International Journal of Emergency Mental Health and Human Resilience
Open Access

Globally, every 40 seconds a person dies by suicide. More than 800 000 people die due to suicide every year (WHO, 2014). Over 3000 adolescents die every day (1.2 million) deaths a year, from largely preventable/avoidable causes (WHO, 2018). One of the leading causes of death around the world is suicide in particular it is the third leading cause of death among young adults (Amelia et al., 2010). It is the second leading cause of death among college students (Schwartz, 2016; Dogra et al., 2008). Approximately 60% of suicides occur in the Asian regions (WHO, 2008).

However, there are limited studies and the resources available to prevent the problem (Li et al, 2012). Suicide is among the leading causes of death and, among young people, the leading cause of death in many Asian countries. It is a leading cause of death for adolescents since young people spend the majority of their day at school (Erbacher et al., 2014). Asia is culturally, economically, and socially diverse, but, the research on attitudes towards suicide in Asia is limited (Kristen & Joung, 2014).

South Korea has the highest suicide rate among the OECD nations (Sungwon et al, 2016). Adolescent suicide is a sad phenomenon in all over the social aspects. However, the suicide rate has been increasing every year in South Korea. Korea’s adolescent suicide rate was increased, showing a total of 47%, which is 5th among the OECD nations (NSO, 2013). In Korea, students seem to feel suicide ideation due to diverse reasons such as school tests/exam, low self-esteem and external conflicts such as insecure relationship (Korean Youth Counseling Institute, 2006). Kim (2009) was recommended further research to make clear the role of attitudes in Korea’s suicide problem. Moreover, Westefeld et al. (2005) have found that 24% of college students have thought about attempting suicide. Suicide among college young adult is an issue of great importance, and there is a need to investigate the factors associated with suicidal ideation in young adults.

It is important for researchers to identify cross cultural risks and protective factors that may be predictive of suicide ideation in young adults with regard to protecting young and productive generation of Korea. It is important to examine the role of suicide attitudes in predicting suicide ideation among graduate students in Korea. The extent to which a person believes suicide is an acceptable action, and favorable attitudes toward suicide may increase the actual suicide behavior (Gibb et al., 2006).

Attitudes towards suicide play role in the way people think about suicide have been researched by few scholars (e.g., Domino et al., 2005; Eskin et al., 2015). However, to date cross-cultural studies involving cross cultural attitudes are scarce. Several studies (e.g., Colucci & Martin, 2007; Colucci & David, 2020) have explored cultural factors that may account for suicide rates and impact an individual’s decision to take his or her own life.

Explanations for differences between countries or cultures in their suicide rates, there is much emphasis in the literature on the role of cultural influences in shaping attitudes to suicidal behavior. Justification are often presented in terms of “attitudes”, “social atmosphere”, and so on, but not many studies investigate these attitudes, and only a few assess attitudes in different cultures using similar instruments (Colucci & David, 2020).

For instance, the number of suicidal attempts and suicidal deaths reported is heavily impacted by cultural views which tend to look upon such behavior as shameful, and this has likely resulted in an underestimation of both of these values. Survivors in the family of a suicide victim are often viewed as being psychologically disturbed. Culture throughout history has adopted its own view of suicidal behavior, whereas, some cultures have supported and encouraged such behavior, others have strongly opposed and condemned it. These extreme differences support the notion that suicide is embedded within a cultural context (Colucci & David, 2020).

Yet suicides are preventable. “Preventing suicide: a global imperative” is the first WHO report of its kind. It aims to increase awareness of the public health significance of suicide and suicide attempts, to make suicide prevention a higher priority on the global public health agenda, and to encourage and support countries to develop or strengthen comprehensive suicide prevention strategies in a multi-sectoral public health approach (WHO, 2018).

Suicide is a global phenomenon and occurs throughout the lifespan. Suicide is a global public health concern. Effective and evidence-based interventions can be implemented at population, sub-population and individual levels to prevent suicide and suicide attempts. There are indications that for each adult who died by suicide there may have been more than 20 others attempting suicide (Erbacher et al., 2014).

This current study assessed the current suicidal attitudes, including suicide trends, cultural influences, and risk factors as well as their implications. A number of researchers (Erbacher et al., 2014) have reported that every culture throughout history has adopted its own view of suicidal behavior. Whereas some cultures have supported and encouraged such behavior, others have strongly opposed and condemned it. These extreme differences support the notion that suicide is embedded within a cultural context (Dogra et al., 2008).

Other cultures have also encouraged suicide as an honorable way to die. Chinese and Japanese cultures have at times regarded suicide as honorable, especially within a military context. For the Chinese, defeated generals or overthrown rulers were expected to commit suicide, and the Japanese condoned suicide in the form of hari-kari, in which warriors would die admirably through a long process of self-inflicted disembowelment (Kristen & Joung, 2014).

Suicide can be defined as the termination of one’s own existence by an intentional and deliberate act that works against survival. This type of behavior has become an increasingly important health concern over the past few decades due the drastic increase in its occurrence among young populations (Kandi, 2005). Suicide is a complex, yet preventable public health problem resulting from the interaction of psychological, social, biological, and environmental factors. To address this gap in the literature and to clarify the role of attitudes, the current study assesses attitudes toward suicide among University students in Korea.

The cross-cultural samples were consisted of students from public universities in the capital of Korea. Both Korean and non-Korean students in each university were selected via convenience sampling from 2019 second year graduate students and applied Attitudes toward Suicide (ATTS) instruments. ATTS is widely used to evaluate the views of an individual regarding acceptability of suicide and attitudes towards suicide (Patryk, 2019). The instrument was primarily developed based on university students to measure attitude towards suicide and utilized in various countries.

The ATTS questionnaire was used to collect data and the study participants was rated on a Likert type scale and socio-demographic items. The items of the questionnaire were grouped into eight domains of ATTS suicidal measures for presenting the study data in an understandable way. Finally, Statistical data analyses were conducted using the Statistical Package for Social Sciences (SPSS; version 23), by considering statistical differences and significant values. The scales for the respondents were scored via using the five subscales, and differences in the socio-demographic factors. Lastly, the general linear model univariate were applied to further explore a cross-cultural comparison of the international and Korean graduate students’ attitudes towards suicide in Korea.

The hypothesis that the participants at variance in their attitudes toward suicide, the results indicated statistically significant main effects of participants for the factors: permissiveness [F(1, 451) = 3.73, p<.02, ηp2 = .040], unpredictability [F(1, 347) = 5.04, p<.02, ηp2= .023], non-communication [F(2, 371) = 3.64, p<.05, ηp2 = .019], right to prevent [F(2, 369) = 16.7, p <.01, ηp2= .062], preventability [F(1, 27) = 3.34, p<.04, ηp2= .042], and duration of suicidal process [F(1, 284) = 3.11, p< .04, ηp2 =.024]. However, the results of the ANOVAs revealed that the groups did not significantly differ for incomprehensibility [F (1, 28) = .16, p>.04, ηp2 = .02] and relation-caused [F(1, 130) = 1.32, p>.04, ηp2 =.06]. The present study has confirmed the sex was not significant for any of the domains except for right to prevent [F (1, 284) = 08.3, p<.02, ηp2 = .032]. The interaction of group and gender was not significant for any of the attitudes toward suicide. The results of the ANOVAs are summarized in Table 1.

Table 1: Means and standard deviations of the participants’ attitude toward suicide

Moreover, the comparisons were used to further examine the factors for which the Foreign and Koreans had a significant main effect. The permissive attitudes, Korean participants had a significantly higher mean than Non-Korean participants, p=.04 for unpredictability. The results of non-communication Korean participants had a significantly higher mean Non-Korean students had than p< .001. Non-Korean students had a significantly higher mean than Korean students, i.e. p< .001 for right to prevent. The results of preventability, Korean students in Korea had a significantly lower mean on preventability than Non-Korean students in Korea, p= .03. Lastly, Korean students had a significantly higher mean than non-Korean students in Korea, p=.029 for duration of suicidal process.

The study indicates important issues and the current suicidal attitudes, including suicide trends, cultural influences, and risk factors as well as their implications among Koreans and non-Koreans students in Korea. The results of this study have a number of practical research basis and implications which able to contribute new evidences to fill gaps.

The present study has confirmed the prevalence of, suicidal attitudes and behaviors of, suicide attempt history and psychological distress association with suicidality among students is needed to fully understand and establish a greater degree of accuracy on this matter. Around 40% of students may plans and 20% may attempt suicide during college found that college students are at high risk of suicidal ideation (Geumsook and Bumseok, 2018). A history of psychopathology and mental disorders are among the major risk factors of suicide in college students.

The social and college-related factors are unique to students and exemplified as a “transition” period in their life in terms of academic, psychological, and social issues. This transition may aggravate existing psychosocial complicatedness which may lead to suicide. The study focused on the interpretation of the characteristics of attitudes towards suicide with suicidal beliefs, risk factors, and suicide attempts among graduate students in the country. In recent studies, it has been shown that the students felt suicide ideation and going through initial suicide attempts without telling their parents, friends, or anyone else about how they felt (Zong, 2015; Kim and Park, 2014). Even some students didn't know what they exactly felt and easily became felt helpless and lost their lives, and suicide was one of the major causes of adolescents’ mortality in Korea for the last two decades. They consider that no one would understand or share their feelings.

A wider viewpoint has been adopted stressful situations and other personal attitudes towards self-such as meaning in life, reasons for living, etc. mainly contribute to students’ suicide (Dogra et al., 2008). Similarly, suicide-related thinking and attempts are stigmatized and that societal attitudes toward suicidal behavior in common considered a serious mental illness and decreased help-seeking behavior. Look at the adolescents’ attitudes, societal perceptions of suicide ideation and experiences of suicide attempts are significant to save the students from committing suicide.

On the other vein, Khang et al. (2010) argue that suicidal beliefs, attitudes, and decisions are invisible, only its action is visible to others; prevention activities need to be more focused on invisible variables such as attitudes, perceptions, etc. Suicide has become a serious socioeconomic and mental health problem in Korea, however, little is known about the risk of university students’ suicidal thoughts and attempts, and the role of attitudes to-wards suicide.

The most common factors for suicide attempts in the studies were stress about academic achievements, family problems, relationship concerns, financial concerns, hopelessness, anxiety, and depression. However, yet, it is unknown, whether university students are at raised risk compared with same-aged peers out of university due to limited research reports in South Korea. Students’ thinking of suicide at individual and general levels influences the suicidal behavior of oneself and other students on a specific campus. There remain several aspects of dating and relation-ship issues about which relatively little is unknown. Therefore, to reduce suicidal risks in future Korea, the Government and stakeholders’ should go beyond symptoms and effects, one of the most profound problems that need to be ad-dressed is societal beliefs and the role of individual attitudes towards suicide.

The current study assessed the various hot issues and examined recent studies and explored the cross-cultural attitudes towards suicide and attempts among the international and domestic graduate students in Korea. It suggested future directions for empirical study themes and suicide prevention programs. A variety of studies indicated that attitudes ultimately influence suicidal ideation and dictates subsequent action. The findings show that societal beliefs, values, and perceptions also play an important role, these should be given due significance in moderating suicide.

Nevertheless, the risk factors associated with suicide ideation and attitudes have not been studied in broader at university contexts in Korea. In fact, suicide is such a multifaceted incident that it needs to be approached contextually and from various perspectives. The present results highlight various dimensions of individual behavior, socio-cultural problem, and a mental disorder that requires broader interventions.

In general, the study strengthens the fact that there are limited studies on the role of attitudes toward suicide among University students. Further research is needed to better understand suicidal ideation, past attempts, and exposure to suicide. The findings of this study have a number of important implications for future practice and research. In the future, it will be important to explore permissive attitudes mainly related to the high suicide attempts and mental health problems and suicidal disorder.

The Korean Foundation Fellowship for Field Research

The Korean Foundation Fellowship for Field Research

The author declares that this manuscript is original, has not been funded, has not been published before elsewhere, and considered all the required ethical standards.

The authors declare that they have no competing interests.

This research paper was supported by the Korea Foundation Fellowship for Field Research fund.