Suicide warning signs that are challenging to recognize: a psychological autopsy study of Korean adolescents.

BACKGROUND: In South Korea, the leading cause of youth death has been suicide for about 20 years. In this study, we conducted a multi-method psychological autopsy to identify the psychiatric diagnosis, developmental history, personality traits, family history, school life, warning signs of suicide, and risk factors related to suicide for the first time in Korea. METHODS: This was a postmortem, retrospective, and descriptive study of 36 adolescents who died by suicide between August 2015 and July 2021 in South Korea. We obtained qualitative and quantitative data from the Korean Psychological Autopsy of Adolescent, conducted by the Suicide and School Mental Health Institute, the official student mental health policy-focused research institute of the Korean Ministry of Education. RESULTS: The adolescents comprised equal percentage of girls and boys. Approximately half of the deaths (55.6%) occurred at home and most (72.2%) involved jumping from a height. Most of the adolescents (97.2%) had one major psychiatric disorder before death, with depressive disorder being the most prevalent (75%). They were at a high risk for internet addiction before death. The most common personality trait was avoidance (28.6%), followed by submissiveness (27.3%). Half of the parents reported that the adolescents were satisfied with their school life and the teachers observed that they had no behavioral problems. One year before death, seven (19.4%) adolescents injured themselves and five (13.9%) had attempted suicide. Most of the deceased (80.6%) had expressed suicide warning signs to their families within one year before death. Adolescents had a long experience of family-related adverse events. CONCLUSIONS: Most of the adolescents had mental health disorders and expressed suicidal intentions using verbal and nonverbal signs. However, it was challenging for families to recognize the risk signs because of adolescents' personality traits or a good school life. To prevent adolescent suicide, adolescents, parents, and teachers need to be educated to recognize signs of suicide warning signs and equipped to guide adolescents to appropriate care.

A Latent Class Analysis of Suicidal Behaviors in Adolescents.

OBJECTIVE: The purpose of the present study was to identify adolescents' suicide subgroups using five indicators (depression, anxiety, suicide ideation, and planned and attempted suicide), and explore the distinctive features of each subgroup. METHODS: This study included 2,258 teenagers from four schools. Both adolescents and their parents, who voluntarily agreed to participate in the study, completed a series of self-reported questionnaires on depression, anxiety, suicide, self-harm, self-esteem, impulsivity, childhood maltreatment, and deviant behaviors. The data were analyzed using latent class analysis, a person-centered method. RESULTS: Four classes were detected: "high risk for suicide without distress," "high risk for suicide with distress," "low risk for suicide with distress," and "healthy." The "high risk for suicide with distress" class was the most severe on all evaluated psychosocial risk factors, namely, impulsivity, low self-esteem, self-harming behaviours, deviant behaviour problems, and childhood maltreatment, followed by "high risk for suicide without distress." CONCLUSION: This study identified two high risk subgroups for adolescent' suicidality, "high risk for suicide with or without distress." Both high risk subgroups for suicide showed higher scores for all psychosocial risk factors than low risk subgroups for suicide. Our findings suggest that special attention needs to be paid to the latent class "high risk for suicide without distress," as this group's "cry for help" might be relatively difficult to detect. Specific interventions for each group (e.g., distress safety plans for "suicidal potential with or without emotional distress") need to be developed and implemented.

Suicidal Ideation, Depression, and Insomnia in Parent Survivors of Suicide: Based on Korean Psychological Autopsy of Adolescent Suicides.

BACKGROUND: This study aims to evaluate suicidal ideation, depression, and insomnia among parent survivors of adolescents who died by suicide and their relevant risk factors using psychological autopsy results from South Korea. METHODS: The participants were 42 parent survivors (10 fathers and 32 mothers) of 35 adolescents who died by suicide. We used the Patient Health Questionnaire-9 and the Korean version of the Insomnia Severity Index to evaluate the mental health of the bereaved parents. We used the Korean Psychological Autopsy Checklist for Adolescents, the Korean Beck Depression Inventory, the Korean Version of the Barratt Impulsiveness Scale-II, and the Kiddie-Schedule for Affective Disorders and Schizophrenia-Present and Lifetime-Korean versions to evaluate the mental health of deceased adolescents before their deaths. RESULTS: The results showed that many parent survivors of suicide had developed clinically significant suicidal ideation, depression, and insomnia (75.6%, 73.2%, and 42.9%, respectively). Furthermore, the higher the incidence of traumatic events experienced by the deceased adolescents, the higher the severity of depression and insomnia experienced by surviving parents. CONCLUSION: We should pay attention that parent survivors of suicide can suffer mental disorders after their offspring's death. In future studies, long-term follow-up studies with larger samples need to generalize our findings and clarify the causal relationship.

Harm avoidance, daily stress, and problematic smartphone use in children and adolescents.

Objective: Temperament is close to susceptibility to stress and the increased level of stress may lead problematic smartphone use (PSU). In this study, the relationships between harm avoidance (HA) as a personality trait, daily traits, and PSU in children and adolescents were investigated. Methods: At baseline, all participants (184 children and adolescents, mean age 13.15 years) completed questionnaires on PSU using the Smartphone Addiction Scale-Short Version (SAS-SV) and the Korean Smartphone Addiction Proneness Scale (SAPS). The Daily Hassles Questionnaire (DHQ) and Junior Temperament and Character Inventory (JTCI) were also administered to evaluate stress levels and personality traits. SAS-SV, SAPS, and DHQ were reassessed at 3 and 6 months. Results: Among JTCI temperament, HA displayed robust positive correlations with SAS-SV, SAPS, and DHQ at all time points. Mediation effects of daily stress on the relationship between HA and PSU were observed at baseline, 3, and 6 months. Conclusion: The findings suggest that managing stress may important in PSU children and adolescents with high HA.

Characteristics of Korean students advised to seek psychiatric treatment before death by suicide.

Introduction: Suicide is the leading cause of death among adolescents in Korea. Psychiatric disorders are well-known risk factors for suicide, but the proportion of children and adolescents who died by suicide and who had received psychiatric treatment is low. This study aims to examine how many school students who died by suicide were advised by their school to seek psychiatric treatment before their death and to characterize their clinical characteristics. Methods: We analyzed data collected by the Ministry of Education of Korea for all students who died by suicide between 2016 and 2020. Students were grouped according to whether or not they were advised to seek psychiatric treatment by their school-based on mental health screening and teachers' judgments. Sociodemographic characteristics (sex, educational stage, family structure, and socioeconomic status), suicide-related characteristics (place of suicide, suicide method, suicide note, previous self-harm, and previous suicide attempt), emotional and behavioral status, school life and personal, and family problems were compared between the two groups. Results: Analysis was conducted for 544 students, 110 (20.2%) of whom were advised to seek psychiatric treatment by their school before their death. This group had a higher proportion of girls; poorer attendance; higher frequency of depression, anxiety, impulsivity, and social problems; personal problems (appearance, friend-related, and mental and physical health problems); family problems (mental health problems of family, bad relationship with parents, and conflict of parents); and higher incidence of self-harm or suicide attempts (P < 0.001) than the other group. Conclusion: Teachers seem to advise psychiatric treatment when mental health problems are revealed at school. It showed distinctive clinical characteristics between the two groups. Preventing suicide among students requires the attention and effort not only of schools, but also of families, communities, and mental health professionals.

Characteristics of Korean Children and Adolescents Who Die by Suicide Based on Teachers' Reports.

We analyzed the clinical characteristics and suicide-related factors of students who died by suicide in Korea in 2016-2020, based on teachers' reports. Using data on total suicide deaths (N = 654, mean age = 16.0, 52.6% boys) collected by the Ministry of Education of Korea, we investigated the demographic and clinical characteristics and suicide-related factors of suicide deaths in students aged 9-18 years. Considering gender, more boys (52.6%, N = 344) died by suicide than girls (47.4%, N = 310). About 425 (65.0%) of the suicides were among high school students. The most common suicide method was jumping from a high place (70.6%, N = 454), followed by hanging (25.7%, N = 165). Additionally, 9.4% (N = 48) of the students who died by suicide had a history of attempted suicide, 13.4% (N = 73) had attempted self-harm, and 12.8% (N = 48) were acquainted with someone who had died by suicide. Teachers observed 20.6% (N = 120) of the suicide warning signs at school. Girls tended to have higher rates of attempted suicide, emotional problems, and psychiatric disorders than boys. This study was conducted with the largest sample of Korean suicide students observed at school. Effective suicide-related mental health training for teachers could contribute to suicide prevention in students.

How COVID-19 Affected Healthcare Workers in the Hospital Locked Down due to Early COVID-19 Cases in Korea.

BACKGROUND: The healthcare workers (HCWs) were exposed to never-experienced psychological distress during the early stage of the coronavirus disease 2019 (COVID-19) pandemic. The aim of this study was to investigate how the COVID-19 pandemic affected the mental health of HCWs during the hospital lockdown period due to mass healthcare-associated infection during the early spread of COVID-19. METHODS: A real-time online survey was conducted between April 14-18, 2020 among HCWs who worked at the university hospital where COVID-19 was confirmed in a patient, and the hospital was shut down for 3 weeks. Along with demographic variables and work-related information, psychological distress was measured using the Generalized Anxiety Disorder-7 (GAD-7), the Patient Health Questionnaire-9 (PHQ-9), the Maslach Burnout Inventory-General Survey scale, and the Stress and Anxiety to Viral Epidemics-9. RESULTS: The HCWs working in the cohort ward and those who have experienced social discrimination had significantly higher level of depression (PHQ-9 score; 5.24 ± 4.48 vs. 4.15 ± 4.38; P < 0.01 and 5.89 ± 4.78 vs. 3.25 ± 3.77; P < 0.001, respectively) and anxiety (GAD-7 score; 3.69 ± 3.68 vs. 2.87 ± 3.73; P < 0.05 and 4.20 ± 4.22 vs. 2.17 ± 3.06; P < 0.001, respectively) compared to other HCWs. Worries regarding the peer relationship and the skepticism about job were associated with depression (odds ratio [OR], 1.39; 95% confidence interval [CI], 1.07-1.79; P < 0.05 and OR, 1.69; 95% CI, 1.31-2.17; P < 0.001, respectively) and anxiety (OR, 1.73; 95% CI, 1.21-2.49; P < 0.01 and OR, 1.54; 95% CI, 1.09-2.17; P < 0.05, respectively), while fear of infection or worsening of health was not. Path analysis showed that work-related stress associated with the viral epidemic rather than anxiety about the viral epidemic mainly contributed to depression. CONCLUSION: The present observational study indicates that mental health problems of HCWs exposed to COVID-19 are associated with distress in work and social relationship. Early intervention programs focusing on these factors are necessary.

Classification of Adolescent Suicide Based on Student Suicide Reports.

Exploring the risk factors of adolescent suicide is important for effective suicide prevention. This study explored the clustering of adolescent suicides based on six risk factors: mental disorder, broken family, depression, anxiety, previous suicide attempts, and deviant behaviors. Using 173 student suicide reports obtained from the Ministry of Education, we evaluated the associations between suicide and variables related to mental disorders; dysfunctional family life; depression and anxiety; previous suicide attempts; deviant behaviors such as drinking and smoking; and school life characteristics, including attendance and discipline, problems within the past year, and incidents prior to suicide. In addition, reports of warning signs just before suicide were included in the analysis. The two-stage cluster analysis classified the students into three clusters: the silent type (cluster 1; 48.55%), in which no risk factors were observed; environmental-risk type (cluster 2: 24.28%), which featured a high frequency of broken households, deviant behaviors such as smoking/drinking and running away from home; and depressive type (cluster 3: 27.17%), which featured a high frequency of mental health problems such as depression, anxiety, and suicide attempts. Identifying the sub-types of adolescent suicide may help to inform tailored suicide prevention and intervention strategies in school.

Characteristics of First Visit Pediatric Patients with Suicidal Ideation and Behavior: An 8-Year Retrospective Chart Review.

OBJECTIVES: Our study aimed to analyze the demographic and clinical characteristics of children and adolescents during their first visit to psychiatric outpatient departments for the management of suicidal ideation and behavior, and to compare the changes before and in 2012 or later. METHODS: This multicenter study was conducted at five university hospitals in a metropolitan area in South Korea. Medical records of patients aged 6-18 years were retrospectively reviewed from January 2009 to December 2016. Patients were analyzed by classifying them into suicidal and non-suicidal groups based on their visit to the hospital for management of suicidal ideation or suicide attempt and other mental problems, respectively. RESULTS: There were differences in the year of visit, diagnosis, education level, and referral sources between patients in the suicidal and non-suicidal groups. Multiple regression analysis was conducted based on the sex, education level, referral by school, and diagnosis of depression in patients in the suicidal group, which revealed significant association. CONCLUSION: Suicide-related problems were significantly associated with the sex, education level, referral by school, and a diagnosis of depression in the patients. A well-connected referral system would be necessary for professional mental health management of high-risk children and adolescents.

Diagnostic Usefulness of an Ultra-Brief Screener to Identify Risk of Online Gaming Disorder for Children and Adolescents.

OBJECTIVE: This study examined the diagnostic validity of a three-item ultra-brief screening tool for online gaming disorder in line with the gaming disorder criteria in the International Classification of Diseases 11th Revision. METHODS: The Three-item Gaming disorder Test-Online-Centered (TIGTOC) was composed of three items using a four-point Likert scale selected from the Internet Game Use-Elicited Symptom Screen (IGUESS). Among a cohort of 2319 young-adolescent Internet users, the baseline data of 228 healthy controls and 45 Internet-gaming-disorder cases were analyzed. Receiver operation characteristic (ROC) analysis was performed using mental health specialists' diagnoses as the gold standard. RESULTS: The ROC curve analysis showed an area under the curve of 86%. Using a cut-off score of 4 from a full range of 0-9, the sensitivity, specificity, and Cronbach's α were 72%, 90%, and 0.811, respectively. TIGTOC scores was positively associated with time spent on online gaming, depressive symptoms, attention-deficit/hyperactivity disorder symptoms, and addictive Internet use. CONCLUSION: The TIGTOC appears to be a brief, valid, and reliable screening tool for online gaming disorder within the community or in primary care settings.

The Matthew Effect in Recovery from Smartphone Addiction in a 6-Month Longitudinal Study of Children and Adolescents.

The clinical course of problematic smartphone use (PSU) remains largely unknown due to a lack of longitudinal studies. We recruited 193 subjects with smartphone addiction problems for the present study. After providing informed consent, the subjects completed surveys and underwent comprehensive interviews regarding smartphone usage. A total of 56 subjects among the 193 initially recruited subjects were followed up for six months. We compared baseline characteristics between persistent addicted users and recovered users at the end of the 6-month follow-up. Persistent problematic smartphone users displayed higher baseline smartphone addiction severity and were more prone to develop mental health problems at the follow-up. However, baseline depressive or anxiety status did not significantly influence the course of PSU. PSU behaved more like an addictive disorder rather than a secondary psychiatric disorder. Harm avoidance, impulsivity, higher Internet use, and less conversation time with mothers were identified as poor prognostic factors in PSU. Lower quality of life, low perceived happiness, and goal instability also contributed to persistent PSU, while recovery increased these scores as well as measures of self-esteem. These findings suggest that the Matthew effect is found in the recovery of PSU with better premorbid psychosocial adjustment leading to a more successful recovery. Greater clinical resources are required for interventions in vulnerable populations to modify the course of this increasingly prevalent problematic behavior worldwide.

Internet, gaming, and smartphone usage patterns of children and adolescents in Korea: A c-CURE clinical cohort study.

BACKGROUND AND AIM: Whereas many studies on Internet gaming disorder (IGD) have used self-report questionnaires, only a few have adopted clinical interviews and samples. The current study aimed at using data from face-to-face diagnostic interviews, based on the criteria for IGD in the DSM-5, to determine the Internet, gaming, and smartphone usage patterns of children and adolescents. METHODS: A latent class analysis was conducted using data collected through diagnostic interviews for Internet, gaming, and smartphone addiction with 190 participants (M = 13.14 years, SD = 2.46; 143 boys, 47 girls) who were part of a multicenter clinical cohort study. RESULTS: Participants were classified into four groups: pleasure-seeking (Class 1), internal-use (Class 2), problematic-use (Class 3), and pathological-use (Class 4). The pleasure-seeking group (8.11%) showed low tendencies in general and proper control. The internal-use group (17.63%) showed significant increases in "cognitive salience" and "craving," with strong internal desires. The problematic-use group (37.28%) had no "interference with role performance"; however, they displayed "difficulty regulating use" and "persistent use despite negative consequences," with a slight functional impairment. The pathological-use group (36.98%) scored the highest on all these items, revealing a severe functional impairment. Compared to the other groups, the pathological-use group had the highest depression and daily stress levels and displayed the lowest levels of happiness. CONCLUSIONS: This study provides basic data to elucidate Internet, gaming, and smartphone overuse patterns among children and adolescents, which could be used to develop differentiated intervention strategies for each group.

Gaming patterns and related symptoms in adolescents using cluster analysis: Baseline results from the Internet User Cohort for Unbiased Recognition of Gaming Disorder in Early Adolescence (iCURE) study.

PURPOSE: The risk and protective factors of Internet gaming disorder (IGD) could vary by individual. The identification of more homogeneous subgroups may lead to better understanding of gaming behaviors and their consequences in adolescents. The purpose of this study was to investigate the prevalence of IGD among the subgroups defined by cluster analysis in adolescents. METHODS: A total of 2319 adolescents were enrolled in the Internet User Cohort for Unbiased Recognition of Gaming Disorder in Early Adolescence (iCURE) study at baseline. Self-reported IGD was assessed with a DMS-5 adapted measurement. Smartphone addiction, musculoskeletal discomfort, and dry eye symptoms were evaluated by self-administered questionnaires. Cluster analysis was performed using risk and protective factors of IGD after considering multicollinearity. RESULTS: Three different clusters were identified. Cluster 1 (19.2%) was users with combined potential psychological and social issues. Cluster 2 (32.3%) was users with potential social but no psychological issues. Cluster 3 (45.6%) was users with no potential issues of either a social or psychological nature. Adolescents from both clusters 1 and 2 showed higher degrees of IGD, smartphone addiction, musculoskeletal discomfort, and dry eye symptoms than did those from cluster 3. Also compared with adolescents in cluster 3, those in cluster 1 showed statistically higher risks of IGD (aOR:11.9, 95%CI:7.5-19.9), smartphone addiction (aOR:5.4, 95%CI:4.0-7.2), musculoskeletal discomfort (aOR:2.6, 95%CI:2.1-7.4), and dry eye symptoms (aOR:3.8, 95%CI:3.0-4.9). Those in cluster 2 also showed statistically higher risk of IGD, smartphone addiction, musculoskeletal discomfort, and dry eye symptoms compared with cluster 3 (aOR:4.5, 95%CI:2.8-7.6; aOR:2.8, 95%CI:2.1-3.7; aOR:1.6, 95%CI:1.3-1.9; and aOR:1.9, 95%CI:1.6-2.4, respectively). CONCLUSIONS: Clustering based on the risk and preventive factors of IGD may be suitable for determination of high risk of IGD in adolescents. However, we need to confirm the usefulness and clinical application of the classifications by observing their longitudinal changes.

Youth Suicide in Korea Across the Educational Stages.

Background: Youth suicides have diverse characteristics according to the young people's developmental stages. Warning signs and communication of suicidal intent can be vague among early adolescents, while mental health problems may be more evidently related to suicidal ideation in older adolescents. Understanding the developmental characteristics of youth suicide is necessary for effective suicide prevention. Aims: We explored the differences between children and adolescents who died by suicide and the characteristics of these young people as observed by their school teachers. Method: We analyzed teachers' mandatory postmortem reports of suicides among 308 Korean students. We compared: suicide-related information including personal, familial, and school factors; stressful life events; and participation in interventions among elementary, middle, and high school students who died by suicide. We also assessed the distribution of student suicides per month. Results: Suicide among elementary school students increased during school vacations, and suicide among middle and high school students increased during the school semester. According to the teachers' reports, elementary school students who died by suicide were more extroverted and had better academic achievements than their high school peers, and had significantly lower levels of substance/tobacco use. Elementary school students who died by suicide showed significantly less academic stress and use of external professional help than did other groups. Limitations: Because this research is based on mandatory teacher reports, the subjective opinions of teachers may have affected the reliability of the data. Suicide by out-of-school youth was not included. Conclusion: School-based suicide prevention should be implemented in accordance with young people's developmental characteristics.

Risk Factors for Serious Suicide Attempts with High Medical Severity.

OBJECTIVES: his study investigated the risk factors leading to serious suicide attempts with high medical severity. METHODS: Nine hundred and eighty-two patients who visited the emergency room after attempting suicide were divided into two groups: suicide attempters with high medical severity (25.3%) and those with low medical severity (74.7%). Demographic variables, clinical characteristics, and factors related to each suicide attempt were compared between the two groups. Multivariate logistic regression analysis was conducted to investigate risk factors for high medical severity in patients' current suicide attempts. RESULTS: The results show that suicide attempters with high medical severity had more severe depression and psychological disturbances such as agitation, intense emotions, and self-reproach. Suicide attempters with high medical severity also had more serious risk factors for suicide such as repetitive/intense/continuous thoughts of suicide, suicidal planning, and a stronger wish to die. School/work problems and physical illnesses were related to high medical severity with more lethal methods. Logistic regression demonstrated that school/work problems, total risk rating, severity of suicidal ideation, and agitation were risks for more serious suicide attempts, whereas more frequent lifetime suicide attempts were a protective factor. CONCLUSION: This study demonstrates that suicide attempters with high medical severity had more severe psychopathologies and risk factors related to suicidal behavior than those with low medical severity.

Clinical Characteristics of Diagnosis for Internet Gaming Disorder: Comparison of DSM-5 IGD and ICD-11 GD Diagnosis.

The American Psychiatric Association (APA) included internet game disorder (IGD) in section III of the Diagnostic and Statistical Manual of Mental Disorders-Fifth Edition (DSM-5) on the condition that it guaranteed more clinical research and experience. The World Health Organization (WHO) also included Game Disorder (GD) in the 11th final revision of the International Classification of Diseases (ICD-11) and recently recognized it as a diagnosis code. This study aims to compare clinical characteristics and gaming behavior patterns between the IGD diagnosis criteria proposed by the DSM-5 and the GD diagnosis criteria proposed by the ICD-11 based on clinical cohort data (c-CURE: clinic-Cohort for Understanding of internet addiction Rescue factors in Early life) obtained in the Republic of Korea. Psychologists and psychiatrists conducted semi-structured interviews with children/adolescents and their caregivers to identify IGD (Diagnostic Interview for Internet, Game, SNS, etc. Addiction, DIA), and comorbid psychiatric disorders (Kiddie-Schedule for Affective Disorders and Schizophrenia-Present and Lifetime Version-Korean version, K-SADS-PL). The cohort was divided into three IGD diagnosis groups (Normal, DSM5, DSM5 + ICD11) based on DSM-5 and ICD-11 diagnosis criteria. Internet usage pattern and addiction characteristics and psychiatric comorbidities were compared among the three IGD diagnosis groups. The Normal group consisted of 115 subjects, the DSM5 group contained 61 subjects, and the DSM5 + ICD11 group amounted to 12 subjects. The DSM5 + ICD11 group had a lower age of starting use of Internet/games/smartphones than other groups and the average time of Internet/game/smartphone use during weekdays/weekends was the highest. Also, in the eight items scored, excluding 'deceiving' and 'craving', the rate of threshold was highest in the DSM5 + ICD11 group, followed by the DSM5 group and the Normal group. On the other hand, 'deceiving' and 'craving' were the highest in DSM5, followed by DSM5 + ICD11 and Normal. The DSM5 + ICD11 group had significantly higher rates of depressive disorder, oppositional defiant disorder (ODD) and conduct disorder (CD) compared to other groups. This study provides implications for the clinical characteristics of IGD diagnosis in the field by comparing the DSM-5 IGD diagnosis criteria with the ICD-11 GD diagnosis criteria. Furthermore, this study provides empirical evidence that ICD-11 GD emphasizes serious symptoms such as functional impairment caused by excessive Internet/game/smartphone use over a long time, and it supports the validity of the ICD-11 GD diagnosis.

Gender differences in Korean adolescents who died by suicide based on teacher reports.

BACKGROUND: We investigated the characteristics of adolescents who committed suicide in South Korea, and how these characteristics differed by gender. METHOD: Data from middle and high school students who committed suicide between 2014 and 2016 were analyzed. We evaluated differences in suicide method and place, personal characteristics, and school life characteristics by gender using the Chi square test and t test. RESULTS: Jumping from a high place was the most common suicide method for both male and female students. A significantly greater proportion of female adolescents had experienced depressive symptoms, previous self-injury, previous suicide attempts, and had problems with school attendance and peers. Additionally, they were more likely to be classified as high risk according to a school-based mental health screening test and to utilize professional mental health treatment services. CONCLUSION: Our results demonstrate that adolescents who committed suicide exhibited gender differences in personal characteristics and school life. These characteristics might aid in the development of adolescent suicide policies and intervention programs.

Application of Diagnostic Interview for Internet Addiction (DIA) in Clinical Practice for Korean Adolescents.

The increased prevalence of Internet Gaming Disorder (IGD) and the inclusion of IGD in DSM-5 and ICD-11 emphasizes the importance of measuring and describing the IGD symptoms. We examined the psychometric properties of the Diagnostic Interview for Internet Addiction (DIA), a semi-structured diagnostic interview tool for IGD, and verified the application of DIA in clinical practice for Korean adolescents. The DIA is conducted in a manner that interviews both adolescents and their caregivers, and each item has a standardized representative question and various examples. It consists of 10 items based on the DSM-5 IGD diagnostic criteria, which is cognitive salience, withdrawal, tolerance, difficulty in regulating use, loss of interest in other activities, persistent use despite negative results, deception regarding Internet/games/SNS use, use of Internet/games/SNS to avoid negative feelings, interference with role performance, and craving. The study included 103 adolescents divided into three subgroups (mild risk, moderate risk, and addicted group) based on the total score of DIA. Demographic and clinical characteristics were compared among the DIA subgroups using the chi-square test and analysis of variance (ANOVA), and correlation analysis was used to examine the associations of IGD symptoms with clinical variables (e.g., impulsivity, aggression, depression, anxiety, self-esteem). The DIA total score was significantly correlated with Internet and smartphone addiction, depression, state anxiety, self-esteem, impulsivity, aggression, and stress. Furthermore, the moderate risk and addicted group showed significantly higher levels of Internet and smartphone addiction, anxiety, depression, impulsivity, aggression, stress, and lower self-esteem compared with the mild risk group. The Junior Temperament and Character Inventory (JTCI), which measures temperament and character traits, revealed that the mild risk group had higher levels of persistence and self-directedness than did the addicted group. Our findings confirmed the psychometric properties of DIA and the application of the DIA classifications in Korean adolescents.