 7 adolescents were 19.1 % and 4.9%, respectively. The rates were much higher than those of
22
r
23 8 other countries (Husky et al., 2012; Fleming et al., 2007; Abell et al., 2012; Dai et al., 2011;
24
Re
25 9 Nock et al., 2013). Especially, the prevalence of such suicidal behaviors was much higher in
26
27 10 female adolescents (23.4% of suicidal ideation and 6.3% of suicide attempt) than in males.
28
vi
29
11 These findings confirm the previous survey finding in 2006 in Korea (Han et al., 2009).
30
31
12
ew
32 Several studies have reported that the peak hazard age of suicidal behaviors is around 15
33
34 13 years (Borges et al., 2008; Fleming et al., 2007; Husky et al., 2012). However, the most
35
36 14 striking finding in our study was that the age of peak incidence of suicide attempt in female
On
37
38 15 adolescents was 13 years and the rate continuously decreased with age in contrast to the
39
40
41 16 inverted U-shape of the age curve of suicidal behavior in other studies. Although we did not
ly
42
43 17 include adolescents under 12, our data also suggests the possibility of a much higher
44
45 18 prevalence of suicidal behaviors in children under 12 years compared to other countries. In
46
47 19 addition, the suicidal ideation rate in both sexes and suicide attempt rate in male adolescents
48
49
20 did not differ according to age. This means that the high rates of suicidal ideation and suicide
50
51
52 21 attempt rates persist with little change through the entire period of adolescence in South
53
54 7
55
56
57
58
59
60
1
2
3
4 1 Korea. This was an unexpected finding, and the reason is unclear why suicidal behaviors
5
6 2 according to age in South Korea show such different patterns compared to other countries.
7
8
3 Contributing factors may include the consistently widening gap between the rich and the poor,
9
10
11 4 and socioeconomic deprivation after the financial crisis in 1997, marginalization, and
12
13 5 disintegration of the social safety net. However, further extensive studies are warranted to
14
15 6 investigate the reason for the distinct pattern of suicidal behaviors among South Korean
16
17 7 adolescents.
18
Fo
19
20
8 Perceived low SES was associated with both increased rates of suicidal ideation and suicide
21
22
9
r
23 attempt. Individuals who perceived their SES as middle reported decreased frequency of
24
10
Re
25 suicidal ideation and suicide attempt rate compared to those who considered themselves to
26
27 11 have a high SES, and the differences in the rates were small. Self-reported levels of academic
28
vi
29 12 performance that were fair or poor were associated with an increased prevalence of suicidal
30
31
13 behaviors, reflecting the Korean culture of putting enormous importance on academic
ew
32
33
34 14 achievements.
35
36
15
On
37 The subjective feeling of depression was the strongest factor that predicted increased odd
38
39 16 ratios for both suicidal ideation and suicide attempt. It is well known that mental disorders
40
41 17
ly
such as depression are closely related with suicidal behaviors (Hawton and van Heeringen,
42
43
18 2009; Pitman et al., 2012). Although we did not assess the formal diagnosis of major
44
45
46 19 depression, our findings are consistent with the previous findings and this suggests the
47
48 20 importance of the role of psychiatric disorders in the issue of suicide (Li et al., 2011;
49
50 21 Beautrais, 2003; Moller-Leimkuhler, 2002; Jeon et al., 2010). These findings suggest the
51
52 22 urgent need for evaluation and treatment of mental illnesses such as depression for the
53
54 8
55
56
57
58
59
60
1
2
3
4 1 reduction of suicidal behaviors in adolescents. A history of smoking or alcohol drinking was
5
6 2 also associated with suicidal behaviors, which is consistent with previous reports (Conner and
7
8
3 Duberstein, 2004; Miller et al., 2000; Malone et al., 2003). Poorer perceived overall general
9
10
11 4 medical health was associated with suicidal behaviors and this was partly consistent with
12
13 5 previous reports (Husky et al., 2012; Goodwin and Olfson, 2002; Goodwin and Marusic,
14
15 6 2011). Individuals who responded as having poor health were at high risk for both suicidal
16
17 7 ideation and suicide attempt, with the odds ratios more than 3.0. The underlying mechanisms
18
Fo
19
20 8 underpinning the link between the perceived general medical health and suicidal behavior are
21
22 9 not known. Distorted cognitive styles, negative personality constructs, and decreased quality
r
23
24 10 of life might contribute to the increased risk of suicidal behaviors. A history of sexual
Re
25
26 11 intercourse with the opposite or the same sex altogether increased the risk of suicidal
27
28
12 behaviors. Homosexual and bisexual orientations are known to be associated with elevated
vi
29
30
31 13 suicidal risks (Office, 2011b; Park et al., 2013). However, it is an interesting finding that
ew
32
33 14 adolescents who had sexual intercourse with the opposite sex were more likely to show
34
35 15 increased odds of 1-year suicidal ideation and attempt than their counterparts. In addition, the
36
On
37 16 odds of suicidal ideation and attempt in this group were larger than those in adolescents who
38
39
40 17 had sexual intercourse with the same sex. Thus, a history of any experience of sexual
41
ly
42 18 intercourse should be considered in the evaluation and management of suicidal adolescents.

43
44
45 19 Quite a small portion of suicide attempters used mental health services. Although the reason
46
47 20 is unclear, the stigma of psychiatric treatment in Korea might act as a barrier for such
48
49 21 adolescents to receive adequate treatment (Woo et al., 2010). It is also possible that many
50
51
22 suicide attempts might have been unrecognized by family members, peers, or teachers.
52
53
54 9
55
56
57
58
59
60
1
2
3
4 1
5
6
7 2 Several limitations should be mentioned. First, the question about suicide attempt was asked
8
9 3 only to adolescents who had reported suicidal ideation. In the present survey, we did not
10
11
4 assess self-injurious behaviors in adolescents who denied history of suicidal ideation.
12
13
14 5 However, several studies have shown that non-suicidal self-injury such as cutting is closely
15
16 6 related with suicide attempts (Whitlock and Knox, 2007). Thus, there is possibility that the
17
18 7 rates of suicidal attempts in our study were underestimated. Second, because of the self-
Fo
19
20
8 reporting and cross-sectional design, there is potential for recall bias. Third, we used
21
22
9
r
23 perceived SES and academic performance only rather than objective ones. Perceived SES is
24
10
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25 considered to be a kind of identity type akin to gender identity (Ostrove et al., 1999) and has
26
27 11 been used to explore the health outcomes and health inequalities. Recent studies have
28
vi
29 12 repeatedly shown that while perceived SES were influenced by objective SES, perceived SES
30
31
13 independently predicted physical or mental health (Demakakos et al., 2008; Goodman et al.,
ew
32
33
34 14 2007). On the other hands, little is known about the effect of perceived SES on suicidal
35
36 15 behaviors. Thus, our study might shed light on the exploration of the relationship between
On
37
38 16 them. Further studies comparing the roles of objective and perceived SES on suicidal
39
40
17 behaviors are warranted. In terms of academic performance, several studies reported that
41
ly
42
43 18 perceived academic performance was associated with suicidal behavior in adolescents
44
45 19 (Richardson et al., 2005; Martin et al., 2005). In addition, perception of failure in academic
46
47 20 performance was shown to be an independent indicator of risk of attempted suicide in young
48
49 21 adolescents (Richardson et al., 2005). Our results are consistent with the previous reports and
50
51
22 suggest that measuring perceived academic performance as well as perceived SES would be
52
53
54 10
55
56
57
58
59
60
1
2
3
4 1 easy and simple way for teachers to assess the adolescents in the school context. Fourth, we
5
6 2 assessed subjective feelings of depression rather than a formal diagnosis of major depression.
7
8
3 Although major depression is well known predictor of suicide, subjective feelings of
9
10
11 4 depression is not confined to major depression. However, it would be amenable and practical
12
13 5 way for teachers to assess the suicidal risk of their students. Finally, our data on the use of
14
15 6 mental health services was limited to suicide attempters who sought mental health services
16
17 7 only after the attempts.
18
Fo
19
20
8
21
22
r
23
9 The most important implications of our study were that suicide prevention methods in
24
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25
26 10 adolescents in South Korea should be different from those of other countries at least in terms
27
28 11 of demographic data including age and sex. First, the most urgent attention should be paid on
vi
29
30 12 younger female adolescents compared to other countries in which adolescents under 15 years
31
ew
32 13 show low prevalence of suicidal behaviors. In addition, suicide prevention should be made
33
34
14 for all age ranges of adolescents. Second, our results suggest that screening and treatment
35
36
15
On
37 system for mental disorders including depression is warranted. Third, it would be possible to
38
39 16 educate teachers to assess suicide risk of their students by several simple questions in the
40
41 17
ly
school. Finally, the causes of the unique patterns as well as high prevalences of suicidal
42
43
18 behaviors in Korean adolescents are unclear which suggest that multi-disciplinary efforts and
44
45
46 19 studies including psychiatric, familial, social aspects are urgent to solve the problem.
47
48
49 20 In conclusion, our study confirms suicide is a complex and multifactorial phenomenon which
50
51 21 is related to socioeconomic, cultural, psychiatric, developmental, and sexual factors. The
52
53
54 11
55
56
57
58
59
60
1
2
3
4 1 prevention of suicide needs urgent and particular attention in Korea, a nation which is
5
6 2 notorious for its highest and consistently increasing suicide rate, and a multi-disciplinary
7
8
3 approach based on the present data appears to be necessary. Future challenges would include
9
10
11 4 the development of effective prevention and treatment programs.
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13
14 5
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17 6
18
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20 7
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26 9
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35 12
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On
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44 15
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54 12
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1
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4 1 Figure Legends
5
6
7 2 Fig. 1. CONSORT diagram for the flow of the present study
8
9
10 3 Fig. 2. Age curves of suicidal behaviors during the past 12 months according to sex
11
12
13 4
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4 1 Funding Acknowledgement: This study was funded by the National Evidence-based
5
6 2 Healthcare Collaborating Agency (NECA) (Project number: NB2012-008).
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9 3
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12 4 Conflict of interests: None.
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4 1 References
5
6
7 2 Abell WD, Sewell C, Martin JS, et al. (2012) Suicide ideation in Jamaican youth: sociodemographic
8
9 3 prevalence, protective and risk factors. West Indian Med J 61: 521-525.
10 4 An H, Ahn JH and Bhang SY. (2010) The association of psychosocial and familial factors with
11
5 adolescent suicidal ideation: A population-based study. Psychiatry Res 177: 318-322.
12
13 6 Beautrais A. (2003) Suicide in New Zealand II: a review of risk factors and prevention. N Z Med J 116:
14 7 U461.
15
16 8 Borges G, Benjet C, Medina-Mora ME, et al. (2008) Suicide ideation, plan, and attempt in the Mexican
17 9 adolescent mental health survey. J Am Acad Child Adolesc Psychiatry 47: 41-52.
18
10 Bridge JA, Goldstein TR and Brent DA. (2006) Adolescent suicide and suicidal behavior. J Child
Fo
19
20 11 Psychol Psychiatry 47: 372-394.
21 12 Conner KR and Duberstein PR. (2004) Predisposing and precipitating factors for suicide among
22
13 alcoholics: empirical review and conceptual integration. Alcohol Clin Exp Res 28: 6S-17S.
r
23
24 14 Dai J, Chiu HF, Conner KR, et al. (2011) Suicidal ideation and attempts among rural Chinese aged
Re
25
15 16-34 years--socio-demographic correlates in the context of a transforming China. J Affect
26
27 16 Disord 130: 438-446.
28 17 Demakakos P, Nazroo J, Breeze E, et al. (2008) Socioeconomic status and health: the role of
vi
29
30 18 subjective social status. Soc Sci Med 67: 330-340.
31 19 Fleming TM, Merry SN, Robinson EM, et al. (2007) Self-reported suicide attempts and associated risk
ew
32
20 and protective factors among secondary school students in New Zealand. Aust N Z J
33
34 21 Psychiatry 41: 213-221.
35 22 Goodman E, Huang B, Schafer-Kalkhoff T, et al. (2007) Perceived socioeconomic status: a new type
36
23 of identity that influences adolescents' self-rated health. J Adolesc Health 41: 479-487.
On
37
38 24 Goodwin R and Olfson M. (2002) Self-perception of poor health and suicidal ideation in medical
39
25 patients. Psychol Med 32: 1293-1299.
40
41 26 Goodwin RD and Marusic A. (2011) Perception of health, suicidal ideation, and suicide attempt
ly
42 27 among adults in the community. Crisis 32: 346-351.

43
44 28 Han MA, Kim KS, Ryu SY, et al. (2009) Associations between smoking and alcohol drinking and
45 29 suicidal behavior in Korean adolescents: Korea Youth Behavioral Risk Factor Surveillance,
46
30 2006. Prev Med 49: 248-252.
47
48 31 Hawton K and van Heeringen K. (2009) Suicide. Lancet 373: 1372-1381.
49 32 Husky MM, Olfson M, He JP, et al. (2012) Twelve-month suicidal symptoms and use of services
50
51 33 among adolescents: results from the National Comorbidity Survey. Psychiatr Serv 63: 989-
52 34 996.
53
54 15
55
56
57
58
59
60
1
2
3
4 1 Jeon HJ, Lee JY, Lee YM, et al. (2010) Lifetime prevalence and correlates of suicidal ideation, plan,
5
6 2 and single and multiple attempts in a Korean nationwide study. J Nerv Ment Dis 198: 643-646.
7 3 Li Z, Page A, Martin G, et al. (2011) Attributable risk of psychiatric and socio-economic factors for
8
4 suicide from individual-level, population-based studies: a systematic review. Soc Sci Med 72:
9
10 5 608-616.
11 6 Malone KM, Waternaux C, Haas GL, et al. (2003) Cigarette smoking, suicidal behavior, and serotonin
12
13 7 function in major psychiatric disorders. Am J Psychiatry 160: 773-779.
14 8 Martin G, Richardson AS, Bergen HA, et al. (2005) Perceived academic performance, self-esteem
15
9 and locus of control as indicators of need for assessment of adolescent suicide risk:
16
17 10 implications for teachers. J Adolesc 28: 75-87.
18 11 Miller M, Hemenway D, Bell NS, et al. (2000) Cigarette smoking and suicide: a prospective study of
Fo
19
20 12 300,000 male active-duty Army soldiers. Am J Epidemiol 151: 1060-1063.
21 13 Moller-Leimkuhler AM. (2002) Barriers to help-seeking by men: a review of sociocultural and clinical
22
14 literature with particular reference to depression. J Affect Disord 71: 1-9.
r
23
24 15 Nock MK, Green JG, Hwang I, et al. (2013) Prevalence, correlates, and treatment of lifetime suicidal
Re
25 16 behavior among adolescents: results from the National Comorbidity Survey Replication
26
27 17 Adolescent Supplement. JAMA Psychiatry 70: 300-310.
28 18 Office KNS. (2011a) 2010 Population and Housing Census report, Daejon, South Korea: Korea
vi
29
19 National Statistical Office.
30
31 20 Office KNS. (2011b) Death and Cause of Death in Korea, Daejeon, South Korea: Korea National
ew
32 21 Statistical Office.
33
34 22 Ostrove JM, Feldman P and Adler NE. (1999) Relations among Socioeconomic Status Indicators and
35 23 Health for African-Americans and Whites. J Health Psychol 4: 451-463.
36
24 Park JH, Yoo JH and Kim SH. (2013) Associations between non-restorative sleep, short sleep
On
37
38 25 duration and suicidality: findings from a representative sample of Korean adolescents.
39 26 Psychiatry Clin Neurosci 67: 28-34.
40
41 27 Pirkis JE, Irwin CE, Jr., Brindis CD, et al. (2003) Receipt of psychological or emotional counseling by
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42 28 suicidal adolescents. Pediatrics 111: e388-393.

43
29 Pitman A, Krysinska K, Osborn D, et al. (2012) Suicide in young men. Lancet 379: 2383-2392.
44
45 30 Prevention KCFDCa. (2010) The Statistics of 6th Korea Youth Risk Behavior Web-based Survey
46 31 (KYRBWS) in 2010. Available:http://yhs.cdc.go.kr/.
47
48 32 Richardson AS, Bergen HA, Martin G, et al. (2005) Perceived academic performance as an indicator
49 33 of risk of attempted suicide in young adolescents. Arch Suicide Res 9: 163-176.
50
34 Whitlock J and Knox KL. (2007) The relationship between self-injurious behavior and suicide in a
51
52 35 young adult population. Archives of General Psychiatry 161: 634-640.
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54 16
55
56
57
58
59
60
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2
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4 1 Woo JM, Park JS, Chung SK, et al. (2010) Health service utilization in patients with major depressive
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6 2 disorder experiencing significant somatic symptoms in Korea. International Journal on
7 3 Disability and Human Development 9: 23-28.
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9 4
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11 5
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18
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22
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24
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25
26
27
28
vi
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32
33
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On
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1
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4
5 Table 1 Suicidal ideation and suicide attempt among 72,623 adolescents by sociodemographic characteristics during the past 12-monthsa
6
7
8 Suicidal ideation (N = 13,839) Suicide attempt (N = 3529)
9 % Adjusted OR 95% CI % Adjusted OR 95% CI
10
Fo
11 Total 19.1 4.9
12 Sex
13
rR
14 Male (N = 38,012) 15.1 3.5
15 (reference)
16
17 Female (N = 34,611) 23.4 1.72* 1.66−1.79 6.3 1.89* 1.76−2.23
18
19 Age (years)
ev
iew
20 12 − 15 (N = 33,890) 19.4 1.10* 1.06−1.14 5.4 1.40* 1.30−1.50
21
22 16 − 18 (N = 24,894) 18.6 4.1
23 (reference)
24
25
26
27
Perceived socioeconomic
status On
ly
28 High (N = 20,818) 17.1 4.6
29
(reference)
30
31 Middle (N = 34,071) 16.8 0.90* 0.86−0.94 3.9 0.73* 0.67−0.80
32 * *
33 Low (N = 17,734) 25.8 1.48 1.41−1.56 7.1 1.30 1.18−1.42
34 Perceived academic
35
36 performance
37 Excellent (N = 8216) 16.2 3.8
38
39 (reference)
40
41
42
43
44
45
46 Editorial Office Contact: journal.assist@sydney.edu.au
47
48
1
2
3
4
5 Good (N = 17511) 16.9 1.01 0.94−1.09 3.4 0.88 0.76−1.01
6
7 Average (N = 19528) 17.0 1.02 0.95−1.10 4.1 1.13 0.99−1.30
8
Fair (N = 18581) 20.9 1.25* 1.16−1.34 5.5 1.43* 1.25−1.63
9
* *
10 Poor (N = 8787) 26.7 1.65 1.53−1.79 9.2 2.38 2.07−2.74
Fo
11
12 *p < 0.001
13
rR
14 a
Odds ratios were adjusted for all sociodemographic variables
15
16
17
18
19
ev
iew
20
21
22
23
24
25
26
27 On
ly
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
47
48
1
2
3
4
5 Table 2 Suicidal ideation and suicide attempt among 72,623 adolescents by clinical characteristics during the past 12-monthsa
6
7
8 Suicidal ideation (N = 13,839) Suicide attempt (N = 3529)
9 % Adjusted OR 95% CI % Adjusted OR 95% CI
10
Fo
11 History of feeling depressed
12 Yes (N = 27,072) 40.9 9.12* 11.3 9.39*
8.71−9.56 8.49−10.39
13
rR
14 No (N = 45,551) 6.1
15
(reference)
16
17 Smoking
18
19 Ever smoked (N = 19,129) 26.3 1.44*
ev 1.37−1.51 8.8 1.92* 1.76−2.08
iew
20 Never smoked (N = 53,494) 16.5 3.4
21
22 (reference)
23 Alcohol
24
25
26
27
Ever used (N = 39,975)
Never used (N = 32,648)
22.6
14.7
1.29* 1.23−1.35
On 6.4
3.0
1.45* 1.33−1.58
ly
28 (reference)
29
Perceived overall general medical
30
31 health
32
Excellent (N = 12,511) 13.5 3.6
33
34 (reference)
35
36 Good (N = 33,574) 15.8 1.08* 1.01−1.16 3.4 0.87* 0.77−0.97
37 Average (N = 20,604) 22.6 1.42** 1.33−1.52 5.9 1.24** 1.10−1.40
38
** **
39 Fair (N = 5,582) 35.6 2.19 2.01−2.38 10.9 1.89 1.65−2.16
40
41
42
43
44
45
47
48
1
2
3
4
5 Poor (N = 352) 54.8 3.83** 2.98−4.91 23.9 3.39** 2.54−4.53
6
7
8 Sexual intercourse with the opposite
9
10 sex
Fo
11 Ever had (N = 3,229) 30.1 1.28* 1.16−1.40 12.5 1.90* 1.67−2.16
12
13 Never had (N = 69,394) 18.5 4.5
rR
14
Sexual intercourse with the same sex
15
16 Ever had (N = 733) 35.7 1.12* 1.07−1.17 17.1 1.21* 1.14−1.30
17
18
19
Never had (N = 71,890)
*p < 0.001
18.9
ev 4.7
iew
20
21 a
22 Odds ratios were adjusted for all sociodemographic (Table 1) and clinical variables
23
24
25
26
27 On
ly
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
47
48
Fig. 1. CONSORT diagram for the flow of the present survey

1
2
3
4
5 Random samples
6 (n = 75,643)
7
8
9 Excluded (n =663 )
10 ∙ Refuse to participate
11
12
13
14
15
Participants (n = 74,980)
Fo
16
17
18
19
rR
20 Excluded (n = 2,357)
21
22
∙Missing data
23
ev
24
25
26 Analyzed (n = 72,623)
27
ie
28
29
30
w
31
32
33
On
34
35
36
37
38
ly
39
40
41
42
43
44
45
46
47
48
49
50
51
52
53
54
56
57
58
1
2
3
4 Fig. 2. Age curves of suicidal behaviors during the past 12 months
5
6 according to sex
7
Fo
8
9
10 30 10
rR
11 23.9 23.7 24.3 9 8.0 Female
12 25 23.1 23.1 22.4 22.4 7.8
12-month prevalence (%)
12-month prevalence (%)

8 7.1
13 6.8 Male
14 7
ev
20
15 5.6
6
16 4.9
15
iew
17 5 4.0
15.8 15.2 15.4 15.1 15.5
18 14.5 14.1 4
19 10
20 3 4.0 3.8 3.7
Female 3.5 3.5
21 3.1 3.3
On
5 2
22 Male
23 1
24 0
0
25
26
27
28
12 13 14 15
Age (years)
16 17 18
12 13
ly
14 15
Age (years)
16 17 18
29 A. Suicidal ideation B. Suicide attempt

30
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Twelve-month prevalence and predictors of self-reported suicidal ideation and

Article in Australian and New Zealand Journal of Psychiatry · August 2014

Gyung-Mee Kim Jong-Min Woo

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Occupational and organizational mental health View project

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Journal: Australian and New Zealand Journal of Psychiatry

Manuscript ID: ANP-2013-00528.R1

Manuscript Type: Research

Date Submitted by the Author: 31-Mar-2014

Kim, Gyung-Mee; Haeundae Paik Hospital, Inje University School of

Keywords: Adolescent, Korea, Prevalence, Risk factor, Suicide

Editorial Office Contact: journal.assist@sydney.edu.au

23 were influenced by objective SES, perceived SES independently predicted physical or

23 mental disorders including depression is warranted. Third, it would be possible to

32 number. We also added the CONSORT diagram as the Fig. 1.

25 8 Number of words in text: 2481

32 11 Address for correspondence: J.M.Woo, M.D., M.P.H., Ph.D., Department of Psychiatry,

37 14 Disease Control and Prevention”. A cross-sectional, stratified multistage cluster method

32 services after the attempt.

42 18 intercourse should be considered in the evaluation and management of suicidal adolescents.

42 27 among adults in the community. Crisis 32: 346-351.

42 28 suicidal adolescents. Pediatrics 111: e388-393.

Fig. 1. CONSORT diagram for the flow of the present survey

12-month prevalence (%)

29 A. Suicidal ideation B. Suicide attempt

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