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ORIGINAL RESEARCH article

Front. Psychiatry
Sec. Public Mental Health
Volume 15 - 2024 | doi: 10.3389/fpsyt.2024.1423609

Effect of community attitudes on suicide mortality in South Korea: A nationwide ecological study

Provisionally accepted
Minseok Hong Minseok Hong 1Hyesoo Kim Hyesoo Kim 1Christopher H. Park Christopher H. Park 2Hyunju Lee Hyunju Lee 1,3Sang Jin Rhee Sang Jin Rhee 3Sooyeon Min Sooyeon Min 3Min Ji Kim Min Ji Kim 1Jeong Hun Yang Jeong Hun Yang 3Yoojin Song Yoojin Song 1,3Kyunghoon Son Kyunghoon Son 3Yong Min Ahn Yong Min Ahn 1,3*
  • 1 College of Medicine, Seoul National University, Seoul, Seoul, Republic of Korea
  • 2 Asan Medical Center, Seoul, Republic of Korea
  • 3 Seoul National University Hospital, Seoul, Republic of Korea

The final, formatted version of the article will be published soon.

    Background: Attitudes toward suicide are essential in suicide prevention, as suicide is socio-culturally nuanced. Although the relationship between individual attitudes and suicidal behavior has been extensively studied, the effect of community attitudes—aggregated by region—on suicide mortality remains ambiguous. This study explored the association between community attitudes and real-world suicide mortality. Methods: Data on attitudes toward suicide from the 2018 Korea National Suicide Survey (N=1500) and individual mortality data from the MicroData Integrated System were obtained. Confirmatory factor analysis supported a factor structure with three factors: "Permissiveness," "Unjustified behavior," and "Readiness to help/Preventability." Thirty regional units in South Korea aggregated the data for ecological analysis. We used negative binomial models to examine the association at the regional level, and stratified analysis by gender and age group was conducted. Results: "Permissiveness" was associated with reduced suicide rates in a univariate model (P<0.001). Adjusting for gender, age, and additional sociodemographics did not alter the association. Additionally, this relationship was observed in males and individuals under 60 years of age after stratification. However, "Unjustified Behavior" and "Readiness to help/Preventability " exhibited no significant association with suicide in any model or stratum. Conclusion: The observed inverse association between permissive community attitudes and suicide contradicts the findings of previous research that links permissive individual attitudes to increased suicidal behavior. Our findings suggest that attitudes may operate differently at the individual and group levels. Although the cross-sectional design and single-country focus of this study warrant further investigation, our findings indicate that attitudes are significant contextual factors in the process of suicide, which could lead to novel approaches in suicide prevention.

    Keywords: suicidal ideation1, completed suicide2, attitudes toward suicide3, suicide rate4, social stigma5, risk factors6, general population survey7, suicide prevension8

    Received: 26 Apr 2024; Accepted: 26 Aug 2024.

    Copyright: © 2024 Hong, Kim, Park, Lee, Rhee, Min, Kim, Yang, Song, Son and Ahn. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

    * Correspondence: Yong Min Ahn, Seoul National University Hospital, Seoul, 03080, Republic of Korea

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