Income Linked to Suicide and Depression

Summary
The economic recession in the late 1990s was seen to have increased disparities in healthcare, in conjunction with divisions in income and social conditions in South Korea. A study was carried out to view the extent to which income inequality could influence the incidence of depression, suicidal tendency and attempted suicide. Over a 10-year period, the rate was observed to have doubled. The general trend was in favor of the high-income groups that recorded a lower rate of occurrences. It seems that better social services for the underprivileged are imperative.

Introduction
The late 1990s saw an economic crisis in South Korea that led to increased polarization of society and the widening of income inequality. The period that followed this in South Korea was marked by increased suicidal tendancies, a large number of people trying to commit suicide as well as the prevalence of depression. Most of these cases were from economically disparate groups, suggesting that the lesser the income the worse one’s mental health condition. Reported rates of suicide went up from 13 to 26 percent, while prevalence of depression increased from 3.1 to 5.6 percent between 2001 and 2006. Numerous other factors like education, environment and employment might have also contributed to the deterioration of mental health.

Methodology
* The Korea National Health and Nutrition Examination Survey (KHANES) provided information on the economic and health status of non-institutionalized civilians between 1998 and 2007.
* Additionally, other disorders, habits like smoking and drinking, health costs, self-reported events of depression, suicide attempts and suicides were noted.
* Age and gender adjustments were done to standardize the data.
* The illnesses and events were correlated with income status to know the intensity of the impact.

Results
* The risk of developing mental health issues such as depression and having suicidal tendencies was found to be greater in the lower income groups.
* These mental health events doubled at the end of the 10-year study period, although they presented different trends.
* Inequality in income remains the strongest cause for weaker mental health; specifically, depression and suicidal inclinations.

Shortcomings
The reliability and validity of the measures used in this survey were questionable.  The use of a cross-sectional survey design is also not considered useful in studies dealing with health inequalities; however, the data did provide “some early evidence in an area where there is currently no good source of” a mental health panel in South Korea. The self-reported data, which is often subject to bias, could have been modified due to fear of social stigma towards mental health. Only doctor-diagnosed depression subjects were included in the analysis; and since subjects from lower income groups might not visit physicians for this purpose, they might have been underrepresented.

Conclusion
The increasing rates of events of suicides and attempted suicides, and the drop in overall mental health conditions in South Korea in the late 1990s prompted this study. The researchers tried to map several contributing factors including environment and education, to analyze if these could lead to such unfortunate events. However, it was concluded that the major contributing factor to this trend was income. The impact of this inequality in income was more profound in mental health than general health. There is a need to strengthen South Korean government policies to help secure mental health and safety for the affected population.

For More Information:
Income-Related Inequalities in the Prevalence of Depression and Suicidal Behavior: A 10-Year Trend Following Economic Crisis
Publication Journal: World Psychiatry, February 2011
By Jihyung Hong; Martin Knapp; London School of Economics,  London, UK, and King’s College London, Institute of Psychiatry, London, England

*FYI Living Lab Reports Are Summaries of the Original Research.
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