Fallen Flowers

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Osong Public Health Res Perspect. 2016;7(5):279-280
Publication date (electronic) : 2016 September 19
doi : https://doi.org/10.1016/j.phrp.2016.09.002
Editor-in-Chief Osong Public Health and Research Perspectives, Korea Centers for Disease Control and Prevention, Cheongju, Korea
Professor Emeritus College of Medicine, Eulji University, Daejeon, Korea
Managing Editor Osong Public Health and Research Perspectives, Korea Centers for Disease Control and Prevention, Cheongju, Korea
Corresponding author. hwcho@eulji.ac.kr
∗∗Corresponding author. cchu@cdc.go.kr

Suicide is a serious social and health problem in Korea [1]. According to a 2005 report by the Organization for Economic Cooperation and Development [2], Korea had the highest suicide rate with nearly 30 deaths per 100,000 population. Many studies have found that suicidal ideation and attempts among lesbians, gay men, and bisexual persons are higher than among heterosexual individuals (or general populations) 3, 4, 5, 6. In addition, these groups have comparatively higher levels of stress and depression. This may be linked to heterocentric cultures and homophobia; Asian cultures, including Korea's, have higher stigma related to homosexuality. Because Korean tradition places intense value on lineage, marriage, and children, these expectations are considered normal and thus contribute to stigma even just among the unmarried and divorced as well as homosexuals [7].

Homosexuals do not come out for fear of being rejected by family and friends or discrimination in employment, promotion, housing, and other basic rights [7]. The rate of coming out in Korea is only 13.5%, lower than that of other countries [7]. Many studies that have examined determinants of suicidality that are specific to men who have sex with men (MSM) have focused on both developmental life transitions (e.g., adopting sexual identity or coming out) and social and cultural stressors (e.g., perceived stigmatization, antigay hostility). Homosexuals have higher rates of all-cause mortality, and those who live in areas with a higher degree of social stigma towards homosexuality tend to commit suicide at earlier ages [8].

This high prevalence of poor mental health problems and risky behaviors in homosexuals can be explained and understood in terms of minority stress [9]. The stigma, prejudice, and discrimination create a hostile and stressful social environment that causes stress, depression, substance use, and suicidal behavior among minority individuals. Studies on homosexuals focus on perceived stigma and sexual identity, which affect gay-related stress such as coming out as homosexual. The mechanisms that underlie the associations between sexual identity and stress have been explored in a number of studies with mediation models that affect negative mental health problems such as stress and depression and suicidal ideation.

Suicide follows several steps: suicidal ideation, plans, and attempts. Suicidal ideation is believed to precede the onset of the plans and attempts. Thus, it has been considered one of the strong predictors of future suicide 10, 11. Preventing suicide requires interventions that prevent the progression of thought to suicide attempt [12]. Early identification of suicidal ideation is important for preventing suicide. Many studies have identified characteristics of people who have suicidal ideation; risky behaviors, substance abuse, and poor mental health have been considered risk factors of suicidal ideation 13, 14, 15.

MSM have been highlighted as a high-risk group for poor mental health including stress, depression, and suicidal ideation and attempts. However, basic research on mental health including suicidal behavior in this group in Korea is both rare in quantity and deficient in quality, particularly with respect to sampling. Because homosexuality is also regarded as difficult and uncomfortable to discuss, research in this group is in a relatively underdeveloped state in Korea [5]. A number of factors combine to put MSM populations at increased risk.

In the current issue of Osong Public Health and Research Perspectives, a study examined the status of sexual identity, perceived stigma, stress, depression, and suicidal ideation and attempts. It also investigated how sexual identity and coming out affect stress, depression, and suicidal ideation and attempts [16]. Suicidal ideation, psychological health status, and health-related behaviors were assessed using the Internet to maximize the confidentiality of the participants, MSM. The data were collected from a total of 873 MSM aged between 19 years and 59 years in 2014.

The authors found that 20.9% of the MSM had come out (18.0% voluntarily and 2.9% by others). The prevalence of perceived stress and depression among MSM was 46.7% and 42.7%, respectively, compared with 20.1% and 7.4% among general men. Approximately 32% of the MSM reported any suicidal ideation, and 3.3% had attempted suicide in the past year. The likelihood of suicidal ideation was significantly associated with being age 30–39 years [odds ratio (OR) = 1.8], high school or less (OR = 1.6), having been outed (OR = 5.2), feeling stressed (OR = 1.8), and feeling depressed (OR = 12.4) after controlling for sociodemographic factors and other perceptions.

The authors concluded that their present study provides evidence that MSM are at elevated risk for suicidal ideation and attempts with high stress and depression. Some risk factors were specific to being gay or bisexual in a hostile environment. This study can be helpful as basic data for public health decision makers in Korea.


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