What Factors Differentiate Suicide Attempt from Suicidal Ideation? Results from North Korean Refugee Women in South Korea

BACKGROUND AND PURPOSE North Korean Refugee Women (NKRW) are known to be vulnerable to mental health problems such as depression, Post-Traumatic Stress D (PTSD), and suicide. Specifically, the suicide rate of NKRW in South Korea was 128 per 100,000 individuals in 2013, which is not only the highest rate among the Organization for Economic Cooperation and Development (OECD) countries but also over three times higher than that of South Koreans (Ministry of Unification at National Assembly Foreign Affairs and Unification Committee, 2013). However, little has been known about risk factors for suicide among NKRW in South Korea. Recent suicide research emphasizes that not everyone with suicidal ideation attempt suicide and it is imperative to understand factors that cause people to act on their suicidal thoughts. Therefore, this study aimed to examine factors that increase risk for suicidal ideation and to identify factors that differentiate suicide attempt from suicidal ideation among NKRW in South Korea.

METHODS The data was collected in 2012 using snowball sampling due to limited access to the sampling frame. A sample of 140 NKRW was analyzed for this study. Depression was measured with the Center for Epidemiological Studies-Depression (CES-D, Radlof, 1977). Exposure to traumatic events was assessed with 40 binary items such as witnessing execution of their family or neighbors, rape, and inhumane imprisonment in concentration facilities. Life stress was measured with 9 items from the social readjustment rating scale (Holmes & Rahe, 1967). Suicidal ideation and attempt within the past year were also assessed. In the first logistic regression analysis, suicidal ideation was predicted from depression, the number of traumatic experiences, and the life stress controlling for age with the entire sample. Then, suicide attempt was predicted from the same factors, but only NKRW with suicidal ideation were included in the second logistic regression analysis to examine factors differentiating suicide attempt from suicidal ideation.

RESULTS NKRW experienced about seven traumatic events on average. More than 40% of the sample met clinical diagnosis of depression. About 46% of the sample reported suicidal ideation, and 17.9% attempted suicide within the past year. In the first logistic regression, traumatic experience (OR = 1.09, p = 0.042) and life stress (OR = 1.37, p = 0.005) were significantly associated with suicidal ideation. In the second logistic regression among those with suicidal ideation, life stress was the sole significant risk factor for suicide attempt (OR = 1.49, p = 0.016).

CONCLUSIONS Despite the limited generalizability of the findings, this study provides insights into suicide prevention among refugees. The study showed that traumatic experiences and life stress increases risk for suicidal ideation in NKRW. However, only life stress significantly increased risk for suicide attempt among those with suicidal ideation. Results imply that traumatic experiences in the past may increase suicidal ideation, but life stress may have a pivotal role in the transition from suicidal ideation to attempt. Social workers working with refugee populations may benefit from examining current life stress as well as traumatic experiences in preventing suicidal ideation and further attempt.