Characteristics and risk factors of suicide among people who attempted self-harm in South Korea: A longitudinal National Cohort Study in South Korea.

Although self-harm is known as a significant risk factor for suicide, there are insufficient studies on the characteristics of people who self-harmed and the factors affecting suicide using a national dataset in Asia. This study aimed to identify demographic, clinical, and socioeconomic factors of individuals who attempted self-harm concerning suicide mortality. By analyzing the Korean National Health Insurance Service data from 2002 to 2020, we compared the people who attempted self-harm to the general population and explored factors affecting suicide by using the Cox proportional hazards model. Older age, female sex, lower socioeconomic status, and psychiatric conditions were associated with higher self-harm attempts. Suicide was more prevalent among males with mild disabilities, using fatal self-harm methods, and higher Charlson Comorbidity Index (CCI) scores. Socioeconomic factors that were significantly related to self-harm attempt were relatively less significant in the suicide survival analysis, while male gender, older age, fatal self-harm methods, high CCI scores, psychiatric diagnosis, and drinking habits were significantly associated with lower suicide survival rates. These results showed that demographic, clinical and socioeconomic factors affecting self-harm differ from those affecting actual suicidal death after self-harm. These insights may assist in developing targeted prevention strategies for specific populations.

Mitigating from COVID-19 during Intercollegiate Sports Match.

The coronavirus disease 2019 pandemic has posed a significant threat not only to health outcomes but also to other societal sectors, including the educational system. Apart from youth education, colleges and universities are characterized by the integration of in-depth theoretical and practical knowledge in young adulthood. Our observations in this study suggest that college fairs, sports matches, and extracurricular activities can be safely resumed when population-level immunity has reached herd protection.

Firearm Possession Rates in Home Countries and Firearm Suicide Rates Among US- and Foreign-Born Suicide Decedents in the United States: Analysis of Combined Data from the National Violent Death Reporting System and the Small Arms Survey.

BACKGROUND: Suicide by firearms is a serious public health issue in the United States. However, little research has been conducted on the relationship between cultural backgrounds and suicide by firearms, specifically in those born and raised in the United States compared to those who have immigrated to the United States. OBJECTIVE: To better understand the relationship between cultural backgrounds and suicide, this study aimed to examine firearm suicide rates among US- and foreign-born suicide decedents based on the firearm possession rate in the decedent's home country. METHODS: Multivariate logistic regression was performed to analyze data of 28,895 suicide decedents from 37 states obtained from the 2017 National Violent Death Reporting System data set. The firearm possession rate in the home countries of foreign-born suicide decedents was obtained from the 2017 Small Arms Survey. RESULTS: The firearm suicide rate was about twice as high among US-born suicide decedents compared to their foreign-born counterparts. Meanwhile, suicide by hanging was about 75% higher among foreign-born compared to US-born suicide decedents. Those from countries with a low-to-medium firearm possession rate were significantly less likely to use firearms compared to US-born suicide decedents (adjusted odds ratio [AOR]=0.45, 95% CI 0.31-0.65, and AOR=0.46, 95% CI 0.39-0.53, respectively). Meanwhile, firearm suicide rates were not different between US- and foreign-born suicide decedents from countries with a similarly high firearm possession rate. CONCLUSIONS: The results suggest that there is an association between using firearms as a means of suicide and the firearm possession rate in the decedent's home country. Suicide by firearms in the United States needs to be understood in the sociocultural context related to firearm possession.

Investigation of the Relationship Between Psychiatry Visit and Suicide After Deliberate Self-harm: Longitudinal National Cohort Study.

BACKGROUND: Deliberate self-harm (DSH) along with old age, physical disability, and low socioeconomic status are well-known contributors to suicide-related deaths. In recent years, South Korea has the highest suicide death rate among all Organization for Economic Co-operation and Development countries. Owing to the difficulty of accessing data of individuals with DSH behavior who died by suicide, the factors associated with suicide death in these high-risk individuals have not been sufficiently explored. There have been conflicting findings with regard to the relationship between previous psychiatric visits and suicidal death. OBJECTIVE: We aimed to address the following 3 questions: Are there considerable differences in demographics, socioeconomic status, and clinical features in individuals who received psychiatric diagnosis (either before DSH or after DSH event) and those who did not? Does receiving a psychiatric diagnosis from the Department of Psychiatry, as opposed to other departments, affect survival? and Which factors related to DSH contribute to deaths by suicide? METHODS: We used the Korean National Health Insurance Service Database to design a cohort of 5640 individuals (3067/5640, 54.38% women) who visited the hospital for DSH (International Classification of Diseases codes X60-X84) between 2002 and 2020. We analyzed whether there were significant differences among subgroups of individuals with DSH behavior based on psychiatric diagnosis status (whether they had received a psychiatric diagnosis, either before or after the DSH event) and the department from which they had received the psychiatric diagnosis. Another main outcome of the study was death by suicide. Cox regression models yielded hazard ratios (HRs) for suicide risk. Patterns were plotted using Kaplan-Meier survival curves. RESULTS: There were significant differences in all factors including demographic, health-related, socioeconomic, and survival variables among the groups that were classified according to psychiatric diagnosis status (P<.001). The group that did not receive a psychiatric diagnosis had the lowest survival rate (867/1064, 81.48%). Analysis drawn using different departments from where the individual had received a psychiatric diagnosis showed statistically significant differences in all features of interest (P<.001). The group that had received psychiatric diagnoses from the Department of Psychiatry had the highest survival rate (888/951, 93.4%). These findings were confirmed using the Kaplan-Meier survival curves (P<.001). The severity of DSH (HR 4.31, 95% CI 3.55-5.26) was the most significant contributor to suicide death, followed by psychiatric diagnosis status (HR 1.84, 95% CI 1.47-2.30). CONCLUSIONS: Receiving psychiatric assessment from a health care professional, especially a psychiatrist, reduces suicide death in individuals who had deliberately harmed themselves before. The key characteristics of individuals with DSH behavior who die by suicide are male sex, middle age, comorbid physical disabilities, and higher socioeconomic status.

The relationship between suicide bereavement and suicide ideation: Analysis of the mediating effect of complicated grief.

People who have experienced suicide bereavement within social relationships are known to have high risk for suicide, which means that their suicide ideation is high. However, little is known about how suicide bereavement leads to suicide ideation. Therefore, this study aims to understand the pathway of suicide bereavement on suicide ideation by analyzing the mediating effect of complicated grief, which does not abate over time and is known to be highly related to suicide ideation. Data of 1224 people aged 19 or older with bereavement (636 bereaved by suicide and 585 by other causes) were obtained from the Longitudinal study on Suicide Survivors' Mental Health (LoSS) WAVE I [2015-2018], the first nationally-representative longitudinal study in South Korea. Suicide ideation, the dependent variable, was measured by the Scale for Suicide Ideation (SSI), and complicated grief, severe grief that does not abate over time, was measured by the Korean version of the Inventory of Complicated Grief (K-ICG). The results show that suicide bereavement was found to have a significant effect on suicide ideation, and that complicated grief plays a mediating role in the path of suicide bereavement to suicide ideation (Effect = 0.667, [0.387, 0.981]). Based on these findings, clinical and policy suggestions were discussed to understand and prevent suicide ideation of people with suicide bereavement.

Inequalities in Childhood Immunisation in South Asia.

Identifying the inequalities associated with immunisation coverage among children is crucial. We investigated the factors associated with complete immunisation among 12- to 23-month-old children in five South Asian countries: Afghanistan, Bangladesh, India, Nepal, and Pakistan, using nationally representative data sets from the Demographic and Health Survey (DHS). Descriptive statistics, bivariate association, and logistic regression analyses were employed to identify the prevalence and the factors in each country that affect the likelihood of full childhood immunisation coverage. The complete childhood immunisation coverage varied significantly within each country in South Asia. Afghanistan had the lowest immunisation rates (42.6%), whereas Bangladesh ranked the highest in complete childhood immunisation rates, at 88.2%. Similarly, 77.1% of Indian children, 79.2% of Nepali children, and 62.2% of Pakistani children were completely immunised. Household wealth status strongly correlated with full childhood immunisation in Afghanistan, India, and Pakistan at the bivariate level. The results from the logistic regression showed that a higher maternal educational level had a statistically significant association with complete childhood immunisation in all countries compared to mothers who did not attend any school. In conclusion, the study revealed the inequalities of complete childhood immunisation within South Asia. Governments must be proactive in their endeavours to address universal and equitable vaccine coverage in collaboration with national and international stakeholders and in line with the relevant Sustainable Development Goals.

Maternal and child social support and food availability in relation to child growth in four low- and middle-income countries.

Previous studies showed positive associations between specific types of social capital and child nutritional status. Our study examined whether improved food availability mediates the impact of maternal and child social support on child nutritional status in four low- and middle-income countries. We used data from the Young Lives cohort study, comprising 1,000 children aged 8 and 12 in Vietnam and Ethiopia, 1008 in India, and 714 in Peru. The outcome variables were the z-scores for height for age and body mass index (HAZ and BAZ, respectively). The causal mediation analysis framework was used. In Peru, above-median values of maternal social support and receiving child financial support were positively associated with HAZ at age 12. The level of maternal financial support was positively associated with BAZ among 12-year-old children in India. Peru was the only country where a positive association was found between food availability and maternal financial support among children aged 12. However, food availability did not mediate the effect of maternal financial support on HAZ at age 12. Strengthening social support to improve child nutritional status, especially by improving food availability, may not be a sufficient intervention in resource-poor settings because sources of support may lack sufficient food resources to share. However, more comprehensive measurements of social support and food security are necessary to better understand the mechanism of social support and child nutritional status.

The relationship between domain-specific physical activity and depressive symptoms in Korean adults: Analysis of the Korea National Health and Nutrition Examination Survey.

BACKGROUND: This study aimed to investigate the associations of domain-specific physical activity (PA) with the prevalence of depressive symptoms. METHODS: We analyzed data from 11,679 (5,056 men and 6,623 women) participants aged ³19 years in the Korea National Health and Nutrition Examination Survey (2016 and 2018 waves). Depressive symptoms were measured using the Korean version of the Patient Health Questionnaire-9 (PHQ-9), with a cut-off score for depression of 11. The participants were first categorized by sex, and then by their PA level in different PA domains into three different groups. We examined the correlations between domain-specific PA and depressive symptoms using logistic regression analysis after controlling for confounders. RESULTS: Total amount of PA was not associated with depressive symptoms. However, in both sexes, those high in leisure and transport PA had lower levels of depressive symptoms compared with those with no leisure and transport PA (p for trend <0.001). After adjusting for covariates, those high in work PA showed a significantly higher likelihood of having depressive symptoms both in male (OR= 2.74, 95% CI 1.56-4.82) and female participants (OR= 2.84, 95% CI 1.70-4.49), compared to those with no work PA. LIMITATION: Cross-sectional nature of the data prevents causal associations. CONCLUSIONS: Although the total amount of PA participation was not associated with depressive symptoms, domain-specific PAs were differently associated with depressive symptoms. Specifically, higher amount of work PA was significantly associated with higher prevalence of depressive symptoms; this topic deserves further attention and future investigation.

Is the I-PACE (Interaction of Person-Affect-Cognition-Execution) model valid in South Korea? The effects of adverse childhood experiences (ACEs) on internet gaming disorder and the mediating effect of stress on adolescents.

BACKGROUND AND AIMS: The purpose of the present study was to investigate the effects of adverse childhood experiences (ACEs) on internet gaming disorder (IGD) and the mediating effect of stress based on the Interaction of Person-Affect-Cognition-Execution (I-PACE) model. METHODS: The 2017 survey data from one community addiction management center in South Korea were analyzed. A sample of 3,593 adolescents (mean age = 13.75 years, SD = 2.22) were recruited from 23 elementary, middle and high schools and 11 local children's centers. The mediating effect was analyzed by the three-step analysis method. RESULTS: Our study found that ACEs had a significant effect on the stress score (B = 1.420, P < 0.001) and the stress scale score had a significant effect the IGD score (B = 0.127, P < 0.001). After adjusting for the stress score in the model, ACEs had a significant effect on the IGD score (B = 0.328, P < 0.001), and the stress score had partial mediating effects (B = 0.1802, 95% C. I: 0.131-0.239). DISCUSSION: We found that ACEs directly affect IGD and that ACEs directly affect IGD through stress in support of the I-PACE model. In the sensitivity analysis, the mediating effect of stress in the low-risk IGD group was significant, but the mediating effect of stress in the high-risk IGD group was not significant. Prior ACEs should be considered when interviewing IGD clients. In addition, enhancing stress management skills would be beneficial to IGD clients with a history of ACEs, and actions reducing exposure to ACEs in childhood are necessary.

Inequalities in complete childhood immunisation in Nepal: results from a population-based cross-sectional study.

OBJECTIVE: To investigate the effect of different aspects of inequality on childhood immunisation rates in Nepal. The study hypothesised that social inequality factors (eg, gender of a child, age of mother, caste/ethnic affiliation, mother's socioeconomic status, place of residence and other structural barrier factors such as living in extreme poverty and distance to health facility) affect the likelihood of children being immunised. DESIGN: Using gender of a child, age of mother, caste/ethnic affiliation, mother's socioeconomic status, place of residence and other structural barrier factors such as living in extreme poverty and distance to health facility as independent variables, we performed bivariate and multivariate logistic regression analyses. SETTING: This study used data from the most recent nationally representative cross-sectional Nepal Demographic and Health Survey in 2016. PARTICIPANTS: The analysis reviewed data from 1025 children aged 12-23 months old. OUTCOME MEASURES: The main outcome variable was childhood immunisation. RESULTS: Only 79.2% of children were fully immunised. The complete vaccination rate of ethnic/caste subpopulations ranged from 66.4% to 85.2%. Similarly, multivariate analysis revealed that children from the previously untouchable caste (OR 0.58; CI 0.33 to 0.99) and the Terai caste (OR 0.54; CI 0.29 to 0.99) were less likely to be fully immunised than children from the high Hindu caste. CONCLUSION: Given Nepal's limited resources, we suggest that programmes that target the families of children who are least likely to be fully immunised, specifically those who are not only poor but also in financial crises and 'underprivileged' caste families, might be an effective strategy to improve Nepal's childhood immunisation rates.

Gender Differences of Stressful Life Events, Coping Style, Symptom Severity, and Health-Related Quality of Life in Patients With Panic Disorder.

Although affective disorders have been known to have sex differences in the associated clinical characteristics and quality of life (QOL), sex differences among patients with panic disorder (PD) have remained relatively unexplored in Korea. We examined the sex differences in different types of stressful life events (SLEs), coping styles, symptom severity, and health-related QOL (HRQOL) in patients with PD. Data from 291 female and 254 male participants diagnosed with PD were analyzed using a structured clinical interview following the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition criteria. Females with PD reported more SLEs including separation issues, physical illness or disability, and pregnancy-related problems than males. They also reported lower levels of confrontation and help-seeking coping strategies and higher levels of agoraphobia in symptom severity than males. The HRQOL of females with PD was significantly lower than male in physical functioning of HRQOL. This study suggests that the patient's sex is relevant to the assessment and treatment of PD.

Does a TV Public Service Advertisement Campaign for Suicide Prevention Really Work?

BACKGROUND: One of the critical measures in suicide prevention is promoting public awareness of crisis hotline numbers so that individuals can more readily seek help in a time of crisis. Although public service advertisements (PSA) may be effective in raising the rates of both awareness and use of a suicide hotline, few investigations have been performed regarding their effectiveness in South Korea, where the suicide rate is the highest among OECD countries. AIMS: The goal of this study was to evaluate the effectiveness of a television PSA campaign. METHOD: We analyzed a database of crisis phone calls compiled by the Korean Ministry of Health and Welfare to track changes in call volume to a crisis hotline that was promoted in a TV campaign. We compared daily call counts for three periods of equal length: before, during, and after the campaign. RESULTS: The number of crisis calls during the campaign was about 1.6 times greater than the number before or after the campaign. Relative to the number of suicide-related calls in the previous year, the number of calls during the campaign period surged, displaying a noticeable increase. CONCLUSION: The findings confirmed that this campaign had a positive impact on call volume to the suicide hotline.

A Cross-National Validation of the Short Employment Hope Scale (EHS-14) in the United States and South Korea.

The Short Employment Hope Scale (EHS-14) has been developed in the United States to assess an individual's level of psychological self-sufficiency-a complementary measure to the widely used economic self-sufficiency in workforce development programs. This study examined the comparability of the EHS-14 between U.S. and South Korean low-income job seeker groups. A multisample confirmatory factor analysis (CFA) and a series of invariance tests were conducted to validate EHS-14 using two independent samples. A latent means analysis (LMA) was used to test the latent mean difference between the two samples. The results indicate that CFAs on both U.S. and South Korean samples verified the four-factor structure of EHS-14. The study also found evidence for cross-national equivalence, based on satisfying configural, metric, scalar, and factor covariance invariance. LMA results found no significant difference between the two samples. EHS-14 was found to be a reliable and valid measure with cross-cultural applicability in the South Korean socio-politico-economic context. EHS-14 can be used to benchmark the client empowerment process and monitor individualized human development paths to employment success.

Caste- and ethnicity-based inequalities in HIV/AIDS-related knowledge gap: a case of Nepal.

Caste- and ethnicity-based inequalities are major obstacles to achieving health equity. The authors investigated whether there is any association between caste- and ethnicity-based inequalities and HIV-related knowledge within caste and ethnic populations. They used the 2011 Nepal Demographic and Health Survey, a nationally represented cross-sectional study data set. The study sample consisted of 11,273 women between 15 and 49 years of age. Univariate and logistic regression models were used to examine the relationship between caste- and ethnicity-based inequalities and HIV-related knowledge. The study sample was divided into high Hindu caste (47.9 percent), "untouchable" caste (18.4 percent), and indigenous populations (33.7 percent). Within the study sample, the high-caste population was found to have the greatest knowledge of the means by which HIV is prevented and transmitted. After controlling for socioeconomic and demographic characteristics, untouchables were the least knowledgeable. The odds ratio for incomplete knowledge about transmission among indigenous populations was 1.27 times higher than that for high Hindu castes, but there was no significant difference in knowledge of preventive measures. The findings suggest the existence of a prevailing HIV knowledge gap. This in turn suggests that appropriate steps need to be implemented to convey complete knowledge to underprivileged populations.

Association between suicidal ideation and exposure to suicide in social relationships among family, friend, and acquaintance survivors in South Korea.

Exposure to suicide in social relationships may be associated with suicidal ideation among survivors. In South Korea, which is known for having the highest suicide rate among OECD countries, exposure to suicide in social relationships can have serious consequences as social relationships are greatly emphasized in the society. The purpose of this study was to examine the association between survivors' suicidal ideation and their exposure to suicide in close relationships. Data collected through a telephone survey of a total of 1,000 men and women selected from across the nation using a stratified sampling method were analyzed. The results show that individuals who lost a family member, friend, or acquaintance in their lifetime are 4.5 times, 3.7 times, 2.2 times, respectively, more likely to have suicidal ideation in the past year compared to those without such experience. These findings suggest that special intervention for suicide survivors should be considered for those who experience suicide in close relationships.

The relationship between employment status and self-rated health among wage workers in South Korea: the moderating role of household income.

The purpose of the study reported in this article was to investigate the relationship between employment status and self-rated health (SRH) and the moderating effect of household income among wage workers in South Korea. This research analyzed the Korean Labor and Income Panel Study, 2005 to 2008. Of the 10,494 respondents participating in the survey during the period, a total of 1,548 people whose employment status had remained either precarious or nonprecarious were selected. A moderated multiple regression model was used to examine the main effect of employment status on SRH and the moderating effect of total household income on the relationship between employment status and SRH. Among 343 precarious workers and 1,205 nonprecarious workers, after controlling for gender, age, education, smoking, and drinking, employment status was associated with SRH of wage workers, and household income was found to have a moderating effect on SRH in that higher income buffers the link between unstable employment status and low SRH. Unstable employment, combined with low income, was significantly related to precarious wage workers' perceived health. To promote public health, efforts may be needed to secure not only people's employment, but also their income.

Factors associated with intimate partner violence against married women in Nepal.

This study was to explore the factors associated with intimate partner violence (IPV) in Nepal. A sample of 3,373 married women was taken from the 2011 Nepal Demographic and Health Survey. Multilevel logistic regression methods were used to analyze the data. The results show that 28.31% of the population experienced the IPV in the past year. The results indicate that female illiteracy, low economic status, violent family history, and a lack of decision-making autonomy were associated with IPV. Regarding family background, whether or not the husband was an alcoholic, the husband's level of education, and a higher number of children were risk factors associated with IPV. At the community level, women most at risk of IPV were those living in the Terai region, and women belonging to underprivileged castes and ethnic groups. The findings suggest the need for context-specific policy formation and the need for the creation of the certain intervention programs designed to mitigate IPV in Nepal.

Women's autonomy in negotiating safer sex to prevent HIV: findings from the 2011 Nepal Demographic and Health Survey.

Women with greater autonomy have higher HIV-related knowledge and condom use. Inability to negotiate safer sex in high-risk situations might increase HIV infection. This study examined the relationship between women's autonomy and ability to negotiate safer sex practices among married women. The 2011 Nepal Demographic and Health Survey data were used. The data were collected by two-stage stratified cluster sampling and face-to-face interviews. Autonomy was measured in Decision-Making Participation and Assets Ownership, while ability to negotiate safer sex consists of Refusal of Sex and Ask for Condom Use. Among 12,674 women of 15-49 years, married women were analyzed (n = 8,896). Women with greater autonomy in decision-making participation were more likely to negotiate safer sex. After controlling for socio-demographic factors, odds ratios (OR) for refusal of sex was 2.70 (95% CI [2.14, 3.40]) in women with the highest decision-making participation. These women showed higher OR for 'ask for condom use' in high risk situations (2.10, 95% CI [1.81, 2.44]). Assets ownership also demonstrated a positive statistical relationship with asking for a condom use (OR 1.31, 95% CI [1.10, 1.56]). The results point to the importance of women's autonomy on sexual health. It emphasizes women's empowerment-based approach to curbing HIV/AIDS in developing countries.

Family factors associated with children's handwashing hygiene behavior.

Despite the importance of children's hand hygiene and family influence on children's behaviors, few studies have been dedicated to identifying family factors affecting handwashing practice. This study investigated the entire group of sixth-grade students (N = 2323) and their parents (N = 2089) at 11 elementary schools randomly selected from the Seoul Metropolitan Area, Korea. The results show that parents' handwashing practice, parent and child bonding, and shared time have a significant correlation with children's hand hygiene practice. The thoroughness of hand cleansing is more likely to be associated with health education, parents' practice of proper handwashing, greater parent-child bonding, and a greater amount of shared time with parents. Parent-child bonding and shared time are crucial in promoting children's hand hygiene. These results imply that public health policies need to be targeted at not only providing health education but at increasing parent-child bonding and shared time in order to promote children's health more effectively.

Effects of a hypertension management program by Seongcheon primary health care post in South Korea: an analysis of changes in the level of knowledge of hypertension in the period from 2004 to 2009.

The objective of this study was to examine the effects of a hypertension management program provided by a primary health care post located in a distant rural area in South Korea on the level of knowledge of hypertension. The panel data consisted of a total of 319 people or the entire population aged above 40 years of five villages located in Goseong-gun, Gangwon province, South Korea. Preliminary interviews were conducted with all the residents prior to their enrollment in the health care post's hypertension management program. After 5 years of program operation, follow-up interviews were carried out with the same population. A total of 207 participants who completed both interviews were used in the final analysis. First, only the hypertensive group who participated in the program exhibited a significant difference in the level of knowledge. Second, educational level was associated with the level of knowledge in the entire group. Third, the effects of the program differed by gender, with men demonstrating more significant variations in knowledge upon participating in the program. For effective use of resources, considering that the effects of a hypertension education programs worked differently for groups, more customized hypertension management programs need to be targeted at each group to improve the effectiveness of hypertension education programs.