Association between employment status and suicidal ideation among Korean employees

Abstract

Employment status is a key indicator of socioeconomic status. However, research in Asian cultures for the association between employment status and mental health have been limited. The current study investigated the association between employment status and suicidal ideation. Using data from the 2015, 2017, and 2019 Korea National Health and Nutrition Examination Survey, 6,509 participants aged ≥ 20 years were analyzed. Multivariable logistic regression and subgroup analysis were performed. Unemployed status demonstrated 1.85 times more suicidal ideation than employed (adjusted Odd Ratio (aOR) 1.85, 95% confidence interval (CI) 1.41–2.44, p < .001). Low educational attainment (aOR 2.12, 95% CI 1.51–2.98, p < .001), low income (aOR 1.61, CI 1.22–2.14, p < .001), presence of stress recognition (aOR 3.06, 95% CI 2.33–4.02, p < .001), and depression (aOR 13.0, 95% CI 10.0-16.9, p < .001) were also associated with suicidal ideation. In subgroup analysis, all covariates, except women and low BMI, have combined effects with employment status on suicidal ideation. This study showed the association between employment status and suicidal ideation. Suicidal ideation occurs in a complex manner due to various factors, it is important to provide support based on a comprehensive understanding of suicidal ideation related to employment status.

Introduction

Suicide is an important public health issue worldwide because it has various direct and indirect effects at both the individual and the societal level. South Korea (hereafter, Korea) has the highest suicide rate among the Organisation^1,2 for Economic Cooperation and Development (OECD) member countries, so social intervention is necessary for suicidal ideation³.

Employment is an important factor influencing work performance^4,5. Korea has seen difficulties in economic development due to the global economic downturn for the past few years. Economic downturns can exacerbate anxiety by appealing to feelings of isolation and uncertainty about the future due to corporate restructuring, early retirement, and job loss⁶. Employment-related studies in some countries have shown that precarious employment patterns increase suicide rates two- or three-fold at least, and even up to five-fold in certain countries⁷. The pace of social change is faster in Korea than in many countries, and can lead to suicidal ideation due to precarious employment⁸.

The status of being unemployed is also a problem related to suicidal ideation. An irregular lifestyle after dismissal can lead to a strong tendency toward substance abuse, including alcohol consumption and smoking⁹. Unemployed people are also at risk of experiencing depression, anxiety, irritability, and aggression,¹⁰ which are important risk factors for suicidal ideation.

Suicide has been viewed as a continuum of suicidal ideation, suicidal planning, and suicidal behavior¹¹. Suicidal ideations are intricately associated with a variety of risk factors, including biological, psychological, and environmental factors, so a focus on preventing suicidal ideations can prevent suicidal behavior.

Previous studies found factors such as older age, female gender, low income, low education, and other sociodemographic aspects to be related to suicidal ideation^7,10,12−16. Health behaviors such as smoking, physical activity, sleep, and chronic diseases have also been presented as factors related to suicidal ideation^17–21. Furthermore, stress recognition, depression, and the lack of a sense of belonging are mental health factors related to suicidal ideation²². Previous research on suicidal ideation mostly focused on vulnerable groups such as older adults and adolescents. Unemployment and financial problems caused by the economic crisis were also studied²³. Despite many researchers investigating employment status and suicidal ideation, there are limited studies subdividing the association between unemployment and suicidal ideation into sociodemographic factors, health behavior factors, and mental health factors²⁴.

To fill this gap, our study investigated the association between employment status and suicidal ideation in greater detail, using the Korea National Health and Nutrition Examination Survey (KNHANES) data from 2015, 2017, and 2019.

Results

Discussion

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 ideation^1,15. 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 ideation^29,30. 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 studies^32,33.

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.

Methods

Declarations

Ethical consideration

The Institutional Review Board (IRB) of Yongin Severance Hospital waived the requirements for approval and consent because the analyses of the present study were based on de-identified, publicly available secondary data (IRB No. 9-2021-0161). All methods of the study were carried out in accordance with the guidelines and regulations of the Declaration of Helsinki.

Author contributions

S.K. and S.L. led the study conceptualization and design. S.K. and N.S. performed statistical analyses and interpretation. S.K. wrote the first draft of the manuscript, and J.O. and S.L. reviewed and edited the drafts. All authors have full access to all data in the study, and take responsibility for the integrity of the data and the accuracy of the data analysis.

Data availability

This study analyzed data from the 2015, 2017, and 2019 KNHANES. All the KNHANES data are available to the public, and can be downloaded from the KNHANES official website (http://knhanes.kdca.go.kr).

Funding          

None declared.

Competing interests

The authors declare no competing interests.

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