Pathways between Multidimensional Risk Factors and Suicidal Behaviors: Analysis of the 2023 Korean Welfare Panel Study on People with Disabilities

Background

People with disabilities have significantly higher suicide rates compared to the general population, highlighting the urgent need for targeted preventive strategies. This study applies a social determinants of health framework to examine how socioeconomic status, social support, perceived discrimination, and depression collectively influence suicidal behaviors. Using comprehensive data from the 18th Korean Welfare Panel Study's disability supplement survey (2023), this research employs structural equation modeling to identify critical mechanisms underlying suicidal behaviors among individuals with disabilities, informing social work interventions for this vulnerable population.

Methods

Cross-sectional data from 1,576 participants with disabilities were analyzed. Suicidal behaviors were measured through standardized self-report items assessing suicidal ideation, planning, and attempts within the past year. Exogenous variables included food insecurity (6-item Korean Food Security Survey Module), material deprivation (8-item composite index), social support (12-item scale), and perceived discrimination (4-item scale). Depression (11-item CES-D) was specified as a mediating endogenous variable. Demographic characteristics were controlled. The structural model was tested using maximum likelihood estimation with robust standard errors, with indirect effects assessed using bootstrapping (5,000 resamples) with bias-corrected confidence intervals.

Results

Suicidal ideation was reported by 2.02% of participants overall, with elevated rates among low-income participants (4.36%) compared to general participants (1.55%). The structural model showed good fit (χ²[312]=703.16, p<.001, CFI=.938, TLI=.925, RMSEA=.049, SRMR=.043) and explained 47.6% of the variance in suicidal ideation. Direct path coefficients indicated significant effects of food insecurity (β=.18, p<.001), material deprivation (β=.14, p<.01), social support (β=-.16, p<.001), discrimination (β=.09, p<.05), and depression (β=.39, p<.001) on suicidal ideation. SEM analysis revealed significant indirect effects via depression: food insecurity→depression→suicidal ideation (β=.13); material deprivation→depression→suicidal ideation (β=.11); social support→depression→suicidal ideation (β=-.17); and discrimination→depression→suicidal ideation (β=.19). Depression mediated 42.7% of food insecurity effects, 38.2% of material deprivation effects, 51.3% of social support effects, and 67.8% of discrimination effects on suicidal ideation.

Discussion

This study advances understanding of suicidal behaviors among people with disabilities through structural equation modeling that identifies both direct and indirect pathways of risk. The findings highlight depression as a critical mediating mechanism, particularly for discrimination experiences (67.8% mediation), while demonstrating that socioeconomic factors maintain significant direct effects. These results align with social work's person-in-environment perspective and suggest multilevel interventions: (1) micro-level interventions addressing depression; (2) mezzo-level interventions enhancing social support; and (3) macro-level policy reforms targeting economic security and institutional discrimination. These findings validate a complex ecological model of suicide risk and identify specific intervention leverage points across multiple systems levels.