To Be or Not to Be

Suicidal ideation is a key concept to prevent suicide [1]. South Korea marks the highest record for suicidal attempts within the Organization for Economic Co-operation and Development (OECD) countries [2]. Suicide, along with cancer and cardiovascular diseases is one of the leading causes of death in Korea. It is also the first leading cause of death for teens and people in their 20s, second for adults in their 40s and 50s and 4th for the death of the elderly [3]. Each year, approximately 5,000 elderly citizens commit suicide in Korea and about 4% of suicidal attempts cause fatality [4]. Furthermore, there is a much higher rate in suicidal attempt, and even higher rate in suicidal ideation [5]. Suicidal impulse leads to ideation. This can trigger an attempt and cause fatal damage. Therefore, intervening when one conceptualizes suicide or feels an impulse is critical to prevent suicide [6]. Traumatic experiences during one’s childhood and youth can lead to emotional instability, mental maladjustment correlating to committing suicidal attempts. In adolescence, problems such as poor academic performance, drinking, stress due to school or family problems, lack of emotional support, runaway urge and depression tend to be a problem [7]. In the 20s, it can take the form of lack of impulse control, uncertainty of future, academics, financial and relationship problems [8,9]. For elderly citizens, it can be financial instability, illness, chronic pain, health status, and relationship issues [10,11]. Likewise, young people aged under 40 years and middle aged people aged over 40 years have different developmental tasks. Accordingly the stressors in their lives and the factors influencing suicidal ideation will be different. Yong adulthood is a period when one becomes a legal adult and starts to live independently, involve in active social life. Also it is a time to adapt to social demands and physiological changes. Mid to late adulthood requires continued career development, caring for own family and parents and getting ready for retirement. With aging, elders need to prepare for changes in physicality and adjust accordingly [12]. Some studies have reported that education level, job, divorce [13], family conflict, financial problem, social relationship, unemployment [14], depression, despair, stress level, and family cohesion [15], stress, gender, education, and marital status [16] were associated with suicide in adults life. Considering the recent trend of the increment in adult suicide [3], timely investigation of suicidal thoughts experienced by adults is essential. In reality, suicide is socially, culturally and ethically prejudiced, so access is very limited. Moreover, it is difficult to investigate because they are reluctant to expose their own or family suicide experience. Most of the previous studies are cross sectional and make it difficult to understand the causal relationship between each factor at the elapsed time [17]. Suicide may be impulsive, but in many cases it may be the result of accumulation of various psychosocial state. From that point of view, it needs to investigate the accumulated effects of physical, perceived psychological state of an individual on the Copyright © 2017 Korea Centers for Disease Control and Prevention.