Temporal priority of lifetime alcohol use disorders and comorbid psychiatric disorders in adults: Results from a population-based nationwide survey in Korea.

BACKGROUND: Despite the high prevalence of alcohol use disorders (AUDs) in Korea, few studies have been conducted on the temporal priority with comorbid mental disorders. We investigated the temporal priority of lifetime AUDs and comorbid mood and anxiety disorders among the general population of Korea. METHODS: Data of 18,807 respondents aged 18 years or older, collected from three national epidemiological surveys comprising face-to-face interviews using the Korean version of the Composite International Diagnostic Interview for DSM-IV mental disorders. For each mood or anxiety disorder, the extent to which one mental disorder precedes another was investigated by calculating the proportion of primary AUDs by that of primary mood or anxiety disorder. RESULTS: Regarding alcohol dependence, dysthymic disorder is 5.6 times more likely to occur before alcohol dependence. Moreover, generalized anxiety disorder, social phobia, and specific phobia are 3.6 times, 4.5 times, and 6.3 times more likely to occur before, respectively. Regarding alcohol abuse, specific phobia is 6.3 times more likely to occur before, whereas major depressive disorder is two times more likely to occur after. Moreover, the lag times between primary alcohol abuse and subsequent mood or anxiety disorders were longer than those between primary alcohol dependence and the latter. LIMITATIONS: The age of onset might be subject to recall bias. The presence of non-respondents could have influenced the results. CONCLUSION: We need to recognize that one of the mental disorders could lead to another and consider it in the management of people with AUDs or mood and anxiety disorders.

Moderation of Marital and Occupational Status on the Effect of Personality Trait on 1 Year Suicidality of Middle-Aged Adults.

OBJECTIVE: This study aimed to examine how marital status, occupational status, and individual personality influence suicidal ideation and suicide attempts among Korean middle-aged adults, and explore the effects of their interaction. METHODS: A total of 2,464 middle-aged adults were surveyed about suicidality in the past year (1-year suicidality). Participants' current marital and occupational status, including other demographic and clinical variables were investigated. Personality traits were assessed using the Big Five Inventory. The dependent variable was the presence of 1-year suicidality. Independent variables were current marital and occupational status. Generalized linear model (GLM) analysis was performed to adjust for other covariates. RESULTS: The group with 1-year suicidality had significantly lower income. It had a lower proportion of full-time employment, and higher percentages of part-time employment and unemployment. The GLM analysis results showed that marital and occupational status had no significant association with 1-year suicidality. Neuroticism and openness were positively associated with 1-year suicidality, whereas conscientiousness and extraversion had a negative association. Interactions between marital status and neuroticism, conscientiousness, and occupational status were significant. CONCLUSION: Individualized social and psychological interventions for suicide prevention are required according to individual personality traits.

Shifting attitudes toward suicide over time: A latent profile analysis using the Korea National Suicide Survey.

Introduction: South Korea has a high suicide rate, and changes in sociodemographic factors can further increase the rate. This study aims to (1) classify participants using the Attitudes toward Suicide Scale (ATTS) through latent profile analysis (LPA), (2) identify and compare the associations between sociodemographic factors with the ATTS in two survey years (2013, 2018), and (3) determine the moderating effect of survey year. Methods: Six sub-factors of the ATTS were used for LPA with a total of 2,973 participants. Sociodemographic characteristics were compared between groups, and multinomial logistic regression was conducted for each survey year. A moderation analysis was conducted with the survey year as moderator. Results: LPA identified three groups of attitudes toward suicide: incomprehensible (10.3%), mixed (52.8%), and permissive (36.9%). The proportion of permissive attitudes increased from 2013 (32.3%) to 2018 (41.7%). Participants reporting suicidal behavior were more likely to be in the mixed and permissive groups than the incomprehensible group in both years. People reporting no religious beliefs were associated with the permissive group in the two survey years. The influence of education and income levels on groups differed by survey year. Discussion: There were significant changes between 2013 and 2018 in attitudes toward suicide in the Korean population.

Risk factors and outcomes of internet gaming disorder identified in Korean prospective adolescent cohort study.

Background and aims: Internet gaming disorder (IGD) is known to cause various psychological and physical complications. Through data collected from an adolescent prospective longitudinal cohort, we examined how IGD is related to lifestyle and physical symptoms, as well as the temporal relationship between them. Methods: This study was conducted as part of iCURE (Internet user Cohort for Unbiased Recognition of gaming disorder in Early Adolescence) in Korea between 2015 and 2019. Sleep and physical activity time, dry eye symptoms, musculoskeletal pain, and near-miss accidents were measured at baseline and followed-up after one year. IGD risk was evaluated using the Internet Game Use - Elicited Symptom Screen (IGUESS). The association between IGD risk and measured variables was analyzed, both at baseline and at follow-up after one year. Results: At baseline, the IGD risk group had significantly less physical activity time and sleep time and had more dry eye symptoms, musculoskeletal pain, and near-miss accidents than the IGD non-risk group. Additionally, in the IGD risk group at baseline, dry eye symptoms, musculoskeletal pain, and near-miss accidents occurred significantly more after one year of follow-up. Discussion and conclusion: The results of this study show that IGD is a significant risk factor that increases the probability of physical disease and trauma in adolescents. Therefore, interventions aimed at reducing IGD risk and protecting the physical and mental health of adolescents are imperative.

Effect of Attitude Toward Suicide on Suicidal Behavior: Based on the Korea National Suicide Survey.

OBJECTIVE: Suicide is a complex phenomenon; therefore, it should be approached in light of sociocultural perspectives and the general attitude toward suicide. This study aimed to extract factors from the Attitude Toward Suicide Scale (ATTS) and investigate the relationship between attitudes toward suicide and suicidal behavior (i.e., suicidal idea, plan, and attempt) by using a representative sample of Korean adults. METHODS: Three thousand Koreans aged 19 to 75 years were surveyed cross-sectionally in 2013 and 2018. The data collected were subjected to exploratory factor analysis. Extracted attitude factors were compared using a suicidal behavior continuum. Univariate and multivariate logistic models were constructed to compare the association between attitude factors and suicidal behaviors. RESULTS: Among the participants, 477 (15.9%) experienced suicidal idea only, 85 (2.8%) had a suicidal plan without attempt, and 58 (1.9%) attempted suicide. Four meaningful factors were extracted from the factor analysis: "permissiveness," "unjustified behavior," "preventability/readiness to help," and "loneliness." "Permissiveness," "unjustified behavior," and "loneliness" factors showed significant trends across the suicidal behavior continuum. Permissive attitude toward suicide increased the odds of suicidal idea, suicidal plan, and suicide attempt (adjusted odds ratio [aOR]=1.49, 95% confidence interval [CI]=1.25-1.79; aOR=2.79, 95% CI=1.84-4.25; aOR=2.67, 95% CI=1.65-4.33), while attitude toward suicide as unjustified behavior decreased the odds of suicidal ideation and attempt (aOR=0.79, 95% CI=0.67-0.94; aOR=0.64, 95% CI=0.42-0.99). CONCLUSION: A significant association was found between attitude toward suicide and suicidal behaviors. Attitude toward suicide is a modifiable factor that can be used to develop prevention policies.

Association between benign prostatic hyperplasia and suicide in South Korea: A nationwide retrospective cohort study.

Benign prostatic hyperplasia is a commonly diagnosed disease in elderly men, but elderly men with benign prostatic hyperplasia are more likely to have a lower quality of life and depressive symptoms. This study aims to examine the association benign prostatic hyperplasia patients with suicide death relative to a control group comprising individuals without benign prostatic hyperplasia. We used the Korean National Health Insurance Service-National Sample Cohort from 2006 to 2015 comprising of 193,785 Korean adults ≥40 years old, and followed-up for suicide death during the 8.7 years period. Cox-proportional hazard model was used to estimate hazard ratios for suicide among patients with benign prostatic hyperplasia. From 2006 to 2010, a total of 32,215 people were newly diagnosed with benign prostatic hyperplasia. The suicide rate of people without benign prostatic hyperplasia was 61.6 per 100,000 person-years, whereas that of patients with benign prostatic hyperplasia was 97.3 per 100,000 person-years, 1.58 times higher than the control group (p<0.01). After adjusting for covariates, the hazard ratio for suicide among patients with benign prostatic hyperplasia was 1.47 (95% C.I. = 1.21 to 1.78; p<0.01) compared to people without benign prostatic hyperplasia. For men without mental disorders, the hazard ratio for suicide among patients with benign prostatic hyperplasia was 1.36 (95% CI = 1.05 to 1.76) compared to control group after adjusting for multiple covariates. Our study suggests that men with benign prostatic hyperplasia had a higher probability of suicide compared to men without benign prostatic hyperplasia in South Korea. This study suggests that physicians may be aware that men newly diagnosed with benign prostatic hyperplasia had high probability of suicide.

Subthreshold lifetime depression and anxiety are associated with increased lifetime suicide attempts: A Korean nationwide study.

BACKGROUND: Subthreshold depression and anxiety are highly prevalent and known to be associated with functional limitations and future onset of major depression or anxiety disorders. However, studies regarding suicidality at subthreshold levels of depression and anxiety are limited. METHODS: A total of 17,639 Koreans aged from 18 to 64 responded to the Korean version of the WHO-composite international diagnostic interview (K-CIDI) version 2.1 between 2006 and 2016. Prevalence of subthreshold depression and anxiety, and information on lifetime suicide attempt (SA) were assessed. Multivariable logistic regression was performed to calculate the risk of SA by the level of depression or anxiety. RESULTS: The risk of lifetime SA increased incrementally according to the level of depression and anxiety. In the subthreshold depression group, individuals with subthreshold anxiety increased the odds about threefold (OR = 3.15, 95% CI 3.12-3.18) and the threshold anxiety disorder group increased the odds about fivefold (OR = 5.33, 95% CI 5.27-5.38) for SA, compared to the group without any level of anxiety. In threshold depressive disorder, the subthreshold anxiety group showed about 1.8-fold higher odds (OR = 1.76, 95% CI 1.75-1.77) and the threshold anxiety disorder group showed threefold higher odds (OR = 2.93, 95% CI 2.92-2.95) for SA compared to the group without any level of anxiety. CONCLUSIONS: Subthreshold levels of depression and anxiety were prevalent among Koreans and were associated with an increased prevalence of lifetime SA. A detailed assessment of depression and anxiety symptoms according to their level should be performed on a diagnostic continuum to prevent suicide.

Effect of suicidal loss on bereaved individuals' suicidal ideation: Structural equation model using attitudes towards suicide scale and moderation effect of interest in news media.

INTRODUCTION: Exposure to suicidal death may cause trauma and change the bereaved family/friends' attitudes towards suicide and increase their suicide-related behavior. We aimed to examine the life-time prevalence of loss experience among the general population of South Korea, the relationship between attitudes towards suicide and suicidal intensity, and the moderation effect of interest in news media. METHODS: After analyzing 2973 structured interviews, we hypothesized structural equation model and conducted a moderation analysis. RESULTS: A total of 10.1% (n = 301) respondents had experienced the suicide of acquaintances. Acceptive attitudes such as "suicide as right" and "suicide as normal-common" were higher in the "experienced" group. All fit indices of the hypothesized model were satisfied, and experience of suicidal loss was positively associated with both acceptive attitudes and suicidal intensity. "Suicide as normal-common" positively affected suicidal intensity, but "suicide as right" was not significant. "Interest in news media" significantly moderated the relationship between loss experience and suicidal intensity. LIMITATIONS: Since our study was cross-sectional design, further longitudinal studies are needed to draw casual inferences between factors. We used the at home interview method, which might have resulted underestimated experience of suicidal loss. CONCLUSION: Our findings showed that experiencing suicide death of any acquaintances could increase individual's acceptance of suicide and also increase the risk of suicide. Frequent exposure to suicide-related news amplified their risk of suicide. To reduce the suicide risk behavior, targeted intervention with those bereaved by suicide and restriction of media reports on suicide news will be needed as prevention strategies.

Associations between game use and mental health in early adulthood: A nationwide study in Korea.

BACKGROUND: The number of digital game users is increasing, and so is attention to digital gaming's effects on mental health. We aimed to reveal if risky (game addiction) and usual game use (non-risky) are associated with mental health in early adulthood. METHODS: Using data from the nationwide cross-sectional Korean Epidemic Catchment Area study for psychiatric disorders, 415 participants aged 18-30 years were divided into "non-game," "usual game," and "risky game" user groups based on the previous month's game use and cut-off value of game overuse screening questionnaire. Multiple linear and logistic regressions revealed the association between game use groups, perceived mental health, and lifetime prevalence of clinical mental disorders including suicidal ideation. RESULTS: Among the 415 participants, 167 were non-game users, 175, usual game users, and 73, risky game users. Risky game users self-reported decreased satisfaction and happiness, and a significantly higher lifetime prevalence of major depressive disorder, alcohol dependence, and suicidal ideation. Usual game users were significantly associated with higher lifetime prevalence of alcohol dependence and suicidal ideation. Self-reported happiness partially mediated between game use and lifetime suicidal ideation in risky, but not usual game users. LIMITATIONS: This study is a cross-sectional observational study which was not possible to define the temporal relationship. CONCLUSIONS: Both risky and usual game use are associated with mental health problems in early adulthood, indicating the need for careful mental health screening on not only risky game users but also usual game users.

Prevalence of lifetime psychiatric disorders and suicidality in adults with subthreshold posttraumatic stress disorder: A population-based nationwide study in Korea.

BACKGROUND: Subthreshold posttraumatic stress disorder (PTSD) is a chronic condition, and despite its clinical importance, few studies have been conducted. We investigated the relationship of subthreshold PTSD with various psychiatric disorders and suicidality in a South Korean general population. METHOD: A total of 5,102 respondents, aged at least 18 years, completed face-to-face interviews using the Korean version of the Composite International Diagnostic Interview and questionnaires for lifetime suicidal ideation, plans, and attempts. Subthreshold PTSD was defined as at least one symptom in each of the three symptom clusters (Criteria B, C, and D) and a symptom duration of ≥ 1 month (Criterion E). RESULTS: The lifetime prevalence of subthreshold PTSD (2.5%) was higher than that of PTSD (1.5%). After adjusting for sociodemographic factors, subthreshold PTSD was significantly associated with nicotine use disorders, major depressive disorder, obsessive-compulsive disorder (OCD), generalized anxiety disorder, and specific phobia. Among psychiatric disorders, the odds ratio for OCD was notably high. Subthreshold PTSD was associated with increased suicidal ideation (adjusted OR [AOR] = 2.90, 95% CI [1.98, 4.26]), suicidal plans (AOR = 3.58, [1.86, 6.89]), and suicide attempts (AOR = 3.93, [1.93, 8.01]) after adjusting for sociodemographic factors. When adjusted for sociodemographic factors and psychiatric disorders, suicidal ideation (AOR = 2.04, [1.34, 3.11]) remained statistically significant. CONCLUSION: This study found that subthreshold PTSD was associated with various psychiatric disorders and suicidality. Increased attention to the mental health of individuals with subthreshold PTSD is necessary. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

The Association of Childhood Maltreatment with Adulthood Mental Disorders and Suicidality in Korea: a Nationwide Community Study.

BACKGROUND: Although childhood maltreatment is a known risk factor for adulthood mental health, the impact of different types of childhood maltreatment on mental disorders is not yet clear. This study explored the association of each type of childhood maltreatment with adulthood mental disorders and suicidality in South Korea. METHODS: A total of 5,102 individuals from the general populations over the age of 18 responded to the Korean version of the Composite International Diagnostic Interview and questions about childhood maltreatment (emotional neglect, psychological abuse, physical abuse, and sexual abuse). To evaluate the odds ratio for mental disorders and suicidality associated with each type of childhood maltreatment, we used logistic regression analysis. RESULTS: About 17.0% of the respondents reported having experienced a type of maltreatment in childhood. According to the type, 9.4% reported physical abuse, 9.3% reported emotional neglect, 7.9% reported psychological abuse, and 3.8% reported sexual abuse. Exposure to each type of childhood maltreatment was associated with most types of mental disorders after adjusting for sociodemographic factors. Each type of childhood maltreatment victim was associated with suicidality (suicidal ideations, suicide plans, and suicide attempts). Dose-response patterns for suicide attempts were observed in all types of victims. Moreover, the respondents who experienced frequent childhood emotional neglect were 14 times more likely to have attempted suicide. CONCLUSION: Childhood maltreatment was associated with mental health in adulthood. The findings show the need for early detection and intervention of victims of childhood maltreatment to minimize its negative impact on adult mental health.

Development of a Short Form Depression Screening Questionnaire for Korean Soldiers.

BACKGROUND: The frequencies of South Korean soldiers' depression and resulting suicide are increasing every year. Thus, this study aimed to develop and confirm the reliability and validity of a simple short form depression screening scale for soldiers. METHODS: This study was conducted as part of a 2013 research project named 'The Epidemiological Study on the Prevalence of Depression in Military Service and a Search for High Risk Group Management.' Clinical depression was diagnosed using the Korean version of the Mini International Neuropsychiatric Interview and suicide risk was assessed through the Korean version of the Composite International Diagnostic Interview. Furthermore, the Center for Epidemiological Studies for Depression Scale (CES-D), the Stress Response Inventory, and the Barret Impulsiveness Scale were employed. Of the 20 CES-D items, three of the most correlated items with clinical diagnosis were derived to form the short form scale. Analyses for internal consistency, concurrent validity, and factor analysis were implemented for its validation. We performed a receiver operating curve (ROC) analysis using a clinical diagnosis of depression as a gold standard to calculate the area under the curve (AUC) value, cut-off score, and corresponding sensitivity and specificity to that cut-off score. RESULTS: According to the results of the correlation analysis, 7, 18, and 4 were selected to be on our scale. The three-item scale was reliable with a Cronbach's alpha value of 0.720, and a factor was derived from the factor analysis. The ROC analysis showed a high discriminant validity, with an AUC value of 0.891. The sensitivity and specificity were 84.8% and 78.2%, and 71.7% and 91.6%, respectively, for each when the selected cut-off scores were 2 and 3, respectively. Depression screened through the scale when the cut-off score was 2 or 3 was significantly associated with suicidality, stress, and social support. CONCLUSION: The depression screening questionnaire for Korean soldiers developed through this study demonstrated high reliability and validity. Since it comprises only three items, it can be utilized easily and frequently. It is expected to be employed in a large-scale suicide prevention project targeting military soldiers in the future; it will be beneficial in selecting high-risk groups for depression.

Impacts of Remaining Single above the Mean Marriage Age on Mental Disorders and Suicidality: a Nationwide Study in Korea.

BACKGROUND: This study investigated the impact of getting older than the mean marriage age on mental disorders and suicidality among never-married people. METHODS: We performed an epidemiological survey, a nationwide study of mental disorders, in 2016. In this study, a multi-stage cluster sampling was adopted. The Korean version of the Composite International Diagnostic Interview was conducted with 5,102 respondents aged 18 years or above. The associations between never-married status, mental disorders, and suicidality were explored according to whether the mean age of first marriage (men = 32.8 years; women = 30.1 years) had passed. RESULTS: Never-married status over the mean marriage age was associated with agoraphobia, obsessive-compulsive disorder, mood disorders, and major depressive disorder after adjusting for sociodemographic factors. Respondents with never-married status above the mean marriage age were associated with suicide attempts (adjusted odds ratio [aOR], 3.21; 95% confidence interval [CI], 1.36-7.60) after controlling for sociodemographic factors and lifetime prevalence of mental disorders, while respondents with never-married status under the mean marriage age were not. Moreover, in respondents with never-married status, getting older than the mean marriage age was associated with suicidal ideations (aOR, 1.49; 95% CI, 1.04-2.15) and suicide attempts (aOR, 3.38; 95% CI, 1.46-7.84) after controlling for sociodemographic factors and lifetime prevalence of mental disorders. CONCLUSION: Never-married status above the mean first marriage age was associated with mental disorders and suicidality. These findings suggest the need for a national strategy to develop an environment where people with never-married status do not suffer even if their marriage is delayed.

Age-related differences in the associations among at-risk drinking, alcohol use disorder, and psychological distress across the adult lifespan: a nationwide representative study in South Korea.

PURPOSE: To investigate age-related differences in the relationships among at-risk alcohol consumption, alcohol use disorder (AUD), and psychological distress with a special focus on older adults. METHODS: We used a nationwide cross-sectional study of a representative sample of community-dwelling adults from the Korean Epidemiologic Catchment Area study for psychiatric disorders conducted by door-to-door interviews. The Korean version of the Composite International Diagnostic Interview was applied. Subjects were categorized into four age groups: young-to-middle-aged (20-54 years), near-old (55-64 years), early-old (65-74 years), and late-old (≥ 75 years). The associations among at-risk drinking, alcohol use disorder, and psychological distress were examined according to age groups. RESULTS: Among a total of 5102 individuals, half of them drank alcohol in the previous year, of whom 20.5% were at-risk drinkers (≥ 100 g/week). Older people were less often diagnosed with AUD than young-to-middle-aged adults with a similar degree of at-risk drinking. They were less likely to meet the DSM-5 AUD criteria in terms of social and vocational role disruption or creation of a physically hazardous situation. However, at-risk drinking showed a stronger association with subjective psychological distress in older adults, particularly in the near-old group (adjusted odds ratio 1.82, 95% confidence interval 1.09-3.03; p = 0.023). CONCLUSIONS: These findings indicate the importance of screening for mental health problems in older adults, especially near-old adults, who drink more than 100 g of alcohol per week even when they do not satisfy the criteria for a diagnosis of AUD.

The Association of Childhood Experience of Peer Bullying with DSM-IV Psychiatric Disorders and Suicidality in Adults: Results from a Nationwide Survey in Korea.

BACKGROUND: Few studies have examined the association between childhood bullying and adulthood mental disorders based on the Diagnostic and Statistical Manual of Mental Disorders (DSM) criteria. We investigated the association of childhood peer bullying with Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV) psychiatric disorders and suicidality in adults. METHODS: A total of 5,102 respondents aged 18 or over completed the Korean version of the Composite International Diagnostic Interview for DSM-IV psychiatric disorders and a questionnaire for suicidal ideas, plans, and attempts. We evaluated peer bullying using an item in the Adverse Childhood Experiences International Questionnaire. Logistic regression analyses were used to identify the association between victimization of peer bullying, adult psychiatric disorders, and suicidality. RESULTS: Around 8.8% of the general population in Korea reported the experience of being bullied when growing up. Bullying experience was associated with an increase in the adulthood prevalence of nicotine use disorders (adjusted odds ratio [aOR], 2.47; 95% confidence interval [CI], 1.75-3.49), alcohol use disorders (aOR, 1.93; 95% CI, 1.49-2.51), mood disorders (aOR, 4.23; 95% CI, 3.01-5.94), and anxiety disorders (aOR, 2.89; 95% CI, 1.89-4.43) after adjusting for sociodemographic variables. Among anxiety disorders, the OR for post-traumatic stress disorder (aOR, 9.95; 95% CI, 5.62-17.63) was notably high. Frequent victimization (many times) was significantly associated with suicidality even after adjusting for sociodemographic variables and lifetime prevalence of psychiatric disorders, whereas occasional victimization (once or a few times) was not. CONCLUSION: Childhood bullying experience was associated with adult psychiatric disorders and suicidality. The findings indicated the importance of the early detection and management of childhood peer bullying to reduce detrimental adulthood consequences.

Improvement of Nonalcoholic Fatty Liver Disease Reduces the Risk of Type 2 Diabetes Mellitus.

Background/Aims: Little evidence is available about the effect of change in nonalcoholic fatty liver disease (NAFLD) status on risk of diabetes mellitus (DM) development. In this study, we tried to analyze the DM risk according to change in NAFLD status over time. Methods: Among a total of 10,141 individuals for whom routine healthcare assessment was performed, 2,726 subjects were selected according to the inclusion/exclusion criteria. NAFLD status change was determined by using serial abdominal ultrasonography and fatty liver index (FLI) during the follow-up period. Results: Subjects were categorized according to change in NAFLD status as follows: 670 subjects in the persistent NAFLD group, 155 subjects in the resolved NAFLD group, 498 subjects in the incident NAFLD group, and 1,403 subjects in the no NAFLD group. Multivariate Cox regression analysis revealed that incident NAFLD (hazard ratio [HR], 1.94; 95% confidence interval [CI], 1.08 to 3.50; p=0.026) and persistent NAFLD (HR, 3.59; 95% CI, 2.05 to 6.27; p<0.001) were independent risk factors for predicting DM development, whereas the risk with resolved NAFLD was not significantly different from that with no NAFLD. FLI could reproduce the results acquired by ultrasonography. Conclusions: This study demonstrated that future DM risk could be influenced by changes in NAFLD status over time. Resolution of NAFLD could reduce the risk of future DM development, while the development of new NAFLD could increase the risk of DM development.

A Comparison of Attitudes Toward Suicide Among Individuals With and Without Suicidal Thoughts and Suicide Attempts in South Korea.

BACKGROUND: A suicidal person can go through different stages that include suicidal thoughts and suicide attempts. For a few individuals, these can end up with suicide. However, there have been no studies investigating any differences in attitudes toward suicides among individuals with no suicidal thoughts, those with suicidal thoughts, and those with suicide attempts. AIMS: This study was carried out to compare attitudes toward suicide among three different groups: individuals with a history of no suicidal thoughts, those with a history of suicidal thoughts, and those with a history of suicide attempts. METHOD: To examine Koreans' attitudes toward suicide, we analyzed the data from the 2013 National Suicide Survey involving 1,500 participants aged between 19 and 75 years. RESULTS: Different attitudes toward suicide were found among the three groups. Persons reporting that they had made a suicide attempt in their life showed the most permissive attitudes toward suicide. LIMITATIONS: Since this research is based on cross-sectional data, it is difficult to eliminate the possibility of changes in attitude toward suicide completely after having a suicidal thought and suicide attempt. CONCLUSION: These results can be a useful source for constructing effective messages for suicide prevention campaigns and can ultimately contribute to an improvement in the public's perceptions of suicide in the future.

Changing trends in suicide rates in South Korea from 1993 to 2016: a descriptive study.

OBJECTIVES: The South Korean government has recently implemented policies to prevent suicide. However, there were few studies examining the recent changing trends in suicide rates. This study aims to examine the changing trends in suicide rates by time and age group. DESIGN: A descriptive study using nationwide mortality rates. SETTING: Data on the nationwide cause of death from 1993 to 2016 were obtained from Statistics Korea. PARTICIPANTS: People living in South Korea. INTERVENTIONS: Implementation of national suicide prevention policies (first: year 2004, second: year 2009). PRIMARY OUTCOME MEASURES: Suicide was defined as 'X60-X84' code according to the ICD-10 code. Age-standardised suicide rates were estimated, and a Joinpoint regression model was applied to describe the trends in suicide rate. RESULTS: From 2010 to 2016, the suicide rates in South Korea have been decreasing by 5.5% (95% CI -10.3% to -0.5%) annually. In terms of sex, the suicide rate for men had increased by 5.0% (95% CI 3.6% to 6.4%) annually from 1993 to 2010. However, there has been no statistically significant change from 2010 to 2016. For women, the suicide rate had increased by 7.5% (95% CI 6.3% to 8.7%) annually from 1993 to 2009, but since 2009, the suicide rate has been significantly decreasing by 6.1% (95% CI -9.1% to -3.0%) annually until 2016. In terms of the age group, the suicide rates among women of almost all age groups have been decreasing since 2010; however, the suicide rates of men aged between 30 and 49 years showed continuously increasing trends. CONCLUSION: Our results showed that there were differences in the changing trends in suicide rate by sex and age groups. Our finding suggests that there was a possible relationship between implementation of second national suicide prevention policies and a decline in suicide rate.

Association between level of suicide risk, characteristics of suicide attempts, and mental disorders among suicide attempters.

BACKGROUND: Past attempted suicide is a strong predictor of future suicide risk, but the risk varies among suicide attempters. Hence, it is important to clarify distinguishing features of lifetime attempters with a high level of current suicide risk for efficient preventive management. METHODS: We compared characteristics of suicide attempts and clinical characteristics among high-, moderate-, and low-risk attempters. Among the total of 6022 participants in the Korean Epidemiologic Catchment Area study, 193 reported a suicide attempt in their lifetime, 36 of which had high, 126 moderate, and 30 low levels of current suicide risk (1 incomplete response). RESULTS: High-risk suicide attempters had more past attempts compared with moderate- and low-risk suicide attempters. Suicide attempts were closely linked to a wide range of psychiatric comorbidities regardless of degree of current level of suicide risk, but the relative risk for having at least one mental disorder was the highest in high-risk attempters. Specifically, the relative risks for depressive disorder, anxiety disorders including obsessive-compulsive disorder and post-traumatic stress disorder, and substance use disorders were higher in high-risk attempters, and relative risk for somatoform disorder was higher in low-risk attempters than others. CONCLUSIONS: Our findings indicated that special attention is required for suicide attempters with a history of repeated attempts and current mental disorders, particularly anxiety disorders.