National Trends in Sadness, Suicidality, and COVID-19 Pandemic–Related Risk Factors Among South Korean Adolescents From 2005 to 2021

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Key Points

Question

How has the long-term trend of suicidality among Korean youths changed during the COVID-19 pandemic?

Findings

In this nationwide serial cross-sectional survey study from 2005 to 2021 of 1 109 776 Korean adolescents aged 13 to 18 years, the slope of the long-term trends in suicidality decreased in the prepandemic period (from 23.0% in 2005-2007 to 12.3% in 2016-2019), whereas the slope increased during the COVID-19 pandemic (from 10.7% in 2020 to 12.5% in 2021). The risk factors for suicidality during the pandemic were younger age, female sex, urban residence, smoking, current alcohol use, and low economic status.

Meaning

These results can help improve the understanding of suicidality during the COVID-19 pandemic.

Abstract

Importance

Despite the COVID-19 pandemic’s effect on daily life, limited research exists on the prevalence and risk factors of suicidality and sadness among South Korean adolescents.

Objectives

To examine whether the observed sadness and suicidality in the early to middle periods of the COVID-19 pandemic differed from the expected level and to investigate changes in risk factors for sadness and suicidality.

Design, Setting, and Participants

This nationwide serial cross-sectional survey study used data on 1 109 776 Korean adolescents aged 13 to 18 years from the Korea Youth Risk Behavior Web-based Survey from 2005 to 2021.

Exposure

The COVID-19 pandemic.

Main Outcomes and Measures

The pattern of changes in the percentage or proportion of sadness or suicidality, as well as the risk factors for sadness or suicidality. The transitional effect of the COVID-19 pandemic was assessed using weighted odds ratios (wORs) or weighted beta coefficients with 95% CIs.

Results

Between 2005 and 2021, 1 109 776 adolescents (mean [SD] age, 15.0 [1.7] years; 51.5% male adolescents; and 51.7% in grades 7-9 and 48.3% in grades 10-12) were included in the Korea Youth Risk Behavior Web-based Survey. The slope of the long-term trends in sadness and suicidality decreased in the prepandemic period (sadness: from 37.8% [95% CI, 37.4%-38.2%] in 2005-2007 to 26.1% [95% CI, 25.9%-26.4%] in 2016-2019; suicidality: from 23.0% [95% CI, 22.7%-23.3%] in 2005-2007 to 12.3% [95% CI, 12.1%-12.5%] in 2016-2019), whereas the slope increased during the COVID-19 pandemic (sadness: from 25.0% [95% CI, 24.5%-25.6%] in 2020 to 26.6% [95% CI, 26.1%-27.1%] in 2021; trend difference in β, 0.249 [95% CI, 0.236-0.262]; suicidality: from 10.7% [95% CI, 10.3%-11.1%] in 2020 to 12.5% [95% CI, 12.1%-12.9%] in 2021; trend difference in β, 0.328 [95% CI, 0.312-0.344]). The trends presented a similar tendency in the subgroups according to sex, school grade, residential area, smoking status, and current alcohol use. Compared with the prepandemic period, the risk factors associated with sadness during the pandemic were younger age (wOR, 0.907; 95% CI, 0.881-0.933), female sex (wOR, 1.031; 95% CI, 1.001-1.062), urban residence (wOR, 1.120; 95% CI, 1.087-1.153), current smoking status (wOR, 1.134; 95% CI, 1.059-1.216), and current alcohol use (wOR, 1.051; 95% CI, 1.002-1.102). Female sex (wOR, 1.064; 95% CI, 1.021-1.109), urban residence (wOR, 1.117; 95% CI, 1.074-1.162), and low economic status (wOR, 1.286; 95% CI, 1.180-1.403) were the risk factors significantly associated with suicidality after the COVID-19 pandemic began.

Conclusions and Relevance

In this nationwide serial cross-sectional survey study of South Korean adolescents, the slope of the prevalence of sadness and suicidality increased during the COVID-19 pandemic after a decrease prior to the pandemic. The findings suggest that public health measures are needed to recognize vulnerable groups with risk factors and to prevent an increase in sadness and suicidality among adolescents during the COVID-19 pandemic.

Abstract

This survey study of more than 1 million Korean adolescents examines whether the observed sadness and suicidality in the early to middle periods of the COVID-19 pandemic differed from the expected level and investigates changes in risk factors for sadness and suicidality.

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Most cited references 50

Record: found
Abstract: found
Article: found

Our future: a Lancet commission on adolescent health and wellbeing

George C Patton, Susan Sawyer, John S Santelli … (2016)

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An investigation of mental health status of children and adolescents in China during the outbreak of COVID-19

Li Xin Duan, Xiaojun Shao, Yuan Wang … (2020)

Highlight • Children and adolescents who are often neglected in the wake of the outbreak were taken as subjects to investigate their mental health status and analyze the related influencing factors during the global pandemic of COVOID-19. • The presence of clinical depressive symptoms, resident in urban regions, implementation of the precaution and control measures, being female, having a family member or friend infected with coronavirus were associated with increased levels of anxiety. • Smartphone addiction, Internet addiction, resident in Hubei province and urban areas, family members or friends infected with coronavirus, graduation affected by the epidemic, levels of separation anxiety, physical injury fear, and tendency to adopt an emotion-focused coping style were associated with increased levels of respondents’ depressive symptoms. • It's urgent to concern and address emotional distress for children and adolescents during the epidemic. Targeted intervention measures could be formulated based on the significant influencing factors on anxiety and clinical depressive symptoms.

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Mental health considerations for children quarantined because of COVID-19

Jia Liu, Yanping Bao, Xiaolin Huang … (2020)

To control the transmission of coronavirus disease 2019 (COVID-19), the Chinese Government has implemented strict domestic quarantine policies. As of March 24, 2020, more than 80 000 individuals with COVID-19, and 690 000 individuals who have come into close contact with individuals with COVID-19 have been registered and quarantined, including a large number of children. 1 This quick action has effectively slowed the spread of new cases of infection on both the Chinese mainland and the rest of the world. However, researchers have realised that such measures might have adverse psychological effects on children who are quarantined. For children who are quarantined at home with their parents or relatives, the stress caused by such a sharp change in their environment might be eased to some degree. 2 However, children who are separated from their caregivers require special attention, including children infected with or suspected of being infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), who are quarantined in local hospitals or collective medical observation centres; and children whose caregivers are infected with SARS-CoV-2 or who have died from the disease and are thus under the care of social charity groups. These children might be more susceptible to mental health problems because of their higher risk of infection, and the grief and fear caused by parental loss or separation. Companionship is essential for children's normal psychological development and wellbeing. 3 Separation from caregivers pushes children into a state of crisis and might increase the risk of psychiatric disorders. 4 Sprang and colleagues 5 reported that children who were isolated or quarantined during pandemic diseases were more likely to develop acute stress disorder, adjustment disorder, and grief. 30% of the children who were isolated or quarantined met the clinical criteria for post-traumatic stress disorder. 5 Furthermore, separation from parents or parental loss during childhood also has long-term adverse effects on mental health, including a higher risk of developing mood disorders and psychosis, and death by suicide in adulthood.6, 7 The age of the initial separation is known to be relevant to psychological development. The parent–child separation initiated in the first few years after birth might disrupt the ongoing attachment processes, which might be associated with poorer mental health outcomes. 8 The Chinese Government has implemented a series of strategies to prevent the potential mental health problems that might arise among children who are quarantined during the COVID-19 pandemic. For example, in many Chinese tier 1 cities —typically the largest and wealthiest—like Shanghai, Guangzhou, and Hangzhou, nurses are guaranteed to be available 24 h per day in the children's isolation ward. Nutritionists are invited to give professional guidance for children's diets according to their medical conditions and normal developmental requirements. To reduce fear and other psychological discomfort, children who are quarantined can communicate with their parents via mobile devices at any time. Many citizens from the local community or district volunteers act as temporary mothers to care for recovered children after their discharge, when their caregivers are not available because of infection, quarantine, or death. In response to the notice on improving rescue and protection for children without effective guardianship issued by the Ministry of Civil Affairs, many cities like Zhengzhou opened free psychological counselling hotlines, which were available 24 h per day. 9 Most recently, the National Health Commission of China issued guidelines and listed specific intervention strategies for children who are quarantined in collective medical observation centres. For example, these measures seek to increase children's communication time with their parents; increase children's access to disease information via comic books and videos; guide children to establish a regular activity schedule; provide night lights and small gifts; and provide timely referrals to psychiatrists when children feel mental discomfort, such as worry, anxiety, difficulty sleeping, and loss of appetite. 10 Although great efforts have been made across China, the emerging psychological interventions are unlikely to be provided nationwide because most local support for unaccompanied children focuses only on meeting children's basic daily needs. We propose that paediatric health-care workers should receive formal training to facilitate the early identification of children's mental health problems by learning to discern children's normal and abnormal behaviours, recognise red flags indicating further intervention or referral are needed, and standardise the use of rapid screening tools for mental health. Furthermore, mental health professionals should establish evidence-based guidelines and easy operational strategies to cope with COVID-19 pandemic-related mental health problems in children. We also believe that children's access to mental health services can be improved through collaborative networks that are established nationwide and consist of psychiatrists, psychotherapists, researchers, and community volunteers. Additionally, the post-pandemic surveillance of mental disorders among these children should be considered. Since the global transmission of COVID-19 began, the total number of cases in countries other than China have already exceeded that in China. Following WHO's recommendation, an increasing number of countries have learned from China's experience with regard to quarantine policies. We suggest that the specific response to the mental distress of children who are quarantined should also be considered when designing psychological intervention strategies in response to COVID-19. © 2020 estherpoon/iStock 2020 Since January 2020 Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre - including this research content - immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active.

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Author and article information

Journal

Journal ID (nlm-ta): JAMA Netw Open

Journal ID (iso-abbrev): JAMA Netw Open

Title: JAMA Network Open

Publisher: American Medical Association

ISSN (Electronic): 2574-3805

Publication date (Electronic): 24 May 2023

Publication date Collection: May 2023

Publication date PMC-release: 24 May 2023

Volume: 6

Issue: 5

Electronic Location Identifier: e2314838

Affiliations

[1 ]Department of Neurology, Kyung Hee University Medical Center, Kyung Hee University College of Medicine, Seoul, South Korea

[2 ]Department of Medicine, Kyung Hee University College of Medicine, Seoul, South Korea

[3 ]Department of Precision Medicine, Sungkyunkwan University School of Medicine, Suwon, South Korea

[4 ]Research and Development Unit, Parc Sanitari Sant Joan de Deu, Network Centre for Biomedical Research in Mental Health, Health Institute Carlos III, Barcelona, Spain

[5 ]Catalan Institution for Research and Advanced Studies (ICREA), Pg. Lluis Companys, Barcelona, Spain

[6 ]Faculty of Medicine, University of Versailles Saint-Quentin-en-Yvelines, Montigny-le-Bretonneux, France

[7 ]Centre for Health, Performance and Wellbeing, Anglia Ruskin University, Cambridge, United Kingdom

[8 ]Center for Digital Health, Medical Science Research Institute, Kyung Hee University College of Medicine, Seoul, South Korea

[9 ]Department of Biomedical Engineering, Kyung Hee University, Yongin, South Korea

[10 ]Department of Biomedical Engineering, University of Michigan, Ann Arbor

[11 ]Assistance Publique-Hôpitaux de Marseille, Aix-Marseille University, CEReSS–Health Service Research and Quality of Life Center, Marseille, France

[12 ]Depression and Schizophrenia Expert Center, FondaMental Foundation, Creteil, France

[13 ]Institute of Data Science, Korea University, Seoul, South Korea

[14 ]Department of Pediatrics, Kyung Hee University Medical Center, Kyung Hee University College of Medicine, Seoul, South Korea

[15 ]Department of Otolaryngology–Head & Neck Surgery, Kyung Hee University Medical Center, Kyung Hee University College of Medicine, Seoul, South Korea

[16 ]Department of Endocrinology and Metabolism, Kyung Hee University School of Medicine, Seoul, South Korea

[17 ]Department of Pediatrics, Yonsei University College of Medicine, Seoul, South Korea

Author notes

Article Information

Accepted for Publication: April 10, 2023.

Published: May 24, 2023. doi:10.1001/jamanetworkopen.2023.14838

Corresponding Authors: Jae Il Shin, MD, PhD, Department of Pediatrics, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul 03722, South Korea ( shinji@ 123456yuhs.ac ); Dong Keon Yon, MD, Department of Pediatrics, Kyung Hee University College of Medicine, 23 Kyungheedae-ro, Dongdaemun-gu, Seoul 02447, South Korea ( yonkkang@ 123456gmail.com ).

Author Contributions: Dr D. K. Yon had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. Drs Woo, Park, and H. Yon contributed equally to this work.

Concept and design: Woo, Park, H. Yon, Smith, H. Lee, Choi, Rhee, Shin, D. K. Yon.

Acquisition, analysis, or interpretation of data: Woo, Park, H. Yon, S. W. Lee, Koyanagi, Jacob, Smith, Cho, Min, J. Lee, H. Lee, Kwon, Fond, Boyer, Joo, Yeo, D. K. Yon.

Drafting of the manuscript: Woo, Park, H. Yon, Smith, H. Lee, Choi, D. K. Yon.

Critical revision of the manuscript for important intellectual content: Woo, Park, H. Yon, S. W. Lee, Koyanagi, Jacob, Smith, Cho, Min, J. Lee, H. Lee, Kwon, Fond, Boyer, Joo, Yeo, Rhee, Shin, D. K. Yon.

Statistical analysis: Woo, Park, H. Yon, S. W. Lee, Cho, Min, H. Lee, Kwon, D. K. Yon.

Obtained funding: Woo, D. K. Yon.

Administrative, technical, or material support: Woo, Cho, Yeo, D. K. Yon.

Supervision: Woo, Jacob, Smith, H. Lee, Fond, Joo, Choi, Yeo, Rhee, Shin, D. K. Yon.

Conflict of Interest Disclosures: None reported.

Funding/Support: This research was supported by grants HV22C0233 and HI22C1976 from the Korea Health Technology R&D Project through the Korea Health Industry Development Institute, funded by the Ministry of Health & Welfare, Republic of Korea.

Role of the Funder/Sponsor: The funding source had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

Data Sharing Statement: See Supplement 2.

Article

Publisher ID: zoi230458

DOI: 10.1001/jamanetworkopen.2023.14838

PMC ID: 10209749

PubMed ID: 37223902

SO-VID: a2250487-65dc-4846-b67e-9dad17395f03

License:

This is an open access article distributed under the terms of the CC-BY License.

National Trends in Sadness, Suicidality, and COVID-19 Pandemic–Related Risk Factors Among South Korean Adolescents From 2005 to 2021

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Key Points

Question

Findings

Meaning

Abstract

Importance

Objectives

Design, Setting, and Participants

Exposure

Main Outcomes and Measures

Results

Conclusions and Relevance

Abstract

Related collections

Novel Coronavirus Disease COVID-19

Most cited references 50

Our future: a Lancet commission on adolescent health and wellbeing

An investigation of mental health status of children and adolescents in China during the outbreak of COVID-19

Mental health considerations for children quarantined because of COVID-19

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