자살과 위기중재

김성완,김재민,신일선,윤진상 대한의사협회 2012 대한의사협회지 Vol.55 No.4

The rate of suicide, which is the fourth leading cause of death in Korea, has been increasing rapidly. Thus, the development of appropriate crisis intervention and treatment approaches is important for efforts to prevent suicide. In the context of crisis intervention, interviews with persons at risk of suicidal behavior should be characterized by the following three elements:empathic communication (active listening), the evaluation of suicidal ideation and risk factors,and the enhancement of protective factors against suicide. The intensity of suicidal thoughts,thoughts of suicide methods, intent to act on suicidal thoughts, and specific suicide plans should be evaluated in detail. Risk factors associated with suicide include being male, older, or divorced;having a physical illness or a recent discharge from a psychiatric hospital; experiences of hopelessness or aggression; impulsivity; and easy access to a method of suicide. Any history of previous suicide attempts should be identified in all persons at risk for suicide because such a history is an important clinical indicator of both additional attempts and completed suicides. More than 90% of all suicides are attributable to an emotional or psychiatric illness such as depressive disorder, bipolar disorder, alcohol-use disorder, or schizophrenia. Therefore, immediate and appropriate psychiatric treatment for psychiatric illnesses related to suicide risk is essential. Hospitalization in a closed psychiatric ward can help to prevent suicide among those presenting with a high and immediate risk for suicide. In conclusion, suicide and attempted suicide can be prevented by adequate treatments such as antidepressants, lithium, clozapine, and cognitive-behavioral therapy.

초기불교 문헌에 나타난 자살 – 사례를 중심으로

김재성 한국불교연구원 2024 불교연구 Vol.60 No.-

자살은 현대 한국사회의 심각한 사회문제이다. 자살을 포함해서 초기불교는 죽음에 대한 가르침이 자주 제시된다. 죽음의 괴로움은 대표적인 실존적 괴로움이며, 죽음에 대한 명상은 중요한 수행법이다. 초기불교문헌의 경전과 율장에는 다양한 자살사례가 나온다. 살인의 일종인 자살은 인간으로 태어난 기회를 의도적으로 끊어버리는 악행으로 보며, 자살의 배경에는 비존재의 갈애라는 죽음에의 갈망이 있다. 보통 인간들은 탐진치에 의해 자살을 선택한다. 하지만 성자들은 의도적인 살인을 하지 않으며, 자살을 하지도 않는다. 하지만 극심한 병고에 시달리는 수행승이 아라한이 되었다고 잘못 생각해서 자살을 하거나, 선정 수행 도중에 선정의 결과로 천상에 태어나기 위해 자살을 한 경우가 있는데, 이들은 자살 시행 후 생명이 끊어지는 순간 아라한이 되면서 임종하였기에 붓다는 아라한이 되어 죽음을 맞이했다는 점만을 말하며, 자살의 잘못에 대해서는 업급하지는 않았다. 하지만 초기불교 문헌의 다양한 사례에서 볼 때, 자살은 살인의 한 방식이어서 악행으로 금지하고 있음을 알 수 있다. Suicide is a serious social problem in modern Korean society. In early Buddhism, including suicide, teachings about death are frequently offered. The agony of death is a typical existential distress, and meditation on death is an important practice. Various suicide cases appear in the scriptures and chapters of early Buddhist literature. Suicide, a type of murder, is seen as an evil act that intentionally cuts the chance of being born as a human being, and the background of suicide is the desire to die, which is the love of non-existence. Usually, humans choose to kill themselves by means of indulgence. However, saints do not commit murder intentionally, nor do they commit suicide. However, there are cases where a monk who suffers from severe illness accidentally commits suicide because he thinks that he has become Arahan, or during the selection process, he commits suicide to be born in heaven as a result of selection. The Buddha only died as Arahan when his life was cut off after committing suicide, and he did not pay for the wrongdoings of suicide. However, various examples of early Buddhist literature show that suicide is prohibited as an evil act because it is a method of murder.

Effect of Attitude Toward Suicide on Suicidal Behavior: Based on the Korea National Suicide Survey

Kim Min Ji,Lee Hyunju,Shin Daun,Hong Minseok,Rhee Sang Jin,Park Jong-Ik,Ahn Yong Min 대한신경정신의학회 2022 PSYCHIATRY INVESTIGATION Vol.19 No.6

Objective Suicide is a complex phenomenon; therefore, it should be approached in light of sociocultural perspectives and the general attitude toward suicide. This study aimed to extract factors from the Attitude Toward Suicide Scale (ATTS) and investigate the relationship between attitudes toward suicide and suicidal behavior (i.e., suicidal idea, plan, and attempt) by using a representative sample of Korean adults.Methods Three thousand Koreans aged 19 to 75 years were surveyed cross-sectionally in 2013 and 2018. The data collected were subjected to exploratory factor analysis. Extracted attitude factors were compared using a suicidal behavior continuum. Univariate and multivariate logistic models were constructed to compare the association between attitude factors and suicidal behaviors.Results Among the participants, 477 (15.9%) experienced suicidal idea only, 85 (2.8%) had a suicidal plan without attempt, and 58 (1.9%) attempted suicide. Four meaningful factors were extracted from the factor analysis: “permissiveness,” “unjustified behavior,” “preventability/readiness to help,” and “loneliness.” “Permissiveness,” “unjustified behavior,” and “loneliness” factors showed significant trends across the suicidal behavior continuum. Permissive attitude toward suicide increased the odds of suicidal idea, suicidal plan, and suicide attempt (adjusted odds ratio [aOR]=1.49, 95% confidence interval [CI]=1.25–1.79; aOR=2.79, 95% CI=1.84–4.25; aOR=2.67, 95% CI=1.65–4.33), while attitude toward suicide as unjustified behavior decreased the odds of suicidal ideation and attempt (aOR=0.79, 95% CI=0.67–0.94; aOR=0.64, 95% CI=0.42–0.99).Conclusion A significant association was found between attitude toward suicide and suicidal behaviors. Attitude toward suicide is a modifiable factor that can be used to develop prevention policies.

Epidemiology of Suicide by Hanging in Fars Province, Iran (2011-2019): A Population-based Cross-sectional Study

Leila Moftakhar,Alireza Mirahmadizadeh,Sanaz Amiri,Fariba Rezaei,Habibollah Azarbakhsh The Korean Society for Preventive Medicine 2023 예방의학회지 Vol.56 No.3

Objectives: Hanging is a common method of attempted suicide. This study investigated the epidemiological profile of attempted and completed suicides by hanging in southern Iran. Methods: This cross-sectional study was performed on 1167 suicide attempts by hanging between 2011 and 2019. All data related to suicide attempts by hanging were collected from the Fars Suicide Surveillance System. The trends in suicide cases and the mean age of attempted and completed suicides were plotted. The chi-square test was used to identify suicide-related factors. Crude rates of incidence, mortality, and standardized fatality during the study period were calculated. Finally, logistic regression was used to identify the predictors of death in individuals who attempted suicide. Results: The mean age of those who attempted suicide was 33.21±16.82 years; the majority were male (80.5%). The rate of attempted and completed suicide by hanging were 3.50 and 2.79 per 100 000 people, respectively. The case-fatality rate was calculated as 79.34%. The results of our study indicated an increasing trend in suicide attempts by hanging. The likelihood of death was 2.28 times higher in individuals with a previous history of suicide attempts and 1.85 times higher in those with a psychological disorder. Conclusions: The findings of this study suggest an increasing trend in attempted and completed suicide by hanging, especially among individuals with a history of suicide attempts and psychological disorders. It is necessary to take action to reduce the rate of suicide attempts and identify the underlying causes of suicide attempts by hanging.

COVID-19 이후 청년여성 자살위기자에 대한 자살예방실무자의 인식과 경험

최명민,백경원 한국사회복지질적연구학회 2023 한국사회복지질적연구 Vol.17 No.2

COVID-19 팬더믹 상황에서 전 국민적 정신건강에 대한 우려가 제기된 가운데 두드러진 문제 중 하나는 청년여성의 자살위기였다. 특정 집단의 자살위기 증가는 자살예방현장에 영향을 미치며 그에 따른 적절한 대응을 요구한다. 그러나 청년여성의 자살위기 증가가 자살예방현장에서 어떻게 이해되고 다뤄지고 있는지에 대한 논의는 부족한 실정이다. 이에 본 연구는 자살예방현장 실무자들이 최근 증가해 온 청년여성 자살위기자들을 어떻게 바라보고 대응해 왔는지, 그 인식과 경험을 파악하기 위해 시행되었다. 이를 위하여 지역정신건강복지센터에서 자살예방 업무를 담당해온 8명의 실무자를 개별 인터뷰하여그 내용을 전사한 후 귀납적 주제분석방법을 통해 핵심주제를 도출하였다. 그 결과 ‘코로나와 맞물려 어느덧 자살예방현장의 다수를 차지하게 된 젊은 여성들’, ‘기존에 잘 볼 수 없었던 새로운 유형의 클라이언트로서 청년여성 자살위기자’, ‘(들여다보면) 근본적인 문제는 사회구성원으로 설 수 있는 토대 부재로 낙오가 기정사실화되는 상황’, ‘자해와 음주문제로 드러나는 무망감과 무력감’, ‘청년여성 대상 서비스 제공과정에서 실무자들이 경험하는 압박과 혼란’, ‘자살위기 청년여성 대상 서비스를 위한 제도개선과 교육기회 희망’과 같은 주제를 도출하였다. 이와 같은 실무자들의 경험적 진술을 통해, 청년여성 자살위기문제와 그 대응 상황에 대한 이해를 도모하고, 향후 보다 효과적인 서비스를 제공하기 위해 어떤 자살예방 정책과 실천적 변화가 요구되는지를 논의할 수 있었다. In the pandemic situation caused by Corona 19, concerns about the national mental health have been raised, and the prominent problem among them was the increase of suicide crisis in young women. The increase in the suicide crisis of a specific group affects the suicide prevention field, and appropriate responses are required accordingly. However, there is a lack of discussion on how the increase in suicide crisis among young women is understood and dealt with in the field of suicide prevention. Accordingly, this study was conducted to find out how suicide prevention practitioners have viewed and responded to young female at suicide risk. To this end, 8 practitioners who have been in charge of suicide prevention at the community mental health welfare center were interviewed individually, transcribed, and key themes were derived by inductive thematic analysis. As a result, ‘young women who have become the majority client in suicide prevention, recently’, ‘young women at risk of suicide as a new type of clients that have not been seen before.’, ‘the fundamental problem is the lack of the foundation on which they can stand as members of society’, ‘sense of hopelessness and helplessness revealed through self-harm and drinking’, ‘pressure and confusion experienced by practitioners in the process of providing services to young women’, ‘hoping system improvement and more education for better services to young women at risk of suicide’ were derived. Through these empirical statements of practitioners, we could discuss what suicide prevention policies and practical changes are required to provide more effective services in the future.

대중매체의 자살보도 및 사회적 지지가 대학생의 자살생각에 미치는 영향

한수미,Han, Su-Mi 한국학교보건학회 2012 韓國學校保健學會誌 Vol.25 No.1

Purpose: The purpose of this study is to identify the effects of suicide reports by mass media and social support on suicide ideation for college students. Methods: Participants are 350 undergraduate students in one university. This study uses three questionnaires: Perception and Attitude toward Suicide Reports, Social Support, and Suicidal Ideation. The SPSS/WIN 12.0 program is used to analyze the data. In particular, the participants' biographical data are analyzed into frequency and percentage. The degrees of suicide reports, social support, and suicide ideation are calculated into Mean and SD. Moreover, the suicide ideation by suicide report and social support are analyzed by the two-way analysis of variance (ANOVA). Results: This study reveals that college students have an average of 30 minutes to one hour news time a day (38.9%) and have at least one suicide report in a month (30.3%). 79.7% participants believe that the suicide report of mass media results in the cause of the copycat suicide. In terms of suicide report and suicide ideation, the types of mass media (F (4,340)=2.41, p<.05) and suicidal urge (F (1,340)=31.23, p<.01), respectively, have significant influences on suicide ideation. On the other hand, the social support and suicide ideation, whether college students have their mentors (F (1,328)=13.26, p<.001) and/or careres (F (1,328)=26.84, p<.001) have significant influences on suicide ideation. Conclusion: College students have higher suicide ideation at news by internet site rather than by radio, TV, and so on. Moreover, college students who have a suicide feeling in the last one year, have more suicide ideation than who have not. On the other hand, college students who have a mentor and carer tend to have less suicide ideation.

Attitudes and Misconceptions Toward Suicidal Individuals among Suicide Gatekeeper Education Program Participants in South Korea *

안치수(Chi-Soo An),이강욱(Kanguk Lee) 대한사회정신의학회 2017 사회정신의학 Vol.22 No.2

Objectives : Suicide is a prominent public health issue in South Korea; participants in suicide gatekeeper education programs engage with potentially suicidal individuals and may refer those individuals to mental health professionals. This study examined opinions and attitudes regarding suicidal behavior among suicide gatekeeper education program participants in the Gangwon province of South Korea in order to develop recommendations for the development of suicide prevention and education programs. Methods : Questionnaires were administered containing questions examining participants’ experiences of suicidal behavior and attitudes toward suicidal individuals. Chi-square and multivariate regression analysis were used to examine differences and associations between participants’ attitudes toward suicidal individuals, sociodemographic characteristics, and experiences of suicide. Results : Participants who were male, older, or had experience with suicide (e.g., suicidal ideation or attempts, the loss a significant other to suicide) were more likely to hold misconceptions toward suicidal individuals. Experience with suicide programs was correlated with more positive attitudes toward suicidal individuals. Conclusion : Demographic characteristics and experience with suicidal behavior may affect misconceptions and attitudes toward suicidal individuals among participants in suicide gatekeeper education programs. Suicide gatekeeper education programs should particularly provide education and training to suicide gatekeepers who have these characteristics, thereby improving suicide gatekeepers’ ability to manage individuals facing a high suicide risk.

셰익스피어 비극에 나타난 자살과 젠더

강석주(Seok Joo Kang) 한국셰익스피어학회 2021 셰익스피어 비평 Vol.57 No.3

Suicide scenes in Shakespeare’s tragedies reflect the contemporary gender consciousness that men are superior to women. Even though suicide was regarded as unforgivable sin against God’s will in Shakespeare’s England, it seems not that Shakespeare has any prejudice against suicide. The suicides of Shakespeare’s characters are the dramatic means to keep the value they cherish and for which they are responsible. However it is certain that we can find gender difference in those suicide scenes. Male characters who commit suicide in Shakespeare’s tragedies show dignity and subjective judgement. Including the famous Roman characters, Shakespeare’s male characters committing suicide are portrayed noble and brave. The suicides of non-roman Othello and Romeo are also portrayed brave and heroic. On the other hand, the suicides of most female characters are often portrayed as the result of mental illness or God’s punishment. Even the moving and heroic suicides of Juliet and Cleopatra reveal the heroine’s dependence on their male partners. Shakespeare’s suicide scenes are affected not so much by the Christian prejudice as by the gender prejudice. Greek and Roman view of suicide as an honorable and brave act is usually applied to male characters. And The Christian view of suicide as unforgivable sin is mostly applied to female characters. Emile Durkheim, in his famous book Le Suicide, analyzes the importance of social causes rather than unsocial causes, studying the statistical data of suicides of European countries in 19th century. However, Shakespeare’s suicide scenes certainly reflect the contemporary view of suicide which emphasizes the unsocial causes like gender difference. In Shakespeare, suicide is a kind of dramatic means to represent the social prejudice of gender.

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.

ERP investigation of attentional disengagement from suicide-relevant information in patients with major depressive disorder

Baik, Seung Yeon,Jeong, Minkyung,Kim, Hyang Sook,Lee, Seung-Hwan Elsevier 2018 Journal of affective disorders Vol.225 No.-

<P><B>Abstract</B></P> <P><B>Background</B></P> <P>Previous studies suggest the presence of attentional bias towards suicide-relevant information in suicidal individuals. However, the findings are limited by their reliance on behavioral measures. This study investigates the role of difficulty in disengaging attention from suicide-relevant stimuli using the P300 component of event-related potentials (ERPs).</P> <P><B>Methods</B></P> <P>Forty-four adults with Major Depressive Disorder (MDD) were administered the spatial cueing task using suicide-relevant and negatively-valenced words as cue stimuli. Disengagement difficulty was measured using reaction time and P300 during invalid trials.</P> <P><B>Results</B></P> <P>P300 amplitudes at Pz were higher in suicide-relevant compared to negatively-valenced word condition on invalid trials for participants with low rates of suicidal behavior. However, no such difference was found among participants with high rates of suicidal behavior. P300 amplitudes for suicide-relevant word condition were negatively correlated with “lifetime suicide ideation and attempt” at Pz. No significant results were found for the reaction time data, indicating that the ERP may be more sensitive in capturing the attentional disengagement effect.</P> <P><B>Limitations</B></P> <P>The groups were divided according to Suicidal Behaviors Questionnaire-Revised (SBQ-R) total score. Neutral stimulus was not included as cue stimuli. Most participants were under medication during the experiment.</P> <P><B>Conclusions</B></P> <P>Our results indicate that patients with MDD and low rates of suicidal behavior show difficulty in disengaging attention from suicide-relevant stimuli. We suggest that suicide-specific disengagement difficulties may be related to recentness of suicide attempt and that acquired capability for suicide may contribute to reduced disengagement difficulties.</P> <P><B>Highlights</B></P> <P> <UL> <LI> Reaction time and P300 amplitudes are higher for invalid trials than valid trials. </LI> <LI> Suicide-related attentional bias is associated with disengagement difficulties. </LI> <LI> Suicidal patients show reduced difficulty disengaging attention from suicidal words. </LI> <LI> Greater lifetime suicidal behavior is related to less disengagement difficulties. </LI> </UL> </P>