Relationship Between Suicidal Plans and Atempts Among Korean Adolescents with Suicidal Thoughts: Testing for Violence Experience and Social Support As Mediators

Background/Purpose:

Suicide is a global phenomenon. In 2012, suicide is the third cause of death among adolescents in the U.S. and is the first cause of death among youth in South Korea. Suicide is a complex endpoint on a continuum ranging from thoughts, plans, attempts, and completions. Research reported that a third of youth with suicidal thoughts go on to develop a suicidal plan, with around 60% of those with a plan proceeding to attempt suicide. Understanding a path of suicide and mediators between suicidal plans and attempts are important to prevent adolescents from suicidal completion. Therefore, this current study will test 1) the relationship between suicidal plans and attempts among adolescents who had suicidal thoughts and 2) violence experience and social support as mediators of the relationship between suicidal plans and attempts.

Methods: Data and Sample: This study used secondary analysis of the 2014 Korean Youth Health Risk Behavior On-line Survey (KYHRBS), which used a two-stage of cluster sampling method that produced a representative sample of students attending grade 1-3 from 400 middle schools and from 400 high schools in South Korea. Of a total of 72,060 adolescents, this current study used 9,438 adolescents who reported suicidal thoughts during the past 12 months.

Measures:Suicidal plans were measured by whether respondents had a plan during the past 12 months. Suicidal attempts were measured by whether respondents attempted to suicide during the past 12 months. Violence experience was assessed by whether respondents experienced violence (i.e, bullying, physical violence, threat) during the past 12 months. Social support was assessed separately for support from 1) family, 2) friends, 3) school teachers, and 4) others.   

 Control variables included gender, year in school, living with parents, economic situation, school performance, perceived stress, and depressive feelings. Structural Equation Model was used to examine the causality between plans for suicide and suicidal attempts and to analyze violence experience and social support as mediators between suicidal plans and attempts.

Results: Suicidal plans were statistically associated with suicidal attempts (β =0.362, p<. 001). Violence experience, family social support and friends social support statistically mediated the relationship between suicidal plans and suicidal attempts. In addition, gender (β =0.031), living with parents (β = -0.04), school performance (β =-0.01) and depressive feelings (β =0.05) were statistically associated with suicidal attempts.

Conclusions and Implications: This study finding suggest that suicidal plans leads to attempt suicide. In addition, this study found that violence experiences increased a risk of suicidal attempts while social support from family and friends decreased possibility of suicidal attempts.  The findings stresses that social support appears to be a  key factor to prevent from suicide deaths.