The prediction model of suicidal thoughts in Korean adults using Decision Tree Analysis: A nationwide cross-sectional study

Autoři: Sung-Man Bae aff001
Působiště autorů: Department of Psychology and Psychotherapy, College of Health Science, Dankook University, Cheonan, Chungnam, Republic of Korea aff001
Vyšlo v časopise: PLoS ONE 14(10)
Kategorie: Research Article
doi: 10.1371/journal.pone.0223220


The purpose of this retrospective decisional analysis study is to develop the prediction model of suicidal ideation. We used a Decision Tree Analysis using SPSS 23.0 program to explore predictors of suicide thoughts for 12,015 Korean adults aged 19–98 years. As a result, the most powerful predictor of suicidal ideation was the level of depression. Of people who suspected depression (CESD-11>16), 32.6% experienced suicidal ideation, which is 12 times higher than that of total subjects. The group with the highest rate of suicidal ideation was people who experienced financial difficulties in depression-suspected group and the rate of suicidal thoughts in this group was 56.7%, which was the highest rate. However, in the non-depressive group, the satisfaction of family relationship was the strongest predictor of suicidal ideation. In the non-depressive group, the rate of suicidal thoughts of people with high level of family relationship satisfaction and high level of health satisfaction was 0.6%, which was the lowest rate. The contribution of this study was that it provided the combination of variables to predict the risk groups of adult suicide. This study suggests that researchers and clinicians should consider comprehensively depressive symptoms, family relationships, economic difficulties, and health status to prevent the suicide of adults.

Klíčová slova:

Adults – Decision trees – Depression – Finance – Housing – Human families – Psychological stress – Suicide


1. Organization for Economic Cooperation Development. Health Data 2015.

2. Bagge CL, Littlefield AK, Conner KR, Schumacher JA, Lee H. Near-term predictors of the intensity of suicidal ideation: an examination of the 24 h prior to a recent suicide attempt. Journal of Affective Disorders. 2014;165:53–58. doi: 10.1016/j.jad.2014.04.010 24882177

3. Cheng JKY, Fancher TL, Ratanasen M, Conner KR, Duberstein PR, Sue S, et al. Lifetime suicidal ideation and suicide attempts in Asian Americans. Asian American journal of psychology. 2010;1(1):18–30. doi: 10.1037/a0018799 20953306

4. Eikelenboom M, Smit JH, Beekman ATF, Penninx BWJH. Do depression and anxiety converge or diverge in their association with suicidality? Journal of Psychiatric Research. 2012;46(5):608–615. doi: 10.1016/j.jpsychires.2012.01.025 22340981

5. Kuroki Y. Risk factors for suicidal behaviors among Filipino Americans: a data mining approach. The American journal of orthopsychiatry. 2015;85(1):34–42. doi: 10.1037/ort0000018 25110976

6. Simon GE, Rutter CM, Peterson D, Oliver M, Whiteside U, Operskalski B, et al. Does response on the PHQ-9 depression questionnaire predict subsequent suicide attempt or suicide death? Psychiatric services (Washington, D.C.). 2013;64(12):1195–1202. doi: 10.1176/ 24036589

7. Sun WJ, Xu L, Chan WM, Lam TH, Schooling CM. Depressive symptoms and suicide in 56,000 older Chinese: a Hong Kong cohort study. Social Psychiatry and Psychiatric Epidemiology. 2012;47(4):505–514. doi: 10.1007/s00127-011-0362-z 21384121

8. Bruffaerts R, Demyttenaere K, Borges G, Haro JM, Chiu WT, Hwang I, et al. Childhood adversities as risk factors for onset and persistence of suicidal behaviour. The British journal of psychiatry. 2010;197(1):20–27. doi: 10.1192/bjp.bp.109.074716 20592429

9. Power J, Gobeil R, Beaudette JN, Ritchie MB, Brown SL, Smith HP. Childhood abuse, nonsuicidal self-injury, and suicide attempts: an exploration of gender differences in incarcerated adults. Suicide and Life-Threatening Behavior. 2016;46(6):745–751. doi: 10.1111/sltb.12263 27291490

10. Van Orden KA, Witte TK, Cukrowicz KC, Braithwaite SR, Selby EA, Joiner TE Jr. The interpersonal theory of suicide. 2010;117(2):575–600. doi: 10.1037/a0018697 20438238

11. Kuroki Y, Tilley JL. Recursive partitioning analysis of lifetime suicidal behaviors in Asian Americans. Asian American Journal of Psychology. 2012;3(1):17–28.

12. Seo HJ, Song HR, Yim HW, Kim JB, Lee MS, Kim JM, et al. Age-related differences in suicidality between young people and older adults with depression: data from a nationwide depression cohort study in Korea (the CRESCEND study). Comprehensive Psychiatry. 2015;56:85–92. doi: 10.1016/j.comppsych.2014.10.003 25459419

13. Coope C, Donovan J, Wilson C, Barnes M, Metcalfe C, Hollingworth W, et al. Characteristics of people dying by suicide after job loss, financial difficulties and other economic stressors during a period of recession (2010–2011): A review of coroners׳ records. Journal of Affective Disorders. 2015;183:98–105. doi: 10.1016/j.jad.2015.04.045 26001669

14. Knipe DW, Carroll R, Thomas KH, Pease A, Gunnell D, Metcalfe C. Association of socio-economic position and suicide/attempted suicide in low and middle income countries in South and South-East Asia—a systematic review. BMC Public Health. 2015;15:2301–2305.

15. Stack S, Wasserman I. Economic strain and suicide risk: a qualitative analysis. Suicide & life-threatening behavior. 2007;37(1):103–112.

16. Chen YY, Wu KC, Yousuf S, Yip PSF. Suicide in Asia: opportunities and challenges. Epidemiologic Reviews. 2012;34(1):129–144.

17. Hung GC, Kwok CL, Yip PS, Gunnell D, Chen YY. Predicting suicide in older adults: a community-based cohort study in Taipei City, Taiwan. Journal of Affective Disorders. 2014;2015;172:165–170. doi: 10.1016/j.jad.2014.09.037 25451412

18. Erlangsen A, Stenager E, Conwell Y. Physical diseases as predictors of suicide in older adults: a nationwide, register-based cohort study. Social Psychiatry and Psychiatric Epidemiology. 2015;50(9):1427–1439. doi: 10.1007/s00127-015-1051-0 25835959

19. Hempstead KA, Phillips JA. Rising suicide among adults aged 40–64 years: the role of job and financial circumstances. American journal of preventive medicine. 2015;48(5):491–500. doi: 10.1016/j.amepre.2014.11.006 25736978

20. Milner A, Currier D, LaMontagne AD, Spittal MJ, Pirkis J. Psychosocial job stressors and thoughts about suicide among males: a cross-sectional study from the first wave of the Ten to Men cohort. Public Health. 2017;147:72–76. doi: 10.1016/j.puhe.2017.02.003 28404500

21. Wu J, Värnik A, Tooding LM, Värnik P, Kasearu K. Suicide among older people in relation to their subjective and objective well-being in different European regions. European Journal of Ageing. 2014;11(2):131–140. doi: 10.1007/s10433-013-0297-1 28804321

22. Zhang J, Liu Y, Sun L. Life satisfaction and degree of suicide intent: a test of the strain theory of suicide. Comprehensive Psychiatry. 2017;74:1–8. doi: 10.1016/j.comppsych.2016.12.002 28040550

23. Gould MS, Greenberg T, Velting DM, Shaffer D. Youth suicide risk and preventive interventions: a review of the past 10 years. Journal of the American Academy of Child and Adolescent Psychiatry. 2003;42(4):386–405. doi: 10.1097/01.CHI.0000046821.95464.CF 12649626

24. Perry EJ, Selden M. Chinese Society: Change, Conflict and Resistance. Routledge; 2003.

25. Crump C, Sundquist K, Sundquist J, Winkleby MA. Sociodemographic, psychiatric and somatic risk factors for suicide: a Swedish national cohort study. Psychological Medicine. 2014;44(2):279–289. doi: 10.1017/S0033291713000810 23611178

26. Williams JMG. Cry of pain: understanding suicide and self-harm. England: Penguin; 1997.

27. Franks R, Burnett DO, Evans RR. Risk factors and prevention strategies for suicide among the elderly. Alabama Counseling Association Journal. 2012;38(2):32–42.

28. Kohout FJ, Kohout FJ, Berkman LF, Berkman LF, Evans DA, Evans DA, et al. Two shorter forms of the CES-D depression symptoms index. Journal of Aging and Health. 1993;5(2):179–193. doi: 10.1177/089826439300500202 10125443

29. World Health Organization. AUDIT: the alcohol use disorders identification test: guidelines for use in primary health care / Babor TF, Higgins-Biddle JC, Saunders JB, Monteiro MG. Geneva: World Health Organization; 2001.

30. Bae JN, Cho MJ. Development of the Korean version of the geriatric depression scale and its short form among elderly psychiatric patients. Journal of Psychosomatic Research. 2004;57(3):297–305. doi: 10.1016/j.jpsychores.2004.01.004 15507257

31. Song Y, Lu Y. Decision tree methods: applications for classification and prediction. Shanghai Archives of Psychiatry. 2015;27(2):130–135. doi: 10.11919/j.issn.1002-0829.215044 26120265

32. Meltzer H, Bebbington P, Brugha T, Jenkins R, McManus S, Dennis MS. Personal debt and suicidal ideation. Psychological Medicine. 2011;41(4):771–178. doi: 10.1017/S0033291710001261 20550757

33. Oyesanya M, Lopez-Morinigo J, Dutta R. Systematic review of suicide in economic recession. World journal of psychiatry. 2015;5(2):243–254. doi: 10.5498/wjp.v5.i2.243 26110126

34. Currier D, Spittal MJ, Patton G, Pirkis J. Life stress and suicidal ideation in Australian men—cross-sectional analysis of the Australian longitudinal study on male health baseline data. BMC Public Health. 2016;16(Suppl 3):43–49.

35. Joiner TE, Van Orden KA, Witte TK, Selby EA, Ribeiro JD, Lewis R, et al. Main predictions of the interpersonal psychological theory of suicidal behavior: Empirical tests in two samples of young adults. Journal of Abnormal Psychology. 2009;118(3):634–646. doi: 10.1037/a0016500 19685959

36. Liu RT, Miller I. Life events and suicidal ideation and behavior: A systematic review. Clinical Psychology Review. 2014;34(3):181–192. doi: 10.1016/j.cpr.2014.01.006 24534642

37. Barzilay-Levkovitz S, Feldman D, Snir A, Apter A. Self destructive and Self harm behavior in adolescence—an integration of dynamic and empirical psychological models. Adolescent Psychiatry. 2012;2(4):289–295.

38. Fairweather AK, Anstey KJ, Rodgers B, Butterworth P. Factors distinguishing suicide attempters from suicide ideators in a community sample: social issues and physical health problems. Psychological Medicine. 2006;36(9):1235–1245. doi: 10.1017/S0033291706007823 16734946

39. Elbogen EB, Swanson JW, Swartz MS, Van Dorn R. Family representative payeeship and violence risk in severe mental illness. Law and Human Behavior. 2005;29(5):563–574. doi: 10.1007/s10979-005-7120-2 16254743

40. Elbogen EB, Beckham JC, Butterfield MI, Swartz M, Swanson J. Assessing risk of violent behavior among veterans with severe mental illness. Journal of Traumatic Stress. 2008;21(1):113–117. doi: 10.1002/jts.20283 18302172

Článek vyšel v časopise


2019 Číslo 10