Review of Suicide Prevention Programs: Massachusetts, United States, in Comparison with Seoul

백지현,박종익,안정훈,노성원,허정윤,Maurizio Fava,David Mischoulon,전홍진 대한신경정신의학회 2015 PSYCHIATRY INVESTIGATION Vol.12 No.3

Suicide is a tragedy that has massive impact on society. In order to prevent suicide, active government intervention is necessary. The suicide rate in Seoul is rapidly increasing and is more than five times higher than that in the state of Massachusetts (MA) during the last decade, especially in the elderly. The suicide prevention program of MA is one of the most effective suicide prevention programs in the United States. The program views suicide as a preventable public health problem, and emphasizes treatment of depression and de-stigmatization of mental health illnesses to prevent suicide. Also, through active collaboration with mental health professionals, they try to identify atrisk populations and help them to get medical interventions. The program also actively collaborates with the regional coalition program and the Samaritans in taking care of the elderly, and supports the elderly in feeling worthwhile after retirement by helping them to work for communities as volunteers. For its part, the Seoul suicide prevention program puts more emphasis on “life respect culture” and “emotional support to high risk individuals by regular visiting”. The annual budget of the Seoul suicide prevention program is one-quarter and that for mental health is about one-twentieth that of MA. Considering the high suicide rate and lower mental health service usage in Seoul, it is crucial to raise awareness of depression and decrease the stigma on mental illnesses. Furthermore, educational efforts with long-term investment in research on suicide are necessary.

The Korea National Suicide Survey (KNSS) : Rationale and Design

Kim, Bora,Jung, Keum Ji,Lee, Sang Uk,Sea, Jonghan,Kim, Eun Young,Kim, Se Hyun,Jee, Sun Ha,Park, Jong-Ik,Kim, Kyungil,Ahn, Yong Min The Korean Society of Biological Psychiatry 2015 생물정신의학 Vol.22 No.1

Suicide, the fourth leading cause of death in Korea, is a serious national problem. The Korea National Suicide Survey (KNSS) is the result of the first legislation to address this issue, "Article 11 of THE ACT FOR THE PREVENTION OF SUICIDE AND THE CREATION OF A CULTURE OF RESPECT FOR LIFE" (the "Act for the Prevention of Suicide"). To overcome the limitations of previous studies, the KNSS was designed by collaborators from a variety of fields : psychology, epidemiology, social welfare, and psychiatry. The KNSS was composed of four substudies that addressed the multifaceted process involved in suicide-related behavior over time, exploring general attitudes toward suicide and suicidal ideation, suicide planning, suicide attempts, and completed suicides. Study 1 examined the risk factors for suicide based on data regarding completed suicides ; Study 2 adopted the approach of a psychological autopsy ; Study 3 focused on suicide attempters ; and Study 4 explored attitudes toward suicide in the general population. The KNSS was designed to provide a comprehensive understanding of suicide from a longitudinal, multifaceted perspective to serve as a basis for policies aimed at suicide prevention.

자살의 계절성과 경기반응

노용환 통계청 2014 통계연구 Vol.19 No.2

This study aims at analyzing the seasonal variations of suicide in Korea and the effect of business cycle on the suicide during the period of Jan. 1995 – Dec. 2012. Variations of suicide in Korea suggest an obvious seasonal pattern for both male and female: a distinct annual rhythm with the peak in Spring the trough in Winter. Previous studies on the business cycle and suicide reported mixed findings. Some show a negative link between economic prosperity and suicide trends over time, while others find mixed conditional relations depending on individual attributes and time period researched. Some researches also find no relationship between business cycle and suicide. In this research, after controlling for seasonality and time trends of suicide data, a ‘vector autoregression’(VAR) model is used to analyze the business cycle effects of Korean suicides. The resulting impulse response function analysis associated with a VAR model shows that the business cycle could be a predictor of suicide trends: otherthings being equal, the number of suicide increases during the economic recession and decreases when the economic situation is relieved. In particular, the economic shock represents ‘delayed response’ in suicide. Recognizing the fact that the economic recession is related to suicide potential, an appropriate preventive remedy to suicide has to be prepared. 우리나라 자살통계 장기시계열의 변동성은 일반 시계열의 특성과 마찬가지로 추세와 계절성, 그리고 경기변동성을 내포하고 있다. 본 연구는 이미 많은 연구를 통해 식별되어 온 자살 추세의 원인을 밝히려는 목적보다는 우리나라 자살통계 시계열의 추세와 계절성을 분석한 후, 추세와 계절성이 통제된 상태에서 자살이 경기변동에 의해 어떻게 영향을 받아 왔는지를 분석한다. 우리나라의 자살은 분석기간 (1995:01-2012:12)인 지난 17년 동안 장기적으로 추세적인 증가와 함께 변동성 측면에서 봄철에 정점에 달하였다가 겨울철에 최하점에 도달하는 계절적 리듬을 반복해 왔다. 또한 자살은 경기변동과 밀접한 관련을 맺고 있는 것으로 나타났는데, 경기하강 국면에 시차를 두고 자살자수가 증가하는 현상이 관찰되었으며, 그 충격은 1년 이상 소멸되지 않는 ‘지연형 반응’ (delayed response)으로 분석되었다. 따라서 자살의 계절적 리듬의 고리를 끊어내기 위해서는 특히 자살이 급증하는 시기인 3월부터 최고조에 달하는 5월 전후에 자살예방 노력이 집중될 필요가 있다. 자살의 경기대응 수단 강구는 즉시 이루어져야 하며 또한 지속되어야 한다. 경기하강이 관측되면 늦어도 3개월 이내에 자살위험군을 식별하여 자살을 예방하기 위한 신속한 정책 대응방안의 준비가 필요하다.

자살 유서를 통한 자살 사망자의 심리상태에 대한 질적 연구

함근수,유성호,표주연,박종필,나주영,이이나 대한법의학회 2014 대한법의학회지 Vol.38 No.4

Suicide notes are essential for investigating the psychological state of suicide victimsand establishing suicide prevention programs. Since only a few studies haveattempted to identify the causes of suicidal behavior through suicide notes, it would beworth examining suicide notes. Quantitative research on suicide has offered a limitedunderstanding of suicide. Results showed that the suicide victims had used the suicidenote as a tool for their last communication. Further, in addition to neutral contentssuch as directions for funeral, the note often contained information about precipitatingevents that caused the suicidal ideation. Writing a suicide note seemed to help the victimsconsider concrete plans for suicide. This study proved that qualitative researchon suicide notes would be helpful for researchers to understand suicide victims indepth, which cannot be achieved by quantitative methods alone. Based on theseresults, several suggestions for suicide prevention programs were discussed.

Factors Affecting Suicide Attempters Visiting Emergency Departments: Through a Focus on Acquired Capability with Rehearsal for Suicide, Negative Urgency, and Social Support

한소리,이영숙,김지선,김은지,허인수,이주영,윤희정,심세훈 대한우울조울병학회 2020 우울조울병 Vol.18 No.2

This study examines how acquired capability for suicide, negative urgency, and social support effectuate a suicide attempt. Sixty-three adults having visited an emergency room due to a suicide attempt were studied. The results can be summarized as follows. First, there were no significant sex differences in acquired capability for suicide, negative urgency, and social support. Second, the correlation among suicidal ideation, acquired capability for suicide, negative urgency, social support, and suicide attempts was examined. Results showed that suicide attempts were significantly and positively correlated with suicide ideation, acquired capability for suicide, and negative urgency. However, social support and suicide attempts did not significantly correlate. Third, results of hierarchical regression analysis indicated that acquired capability for suicide and negative urgency significantly predicted suicide attempts even when suicide ideation was controlled, but social support did not significantly explain attempts. In other words, study results imply that suicide attempts increase when acquired capability for suicide and negative urgency are high. Study results offer empirical data for understanding the intrinsic characteristics of individuals attempting suicide.

우리나라 자살기도자의 특징

임미래,이수정,박종익 대한신경정신의학회 2015 신경정신의학 Vol.54 No.2

Objectives ZZIn the current study, we investigated the general characteristics of suicide attempters and attempted to determine factors contributing to suicide attempt by analyzing severe suicide ideation and intent. MethodsZZThis study analyzed medical records of suicide attempters who visited the emergency departments. Data were collected from 7 university hospitals nationwide. As an evaluation measure of suicide intent, we used Suicide Intent Scale (SIS). Colombia Suicide Severity Rating Scale (C-SSRS) was applied for assessment of severity and intensity of suicide idea and lethality of suicide behavior. ResultsZZMale gender, old age and living alone group showed higher SIS score. Male gender, low income, and having psychiatric diagnosis or suicide history group showed a high score on the severity subscale of suicide ideation of C-SSRS. Old age, low income, and having psychiatric diagnosis showed a high score on the intensity subscale of suicide ideation of C-SSRS. Actual lethality scale of C-SSRS was high in male gender and old age group. Severity and intensity of suicide ideation and suicide intent showed positive correlation with actual lethality of suicide behavior. ConclusionZZMale gender, old age, living alone, psychiatric diagnosis, and suicide history were risk factors affecting severity and intensity of suicide ideation and intent of suicide. Severity and intensity of suicide ideation and intent are positively related to lethality of suicide behavior.

지역사회의 생태적 특성과 자살태도 및 자살생각의 관계검증

윤우석 대한범죄학회 2014 한국범죄학 Vol.8 No.1

The purpose of this study is to examine the effects on attitude and ideation about suicide of social cohesion, informal social control, and social disorder and measuring the main concepts of social integration and regulation in Anomie theory. To accomplish the aim of study, the author used survey data from 677 respondents living in Daegu City. The results show that independent variables expressing community’s ecological characteristics fail to show significant direct effects on attitude toward suicide and ideation on suicide but show indirect effects on them throughout disorder. As like previous findings, the disordered resident environment has a negative influence on attitude toward suicide and makes people frequently thinking about suicide. As a result, it is required to make resident space better and enhance informal social control and so that attitude toward suicide and ideation on suicide can be changed to the better way. Meanwhile, age and socioeconomic status among demographic characteristics improve attitude toward suicide and people experiencing family disrupt are more likely to think suicide. It means that the older people show conservatively negative opinion about suicide as a way to solve any problems in lives. While the perception of socioeconomic status also has fail to support anomie theory since the higher perception of their socioeconomic status is related to show the negative perception about suicide. Disrupt family as a traditional measure of social integration in prior researches is more effective than new measures suggested in this study because it shows the direct effect on ideation of suicide 이 연구의 목적은 뒤르켕의 아노미이론과 사회해체이론을 통합적으로 논의하여 사회통합과 규제를 사회해체이론의 주요 개념인 사회유대와 비공식적 사회통제로 측정하고 사회유대, 비공식적 사회통제, 그리고 무질서가 자살태도와 자살생각에 미치는영향을 파악하고자 하였다. 연구의 수행을 위해 대구시 성인남녀 677명의 설문자료를 분석에 이용하였다. 자료의 분석결과 지역사회의 생태학적 특성을 나타내는 주요 독립변인들은 자살태도와 자살생각에 직접적인 영향을 미치지는 않았으나 무질서를 통해 그 영향이 매개되는 것으로 나타났다. 기존 연구들의 결과들과 마찬가지로 무질서한 주거환경은 개인의 자살에 대한 태도에 부정적인 영향을 미쳐 자살생각을 보다 더 많이 하는 것으로 나타났다. 따라서 자살생각과 자살태도의 변화를 위해서는 주거환경의 개선노력이 요구되며 비공식적 사회통제를 통해 그 해결책을 찾을 수 있을 것으로 보인다. 한편, 개인의 인구학적 특성 중 연령과 경제력 인식은 자살태도에 부적인 영향을 미치는 것으로 나타났고 결손가정은 자살생각을 증가시키는 것으로 나타났다. 즉, 연령이 높을수록 자살에 보수적인 반응을 보여 자살을 문제해결의 수단으로 사용하는 것에 대하여 부정적인 인식을 나타냈다. 한편 경제적 지위가 높을수록 자살태도에 부정적인 반응을 보여 뒤르켕의 아노미이론에서 가정하였던 내용과 반대의 결과를 보여주었다. 자살연구에서 전통적인 사회적 통합을 측정하는 결손가정은 자살생각에 직접적인 영향을 미치는 것으로 나타나 이 연구에서 시도하였던 새로운 측정도구에 비하여 보다 효과적으로 자살을 예측하는 것으로 나타났다.

A Call for Community-Based Suicide Prevention in South Korea

육성필,Hirsch 한국문화및사회문제심리학회 2010 한국심리학회지: 문화 및 사회문제 Vol.16 No.2

In this paper, we reviewed the community-based approaches to suicide prevention and national strategies for the decrement of suicide rate, and made some suggestions to decrease the suicide rate in South Korea. Until now, efforts to understand and prevent suicide have been pursued singularly by specialized interest groups such as psychiatrists, psychologists, mental health practitioners, and private organizations with little interaction between them, resulting in narrow approaches toward suicide that existed in relative isolation to one another and that have been largely ineffective. To decline the suicide rate in South Korea, the people lived in Korea community ought to have enough knowledge related to suicide and have to cooperate with other people. Through these efforts, Korea community would have established social safety networks to improve the community’s mental health. The most important factor in suicide prevention and declining the suicide rate is reducing the stigma and increase the self-help seeking behaviors associated with suicide and mental health. Therefore, suicide is not an individual problem solved by suicidal patient, but a community’s problem solved by community in recognizing, managing and preventing suicide.

자살예방에 대한 사회정신의학적 접근

김성완,전민,김미나,백종우,김재민,윤진상 대한의사협회 2019 대한의사협회지 Vol.62 No.2

Suicide is the fifth-leading cause of death in Korea, accounting for 4.4% of all deaths. Therefore, suicide is a serious medical problem, as well as a social problem. In this paper, we provide a social psychiatric perspective on suicide and recommend suicide prevention strategies based on programs with roots in the Gwangju mental health pilot project and an analysis of suicide patterns in Seoul. First, early intervention and active case management are mandatory to prevent suicide among individuals with mental illnesses such as depression, schizophrenia, and alcohol use disorder. To this end, mental health and welfare centers, addiction management centers, suicide prevention centers, and care program after a suicide attempt in the emergency department of general hospitals should collaborate via a multidisciplinary approach. Second, crisis intervention should be provided in collaboration with the police, government officials, and mental health agencies to people who are at immediate risk of suicide. Additionally, case management services should be expanded for individuals who are treated at hospitals for psychiatric illness. Third, social welfare services should be offered to low-income individuals at risk of suicide. Fourth, the mass media should restrict reporting about suicide and follow the relevant reporting guidelines. Finally, access to methods of committing suicide, such as charcoal for burning and agrichemical poisoning, should be regulated by the government. Proactive psychosocial strategies implemented with government support will prevent suicide-related deaths and decrease the suicide rate in Korea.

자살 생각에 따른 자살 시도 고위험군 규명

한명희(Myeunghee Han) 한국산학기술학회 2023 한국산학기술학회논문지 Vol.24 No.4

본 연구는 2021 지역사회건강조사 자료를 활용하여 자살 생각 경험이 있는 대상자 중 자살 고위험군을 예측하는 모델을 구축하였다. 본 연구는 자살생각 경험이 있는 총 대상자(N=16,070명)를 자살 시도 경험군(n=699명)과 비경험군 (n=15,371명)으로 나누어 의사결정나무분석을 통해 자살시도 고위험군을 파악하였다. 본 연구의 전체 대상자를 중심으로 한 예측 모형에서는 우울증상이 있고, 흡연을 하며 삶의 만족도가 4점 이하로 낮은 경우가 자살 시도율 20.0%로 자살 고위험군으로 확인되었다. 연령을 기준으로 한 자살 고위험군 예측 모형에서는 연령 군 19-29세에 해당하면서, 흡연자이고, 삶의 만족도가 낮은 경우 자살 시도율 30.9%로 가장 높았다. 성별을 고려한 자살 시도 모델에서는 여성이면서 우울하고 흡연하는 경우가 21.3%로 고위험군이었다. 자살은 자살생각, 자살 계획 그리고 자살 시도의 일련의 과정으로 일어날 가능성이 크다. 따라서 자살 생각 경험이 있는 대상자를 중심으로 정기적인 자살 관련 검진을 실시하고 다양한 프로그램을 적용하여 자살을 예방할 수 있도록 지역사회가 노력해야 할 것으로 사료된다. This study used the 2021 Community Health Survey data to build a model that predicts the high-risk suicide group among subjects with suicidal thoughts. To predict the high-risk group, the total number of subjects identified with suicidal ideation (N=16,070) was divided into a group that had experienced a suicide attempt (n=699) and a non-experienced group (n=15,371). Decision tree analysis was applied to identify the high-risk group. Subjects with depressive symptoms, smoking, and low life satisfaction were identified as the high suicide risk group and were determined to have a suicide attempt rate of 20.0%. In the age-based suicide risk group prediction model, the highest suicide attempt rate at 30.9% was in the age group of 19-29 years old, smoker, and with low life satisfaction. In the suicide attempt model considering gender, the high-risk group included 21.3% of women, depression, and smoking. Since suicide is likely to occur as a series of suicidal thoughts, suicide plans, and suicide attempts, it is necessary to conduct regular suicide-related checkups for people experiencing suicidal thoughts. Also, the community should make efforts in the prevention of suicides by employing various programs.