Classification of Adolescent Suicide Based on Student Suicide Reports

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.

Spatial, geographic, and demographic factors associated with adolescent and youth suicide: a systematic review study

Background

Suicide is a public health issue and a main cause of mortality among adolescents and the youth worldwide, particularly in developing countries.

Objectives

The present research is a systematic review aiming to investigate the spatial, geographical, and demographic factors related to suicide among adolescents and the youth.

Methods

In this systematic review, two researchers examined PsycINFO, Web of Science, Scopus, and PubMed databases on December 7th, 2022 with no time limits from the beginning of publication until 2022 to identify the primary studies on spatial and geographic analysis on adolescent and youth suicides. Once duplicate studies were identified and removed, the titles and abstracts of studies were examined and irrelevant studies were also removed. Finally, 22 studies were reviewed based on the inclusion criteria.

Results

Our findings show that suicide rates are generally higher among men, residents of rural and less densely populated regions, coastal and mountainous regions, natives, 15-29 age group, less privileged populations with social fragmentation, unemployed, divorced or lonely people, those who live in single parent families, people with mental health issues, and those with low levels of education.

Conclusions

Stronger evidence supports the effects of geographic and demographic variables on youth and adolescent suicide rates as compared with spatial variables. These findings suggest that policy makers take spatial and demographic factors into consideration when health systems allocate resources for suicide prevention, and that national policymakers integrate demographic and geographic variables into health service programs.

Systematic Review Registration

https://www.crd.york.ac.uk/prospero/, identifier CRD42023430994.

Promoting Mental Health Literacy at Schools in South Korea

The onset of many lifelong mental illnesses is during childhood and adolescence. There has been an increase in these conditions among children and adolescents especially, during the COVID-19 pandemic. It is essential to promote mental health literacy (MHL) as a preventive and universal intervention for children and adolescents. Positive mental health status in adolescence is related to an increased level of MHL, and various MHL programs at schools have been reported to be effective for adolescent students worldwide. Recently, MHL programs have been developed in South Korea to be used by schoolteachers. There is a need for active dissemination and development of future programs. For continuous and effective education, it is desirable to include MHL education in regular school curricula.

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.

Comparison of Suicide Attempts and Suicide Deaths by Jumping from a High Place in Korean Children and Adolescents

Jumping from a high place is the most common method of suicide among Korean children and adolescents. The aim of this study was to examine the personal, family, and school life of Korean children and adolescents who chose jumping from a high place, among suicide attempts and suicide deaths, based on teachers’ reports. Data on suicide attempts and suicide deaths by jumping from a high place in children and adolescents were collected through the Ministry of Education in South Korea from 2016 to 2018. We compared sociodemographic variables, suicide-related variables, emotional and behavioral status, school life related variables, and variables related to family problems among suicide deaths (n = 262), actual suicide attempts (n = 50), and interrupted or aborted suicide attempts (n = 210). There were differences in educational stage (p < 0.001), place of suicide (p < 0.001), presence of suicide note (p < 0.05) and previous suicide attempt (p < 0.001) among the three groups. The total difficulty score on the Strength Difficulty Questionnaire of interrupted or aborted suicide attempts was higher than that of the other two groups. Our study suggests that the suicide death group tend to present fewer personal and family pathologies and better school adjustment than the suicide attempt group.

A Multifactorial Interpretation of a Teenager's Suicide: Based on Krystal's Death in Casual Vacancy

Objectives

It is hard to accumulate research data on adolescents’ suicide, because friends and family of the suicide completers might be reluctant to share the experience. To overcome the lack of information on adolescent suicide victims, the authors examined the risk and protective factors for adolescents’ suicide from a character in a novel.

Methods

Krystal, an adolescent female in the novel The Casual Vacancy by Joanne Rowling, failed to overcome her unfortunate cir-cumstances and committed suicide. The authors analysed Krystal’s case based on the guideline for patients with suicidal behaviours to address the complicated situation of her death.

Results

Krystal grew up in a poor and dangerous environment. Despite the environmental hardships, she developed ego maturation with affectionate help from Mr Fairbrother, an assistant coach of the Girls’ Rowing Team and a parish councillor. The sudden passing away of Mr Fairbrother brought on a crisis of identity for Krystal. In addition, a villainous character raped her and her brother drowned to death, which brought her great sorrow. She felt helpless and committed suicide.

Conclusion

In spite of many risk factors for suicide, Krystal was able to keep her life with a few protective factors, a younger brother in the home, and a sense of responsibility for the family. After the loss of her brother, however, she collapsed in a moment. Krystal’s suicide might not only be a personal choice but a breakdown of the social protection system for the youth.