Hong Minseok, Kim Hyesoo, Park C Hyung Keun, Lee Hyunju, Rhee Sang Jin, Min Sooyeon, Kim Min Ji, Yang Jeong Hun, Song Yoojin, Son Kyunghoon, Ahn Yong Min
Department of Psychiatry, Seoul National University College of Medicine, Seoul, Republic of Korea.
Department of Psychiatry, Asan Medical Center, Seoul, Republic of Korea.
Front Psychiatry. 2024 Sep 16;15:1423609. doi: 10.3389/fpsyt.2024.1423609. eCollection 2024.
Attitudes toward suicide are essential in suicide prevention, as suicide is socio-culturally nuanced. Although the relationship between individual attitudes and suicidal behavior has been extensively studied, the effect of community attitudes-aggregated by region-on suicide mortality remains ambiguous. This study explored the association between community attitudes and real-world suicide mortality.
Data on attitudes toward suicide from the 2018 Korea National Suicide Survey (N = 1500) and individual mortality data from the MicroData Integrated System were obtained. Confirmatory factor analysis supported a factor structure with three factors: "Permissiveness," "Unjustified behavior," and "Readiness to help/Preventability." Thirty regional units in South Korea aggregated the data for ecological analysis. We used negative binomial models to examine the association at the regional level, and stratified analysis by gender and age group was conducted.
"Permissiveness" was associated with reduced suicide rates in a univariate model (P < 0.001). Adjusting for gender, age, and additional sociodemographics did not alter the association. Additionally, this relationship was observed in males and individuals under 60 years of age after stratification. However, "Unjustified Behavior" and "Readiness to help/Preventability" exhibited no significant association with suicide in any model or stratum.
The observed inverse association between permissive community attitudes and suicide contradicts the findings of previous research that links permissive individual attitudes to increased suicidal behavior. Our findings suggest that attitudes may operate differently at the individual and group levels. Although the cross-sectional design and single-country focus of this study warrant further investigation, our findings indicate that attitudes are significant contextual factors in the process of suicide, which could lead to novel approaches in suicide prevention.
由于自杀具有社会文化层面的细微差别，因此对自杀的态度在自杀预防中至关重要。尽管个体态度与自杀行为之间的关系已得到广泛研究，但按地区汇总的社区态度对自杀死亡率的影响仍不明确。本研究探讨了社区态度与实际自杀死亡率之间的关联。
获取了2018年韩国全国自杀调查中关于自杀态度的数据（N = 1500）以及微观数据集成系统中的个体死亡率数据。验证性因素分析支持了一个具有三个因素的因素结构：“宽容度”、“不合理行为”和“帮助意愿/可预防性”。韩国的30个地区单位汇总了数据以进行生态分析。我们使用负二项式模型来检验地区层面的关联，并按性别和年龄组进行了分层分析。
在单变量模型中，“宽容度”与自杀率降低相关（P < 0.001）。在调整了性别、年龄和其他社会人口统计学因素后，这种关联没有改变。此外，分层后在男性和60岁以下个体中也观察到了这种关系。然而，在任何模型或分层中，“不合理行为”和“帮助意愿/可预防性”与自杀均无显著关联。
观察到的社区宽容态度与自杀之间的反向关联与先前将个体宽容态度与自杀行为增加联系起来的研究结果相矛盾。我们的研究结果表明，态度在个体和群体层面可能有不同的作用方式。尽管本研究的横断面设计和单一国家的研究重点需要进一步调查，但我们的研究结果表明，态度是自杀过程中的重要背景因素，这可能会带来自杀预防的新方法。
