J Korean Med Sci.  2021 Apr;36(15):e96. 10.3346/jkms.2021.36.e96.

How Is the Suicide Ideation in the Korean Armed Forces Affected by Mental Illness, Traumatic Events, and Social Support?

Affiliations
  • 1Department of Preventive Medicine, Armed Forces Medical Command, Seongnam, Korea
  • 2Preventive Medicine Program, Graduate School of Public Health, Seoul National University, Seoul, Korea
  • 3Department of Preventive Medicine, Gachon University College of Medicine, Incheon, Korea
  • 4Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Korea
  • 5Department of Psychiatry, Armed Forces Capital Hospital, Seongnam, Korea
  • 6Geumcheon Kidari Mental Clinic, Seoul, Korea
  • 7Department of Psychiatry, Armed Forces Guri Hospital, Armed Forces Medical Command, Guri, Korea
  • 8Department of Psychiatry, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea

Abstract

Background
Suicide is one of the leading causes of death in the military as in the general population. To mitigate such a serious public health problem, identifying the risk or protective factors of suicide behaviors is crucial.
Methods
We analyzed the representative data of the 2014 Korean Armed Forces to explore the relationship between past year adverse events (PAE), accumulated lifetime trauma (ALT), mental illness vulnerability, perceived social support, and suicidal ideation in the previous year.
Results
Among the 6,377 subjects, 3.7% of males and 6.2% of females reported suicidal ideation in the previous year. Multivariate analytic models identified significant associations of PAE and ALT with suicidal ideation with a dose-response pattern. The mental illness vulnerability showed the most significant association with suicidal ideation even after controlling PAE or ALT. We found that perceived social support may be potentially linked with a reduced risk of suicidal ideation.
Conclusion
This Korean military representative data demonstrates mental illness vulnerability; PAE; and lifetime trauma as significant risk factors of suicidal ideation, while perceived social support was found as a potential protective factor. Given the importance of the prevention of suicide in the military, those risk and protective factors may be used to screen soldiers at risk of suicide and provide further support on mental health services as needed.

Keyword

Mental Disorders; Military Psychiatry; Psychological Trauma; Social Support; Suicidal Ideation

Reference

1. World Health Organization. Preventing Suicide: a Global Imperative. Geneva: World Health Organization;2014.
2. Statistics Korea. Causes of death in the military 2008–2016. Updated 2018. Accessed March 24, 2018. http://www.index.go.kr/potal/main/EachDtlPageDetail.do?idx_cd=1701.
3. Laukkala T, Partonen T, Marttunen M, Henriksson M. Suicides among military conscripts between 1991–2007 in Finland--a descriptive replication study. Nord J Psychiatry. 2014; 68(4):270–274. PMID: 23957461.
Article
4. Schoenbaum M, Kessler RC, Gilman SE, Colpe LJ, Heeringa SG, Stein MB, et al. Predictors of suicide and accident death in the Army Study to Assess Risk and Resilience in Servicemembers (Army STARRS): results from the Army Study to Assess Risk and Resilience in Servicemembers (Army STARRS). JAMA Psychiatry. 2014; 71(5):493–503. PMID: 24590048.
5. Shelef L, Kaminsky D, Carmon M, Kedem R, Bonne O, Mann JJ, et al. Risk factors for suicide attempt among Israeli Defense Forces soldiers: a retrospective case-control study. J Affect Disord. 2015; 186:232–240. PMID: 26253904.
Article
6. Wilcox HC, Storr CL, Breslau N. Posttraumatic stress disorder and suicide attempts in a community sample of urban American young adults. Arch Gen Psychiatry. 2009; 66(3):305–311. PMID: 19255380.
Article
7. Stein DJ, Chiu WT, Hwang I, Kessler RC, Sampson N, Alonso J, et al. Cross-national analysis of the associations between traumatic events and suicidal behavior: findings from the WHO World Mental Health Surveys. PLoS One. 2010; 5(5):e10574. PMID: 20485530.
Article
8. Wesseling C, van Wendel de Joode B, Keifer M, London L, Mergler D, Stallones L. Symptoms of psychological distress and suicidal ideation among banana workers with a history of poisoning by organophosphate or n-methyl carbamate pesticides. Occup Environ Med. 2010; 67(11):778–784. PMID: 20798019.
Article
9. Panagioti M, Gooding PA, Tarrier N. A meta-analysis of the association between posttraumatic stress disorder and suicidality: the role of comorbid depression. Compr Psychiatry. 2012; 53(7):915–930. PMID: 22483367.
Article
10. Harris LM, Huang X, Linthicum KP, Bryen CP, Ribeiro JD. Sleep disturbances as risk factors for suicidal thoughts and behaviours: a meta-analysis of longitudinal studies. Sci Rep. 2020; 10(1):13888. PMID: 32807889.
Article
11. Sutaria S, Devakumar D, Yasuda SS, Das S, Saxena S. Is obesity associated with depression in children? Systematic review and meta-analysis. Arch Dis Child. 2019; 104(1):64–74. PMID: 29959128.
Article
12. Perera S, Eisen RB, Dennis BB, Bawor M, Bhatt M, Bhatnagar N, et al. Body mass index is an important predictor for suicide: results from a systematic review and meta-analysis. Suicide Life Threat Behav. 2016; 46(6):697–736. PMID: 27094229.
Article
13. Afifi TO, Taillieu T, Zamorski MA, Turner S, Cheung K, Sareen J. Association of child abuse exposure with suicidal ideation, suicide plans, and suicide attempts in military personnel and the general population in Canada. JAMA Psychiatry. 2016; 73(3):229–238. PMID: 26817953.
Article
14. Bishop TM, Walsh PG, Ashrafioun L, Lavigne JE, Pigeon WR. Sleep, suicide behaviors, and the protective role of sleep medicine. Sleep Med. 2020; 66:264–270. PMID: 31727433.
Article
15. Bryan CJ, Rudd MD, Wertenberger E, Young-McCaughon S, Peterson A. Nonsuicidal self-injury as a prospective predictor of suicide attempts in a clinical sample of military personnel. Compr Psychiatry. 2015; 59:1–7. PMID: 25749478.
Article
16. Bryan CJ, Bryan AO, Clemans TA. The association of military and premilitary sexual trauma with risk for suicide ideation, plans, and attempts. Psychiatry Res. 2015; 227(2-3):246–252. PMID: 25863823.
Article
17. McLean CP, Zang Y, Zandberg L, Bryan CJ, Gay N, Yarvis JS, et al. Predictors of suicidal ideation among active duty military personnel with posttraumatic stress disorder. J Affect Disord. 2017; 208:392–398. PMID: 27810723.
Article
18. Roy A, Sarchiapone M, Carli V. Low resilience in suicide attempters. Arch Suicide Res. 2007; 11(3):265–269. PMID: 17558611.
Article
19. Pietrzak RH, Goldstein MB, Malley JC, Rivers AJ, Johnson DC, Southwick SM. Risk and protective factors associated with suicidal ideation in veterans of operations enduring freedom and Iraqi freedom. J Affect Disord. 2010; 123(1-3):102–107. PMID: 19819559.
Article
20. An HJ, Kwon SC, Kim HM. Factors that influence non-combat military soldiers' suicidal ideation. J Korean Acad Psychiatr Ment Health Nurs. 2010; 19(3):299–306.
Article
21. Kim H, Keum R, Kim S, Park SI, Park JY. Military stress, stress coping, and mental health status among soldiers who need intensive care. J Korean Acad Psychiatr Ment Health Nurs. 2013; 22(4):285–294.
Article
22. Lee AY, Lee HW, Jo SJ, Yim HW, Jang S, Park JI. The correlation between stress, depression, and social relations of Korean soldiers with a history of suicidal behavior. J Korean Neuropsychiatr Assoc. 2018; 57(4):323–331.
Article
23. Kim TK, Lee SG, Han KT, Choi Y, Lee SY, Park EC. The association between perceived unmet medical need and mental health among the Republic of Korea Armed Forces. J R Army Med Corps. 2017; 163(3):184–192. PMID: 27660285.
Article
24. Franklin JC, Ribeiro JD, Fox KR, Bentley KH, Kleiman EM, Huang X, et al. Risk factors for suicidal thoughts and behaviors: a meta-analysis of 50 years of research. Psychol Bull. 2017; 143(2):187–232. PMID: 27841450.
Article
25. Berardelli I, Corigliano V, Hawkins M, Comparelli A, Erbuto D, Pompili M. Lifestyle interventions and prevention of suicide. Front Psychiatry. 2018; 9:567. PMID: 30459660.
Article
26. Bae H, Kim D, Koh H, Kim Y, Park JS. Psychometric properties of the life events checklist-Korean version. Psychiatry Investig. 2008; 5(3):163–167.
Article
27. Gray MJ, Litz BT, Hsu JL, Lombardo TW. Psychometric properties of the life events checklist. Assessment. 2004; 11(4):330–341. PMID: 15486169.
Article
28. Kessler RC, Barker PR, Colpe LJ, Epstein JF, Gfroerer JC, Hiripi E, et al. Screening for serious mental illness in the general population. Arch Gen Psychiatry. 2003; 60(2):184–189. PMID: 12578436.
Article
29. Furukawa TA, Kessler RC, Slade T, Andrews G. The performance of the K6 and K10 screening scales for psychological distress in the Australian National Survey of Mental Health and Well-Being. Psychol Med. 2003; 33(2):357–362. PMID: 12622315.
Article
30. Min JW, Lee SH. Validation of the K6/K10 scales of psychological distress and their optimal cutoff scores for older Koreans. Int J Aging Hum Dev. 2015; 80(3):264–282. PMID: 26195502.
Article
31. Holma KM, Melartin TK, Haukka J, Holma IA, Sokero TP, Isometsä ET. Incidence and predictors of suicide attempts in DSM-IV major depressive disorder: a five-year prospective study. Am J Psychiatry. 2010; 167(7):801–808. PMID: 20478879.
Article
32. Tsai AC, Lucas M, Sania A, Kim D, Kawachi I. Social integration and suicide mortality among men: 24-year cohort study of U.S. health professionals. Ann Intern Med. 2014; 161(2):85–95. PMID: 25023247.
Article
33. Tsai AC, Lucas M, Kawachi I. Association between social integration and suicide among women in the United States. JAMA Psychiatry. 2015; 72(10):987–993. PMID: 26222043.
Article
34. Park JW. A study to development a scale of social support [dissertation]. Seoul: Yonsei University;1985.
35. Yoon CG, Bae KJ, Kang MY, Yoon JH. Is suicidal ideation linked to working hours and shift work in Korea? J Occup Health. 2015; 57(3):222–229. PMID: 25752659.
Article
36. Roy A, Hu XZ, Janal MN, Goldman D. Interaction between childhood trauma and serotonin transporter gene variation in suicide. Neuropsychopharmacology. 2007; 32(9):2046–2052. PMID: 17356577.
Article
37. Risch N, Herrell R, Lehner T, Liang KY, Eaves L, Hoh J, et al. Interaction between the serotonin transporter gene (5-HTTLPR), stressful life events, and risk of depression: a meta-analysis. JAMA. 2009; 301(23):2462–2471. PMID: 19531786.
38. Debeer BB, Kimbrel NA, Meyer EC, Gulliver SB, Morissette SB. Combined PTSD and depressive symptoms interact with post-deployment social support to predict suicidal ideation in operation enduring freedom and operation Iraqi freedom veterans. Psychiatry Res. 2014; 216(3):357–362. PMID: 24612971.
Article
39. Belik SL, Stein MB, Asmundson GJ, Sareen J. Are Canadian soldiers more likely to have suicidal ideation and suicide attempts than Canadian civilians? Am J Epidemiol. 2010; 172(11):1250–1258. PMID: 20978087.
Article
Full Text Links
  • JKMS
Actions
Cited
CITED
export Copy
Close
Share
  • Twitter
  • Facebook
Similar articles
Copyright © 2024 by Korean Association of Medical Journal Editors. All rights reserved.     E-mail: koreamed@kamje.or.kr