Sungeun You

Social Connections and Suicidal Thoughts and Behavior

Disrupted social connectedness is associated with suicidal thoughts and behaviors among individuals with substance use disorders (SUDs). The current study sought to further characterize this relationship by examining several indices of social connectedness--(a) living alone, (b) perceived social support, (c) interpersonal conflict, and (d) belongingness. Participants (n = 814) were recruited from 4 residential substance-use treatment programs and completed self-report measures of social connectedness as well as whether they had ever thought about or attempted suicide. Multivariate results indicated that interpersonal conflict and belongingness were significant predictors of a history of suicidal ideation, and that belongingness, perceived social support, and living alone were significant predictors of suicide attempt. These results indicate the most consistent support for the relationship between suicidality and thwarted belongingness, and also support the clinical utility of assessing whether individuals live alone.

Suicide rates among working-age adults in South Korea before and after the 2008 economic crisis

Background Multiple studies have shown that macroeconomic factors are associated with changes in suicide rates. We investigated how changes in economic conditions associated with the recent economic crisis in South Korea influenced suicide rates among working-age adults. Methods Time-series analyses were performed to examine the temporal associations of national unemployment rates and sex-employment-specific suicide rates in South Korea from 2003 to 2011, with particular attention to the increases of suicides that occurred during the recessionary period that began in 2008. We also compared the relative risk of suicide among different occupations. Results National unemployment rates were positively associated with suicide rates among employed and unemployed men and women, with a 2-month to 3 month lagged period. Significant increases of suicide rates among working-age adults during the recession were detected in most of the subgroups stratified by age, sex and employment status. Forty-three per cent of the increase of suicides was derived from the employed population. Compared with workers in elementary occupations, the relative risk of suicide for mangers increased by threefold during the recessionary period. Among those who were employed, half of the increases in suicides occurred among clerks and workers involved in sales and services. Conclusions Changes in macroeconomic conditions are tied to population-level suicide risks for employed and unemployed persons. However, these associations vary depending on sex, employment status and occupational roles. In advance of future economic crises, it is important to develop prevention initiatives intended to reach the diverse populations potentially exposed to the adverse effects of sudden economic disruptions.

Childhood physical abuse, aggression, and suicide attempts among criminal offenders

Childhood physical abuse (CPA) has numerous short and long-term negative effects. One of the most serious consequences of CPA is an increased risk for suicide attempts. Clarifying the mechanisms by which CPA increases risk for suicidal behavior may enhance preventive interventions. One potential mechanism is a tendency toward aggression. In a sample of 266 criminal offenders, ages 18-62, we examined the relationships among CPA, lifetime aggression, and suicide attempts and tested lifetime history of aggression as a mediator of the relationship between CPA and suicide attempts. Results indicated that CPA and aggression were associated with suicide attempts. Consistent with our hypothesis, lifetime aggression mediated the CPA and suicide attempts relationship. Findings suggest that aggression may be an important mediator of the relationship between CPA and suicide attempts among criminal offenders, and are consistent with the possibility that treating aggression may reduce risk for suicide attempts.

Stressful life events and suicidal behavior in adults with alcohol use disorders: Role of event severity, timing, and type

BACKGROUND Stressful life events (SLEs) play a key role in suicidal behavior among adults with alcohol use disorders (AUD), yet there are meager data on the severity of SLEs preceding suicidal behavior or the timing of such events. METHOD Patients in residential substance use treatment who made a recent suicide attempt (cases, n=101) and non-suicidal controls matched for site (n=101) were recruited. SLEs that occurred within 30 days of the attempt and on the day of the attempt in cases were compared to SLEs that occurred in the corresponding periods in controls. SLEs were categorized by type (interpersonal, non-interpersonal) and severity (major, minor) and were dated to assess timing. Degree of planning of suicide attempts was also assessed. RESULTS Major interpersonal SLEs conferred risk for a suicide attempt, odds ratio (95% CI)=5.50 (1.73, 17.53), p=0.005. Cases were also more likely to experience an SLE on the day of the attempt than on the corresponding day in controls, OR (95% CI)=6.05 (1.31, 28.02), p=0.021. However, cases that made an attempt on the day of a SLE did not make lower planned suicide attempts compared to other cases, suggesting that suicide attempts that are immediately preceded by SLEs cannot be assumed to be unplanned. CONCLUSIONS Results suggest the central importance of major interpersonal SLEs in risk among adults with AUD, a novel finding, and documents that SLEs may lead to suicide attempts within a short window of time (i.e., same day), a daunting challenge to prevention efforts.

Stressful life events and depressive symptoms: influences of gender, event severity, and depression history.

Informed by Post’s (1992) kindling hypothesis, the study examined the association between depressive symptoms and varying levels of perceived life events as determined by respondents, as well as the moderating role of depression history and gender. Severe life events were significantly associated with current depressive symptoms among never depressed women but not among women with depression history. Such a moderating role of depression history was not observed among men where severe life events were associated with current depressive symptoms in men regardless of depression history. No moderating effects of gender and depression history were obtained for mild and moderate life events, but these events were significantly associated with current depressive symptoms. These results support Post’s kindling hypothesis for severe life events but not for mild or moderate life events, and further only in women.

Emotions and suicidal ideation among depressed women with childhood sexual abuse histories.

Depressed women with sexual abuse histories have a heightened risk of suicidal ideation (SI), which may be only in part attributable to psychiatric symptoms of depression and posttraumatic stress disorder (PTSD). Emotions and SI were studied among 106 women with histories of childhood sexual abuse enrolled in treatment trials for major depression. Assessments were conducted at baseline, 10, 24, and 36 weeks. Sadness, guilt, and shame-proneness were associated with self-reported and observer-rated SI across time after adjusting for depressive and PTSD symptoms, suicide attempt history, and sociodemographic characteristics associated with SI. These findings highlight the need for clinical attention to self-directed negative emotions to potentially reduce suicide-related risk.

Changes in South Korean urbanicity and suicide rates, 1992 to 2012

Objectives Studies have highlighted the association between the degree of urbanicity and spatial disparities in suicide, but few have evaluated its changes across time. We explored the geospatial trends of suicide in South Korea from 1992 to 2012, and their relationship to the nations evolving urbanicity. Setting South Korea. Primary outcome measures Age-sex-specific suicide rate. Results Suicide rates increased in all regions of South Korea during the study period. Controlling the effects of age and sex, there was an overall inverse relationship between the degree of urbanicity and regional suicide rates. These associations were, however, attenuated across the periods, as there were smaller increases in suicide rates in mid-sized urban regions as compared to larger cities and to rural areas. Increases over time in the suicide rates among youth and working-age adults were greater in large urban centres and in rural regions. For elders, the increase was far greater in rural regions. Conclusions The association of urbanicity and the geospatial pattern of suicide in South Korea was a dynamic process and varied by age groups across the course of two decades. Internal migration and related social processes most likely contributed to these changes.

Interpersonal Violence Victimization and Suicidal Ideation: An Examination in Criminal Offenders

BACKGROUND Offenders are at elevated risk for interpersonal violence victimization (IVV), which is a risk factor for suicide-related outcomes in some populations, suggesting the importance of examining risk associated with IVV in offenders. AIMS The present study examined the association between IVV and suicidal ideation (SI) among criminal offenders in a pretrial jail diversion program in the United States. METHODS 266 offenders were screened for ten common Axis I psychiatric disorders along with current SI and past-year IVV. RESULTS Past-year IVV was significantly associated with current SI, and the association remained significant after adjusting for symptoms of ten Axis I psychiatric disorders, respectively and simultaneously. Gender did not moderate the IVV-SI association. CONCLUSIONS The findings support a connection between IVV and SI in criminal offenders.

A preliminary evaluation of the training effects of a didactic and simulation-based psychological first aid program in students and school counselors in South Korea

The present study aimed to examine the training effects of a didactic and simulation-based psychological first aid (PFA) program. Based on the competency-based model, the study sought to examine whether the PFA training would enhance knowledge, skills, and attitudes. Study 1 examined the training effects of the PFA program in a sample of undergraduate and graduate students in psychology. Study 2 was conducted with school counselors. In both studies, all participants completed a one-day PFA workshop with a 3-hour didactic lecture and a 3-hour simulation-based practice. Assessments were conducted prior to the didactic lecture and upon completion of the simulation-based practice. In study 1, an examination of pre- and posttest comparisons indicated that the training significantly improved students’ PFA knowledge and perceived competence in PFA skill. In study 2, the same PFA training significantly improved school counselors’ PFA knowledge, perceived competence in PFA skill, perceived preparedness and confidence to provide psychological assistance for future disasters, but their perceived willingness to participate in psychological assistance did not significantly change after the training. This study provides preliminary evidence supporting the effectiveness of the PFA training program using a combined method of didactic and simulation-based practice for disaster mental health providers in Korea.

Comparison of Baseline Characteristics between Community-based and Hospital-based Suicidal Ideators and Its Implications for Tailoring Strategies for Suicide Prevention: Korean Cohort for the Model Predicting a Suicide and Suicide-related Behavior

In this cross-sectional study, we aimed to identify distinguishing factors between populations with suicidal ideation recruited from hospitals and communities to make an efficient allocation of limited anti-suicidal resources according to group differences. We analyzed the baseline data from 120 individuals in a community-based cohort (CC) and 137 individuals in a hospital-based cohort (HC) with suicidal ideation obtained from the Korean Cohort for the Model Predicting a Suicide and Suicide-related Behavior (K-COMPASS) study. First, their sociodemographic factors, histories of medical and psychiatric illnesses, and suicidal behaviors were compared. Second, diagnosis by the Korean version of the Mini International Neuropsychiatric Interview, scores of psychometric scales were used to assess differences in clinical severity between the groups. The results revealed that the HC had more severe clinical features: more psychiatric diagnosis including current and recurrent major depressive episodes (odds ratio [OR], 4.054; P < 0.001 and OR, 11.432; P < 0.001, respectively), current suicide risk (OR, 4.817; P < 0.001), past manic episodes (OR, 9.500; P < 0.001), past hypomanic episodes (OR, 4.108; P = 0.008), current alcohol abuse (OR, 3.566; P = 0.020), and current mood disorder with psychotic features (OR, 20.342; P < 0.001) besides significantly higher scores in depression, anxiety, alcohol problems, impulsivity, and stress. By comparison, old age, single households, and low socioeconomic status were significantly associated with the CC. These findings indicate the necessity of more clinically oriented support for hospital visitors and more socioeconomic aid for community-dwellers with suicidality.