Our study sought to elucidate the complex relationship between employment status and suicidal ideation, a concern of considerable societal and public health significance. The findings showed that unemployment is associated with a 1.85 times higher risk of suicidal ideation than the employed. The associations of covariates with suicidal ideation were also found to be pronounced across specific sociodemographic, health behavioral, and mental health factors.
This was consistent with the findings of an American study by Kposowa et al. (2019), indicating that unemployment was significantly associated with suicidal ideation. Employment status is a means of securing economic power, which is a resource that can satisfy various needs. Kposowa et al. also found that employed persons have a higher quality of life than the unemployed. It can be interpreted that suicidal ideation increases when individual needs are not satisfied by their employment status. Therefore, various types of support should be provided to prevent suicidal ideation by identifying its specific causes among the unemployed.
We showed that suicidal ideation is a complex element associated with a variety of factors, including sociodemographic, health behavior, and mental health factors. Consistent with the findings of Liu et al. (2017) that educational attainment is associated with suicidal ideation, our results indicated that low educational attainment (high school or below) had a 2.12 times higher likelihood of suicidal ideation than high educational attainment. This could be explained by lower education levels leading to income inequality, which, in turn, can lead to suicidal ideation. Furthermore, the study showed that low income groups were 1.61 times more likely to have suicidal ideation. To reiterate, lower education levels can lead to financial difficulties, poorer quality of life, and health inequality, all of which can lead to suicidal ideation [26, 27]. Given that subjective health conditions can affect quality of life and well-being, they are also an influential factor in suicidal ideation; according to the results, poor subjective health condition was 1.79 times more likely to be related to suicidal ideation than good subjective health condition. Similarly, mental health is also related to suicidal ideation, as confirmed by Arri et al. (2009). Among mental health factors, our study found that stress recognition was 3.06 times more likely to cause suicidal ideation, while depression was 13.0 times more likely to cause it. Previous research has noted the important effects of mental health on suicidal ideation [1, 15]. Therefore, suicide prevention should consider factors regarding individuals’ unemployed status, low education and income, poor subjective health condition, and the presence of stress and depression.
The subgroup analysis presented the combined effects of employment status and individual covariates on suicidal ideation. Except the categories of women, no alcohol use, and underweight, all other covariates showed significant association with suicidal ideation when unemployed. In comparing the ORs, men, aged between 40 and 50 years, currently smoking, obese, and with stress recognition showed higher likelihood for suicidal ideation. These findings are in line with Kposowa et al. (2019) work noting that middle-aged people had a high association with suicidal ideation. This can be highly related with external conditions such as financial imbalance and interpersonal relationships [28], both of which can be negatively affected by unemployment. Moreover, middle-aged individuals are likely to have considerable responsibilities as the center of the family economy, such as supporting children’s education and retirement preparation. Under these circumstances, any unemployment environment threatening the family economy might increase their possibility of suicidal ideation.
Dutton et al. (2013) explored the association between obesity and suicidal ideation. Obesity can be said to be a secondary cause of suicidal ideation, rather than a primary cause [30]. Obesity increases the risks of chronic disease experience, depression due to physical dissatisfaction, and the burden on others, all of which can lead to suicidal ideation [29, 30]. Obesity is a factor closely associated with metabolic syndrome [31] and financial support is needed to treat any such illnesses. Unstable financial circumstances due to unemployment can hence lead to potential suicidal ideation. The association between smoking and suicidal ideation has already been investigated in many studies [32, 33].
Our study has several strengths. First, the study is composed of a nationally representative sample data, and it will help to indicate future directions for unemployment welfare in Korea. Second, this study combined various sociodemographic, health behavior, and mental health factors to show whether employment status was associated with suicidal ideation when controlling those covariates. As suicide is a complex factor associated with a variety of components, it is important to appropriately synthesize such factors to comprehensively interpret suicidal ideation. However, this study also has several limitations. Although the association between employment status and suicidal ideation is shown in this cross-sectional study, the causal association cannot be confirmed. In addition, because the institutionalized population was excluded, severe psychological symptoms related with suicidal ideation might not have been addressed adequately. Moreover, even if participants are categorized in the same employment status, there can be differences in the mental state of workers depending on factors such as their occupation, working environment, and social position. Subsequent research should consider a more detailed approach, incorporating a detailed examination of the nature and characteristics of individual occupations.
This study showed the association between employment status and suicidal ideation using the 2015, 2017, and 2019 KNHANES data. While unemployment is associated with suicidal ideation, it is also affirmed that suicidal ideation is not caused by a single cause, but by various causes, including sociodemographic, health behavior, and mental health factors. Therefore, the study underscores the importance of a comprehensive understanding of the interplay between employment status and suicidal ideation. In light of these findings, it becomes imperative to devise comprehensive supportive measures, encompassing both policy interventions and varied forms of assistance, aimed at preventing suicidal ideation among unemployed individuals.