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Osong Public Health Res Perspect > Volume 5(5); 2014 > Article
Kim, Kim, Seo, Lee, and Cho: Suicidal Ideation and its Correlates among Juvenile Delinquents in South Korea

Abstract

Objectives

This study investigated suicidal ideation and its correlates among juvenile delinquents in South Korea.

Methods

Suicidal ideation, psychological health status, and health-related behaviors were assessed using a self-administered questionnaire in 1682 juvenile offenders aged between 15 and 18 years in 2012.

Results

The prevalence of suicidal ideation in juvenile delinquents was 15.2%. Girls were more likely to report suicidal thoughts than boys (30.3% vs. 12.7%). Suicidal ideation was more common among adolescents who were not living with their family prior to entering detention centers (22.6% vs. 13.2%) than their counterparts. The likelihood of suicidal ideation was significantly associated with problem drinking [odds ratio (OR) = 1.84], psychedelic drug use (OR = 2.04), feeling unhappy (OR = 3.05), feeling sad or depressed (OR = 13.37) after controlling for sociodemographic factors, other health behaviors and perceptions.

Conclusion

The present study provides evidence for an association between suicidal ideation and psychological health and health risk behaviors among juvenile delinquents. It also highlights the importance of mental health and behavioral interventions for this population to prevent suicidality.

Keywords

adolescent; health perception; health risk behavior; juvenile delinquent; suicidal ideation

Introduction

Suicide acts as a serious public health problem and a major risk factor leading to dangerously unhealthy lives [1]. According to the report of the Organization for Economic Cooperation and Development (OECD), an association of wealthy and industrialized nations, in 2011, South Korea showed the highest suicide rate among the 30 OECD countries (33.3 deaths per 100,000) and had a 10-fold difference compared to Greece where suicide rates were the lowest (3.1 deaths per 100,000) [2]. In particular, suicide has been the first leading cause of death among Korean adolescents and young adults aged 15–24 years since 2002 [3]. Suicide is the major cause of death in youth in several countries. In the US, suicide is the third leading cause of death among adolescents aged 15–24 years. Among 15–24-year-olds, suicide accounts for 20% of all deaths annually [4].
Suicide is completed through several steps of suicidal ideas, plans, and action. Suicidal thought is believed to precede the onset of suicidal plans and action. Thus, it is considered to be one of the strong indicators of future suicide [5,6]. To prevent suicide, it needs interventions to prevent progression of thought to suicidal attempts [7–9]. Korea Youth Risk Behavior Web-based Survey (KYRBWS) in 2011 found that 19.3% of youth from third-grade in middle school to high school students had thoughts of suicide in the past 12 months [10]. In the United States, the Centers for Disease Control Youth Risk Behavior Surveillance in 2011 reported that 15.8% of youths in Grades 9–12 had seriously considered attempting suicide [4].
Adolescent exposure to delinquency is more dangerous in terms of suicidal ideation risk. Bjorkenstam et al [6] found that adolescents who were delinquents repeatedly were three times more likely to attempt suicide than other youths. Thompson et al [11] also found that delinquent youths tended to have more suicidal ideation than general youth. Juvenile delinquents are defined as the group at high risk for suicide because they are exposed to higher risks of suicide, suicidal attempts, and suicidal ideas than general adolescents [12]. These findings support that suicide problems are related to adolescent delinquent behavior.
Early identification of high-risk groups of adolescents will be important for the prevention of suicide. There have been many studies that define characteristics of adolescents who have suicidal ideation. Sex, poor sociality and family functioning, mood disorder, alcohol abuse, cigarette smoking, and illicit substance use were considered as influential factors of suicidal ideation [13–18]. Poor mental health status also has been a risk factor for suicidal ideation, and an issue in predicting the suicidal ideation [19]. Various studies have been done on the relationship of suicidal idea to health behavior characteristics that be extended to sleeping pattern and physical activity [20,21].
Juvenile delinquents have been pointed out as a high-risk group for suicidal thoughts and attempts but there is a paucity of data on their prevalence and correlates. Therefore, this study defined juvenile delinquents as a high-risk group, and the aims were: (1) to identify the prevalence of suicidal ideation among inmates in youth detention facilities; (2) to identify the differences in suicidal ideation, health behaviors, and perceptions between juvenile delinquents and general adolescents; and (3) to find the correlates of suicidal ideation among juvenile delinquents.

Materials and methods

2.1 Data

Data were collected from a self-report questionnaire at 10 juvenile correctional facilities in South Korea. The participants of the study were 1682 juvenile detainees aged 15–18 years, excluding 28 inmates who refused to respond to the survey questions. In collaboration with the Juvenile Division of the Korean Ministry of Justice, the survey was conducted twice in 2012, once in February–March, and once in August–September. The delinquents under probation for < 1 month were excluded from the study. Almost every juvenile delinquent participated in this survey, therefore, the study participants were the representative juvenile detainees in South Korea.
To compare the data of juvenile delinquents with those of general adolescents, participants in the Eighth KYRBWS in 2012 served as a general youth group. The Eighth KYRBWS at national level used two-stage cluster sampling, and a systematic sampling method within each stratum. Schools were a primary sampling unit and classes at different grades served as a secondary sampling unit. A total of 41804 general adolescents aged 15–18 years were recruited to complete the online survey. This study was approved by the Institutional Review Board of Korea Association of Health Promotion, Seoul, Korea (IRB No. KAHP-12-B-04).

2.2 Measurement of variables

Self-reported questionnaire items on suicidal ideation, health-related behaviors and perceptions were drawn from the Eighth KYRBWS questions. However, some items were revised to be suitable for use in the controlled environment of juvenile facilities. The suicidal ideation was measured using the question: “During the past year, did you ever seriously consider attempting suicide?” Measures on sociodemographic factors included sex, age, level of academic achievement, living with family prior to entering the correctional facilities, and level of household income. The levels of academic achievement and household income were classified as “high or above average”, “average”, and “below average or low”. The measures on living arrangements of adolescents prior to entering the juvenile facility were dichotomized into “lived with family” or “lived apart from family”.
In order to identify behavioral factors associated with suicidal thoughts, we measured smoking, problem drinking, psychedelic drug use, physical activity, and skipping breakfast which were shown to be related to suicidal phenomenon in previous studies [14,22]. For smoking, alcohol drinking and drug use, they were not allowed in the highly controlled detention centers, juvenile detainees were investigated their prior experiences of these risk behaviors prior to entering correctional facilities. Smoking status was assessed in four categories: smoked every day, smoked on some days, quitted smoking, and never smoked. Problem drinking was defined as experiencing two or more of the following problems: drinking alcohol to deal with stress or to hang out with friends; drinking alone; being worried about drinking by friends or family members; driving or riding in a car, bicycle, or autobicycle driven by someone who had been drinking alcohol; experiencing alcohol induced blackouts; and involved in an argument or fight while drunk.
Psychedelic drug use was assessed whether to have used butane gas, glue, stimulant drug, philopon, amphetamines, narcotic, tranquilizers for mood change, hallucination, or weight loss. The physical activity level was assessed by the number of days engaging in moderate or vigorous physical activities. Participants were categorized into an active or inactive group. The active group was defined as adolescents doing at least 30 minutes of moderate intensity physical activity for ≥ 5 days/week, or at least 20 minutes of vigorous activity for ≥ 3 days/week. The frequency of skipping breakfast was assessed in the number of days per week skipped, and categorized into < 5 days/week or ≥ 5 days/week.
Health perceptions as the psychological health status were assessed as hypothesized correlates of suicidal ideation. Perceived happiness, body shape and health status were measured on a 5-point scale and classified into two categories. The perceived happiness was evaluated as participants' overall happiness from “very happy” to “very unhappy”. The perceived body shape and health status were measured from “very thin” to “very fat” and from “very healthy” to “very unhealthy”, respectively. Depressive thought was measured with a question asking about whether they experienced feeling sad or depressed for ≥ 2 weeks in a row during the past year.

2.3 Statistical analysis

Statistical analyses were conducted using SAS version 9.2 (SAS Institute Inc., Cary, NC, USA). The prevalence of suicidal ideation was compared across the sociodemographic factors, and the characteristics of health perception and behavior using the χ2 test or t test according to data type. To compare the rates of suicidal thought, health perception and behavior in the juvenile inmates with those in general adolescents, we calculated standardized event ratios (SERs) using the indirect standardization method. The indirect standardization method was used over the direct method because of the possibility of no cases in any of the sex or age-specific cells [23–25]. The SER was defined as the ratio of observed number of events to expected number of events – provided that juvenile inmate group had the same risk level as adolescent group. Sex-adjusted and age-adjusted SERs with 95% confidence intervals (CIs) were calculated under the assumption of normal distribution. If the SER was > 1, more events occurred in the juvenile inmate group than general adolescent group. A test was based on the null hypothesis that the number of observed and expected events is equal. Logistic regression analysis was used to identify the correlates of suicidal ideation.

Results

3.1 Prevalence of suicidal ideation by the characteristics of juvenile inmates

The overall prevalence of suicidal ideation during the past year was 15.2% among the juvenile delinquents as shown in Table 1. Girls reported more suicidal ideation than boys (30.3% vs. 12.7%, p < 0.0001). Adolescents who lived apart from family prior to entering the juvenile justice system showed a higher rate of suicidal thoughts than those who lived with family members (22.6% vs. 13.2%, p < 0.0001). Adolescents whose self-reported household income was below average or low reported a higher rate of suicidal thoughts (19.1%) than the average or above average group (p < 0.001).
Prevalence of suicidal thought was over twice as high in inmates who had problem drinking and psychedelic drug use experiences than in inmates not having these risk behavior experiences (p < 0.0001 for all). Physically active inmates were less likely to experience suicidal thoughts compared to inactive inmates (17.9% vs. 11.6%, p < 0.001).
Unhappy or depressed adolescents were more likely to report suicidal ideation than their happy or never-depressed counterparts (44.9% vs. 10.8%, p < 0.0001 for perceived happiness, 38.9% vs. 3.8%, p < 0.0001 for depressive thoughts). Adolescents who felt unhealthy were more likely to consider suicide seriously than their healthy counterparts (32.5% vs. 13.5%; p < 0.0001).

3.2 Comparison of suicidal ideation, behavioral and psychological health between juvenile inmates and nationally representative adolescents

Nationwide, 18.4% of general adolescents responded that they had seriously considered attempting suicide during the past year, which was not significantly different from that of juvenile inmates (Table 2). Juvenile inmates were more likely to perceive them as very fat (SER = 1.16, p < 0.001) and very unhealthy (SER = 1.23, p < 0.05) than nationally representative adolescents.
With regard to health risk behaviors, inmates were more likely to experience smoking (SER = 2.52, p < 0.0001), problem drinking (SER = 1.72, p < 0.0001), and psychedelic drug use (SER = 19.02, p < 0.0001) compared to general adolescents. In general adolescents, physical inactivity, and skipping breakfast were more prevalent than in juvenile inmates (SER = 0.91, p < 0.01 for physical activity; SER = 0.63, p < 0.0001 for skipping breakfast).

3.3 Correlates of suicidal ideation among juvenile inmates

The findings from the multiple logistic regression analyses for the association between suicidal ideation and sociodemographic characteristics, without health behaviors (Model 1) and with health behaviors (Model 2) are presented in Table 3. In Model 1, inmates who were girls, lived apart from the family and perceived their household income as lower than average were more likely to have serious suicidal thoughts than their counterparts. The association between suicidal ideation and some sociodemographic variables remained significant after adding health risk behavior variables to Model 2. Even after controlling for sociodemographic variables, inmates who reported problem drinking and psychedelic drug use experiences were about two times more likely to express suicidal ideation than their counterparts [adjusted odds ratio (OR) = 2.43, p < 0.001 for problem drinking; adjusted OR = 2.13, p < 0.001 for drug use], while the association between physical activity and suicidal ideation was marginally significant (adjusted OR = 1.34, p = 0.08). The associations between suicidal ideation and sociodemographics, and physical activity became insignificant when health perception variables were added to Model 3. Of all the health risk behaviors, problem drinking and psychedelic drug use remained significant after controlling for all the other variables (adjusted OR = 1.84, p < 0.05 for problem drinking; adjusted OR = 2.04, p < 0.01 for psychedelic drug use). Two psychological health variables were significantly associated with suicidal ideation after controlling for other factors. Feeling unhappy and depressed were found to be more important than either perceived body shape or health status as predictors of suicidal ideation (adjusted OR = 3.05, p < 0.0001 for perceived happiness; adjusted OR = 13.37, p < 0.0001 for depressive thoughts).

Discussion

This study found a prevalence of 15.2% for suicidal ideation, which is consistent with previous research on juvenile delinquency. The rate of suicidal ideation among inmates aged 14–22 years old in New South Wales, Australia was 14.6% and among inmates aged 10–18 years old in Ohio, USA was 17.9% [26,27]. The difference in the rate of suicidal ideation between juvenile detainees and nationally representative sample of adolescents in Korea did not differ in the present study. However, previous studies have consistently reported greater risk of suicidal ideation in delinquency than non-delinquency groups [28,29]. This result might reflect that suicide is the leading cause of death among Koreans from adolescence to the 30s.
Moderator analysis revealed that the risk of suicidal ideation was more prominent in girls, and in adolescents who did not live with family members prior to entering the correctional facilities. In some studies on juvenile reformatory students, girls were a higher-risk group for suicidal ideation than boys [29–32]. Although living with family did not guarantee healthy and happy lives, it had important meaning as a predictor of suicide ideation. These findings suggested that delinquent girls and youths who lived apart from their family members should be the priorities for the intervention to prevent suicide. However, their associations with suicidal thoughts disappeared when health perception variables were included in the model. We found that mental health factors functioned as mediators between suicidal ideation and sex or cohabiting with a family member. As suggested by Simons and Murphy [8] and Allison et al [33], girls and adolescents not cohabiting with their family showed a higher level of suicidal ideation than their counterparts because of the emotional and family problems such as depressive thoughts, and lack of family concerns and support. King et al [34] also indicated that the higher support or guidance by the parents, the lower the risk of suicidal ideation.
In this study, it was noticeable that detained youth showed higher rates of health risk behaviors than general adolescents. Smoking, problem drinking, and psychedelic drug use were more common in juvenile inmates, whereas lack of physical activity and skipping breakfast ≥ 5 days were more common in general adolescents. Another study [35] presented similar rates of smoking and alcohol drinking (95%), and a higher rate of drug use than the results from our study (65.7% vs.10.1%). It also indicated that inmates were six times higher in smoking, three times higher in alcohol drinking, and 2.8 times higher in drug use than general adolescents. Exposure to correctional environments may provide a chance to learn and practice healthy behaviors. Therefore, the education system and environmental support need to be present to take care of health risk behaviors of adolescent inmates.
Consistent with previous studies [22,36,37], problem drinking and psychedelic drug use experiences were positively related to suicidal ideation in the present study. Rihmer [38] found that adolescents were especially in the high-risk group for suicidal ideation when they were taking drugs. Delfabbro et al [14] also indicated that smoking, alcohol drinking, and drug use were the main risk factors for suicidal ideation of adolescents. The present study, however, could not find a significant association between suicidal thoughts and smoking because of the high prevalence of smoking (98.1%) among juvenile delinquents.
An adequate level of physical activity was related to a low level of suicidal ideation in this study, although it was marginally significant. Physical activity is known to have an effect on preventing suicidal thoughts through improving emotional as well as physical health [21,39,40]. Therefore, it is necessary to provide environmental support to promote physical activity for adolescents in juvenile correctional facilities as well as in schools.
Among the health perception variables, perceived happiness and depressive thoughts were significant predictors of suicidal ideation. The United States Department of Justice [41] suggests life stressors such as interpersonal conflict and disciplinary problems are associated with suicidal ideation in adolescents. Feeling happiness could prevent adolescents from engaging in high-risk behavior such as physical inactivity, binge drinking, smoking, and taking hard drugs and suicidal ideation [42,43]. Mental health issues such as stress or depression are considered as priority problems, which have to be dealt with to prevent suicidal thoughts or attempts. To decrease the risk of suicide in reformatories, regular mental health examination at the facilities should be conducted using a valid and reliable instrument. Furthermore, there is also a need for psychiatric services or programs [44].
The most obvious limitation of the current study was its cross-sectional design. We could not determine causality and directionality of the association between suicidal ideation and its correlates. Data analyzed in the study were solely based on self-repot measures, although self-report measures were recognized as a reliable source of information with regard to delinquent behavior. There might be some possibilities of under- or over-reporting bias when answering the sensitive questions on academic record, household income level, suicidal ideation, and health risk behavior. Another limitation of the study was that we could not apply precise measures for depression in adolescents. Having an experience of depressive thoughts, as defined in this study, might not be a valid measure of depression. Future studies should assess the depression with diagnostic criteria and information from other sources like parents. A series of questions were asked with different time frames, suicidal thoughts during the past year, health risk behaviors prior to entering reformatories, and health perceptions at the time of survey. Findings on their associations should be interpreted with caution. Despite its limitations, this study presented important predictors of suicidal ideation that must be taken into account in suicide prevention intervention. To the best of our knowledge, this study is the first to examine the suicidal ideation and its correlates on entire inmates in South Korea. For this reason, the findings can be generalized into the characteristics of Korean juvenile delinquency.
In conclusion, problem drinking, drug use, perceived happiness, and depressive thoughts were significant predictors for suicidal ideation among incarcerated adolescents in Korea. In order to advance the current knowledge of risk or protective factors on suicidality, more comprehensive sets of psychological variables related to suicidality should be integrated into the explanatory model. For the effective and efficient management of suicidal risk in juvenile delinquents, early detection of adolescents at risk and intervention programs with coping skills to deal with emotional and behavioral problems is required.

Conflicts of interest

All authors declare no conflicts of interest.

Notes

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

References

1. Knox K.L., Conwell Y., Caine E.D.. If suicide is a public health problem, what are we doing to prevent it? Am J Pub Health 94(1):2004 Jan;37-46.
crossref
2. Organisation for Economic Cooperation and Development: CO4.4: Teenage suicide 2013. Available from:. http://www.oecd.org/els/family/CO4_4_Teenage_Suicide_Jan2013.pdf[accessed 11.01.14].

3.

4. Centers for Disease Control and Prevention: Youth risk behavior surveillance – United States, 2011. MMWR 61(SS04):2012 Jun;1-162.

5. Joiner T.E., Rudd M.D., Rajab M.H.. The modified scale for suicidal ideation. J Abnorm Psychol 106(2):1997 May;260-265.
crossref
6. Bjorkenstam E., Bjorkenstam C., Vinnerljung B., Hallqvist J., Ljung R.. Juvenile delinquency, social background and suicide – a Swedish national cohort study of 992881 young adults. Int J Epidemiol 40(6):2011 Dec;1585-1592.
crossref
7. Fortune S., Stewart A., Yadav V., Hawton K.. Suicide in adolescents: using life charts to understand the suicidal process. J Affect Disord 100(1–3):2007 Jun;199-210.
crossref
8. Simons R.L., Murphy P.I.. Sex differences in the causes of adolescent suicide ideation. J Youth Adolesc 14(5):1985 Mar;423-434.
crossref
9. Have M., Graaf R., Dorsselaer S., Verdurmen J., van't Land H., Vollebergh W.. Incidence and course of suicidal ideation and suicide attempts in the general population. Can J Psychiatry 54(12):2009 Dec;824-833.
crossref
10. Korea Centers for Disease Control and Prevention . 2011 7th Korea youth risk behavior web-based survey statistics. Cheongwon Gun. 2012.

11. Thompson M.P., Kingree J.B., Ho C.. Associations between delinquency and suicidal behaviors in a nationally representative sample of adolescents. Suicide Life Threat Behav 36(1):2006 Feb;57-64.
crossref
12. Penn J.V., Esposito C.L., Schaerrer L.E., Fritz G.K., Spirito A.. Suicide attempts and self-mutilative behavior in a juvenile correctional facility. J Am Acad Child Adolesc Psychiatry 42(7):2003 Jul;762-769.
crossref
13. Beautrais A.L., Wells J.E., McGee M.A., Oakley Browne M.A.. Suicidal behaviour in Te Rau Hinengaro: The New Zealand Mental Health Survey. Aust N Z J Psychiatry 40(10):2006 Oct;896-904.
crossref
14. Delfabbro P.H., Winefield H.R., Winefield A.H.. Life-time and current suicide-ideation in Australian secondary school students: socio-demographic health and psychological predictors. J Affect Disord 151(2):2013 Nov;514-524.
crossref
15. Kelly T.M., Lynch K.G., Donovan J.E., Clark D.B.. Alcohol use disorders and risk factor interactions for adolescent suicidal ideation and attempts. Suicide Life Threat Behav 31(2):2001 Summer;181-193.
crossref
16. Jernigan D.H., Sparks M., Yang E., Schwartz R.. Using public health and community partnerships to reduce density of alcohol outlets. Prev Chronic Dis 10:2013 Apr;120090,
crossref
17. Hingson R.W., Zha W., Iannotti R.J., Simons-Morton B.. Physician advice to adolescents about drinking and other health behaviors. Pediatrics 131(2):2013 Feb;249-257.
crossref
18. Wu P., Hoven C.W., Liu X., Cohen P., Fuller C.J., Shaffer D.. Substance use, suicidal ideation and attempts in children and adolescents. Suicide Life Threat Behav 34(4):2004 Winter;408-420.
crossref
19. Fergusson D.M., Woodward L.J., Horwood L.J.. Risk factors and life processes associated with the onset of suicidal behaviour during adolescence and early adulthood. Psychol Med 30(1):2000 Jan;23-39.
crossref
20. Pigeon W.R., Pinquart M., Conner K.. Meta-analysis of sleep disturbance and suicidal thoughts and behaviors. J Clin Psychiatry 73(9):2012 Sep;1160-1167.
crossref
21. Brosnahan J., Steffen L.M., Lytle L., Patterson J., Boostrom A.. The relation between physical activity and mental health among Hispanic and non-Hispanic white adolescents. Arch Pediatr Adolesc Med 158(8):2004 Aug;818-823.
crossref
22. Freedenthal S., Vaughn M.G., Jenson J.M., Howard M.O.. Inhalant use and suicidality among incarcerated youth. Drug Alcohol Depend 90(1):2007 Sep;81-88.
crossref
23. Curtin L.R., Klein R.J.. Direct standardization (age-adjusted death rates). Healthy People 2000 Stat Notes (6):1995 Mar;1-10.
crossref
24. http://www.epidemiolog.net/evolving/Standardization.pdf

25. Yuan Y.. Computing direct and indirect standardized rates and risks with the STDRATE procedure. 2013. SAS Global Forum; Rockville:

26. Kenny D.T., Lennings C.J., Psych O.M.. Risk factors for self-harm and suicide in incarcerated young offenders: implications for policy and practice. J Forensic Psychol Pract 8(4):2008 Dec;358-382.
crossref
27. Kretschmar J.M., Flannery D.J.. Displacement and suicide risk for juvenile justice-involved youth with mental health issues. J Clin Child Adolesc Psychol 40(6):2011 Oct;797-806.
crossref
28. Matsumoto T., Tsutsumi A., Izutsu T., Imamura F., Chiba Y., Takeshima T.. Comparative study of the prevalence of suicidal behavior and sexual abuse history in delinquent and non-delinquent adolescents. Psychiatry Clin Neurosci 63(2):2009 Apr;238-240.
crossref
29. Thompson M.P., Ho C., Kingree J.B.. Prospective associations between delinquency and suicidal behaviors in a nationally representative sample. J Adolesc Health 40(3):2007 Mar;232-237.
crossref
30. Abrantes A.M., Hoffmann N.G., Anton R.. Prevalence of co-occurring disorders among juveniles committed to detention centers. Int J Offender Ther Comp Criminol 49(2):2005 Apr;179-193.
crossref
31. Park H.S., Koo H.Y., Schepp K.G.. Predictors of suicidal ideation for adolescents by gender. Taehan Kanho Hakhoe Chi 35(8):2005 Dec;1433-1442.
crossref
32. Ruchkin V.V., Schwab-Stone M., Koposov R.A., Vermeiren R., King R.A.. Suicidal ideations and attempts in juvenile delinquents. J Child Psychol Psychiatry 44(7):2003 Oct;1058-1066.
crossref
33. Allison S., Roeger L., Martin G., Keeves J.. Gender differences in the relationship between depression and suicidal ideation in young adolescents. Aust N Z J Psychiatry 35(4):2001 Aug;498-503.
crossref
34. King R.A., Schwab-Stone M., Flisher A.J., Greenward S., Kramer R.A., Goodman S.H.. Psychosocial and risk behavior correlates of youth suicide attempts and suicidal ideation. J Am Acad Child Adolesc Psychiatry 40(7):2001 Jul;837-846.
crossref
35. Kim H.S., Kim H.S.. Discriminative factor analysis of juvenile delinquency in South Korea. Taehan Kanho Hakhoe Chi 36(8):2006 Dec;1315-1323.
crossref
36. Chapman J.F., Ford J.D.. Relationships between suicide risk, traumatic experiences, and substance use among juvenile detainees. Arch Suicide Res 12(1):2008 Jan;50-61.
crossref
37. Buttar A., Clements-Nolle K., Haas J., Reese F.. Dating violence, psychological distress, and attempted suicide among female adolescents in the juvenile justice system. J Correct Health Care 19(2):2013 Apr;101-112.
crossref
38. Rihmer Z.. Strategies of suicide prevention: focus on health care. J Affect Disord 39(2):1996 Jul;83-91.
crossref
39. Brown D.R., Galuska D.A., Zhang J., Eaton D.K., Fulton J.E., Lowry R.. Physical activity, sport participation, and suicidal behavior: U.S. high school students. Med Sci Sports Exerc 39(12):2007 Dec;2248-2257.
crossref
40. Lubans D.R., Plotnikoff R.C., Lubans N.J.. Review: a systematic review of the impact of physical activity programmes on social and emotional well-being in at-risk youth. Child Adolesc Ment Health 17(1):2012 Feb;2-13.
crossref
41. Hayes L.M.. Juvenile suicide in confinement: a national survey. 2009. U.S. Department of Justice;

42. Hoyt L.T., Chase-Lansdale P.L., McDade T.W., Adam E.K.. Positive youth, healthy adults: does positive well-being in adolescence predict better perceived health and fewer risky health behaviors in young adulthood? J Adolesc Health 50(1):2012 Jan;66-73.
crossref
43. Choi J., Yu M., Kim L.. Suicidal ideation in adolescents: a structural equation modeling approach. Nurs Health Sci 2014 Jun;
crossref
44. Fazel S., Doll H., Langstro N.. Mental disorders among adolescents in juvenile detention and correctional facilities: a systematic review and metaregression analysis of 25 Surveys. J Am Acad Child Adolesc Psychiatry 47(9):2008 Sep;1010-1019.
crossref
Table 1
Sociodemographic, behavioral and psychological health characteristics of Korean juvenile inmates, 2012.a
Categories Total (n = 1682) Suicidal ideation
p
No
n = 1427 (84.8%)
Yes
n = 255 (15.2%)
n (%) n (%)
Sex
 Girl 238 166 (69.8) 72 (30.3) <0.0001
 Boy 1444 1261 (87.3) 183 (12.7)
Age
 Mean ± SD 17.26 ± 1.09 17.26 ± 1.09 17.29 ± 1.13 0.0586
Academic achievement
 High or above average 93 74 (79.6) 19 (20.4) 0.3202
 Average 317 272 (85.8) 45 (14.2)
 Below average or low 1263 1074 (85) 189 (15)
Living arrangementb
 Lived with family 1329 1153 (86.8) 176 (13.2) <0.0001
 Lived apart from family 345 267 (77.4) 78 (22.6)
Household income
 High or above average 260 217 (83.5) 43 (16.5) 0.0002
 Average 760 675 (88.8) 85 (11.2)
 Below average or low 650 526 (80.9) 124 (19.1)
Health related behaviors
 Smokingb
 No 31 28 (90.3) 3 (9.7) 0.4010
 Yes 1634 1387 (84.9) 247 (15.1)
 Problem drinking experienceb
 No 289 268 (92.7) 21 (7.3) <0.0001
 Yes 1142 943 (82.6) 199 (17.4)
 Psychedelic drug useb
 No 1491 1292 (86.7) 199 (13.4) <0.0001
 Yes 168 120 (71.4) 48 (28.6)
 Physical activityc
 Active 727 643 (88.5) 84 (11.6) 0.0003
 Inactive 954 783 (82.1) 171 (17.9)
 Skipping breakfast
 < 5 days 1404 1192 (84.9) 212 (15.1) 0.7840
 ≥ 5 days 273 230 (84.3) 43 (15.8)
 Mean ± SD 6.8 ± 2.39 6.83 ± 2.38 6.64 ± 2.46 0.2463
Psychological health
 Perceived happiness
 Happy 1450 1294 (89.2) 156 (10.8) <0.0001
 Unhappy 216 119 (55.1) 97 (44.9)
 Depressive thoughts
 No 1135 1092 (96.2) 43 (3.8) <0.0001
 Yes 542 331 (61.1) 211 (38.9)
 Perceived body shape
 Thin 1008 868 (86.1) 140 (13.9) 0.0692
 Fat 671 556 (82.9) 115 (17.1)
 Perceived health status
 Healthy 1530 1324 (86.5) 206 (13.5) <0.0001
 Unhealthy 151 102 (67.6) 49 (32.5)

SD = standard deviation.

a The frequencies may not add up to 100% due to no response.

b Prior to entering juvenile reformatory.

c Physical activity; at least 30 minutes/day, 5 days/week of moderate exercise, or 20 minutes/day, 3 days/week of vigorous exercise.

Table 2
Comparisons of suicidal ideation, health related behaviors and psychological health between juvenile inmates and general adolescents in Korea, 2012.
Categories Juvenile inmates Expected events General adolescents SER
Observed events Rate Rate SERa 95% CI pc
Suicidal ideation (yes) 255 15.2 260.1 18.4 0.98 (0.86, 1.1) 0.7502
Health related behaviors
Smokingb 1634 98.1 648.6 30.5 2.52 (2.4, 2.64) <0.0001
Problem drinkingb 1142 79.8 665.6 45.4 1.72 (1.62, 1.82) <0.0001
Psychedelic drug useb 168 10.1 8.8 0.5 19.02 (16.14, 21.9) <0.0001
Physical activity (inactive) 954 56.8 1048.6 69.7 0.91 (0.85, 0.97) 0.0022
Skipping breakfast (≥ 5 days) 273 16.3 430.3 25.1 0.63 (0.56, 0.71) <0.0001
Psychological health
Perceived happiness (unhappy) 216 13 213.7 13.8 1.01 (0.88, 1.15) 0.8756
Perceived depression 542 32.3 498.9 32.9 1.09 (0.99, 1.18) 0.0641
Perceived body shape (fat) 671 40 577.6 38.9 1.16 (1.07, 1.25) 0.0003
Perceived health status (unhealthy) 151 9 122.5 8.5 1.23 (1.04, 1.43) 0.0202

CI = confidence interval; SER = standardized event ratio.

a SER is observed events in juvenile inmates/expected events.

b Prior to entering juvenile reformatory.

c Test for SER = 1 (null hypothesis).

Table 3
Multivariate logistic regression analyses for suicidal ideation among juvenile inmates.
Categories Model 1
Model 2
Model 3
Adjusted OR (95% CI)a p Adjusted OR (95% CI)a p Adjusted OR (95% CI)a p
Sex
 Boy 1 1 1
 Girl 2.73 (1.95–3.81) <0.0001 2.22 (1.5–3.29) <0.0001 1.53 (0.94–2.49) 0.0854
Age 1.06 (0.92–1.21) 0.4395 1.08 (0.92–1.26) 0.3473 1.04 (0.87–1.24) 0.6787
Academic achievement
 High or above average 1 1 1
 Average 0.64 (0.34–1.19) 0.2687 0.86 (0.42–1.74) 0.7032 0.73 (0.32–1.63) 0.3949
 Below average or low 0.66 (0.38–1.15) 0.2927 0.88 (0.47–1.68) 0.8185 0.85 (0.41–1.76) 0.9861
Living arrangement
 Lived with family 1 1 1
 Lived apart from family 1.52 (1.11–2.09) 0.0091 1.53 (1.08–2.15) 0.0161 1.2 (0.8–1.79) 0.3850
Household income
 High or above average 1 1 1
 Average 0.68 (0.45–1.02) 0.0018 0.64 (0.41–0.99) 0.0051 0.84 (0.5–1.41) 0.2118
 Below average or low 1.20 (0.80–1.79) 0.0107 1.04 (0.67–1.61) 0.1042 1.15 (0.7–1.91) 0.2266
Health related behaviors
Smokingb
 No 1 1
 Yes 0.7 (0.14–3.39) 0.6537 0.98 (0.18–5.46) 0.9797
Problem drinkingb
 No 1 1
 Yes 2.43 (1.5–3.94) 0.0003 1.84 (1.06–3.18) 0.0305
Psychedelic drug useb
 No 1 1
 Yes 2.13 (1.4–3.23) 0.0004 2.04 (1.23–3.39) 0.0059
Physical activityc
 Active 1 1
 Inactive 1.34 (0.96–1.88) 0.0847 1.29 (0.87–1.9) 0.2000
Skipping breakfast
 < 5 days 1 1
 ≥ 5 days 1.22 (0.8–1.85) 0.3611 0.93 (0.57–1.51) 0.7621
Psychological health
Perceived happiness
 Happy 1
 Unhappy 3.05 (2.03–4.59) <0.0001
Depressive thoughts
 No 1
 Yes 13.37 (8.76–20.41) <0.0001
Perceived body shape
 Thin 1
 Fat 1.02 (0.7–1.47) 0.9352
Perceived health status
 Healthy 1
 Unhealthy 1.34 (0.81–2.24) 0.2580

Model 1 involved demographic factors (gender, age, academic record, living arrangement, household income); Model 2 involved factors of health related behaviors (smoking, problem drinking, psychedelic drug use, physical activity, skipping breakfast) with demographic factors; Model 3 involved psychological health factors (perceived happiness, depressive thoughts, perceived body shape, perceived health status) with health behaviors and sociodemographic factors. OR = odds ratio. CI = confidence interval.

a 95% CI for suicidal ideation vs none

b Prior to entering juvenile reformatory

c Physical Activity; at least 30 minutes/day, 5 days/week of moderate exercise, or 20 minutes/day, 3 days/week of vigorous exercise

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