Owing to prolonged social distancing and the resultant isolation, the prevalence of depression and suicidality has increased during the COVID-19 pandemic. This study aimed to investigate the severity of depression and suicidality in Korean community populations and examine their awareness of suicide and suicide prevention during the pandemic.
This study surveyed a community population in 2020 and 2021, involving 668 participants. We evaluated the severity of depression and suicidality using the Patient Health Questionnaire-9 and Beck Scale for Suicidal Ideation as well as questions about awareness of suicide. We performed a correlation analysis to confirm the association between variables, and compared participants’ suicide awareness according to the severity of depression.
The severity of depression and suicidality in the community population decreased in 2021 compared to 2020. Awareness of the importance of suicide prevention increased in 2021, but the percentage reporting that it is possible decreased slightly. The group with higher depressive symptoms reported a lower possibility of suicide prevention.
Increasing social interest in suicide, as well as awareness of suicide prevention, is important for reducing suicide rates. Suicide prevention campaigns, education, and social policies are needed, particularly during the pandemic.
Suicide is a worldwide public health issue, with approximately 800,000 people dying of suicide each year [
The risk of suicide is related to a variety of factors, including demographic, psychopathological, and environmental ones [
The COVID-19 pandemic has significantly affected the living environment of millions of people worldwide [
This study aimed to assess the public’s views on suicide and suicide prevention during the COVID-19 pandemic. A survey was conducted on a community population in 2020 and 2021 during the pandemic period. This study investigated the awareness of suicide, the possibility and importance of suicide prevention, and suicide prevention methods in the community. The study hypotheses were as follows: 1) the severity of depressive symptoms and suicide risk in the general population have increased during the pandemic; 2) people with depressive symptoms perceive that suicide prevention is less likely; and 3) the frequency of contact with acquaintances is related to the severity of depression. In addition, this study examined the methods suggested by the local community population to prevent suicide and identified robust measures for suicide prevention within the community.
A survey was conducted on the adult community population aged 19 years or older living in Ansan-si, a satellite city in Seoul, in 2020 and 2021. The survey was conducted both online and offline by the Ansan Suicide Prevention Center through a questionnaire prepared using Google Forms. An offline survey was conducted among those who participated in suicide prevention education and publicity campaigns for the general population held at universities and public places. After receiving an explanation on how to fill out the questionnaire on-site, the participants were directly connected using a QR code to answer the questionnaire. The online survey was advertised via posters placed in public places, such as hospitals, libraries, universities, large bookstores, and online advertisements using social network services. The participants received sufficient explanation, including the purpose and methods of the study, before answering the questionnaire, and those who agreed to participate were included in the study. A total of 353 participants from the first survey (June 26 to November 22, 2020) and 315 participants from the second survey (March 5 to October 16, 2021) were included in this study. Participants who did not complete the questionnaire were excluded, and 637 participants were included in the analyses.
Sociodemographic information, such as age, sex, employment status, and personal relationships, was collected. Participants completed questionnaires related to suicide and suicide prevention, which comprised five multiple-choice questions. The suicide awareness questionnaire used in the survey was prepared by the Ansan Suicide Prevention Center based on the contents of the suicide awareness and attitude survey questionnaires used in previous studies in Korea [
The Patient Health Questionnaire-9 (PHQ-9) and Beck Scale for Suicidal Ideation (SSI) were used to evaluate participants’ degree of depressive mood and suicidal ideation. Han et al. [
Pearson’s chi-square test and Student’s t-tests were used to compare socioeconomic information (e.g., sex, age, and job), the severity of depressive mood and suicidal ideation, and awareness of suicide prevention among the participants in 2020 and 2021. We also compared the variables according to the perception of the possibility of suicide prevention and investigated the correlation between age, depressive mood (PHQ-9), suicidal ideation (SSI), and awareness of suicide prevention using a correlation test. Spearman’s correlation test was used because the variables did not follow a normal distribution and contained nominal variables. We compared the awareness of suicide prevention according to depressive symptoms (MDD group and non-MDD group) and sex using Pearson’s chi-square test and Student’s t-test. All statistical analyses were performed using the Statistical Package for the Social Sciences 26.0 (IBM Co., Armonk, NY, USA).
The study protocol was approved by the Institutional Review Board of Korea University Medical Center, Ansan Hospital, Gyeonggi-do, Korea (No. 2020AS0138). All participants provided informed consent for online or offline participation.
Although more males than females participated in both 2020 and 2021, the difference was not statistically significant. Mean ages were 30.88±9.12 years in 2020 and 33.55±10.14 years in 2021, respectively, and the mean age of participants in 2021 was significantly higher. Job status was in the order of employed, university students, and unemployed; however, there was a significant difference in the percentage of job status between 2020 and 2021. Regarding awareness of suicide, the proportion of those who thought that suicide should be prevented increased from 74.8% in 2020 to 86.3% in 2021, but the ratio of those who responded that suicide prevention was (absolutely) possible slightly decreased from 56.5% to 54.9%. The sum of the PHQ-9 scores decreased, and the ratio of participants who reported the presence of depressive symptoms increased (58.4% in 2020 and 49.8% in 2021), but the difference was not statistically significant. The total SSI scores decreased significantly in 2021 compared with those in 2020. The proportion of participants who responded that suicide should be prevented was significantly higher among females than males (males: 77.2%, females: 83.8%). The response rate for reporting that suicide prevention was (absolutely) possible was also higher among females, but this difference was not statistically significant (males: 53.9%, females: 57.8%). The number of participants who reported contacting their acquaintances once a month was the largest in both 2020 and 2021, and the rate of reporting that contacting someone was effective in preventing suicide significantly increased from 65.5% to 71.1% (n=211 in 2020 and n=224 in 2021) (
The participants were divided into five groups as follows: “absolutely impossible,” “impossible,” “unsure,” “possible,” and “absolutely possible.” Of the participants, 55.8% answered that suicide prevention was (absolutely) possible, and 12.0% answered that it was (absolutely) impossible. One-third of the participants reported that they were unsure about the possibility of suicide prevention. The mean age of the group that answered that suicide prevention was absolutely possible was the highest, and the group without employment had the highest rate of reporting that suicide prevention was impossible. The total SSI and PHQ-9 scores were higher in the group that reported that suicide prevention was (absolutely) impossible (
We compared the two groups by dividing them into MDD and non-MDD groups based on the PHQ-9’s cut-off point of 10. The non-MDD group was 488 (76.6%) and the MDD group was 149 (23.4%). There was a significant difference in the awareness of suicide between the two groups. The non-MDD group tended to report that suicide should be prevented, and the rate of reporting that suicide prevention was (absolutely) possible was higher than that of the MDD group (60.3% vs. 40.9%). The total score of SSI was also significantly higher in the MDD group (12.30±7.14) than in the non-MDD group (3.80±3.81). The non-MDD group reported a higher rate of contact more than once per week (54.1% vs. 45.0%). In the MDD group, 36 participants reported no contact with people around them (12.8%).
A similar tendency was also observed when the participants were divided into four groups based on the sum of their PHQ-9 scores: no depressive mood (n=292, 45.8%), mild depression (n=196, 30.8%), moderate depression (n=127, 19.9%), and severe depression (n=22, 3.5%). In all, 89.0% of the group without depressive symptoms reported that suicide should be prevented, whereas only 54.5% of the group with severe depressive symptoms reported that suicide should be prevented. Regarding the possibility of suicide prevention, the results confirmed that the higher the depressive symptoms, the lower the possibility of suicide prevention. The results of the comparison between the groups according to the severity of depressive symptoms are presented in
The results indicated that the severity of depressive mood and suicidality decreased with increasing age and that there was a correlation between age and the possibility of suicide prevention. In contrast, the possibility of suicide prevention and the severity of depressive mood were negatively correlated. The more depressed the participants, the more they recognized that suicide could not be prevented. Similarly, the possibility of suicide prevention and the sum of the SSI scores showed a negative correlation. The results of the correlation analysis were statistically significant (
The present study aimed to identify the severity of depressive mood, suicide ideation, and awareness of suicide prevention in a community in Korea using community surveys during the COVID-19 pandemic. We hypothesized that the severity of depressive mood and the risk of suicide would increase due to the worsening of the COVID-19 pandemic in 2021 compared to 2020 in Korea; however, contradictory results were found, and there was a statistically significant decrease in the sum of the PHQ-9 and SSI scores in 2021 compared to 2020. These results possibly reflect the adaptation to lifestyle changes as the COVID-19 pandemic progressed. With the onset of the COVID-19 pandemic in 2020, major changes occurred in the daily lives of individuals. Social distancing was enforced, and opportunities for outdoor activities were reduced. School, college, and university schedules were also delayed or classes were conducted online to reduce the risk of infection. Overall, increased indoor activity time has led to high levels of stress in the population [
In the correlation analyses of awareness and other variables, awareness of suicide prevention was inversely correlated with depressive symptoms and suicide risks. The group without depressive symptoms had a higher rate of reporting that suicide prevention should be prevented and that suicide prevention is possible compared with the group with depressive symptoms. Depressive symptoms can also affect individuals’ acceptance of suicide and vice versa. Therefore, more awareness campaigns and education on suicide prevention are needed for populations with depressive symptoms. For those with suicidal thoughts or intentions, not only the treatment of mental illness but also the attention of people around them and social interests are very important. Therefore, suicide prevention education for the general public is necessary. In a German study, van der Burgt et al. [
The COVID-19 pandemic has led to the emergence of several risk factors for suicide, including a decline in mental health, depression, loneliness, domestic violence, anxiety, and fear. The occurrence and/or aggravation of depression during the pandemic has increased the risk of suicide [
Although the present study reveals important findings, it has some methodological limitations that should be considered. First, online self-report measures might have led to reporting bias, such as desirability bias. Second, participant bias may have occurred because those who participated in the study or the campaign and education conducted by the Ansan Suicide Prevention Center or were interested in suicide prevention might have been included. In addition, the fact that the average age of the participants in 2021 was relatively higher than that of the participants in 2020 may have influenced the results. Older people tend to have a relatively more positive attitude towards suicide prevention [
Nevertheless, this study has strengths in that it identified the changes in depression and suicide risk in the general population during the COVID-19 pandemic and evaluated their impact on suicide awareness. Although social interest is recognized as important for suicide prevention, comprehensive studies on the general public’s awareness of suicide prevention are lacking in South Korea. Future research should include diverse variables that may influence suicide, such as educational level, nationality, income, job, and personality.
In conclusion, the present study identified the awareness of suicide prevention in a community population in Korea during the COVID-19 pandemic. Suicide is both a personal and social problem. To prevent suicide, appropriate treatment of mental illness and management of daily life are required at the individual level, and efforts to reduce social prejudice against suicide and mental illness are necessary at the social level. Along with suicide prevention campaigns and education, social policies should aim to prepare and enable individuals to recognize the risk of suicide in those around them and provide appropriate help. Social interest in suicide and increased social awareness can lead to reduced suicide rates. The results of this study confirmed that the role of people around an individual is important for suicide prevention, and education and campaigns around the same need to be encouraged.
The online-only Data Supplement is available with this article at
Awareness of suicide according to the severity of depressive symptoms
The datasets generated or analyzed during the study are available from the corresponding author on reasonable request.
The authors have no potential conflicts of interest to disclose.
Conceptualization: Jongha Lee, Rayoung Han, Ho-Kyoung Yoon. Data curation: Jongha Lee, Rayoung Han, Nayoung Chae. Formal analysis: Jongha Lee, Cheolmin Shin, Nayoung Chae. Funding acquisition: Ho-Kyoung Yoon. Methodology: Jongha Lee, Cheolmin Shin, Young-Hoon Ko, Ho-Kyoung Yoon. Supervision: Ho-Kyoung Yoon. Writing—original draft: Jongha Lee, Ho-Kyoung Yoon. Writing—review & editing: Jongha Lee, Young-Hoon Ko, Ho-Kyoung.
This study was supported by the National Research Foundation (NRF2020R1A2C1008072) of the Republic of Korea and a Korea University Ansan Hospital Grant (O2207191). The funders had no role in the design and conduct of the study or the decision to submit the article for publication.
Questionnaire related to suicide and suicide prevention
Items | Responses | |||
---|---|---|---|---|
Importance of suicide prevention; Do you think suicide of yourself or those around you must be prevented? | 1. Agree | 2. Unsure | 3. Indifferent | 4. Disagree |
Those who prevent suicide; Who do you think should do suicide prevention? (multiple responses) | 1. Psychiatrist | 2. Counselor | 3. Families | 4. Friends |
5. Polices | 6. Rescue team | 7. General population | 8. Others | |
Who do you think is the person you talk to openly? (multiple responses) | 1. Parents | 2. Siblings | 3. Friends | 4. Teachers |
5. Seniors/juniors | 6. Online friend | 7. None | 8. Others | |
How often do you say hello to your acquaintances? | 1. Almosteveryday | 2. Once a week | 3. 1–2 times in 1 month | 4. 1–2 times in 6 months |
5. 1–2 times in 1 year | 6. Rarely do | |||
Do you think contacting the other person to ask how they are doing can prevent suicide? | 1. Agree | 2. Disagree | 3. Unsure | |
Possibility of suicide prevention; To what extent do you think suicide prevention is possible? | 1. Absolutely impossible | 2. Impossible | 3. Unsure | 4. Possible |
5. Absolutely possible |
Demographic data and awareness of suicide
Variables | 2020 (N=322) | 2021 (N=315) | χ2 or t | p |
---|---|---|---|---|
Sex, female | 157 (48.8) | 146 (46.3) | 0.42 | 0.526 |
Age (yr) | 30.88±9.12 | 33.55±10.14 | -3.49 | 0.001 |
≤29 | 178 (55.3) | 118 (37.5) | 25.99 | <0.001 |
30–39 | 81 (25.2) | 119 (37.8) | ||
40–49 | 50 (15.5) | 52 (16.5) | ||
50–59 | 12 (3.7) | 18 (5.7) | ||
≥60 | 1 (0.3) | 8 (2.5) | ||
Job | 11.78 | 0.019 | ||
University student | 75 (23.3) | 42 (13.3) | ||
Employed | 184 (57.1) | 203 (64.4) | ||
Housewife | 25 (7.8) | 22 (7.0) | ||
Unemployed | 30 (9.3) | 40 (12.7) | ||
Others | 8 (2.5) | 8 (2.5) | ||
Importance of suicide prevention | 19.66 | <0.001 | ||
Agree | 240 (74.5) | 272 (86.3) | ||
Unsure | 52 (16.1) | 26 (8.3) | ||
Indifferent | 23 (7.1) | 7 (2.2) | ||
Disagree | 7 (2.2) | 10 (3.2) | ||
Possibility of suicide prevention | 0.96 | 0.916 | ||
Absolutely impossible | 8 (2.5) | 9 (2.9) | ||
Impossible | 28 (8.7) | 31 (9.8) | ||
Unsure | 104 (32.3) | 102 (32.4) | ||
Possible | 127 (39.4) | 127 (40.3) | ||
Absolutely possible | 55 (17.1) | 46 (14.6) | ||
Frequency of contacting someone | 26.42 | <0.001 | ||
Almost everyday | 74 (23.0) | 45 (14.3) | ||
Once a week | 115 (35.7) | 97 (30.8) | ||
1–2 times in a month | 92 (28.6) | 91 (28.9) | ||
1–2 times in 6 months | 18 (5.6) | 50 (15.9) | ||
1–2 times in 1 year | 10 (3.1) | 9 (2.9) | ||
Almost none | 13 (4.0) | 23 (7.3) | ||
Effectiveness of contacting someone | 6.52 | 0.038 | ||
Effective in suicide prevention | 211 (65.5) | 224 (71.1) | ||
Not effective in suicide prevention | 65 (20.2) | 40 (12.7) | ||
Unsure | 46 (14.3) | 51 (16.2) | ||
PHQ-9 sum | 6.60±5.97 | 5.84±5.91 | 1.60 | 0.109 |
SSI sum | 7.33±6.09 | 4.21±5.47 | 6.80 | <0.001 |
Values are presented as N (%) or mean±standard deviation. PHQ-9, Patient Health Questionnaire-9; SSI, Scale for Suicidal Ideation
Comparison of variables according to the possibility of suicide prevention
Variables | All subjects included (N=637) | Absolutely impossible (N=17, 2.7%) | Impossible (N=59, 9.3%) | Unsure (N=206, 32.3%) | Possible (N=254, 39.9%) | Absolutely possible (N=101, 15.9%) | χ2 or F | p | |
---|---|---|---|---|---|---|---|---|---|
Age (yr) | 32.20±9.72 | 30.77±8.21 | 28.39±6.88 | 32.22±9.55 | 31.89±9.88 | 35.38±10.48 | 2.25 | <0.001 | |
Sex | 2.72 | 0.606 | |||||||
Male | 334 (52.4) | 9 (2.7) | 29 (8.7) | 116 (34.7) | 125 (37.4) | 55 (16.5) | |||
Female | 303 (47.6) | 8 (2.6) | 30 (9.9) | 90 (29.7) | 129 (42.6) | 46 (15.2) | |||
Job | 20.43 | 0.202 | |||||||
University student | 117 (18.4) | 5 (4.3) | 14 (12.0) | 37 (31.6) | 49 (41.9) | 12 (10.3) | |||
Employed | 387 (60.8) | 9 (2.3) | 31 (8.0) | 132 (34.1) | 142 (36.7) | 73 (18.9) | |||
Housewife | 47 (7.4) | 1 (2.1) | 2 (4.3) | 15 (31.9) | 20 (42.6) | 9 (19.1) | |||
Unemployed | 70 (11.0) | 2 (2.9) | 10 (14.3) | 17 (24.3) | 36 (51.4) | 5 (7.1) | |||
Others | 16 (2.5) | 0 | 2 (12.5) | 5 (31.3) | 7 (43.8) | 2 (12.5) | |||
Importance of suicide prevention | 60.83 | <0.001 | |||||||
Agree | 512 (80.4) | 10 (2.0) | 36 (7.0) | 151 (29.5) | 217(42.4) | 98 (19.1) | |||
Unsure | 78 (12.2) | 2 (2.6) | 16 (20.5) | 34 (43.6) | 26 (33.3) | 0 | |||
Indifferent | 30 (4.7) | 3 (10.0) | 6 (20.0) | 12 (40.0) | 8 (26.7) | 1 (3.3) | |||
Disagree | 17 (2.7) | 2 (11.8) | 1 (5.9) | 9 (52.9) | 3 (17.6) | 2 (11.8) | |||
SSI sum | 5.79±6.00 | 9.88±8.51 | 10.42±6.31 | 6.50±5.63 | 6.06±5.56 | 3.01±4.86 | 18.30 | <0.001 | |
PHQ-9 sum | 6.23±5.95 | 8.47±3.79 | 8.51±6.98 | 6.30±5.70 | 5.48±6.00 | 3.47±4.84 | 8.61 | <0.001 |
Values are presented as N (%) or mean±standard deviation. SSI, Scale for suicidal ideation; PHQ-9, Patient Health Questionnaire-9
Demographic data and awareness between MDD group and non-MDD group
Variables | Non-MDD group (N=488, 76.6%) | MDD group (N=149, 23.4%) | χ2 or F | p |
---|---|---|---|---|
Importance of suicide prevention | 33.67 | <0.001 | ||
Agree | 416 (85.2) | 96 (64.4) | ||
Unsure | 42 (8.6) | 36 (24.2) | ||
Indifferent | 18 (3.7) | 12 (8.1) | ||
Disagree | 12 (2.5) | 5 (3.4) | ||
Possibility of suicide prevention | 47.82 | <0.001 | ||
Absolutely possible | 95 (19.5) | 6 (4.0) | ||
Possible | 199 (40.8) | 55 (36.9) | ||
Unsure | 156 (32.0) | 50 (33.6) | ||
Impossible | 29 (5.9) | 30 (20.1) | ||
Absolutely impossible | 9 (1.8) | 8 (5.4) | ||
Frequency of contacting someone | 80.40 | <0.001 | ||
Almost everyday | 102 (20.9) | 17 (11.4) | ||
Once a week | 162 (33.2) | 50 (33.6) | ||
1–2 times a month | 141 (28.9) | 42 (28.2) | ||
1–2 times in 6 months | 52 (10.7) | 16 (10.7) | ||
1–2 times a year | 14 (2.9) | 5 (3.4) | ||
Almost none | 17 (3.5) | 19 (12.8) | ||
SSI sum | 3.80±3.81 | 12.30±7.14 | 125.78 | <0.001 |
Values are presented as N (%) or mean±standard deviation. Non-MDD group: no symptoms and mild depressive symptoms; MDD group: moderate to severe depressive symptoms; MDD, major depressive disorder; SSI, Scale for suicidal ideation
Correlation coefficients between age and PHQ-9 scores, SSI scores, and the possibility of Suicide prevention
Age | PHQ-9 | SSI | Suicide prevention | |
---|---|---|---|---|
Age | 1 | |||
PHQ-9 | -0.237 |
1 | ||
SSI | -0.272 |
0.577 |
1 | |
Suicide prevention |
0.124 |
-0.314 |
-0.251 |
1 |
p<0.01;
p<0.001;
suicide prevention: possibility of suicide prevention.
PHQ-9, Patient Health Questionnaire-9; SSI, Scale for suicidal ideation