An integrated model for the relationship between socio-cultural factors, Attitudes Toward Suicide, and intensity of suicidal ideation in Korean, Japanese, and American populations

Background: Although many studies have identified the risk factors for suicide, the absence of a statistical model that integrates several risk areas makes it difficult to understand the abnormally high suicide rate in South Korea. Therefore, we aimed to establish a multidimensional structural equation model of suicide incorporating socio-cultural and psychiatric factors. We performed cross-national comparisons to identify the unique factors influencing South Korea's suicide rate. Methods: We conducted a web survey inviting adults aged 20- to 59-years from South Korea, Japan, and the United States to respond to questionnaires. A total of 2,213 subjects were included. We then developed a structural equation model, exhibiting a good fit in all countries. Results: A permissive attitude was the factor that most strongly predicted the intensity of suicidal ideation in all countries. In South Korea, a low income was directly associated with both permissive attitude and the intensity of suicidal ideation. South Korea's highly fatalistic attitude related to more receptive attitudes toward suicide. Individual's resilience to stress provided significant protection against suicidal ideation in the United States and Japan, but not in South Korea. Limitations: Since our sample excluded adults over 60 years, thus reducing the generalizability of our results. Furthermore, we employed a cross-sectional design; a longitudinal study is needed to draw causal inferences about suicidal death Conclusions: This study developed the first multidimensional, integrated statistical model of suicidal ideation. Our findings explain the causes of South Korea's high suicide rate and can be used to develop new interventions.