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Hopelessness and Suicidal Behavior among Chinese, Thai and Korean College Students and Predictive Effects of the World Health Organization's WHOQOL-BREF

By Kay, Noy; Li, Kaigang et al. | International Electronic Journal of Health Education, Annual 2009 | Go to article overview

Hopelessness and Suicidal Behavior among Chinese, Thai and Korean College Students and Predictive Effects of the World Health Organization's WHOQOL-BREF


Kay, Noy, Li, Kaigang, Xiao, Xia, Nokkaew, Nattiporn, Park, Bock-Hee, International Electronic Journal of Health Education


Introduction

In Western countries, e.g. U.S., suicide is a significant and complex public health issue and has been widely studied among college students (1,2) as well as in other populations. (3,4) The suicide rate among American young people aged 15 to 24 years had nearly tripled in 40 years before the year 1998, whereas the suicide rate of the overall population had remained stable. (5) In 2005, suicide was identified as the third leading cause of death among 12 and 24year-olds. (6) A number of studies have examined the rates of suicide among American college students. For example, Wright, Snodgrass, and Emmons7 found that 5.7% of males and 6.1% of females among 1,768 college participants had seriously thought of a suicide attempt within the last six months. Westefeld and Furr (8) found that out of 962 college students, 81% had experienced depression since beginning college, 32% had thought about committing suicide, and 4% had attempted suicide during their lives.

Based on the National College Health Risk Behavior Survey, Barrios et al. (2) found that during the 12 months prior to the survey, 11% of U.S. students seriously considered suicide, 8% made a suicide plan, and 2% attempted suicide. Although the findings of previous studies on the issue of suicide rates among American college students were not very consistent or accurate due to some difficulties (e.g. no effective record system for suicide incidents, underreporting, or mislabeling suicides to avoid negative publicity), Westefeld et al. (1) claimed that great effort should be made to reduce those rates no matter how low they might be because suicide on college campuses is a "tragedy."

To prevent suicidal behavior, a number of researchers have tried to find out the reasons why college students had attempted suicide. While summarizing the findings of previous studies which have examined univariate relations between specific risk factors and suicide, Lewinsohn et al. (9) proposed a comprehensive and integrated model including clustered four constructs: psychopathology, physical illness, environment, and interpersonal problems. The structural equation modeling (SEM) analysis showed that psychopathology indicated by variables of depression, anxiety, disruptive behavior, etc is the single most influential effect on suicidal behavior. Physical health and environment significantly contributed to suicidal behavior although the effect was relatively small when compared to psychopathology. Interpersonal problems did not have direct effect without the mediation of cognition and coping. However, this study has its limitations. Although the major findings based on this modeling (9) have been affirmed, some studies suggested more variables needed to be examined relative to suicidal behavior among adolescents. For example, hopelessness was found to be more predictive of future suicide attempts than depression (10) and hopelessness was identified to be one of the two most critical factors (i.e. hopelessness and loneliness) playing a role in suicide attempts. (8,11) Furthermore, the model proposed by Lewinsohn et al. (9) was based on adolescents, so the relationship between the constructs and suicidal behavior among college students remained unclear.

With the influence of studies on the suicide issue in Western countries, more and more researchers have paid attention to the suicide issue in Asian countries. (12-14) However, scarce data was found for examination of the suicide related behaviors among college students, although studies focusing on other populations (14-18) were commonly available. Despite the lack of data regarding the suicide rates in Asian countries, the findings of the studies relating to hopelessness in Asian college students indicated that the suicide behavior might be a significant issue among Asian college students as well as among their Western counterparts.

In three school-based Asian samples, i.e. Taiwanese, Philippine and Thai adolescents, it was found that those who attempted suicide had higher scores in hopelessness and loneliness than non-attempters.

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