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Comparison of Stress and Suicide-Related Behaviors Among Korean Youths Before and During the COVID-19 Pandemic

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Key Points

Question  Was the COVID-19 pandemic associated with suicidality the COVID-19 pandemic in youths?

Findings  In this cross-sectional study of 92 659 Korean youths, suicidality was lower during the early COVID-19 pandemic period compared with the prepandemic period. Thoughts of suicide, plans of suicide, and suicide attempts among 2020 participants were less common compared with 2019 participants.

Meaning  These findings suggest that high levels of stress decreased during the early COVID-19 pandemic period compared with prepandemic stress levels.

Abstract

Importance  The COVID-19 pandemic has had a substantial psychological effect on young people. A quantitative assessment of the association between the pandemic and stress and suicidality in youths is needed.

Objective  To investigate the association of the COVID-19 pandemic with self-reported stress and suicide-related behaviors in youths.

Design, Setting, and Participants  This cross-sectional study used data from the the Korea Youth Risk Behavior Web-based Survey (KYRBWS) conducted in 2019 and 2020 with youths aged 12 to 18 years. Statistical analysis was performed from January to February 2021.

Main Outcomes and Measures  The odds ratios (ORs) with 95% CIs for subjective stress level, sadness or despair, suicidal thoughts, suicide planning, and suicide attempts among 2020 participants were compared with those of the 2019 participants using multiple logistic regression analysis with complex sampling using weighted values.

Results  The 48 443 youths in the 2019 KYRBWS (24 917 male youths [51.3%]; mean [SD] age, 15.0 [1.7] years) and the 44 216 youths in the 2020 KYRBWS (23 103 male youths [52.5%]; mean [SD] age, 15.1 [1.7] years) were compared. The degree of subjective stress was lower in the 2020 participants than in the 2019 participants (severe stress: adjusted OR [aOR], 0.90 [95% CI, 0.83-0.97]; very severe stress: aOR, 0.65 [95% CI, 0.60-0.72]). Sadness or despair was also lower in the 2020 participants than in the 2019 participants (aOR, 0.81 [95% CI, 0.78-0.84]). There were fewer suicide-related behaviors, including suicidal thoughts, suicide planning, and suicide attempts, among the 2020 participants than among the 2019 participants (suicidal thoughts: aOR, 0.77 [95% CI, 0.73-0.80]; suicide planning: aOR = 0.88 [95% CI, 0.81-0.96]; suicide attempts: aOR, 0.64 [95% CI, 0.58-0.70]).

Conclusions and Relevance  This cross-sectional study found that severe stress, sadness or despair and suicide-related behaviors had inverse associations with the early COVID-19 pandemic in Korean youths. These findings suggest that levels of high stress decreased among Korean youths in the early period of the pandemic compared with prepandemic levels.

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Article Information

Accepted for Publication: September 22, 2021.

Published: December 13, 2021. doi:10.1001/jamanetworkopen.2021.36137

Open Access: This is an open access article distributed under the terms of the CC-BY License. © 2021 Kim SY et al. JAMA Network Open.

Corresponding Author: Hyo Geun Choi, MD, PhD, Department of Otorhinolaryngology–Head & Neck Surgery, Hallym University Sacred Heart Hospital, 22, Gwanpyeong-ro 170beon-gil, Dongan-gu, Anyang-si, Gyeonggi-do 14068, Republic of Korea (pupen@naver.com).

Author Contributions: Dr Choi had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Concept and design: H. Kim, Park, Choi.

Acquisition, analysis, or interpretation of data: S. Kim, Choi.

Drafting of the manuscript: S. Kim, H. Kim, Choi.

Critical revision of the manuscript for important intellectual content: S. Kim, Park, Choi.

Statistical analysis: Choi.

Obtained funding: Choi.

Administrative, technical, or material support: H. Kim, Choi.

Supervision: Park, Choi.

Conflict of Interest Disclosures: None reported.

Funding/Support: This work was supported in part by a research grant (NRF-2018-R1D1A1A02085328 and 2021-R1C1C1004986) from the National Research Foundation (NRF) of Korea.

Role of the Funder/Sponsor: The funders had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

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