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In South Korea Open access Forum explored, which enables the stake- Gen Psych: first published as 10.1136/gpsych-2020-100200 on 9 July 2020. Downloaded from Need to establish a new adolescent suicide holders to have a comprehensive prevention programme in South Korea insight and, most importantly, to propose a far- sighted and practical Jiacheng Liu strategy to deal with the issues in a more efficient way.12–14 In the medical and public health field, although ABSTRACT set of Korea Youth Risk Behavior SWOT analysis is not a prospective, Adolescent suicide is the leading cause of death Web- based Survey (KYRBWS), it was double- blind clinical trial, which can among South Korean (Korean) youth. Despite revealed that 12.4% (7443/59 984) provide the highest level of evidence, great efforts being made towards suicide of middle and high school students it is still an important technique to prevention in Korea, the suicide rate has not had a history of suicidal ideation/ decreased significantly. There is an urgent need alter and improve the disease preven- attempt.6 What is worse, only 11.1% for a new adolescent suicide prevention strategy. tion and treatment standards15 and is to 21.6% of the adolescents aged 15 This paper describes the seriousness of the helpful for future clinical and basic years or older with suicidal ideation issue of adolescent suicide in Korea, evaluates research.16 its current management by the SWOT analysis or attempt are receiving psychiatric treatment.7 (strengths, weaknesses, opportunities and Strengths threats) and further recommends a new suicide The causes of suicide in Korean The Korean government provides prevention programme that integrates national/ youth are complicated. Moreover, powerful leadership on suicide social involvement (State Suicide Intervention 34.3% of suicides are associated with prevention. A Five Year Plan for Committee, suicide posts’ monitoring, parental family problems,8 including family National Mental Health was released divorce information sharing and Adolescence history of suicide/mental disorders in 1998, and it is updated every Mental Health Promotion Foundation), school- and low family support9; 17.6% are based programmes (continuous monitoring 5 years.17 In 2004, media guidance was related to students’ own psychi- system, psychology consultation team and introduced, stressing the importance atric disorders, such as depression, mental health educational curricula) and family- of providing responsible reports and another 12% are due to the based programmes (parental education and related to suicides, and amendment academic burden at school.8 10 Other family- school communication). In addition, 3.0 was announced in 2018.18 In addi- factors, including alcohol/substance genetic analysis, biochemical tests and tion, the Korea Suicide Prevention psychological disease registration are the abuse,9 11 peer bullying and social Centre (KSPC), which is supported indispensable elements that aid in suicidal stigma regarding a mental illness,10 directly by the government, was behaviour prevention and prediction. are all associated with suicide attempts established in 2011 with the primary by Korean adolescents. tasks of preventing high- risk suicides, http://gpsych.bmj.com/ Considering the gravity of the INTRODUCTION TO KOREAN ADOLESCENT improving media guidelines, building issue of suicide in Korean youth, the SUICIDE internet monitoring system and so Korean Ministry of Education intro- Suicide is the second leading cause of on.18 The Korean Ministry of Educa- 1 duced a mandatory policy in 2015 that death among the youth worldwide. tion also held six vital prevention required a suicide report should be Nearly 3.4 million adolescents (aged projects for the young, including submitted by the school within 1 week 15–19 years) across the globe have evidence- based prevention strate- of a student committing suicide.8 suicidal ideation, with half of them gies, de- stigmatised social mental 2 on September 28, 2021 by guest. Protected copyright. attempting suicide. In Korea, the health campaigns, early suicide detec- suicide rate was ranked the fourth in tion systems, liaisons between the 3 the world in 2018 with 7.2/100 000 SWOT ANALYSIS OF CURRENT SUICIDE medical support system and psychol- 4 young people committing suicide, MANAGEMENT ogists, skills training for students and and the number of suicides among To perform an in-depth assessment teachers and prevention education adolescents aged 15–18 years is four of the current Korean suicide preven- for adolescents.8 times than that of adolescents aged tion strategies, a SWOT (strengths, In addition, non-governmental 12–14 years according to data from weaknesses, opportunities and organisations (NGOs) are actively the National Statistical Office of threats) analysis is used. SWOT is a involved in suicide prevention 5 Korea. Korean adolescents seem to widely used qualitative method in a programmes. The Korean Associa- be at a risk of having suicide ideation variety of fields, including business, tion for Suicide Protection launched or attempting suicide. In a recent medicine, public health, education, several programmes in 2011, such study that used a nationwide data politics and so on. Through a thor- as ‘Livingworks’ and its branches ough and structured analysis of the ‘ASIST’ and ‘safeTALK’, to train Melbourne School of Population & Global Health, Division of Medicine, Dentistry and Health Sciences, available data relating to a topic of mental health professionals and The University of Melbourne, Melbourne, Victoria, interest, all the intrinsic and extrinsic encourage young people with mental Australia factors, even the mechanism involved disorders to communicate openly 19 Correspondence to Jiacheng Liu; in the occurrence, progression and with others. By the end of 2017, jiachengl5@ student. unimelb. edu. au outcome of a focused event, are 7342 help providers had joined the Liu J. General Psychiatry 2020;33:e100200. doi:10.1136/gpsych-2020-100200 1 General Psychiatry ‘ASIST’ training programme, and lower than WHO’s recommendation Threats Gen Psych: first published as 10.1136/gpsych-2020-100200 on 9 July 2020. Downloaded from 9102 adolescents had taken part in (15%–50%).17 The biggest threat of suicide in Korea ‘safeTALK’.20 comes from the lack of treatment. Other efforts are being made to Opportunities Only 15%–23% of individuals with prevent suicides in Korea. KSPC The great developments in infor- mental disorders receive treatment, developed an internet monitoring mation and computer technologies, which is far less than the 44% treat- 17 team to delete harmful online posts. especially the advances in artificial ment rate in western countries. According to the team, 3123 posts intelligence and deep learning, Another threat comes from the regarding suicide encouragement provide the opportunities to recog- internet. Currently, one can easily and recruitment are deleted on a nise and screen the students with post suicidal encouragement text and 18 8 18 normal day. The National Institute suicidal ideation at an early stage, video online anonymously, which of Mental Health and the Division of including those who have been previ- has immeasurably vicious mental Mental Health Services are devoted ously received a diagnosis of psychi- consequences, especially for young- to mental health research exploring sters. Other suicide- inducing factors, atric disorders. As acknowledged by 8 the aetiology of suicides in Korean teachers, the information provided such as online game addiction and adolescents and prevention strat- loneliness, which are caused by poor 10 17 in their suicide reports may be biased 3 8 egies, the link between mental 8 social/family relationships, parental or incomplete. If closed- circuit tele- 8 disorders and a person’s genetic back- visions (CCTVs) could be installed divorce and social stigma towards ground,21 and so on. It is clear that the 26 27 in every school covering every mental diseases, have also been Korean government and NGOs have corner, detailed dynamic informa- identified. These diverse and complex paid close attention to youth suicide risk factors increase the difficulty tion on the students who committed and have adopted several strategies. of adolescent suicide prevention in suicides in the school could be Korea. traced. By analysing and comparing Weaknesses their behaviour 1 week or 1 month Although numerous efforts have before the incident, some question- been made, a significant decline RECOMMENDATIONS FOR CURRENT able and common behaviours might in the suicide rate has not yet been SUICIDE PREVENTION STRATEGIES 22 be recognised, which in turn could observed. The primary reason is the According to the aforementioned help implement suicide prevention social stigma towards mental illness SWOT analysis, there is a need to training programmes for teachers embedded in Korean culture. On update the current suicide preven- that would enable them to notice the one hand, most Korean people tion strategies in Korea and estab- such behaviours in the future. think it is shameful to admit that lish an integrated framework at the http://gpsych.bmj.com/ Furthermore, modern internet they have mental health problems. administration level and healthcare surveillance technologies can assist Seventy percent of students with level with factors related to nation/ the KSPC’s internet monitoring suicidal ideation do not display their society, schools, families, genetic 8 team to extend their job from simply problematic behaviours at school.
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