This study identified the association between employment status and suicidal ideation using national representative data. The results showed that unemployed individuals were 1.85 times more likely to have suicidal ideation than employed individuals. This was consistent with the findings of an American study by Kposowa et al. (2019), indicating that unemployment was significantly associated with suicidal ideation. Employment status is a means of securing economic power, which is a resource that can satisfy various needs. Kposowa et al. (2019) also found that employed persons have a higher quality of life than the unemployed. It can be interpreted that suicidal ideation increases when individual needs are not satisfied by their employment status. Therefore, various types of support should be provided to prevent suicidal ideation by identifying its specific causes among the unemployed.
We showed that suicidal ideation is a complex element associated with a variety of factors, including sociodemographic, health behavior, and mental health factors. Consistent with the findings of Liu et al. (2017) that educational attainment is associated with suicidal ideation, our results indicated that low educational attainment (high school or below) had a 2.12 times higher likelihood of suicidal ideation than high educational attainment. This could be explained by lower education levels leading to income inequality, which, in turn, can lead to suicidal ideation. Furthermore, the study showed that low income groups were 1.61 times more likely to have suicidal ideation. To reiterate, lower education levels can lead to financial difficulties, poorer quality of life, and health inequality, all of which can lead to suicidal ideation.26,27 Given that subjective health conditions can affect quality of life and well-being, they are also an influential factor in suicidal ideation; according to the results, poor subjective health condition was 1.79 times more likely to be related to suicidal ideation than good subjective health condition. Similarly, mental health is also related to suicidal ideation, as confirmed by Arri et al. (2009). Among mental health factors, our study found that stress recognition was 3.06 times more likely to cause suicidal ideation, while depression was 13.0 times more likely to cause it. Previous research has noted the important effects of mental health on suicidal ideation1,15. Therefore, suicide prevention should consider factors regarding individuals’ unemployment status, low education and income, poor subjective health condition, and the presence of stress and depression.
The subgroup analysis presented the combined effects of employment status and individual covariates on suicidal ideation. Except the categories of women, no alcohol use, and low BMI, all other covariates showed significant association with suicidal ideation when unemployed. In comparing the ORs, men aged between 40 and 50 years, currently smoking, obese, and with stress recognition showed higher likelihood for suicidal ideation. In sociodemographic factors, men and those aged between 40 and 50 years showed a higher association between unemployed status and suicidal ideation compared to other covariates. These findings are in line with Kposowa et al (2019) work noting that middle-aged people had a high association with suicidal ideation. This can be highly related with external conditions such as financial imbalance and interpersonal relationships28, both of which can be negatively affected by unemployment. Moreover, middle-aged individuals are likely to have considerable responsibilities as the center of the family economy, such as supporting children’s education and retirement preparation. Under these circumstances, any unemployment environment threatening the family economy might increase their possibility of suicidal ideation.
Dutton et al. (2013) explored the association between obesity and suicidal ideation. Obesity can be said to be a secondary cause of suicidal ideation, rather than a primary cause30. Obesity increases the risks of chronic disease experience, depression due to physical dissatisfaction, and the burden on others, all of which can lead to suicidal ideation29,30. Obesity is a factor closely associated with metabolic syndrome,31 and financial support is needed to treat any such illnesses. Unstable financial circumstances due to unemployment can hence lead to potential suicidal ideation. The association between smoking and suicidal ideation has already been investigated in many studies32,33.
Our study has several strengths. First, the study is composed of a nationally representative sample data, and it will help to indicate future directions for unemployment welfare in Korea. Second, this study combined various sociodemographic, physical, and mental health factors to show whether employment status was associated with suicidal ideation when controlling those covariates. As suicide is a complex factor associated with a variety of components, it is important to appropriately synthesize such factors to comprehensively interpret suicidal ideation.
However, this study also has several limitations. Although the association between employment status and suicidal ideation is shown in this cross-sectional study, the causal association cannot be confirmed. In addition, because the institutionalized population was excluded, severe psychological symptoms related with suicidal ideation might not have been addressed adequately. Further research is necessary to investigate causal association between employment status and suicidal ideation using various sample data.
This study showed the association between employment status and suicidal ideation using the 2015, 2017, and 2019 KNHANES data. While unemployment is associated with suicidal ideation, it is confirmed that suicidal ideation is not caused by a single cause, but by various causes, including physical and mental health factors. Based on these results, policy interventions and financial support will have to be provided to prevent suicide of unemployed persons.