kjhp Korean Journal of Health Promotion Korean J Health Promot 2234-2141 2093-5676 The Korean Society of Health Promotion and Disease Prevention 10.15384/kjhp.2016.16.3.162 kjhp-16-162 Original Article The Factor Associated with Suicide Risk of High School Students Using the Adolescent Mental Health and Problem Behavior Screening Questionnaire-II OhHwa-Jin LeeKeun-Mi JungSeung-Pil Department of Family Medicine, Yeungnam University College of Medicine, Daegu, Korea Corresponding author: Keun-Mi Lee, MD, PhD Department of Family Medicine, Yeungnam University College of Medicine, 170 Hyeonchung-ro, Nam-gu, Daegu 42415, Korea Tel: +82-53-620-3541, Fax: +82-53-654-2413 E-mail: kmlee@yu.ac.kr 01 2016 20 01 2016 16 3 162 173 25092015 24082016 Copyright © 2016 The Korean Society of Health Promotion and Disease Prevention 2016 This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. Background

The rate of suicide of adolescents is recently significantly increasing in South Korea. Suicide is the first leading cause of death of adolescents aged 15 to 19 years in South Korea and the mortality rate due to suicide of adolescents is 8.9 per 100,000. The aims of this study is to investigate factors that affect suicidal ideation through inventory and scale.

 Methods

A questionnaire was conducted to 820 high school students in a city, and 776 subjects who finished questionare were included in this study. Suicidal ideation, school bullying, excessive sexual thought and family conflict were checked by adolescent mental health and problem behavior screening questionnaire-II (AMPQ-II). Internet addiction degrees and depression was evaluated by internet addiction scale (IAS) and Beck's depression inventory (BDI), respectively.

 Results

AMPQ-II, IAS, BDI, school bullying, suicidal ideation, and family conflict were closely related to each other. Binary logistic analysis showed that victims of school bullying (odds ratio [OR], 2.3; 95% confidence Interval [CI], 1.439–3.816), AMPQ-II high risk (OR 4.9; CI 2.546–9.433) and depression of all grade (OR 1.8 [mild], 2.2 [moderate], 6.4 [severe]) were related to suicidal ideation.

 Conclusions

Presence of school bullying, depression, and AMPQ-II high risk were closely related to suicidal ideation of high school students. Thus, AMPQ-II and BDI score can use as a screening tool for adolescent suicide ideation.

 Adolescent behaviors Depression Suicide Suicidal ideation Family conflict References Korea National Statistical Office 2011 Annual report on the cause of death statics [Internet] Daejeon Korea National Statistical Office 2012 [Accessed September 9, 2016]. Available fro m: http://kosis.kr/nsportalStats/nsportalStats_0102Body.jsp? menuId=6&NUM=247. Korea Institute for Health and Social Affairs OECD Health Data 2012 [Internet] Sejong Korea Institute for Health and Social Affairs 2013 [Accessed September 9, 2016]. Available from: http://www.oecd.org/korea OECD OECD Family Database [Internet] Paris OECD 2015 [Accessed September 9, 2016]. Available from: http://www.oecd.org/els/family/database.htm Choi HI Jon DI Jung MH Hong N Kim JJ Song JE Suicidal behavior and internet use in adolescent depression Korean J Psychopharmacol 201223 2 6573 Jeon HJ Bae J Woo JM Recent statistics and risk factors of suicide in children and adolescents J Korean Med Assoc 201356 2 939 Renaud J Berlim MT McGirr A Tousignant M Turecki G Current psychiatric morbidity, aggression/impulsivity, and personality dimensions in child and adolescent suicide: a case-control study J affect Disord 2008105 1–3 2218 Ra HJ Park GS Do HJ Choi JK Joe HG Kweon HJ Factors influencing the impulse of suicide in adolescence J Korean Acad Fam Med 200627 12 98897 World health organization western pacific region The asia-pacific perspective; redefining obesity and its treatment [Internet] Philippines World health organization western pacific region 2000 [Accessed September 9, 2016]. Available from: http://www.wpro.who.int/nutrition/documents/docs/Redefiningobesity.pdf Jung SA Ahn DH Chung SY Jeong YG Kim YY Development of screening test for adolescent mental health and problem behavior J Korean Neuropsychiatr Assoc 200847 2 16876 Bhang SY Yoo HK Kim JH Kim B Lee YS Ahn D Victims of bullying among Korean adolescents: prevalence and association with psychopathology evaluated using the adolescent mental health and problem behavior screening questionnaire-II standardization study data J Korean Acad Child Adolesc Psychiatry 201223 1 2330 Bhang SY Yoo HK Kim JH Kim B Bahn GH Ahn D Revision of adolescent mental health and problem behavior screening questionnaire: devolpment of adolescent mental health and problem behavior screening questionnaire-II J Korean Acad Child Adolesc Psychiatry 201122 4 27186 Young KS Internet addiction: The emergence of a new clinical disorder Cyberpsychol Behav 19961 3 23749 Hahn HM Yum TH Shin YW Kim KH Yoon DJ Chung KJ A standardization study of beck depression inventory in Korea J Korean Neuropsychiatr Assoc 198625 487500 Beck AT Depression: clinical, experimental, and theoretical aspects 1st ed. New York Hoeber Medical Division, Harper & Row 1967 Park HJ Kim HN Kim IB Jeon SA Reliability of the beck depression inventory in adolescence J Korean Acad Fam Med 200021 2 24453 Center for Disease Control & Prevention Mental health status among Korean adolescents: The results of Korea youth risk behavior web-based survey, 2005–2008. [Internet] Cheongju Center for Disease Control & Prevention 2012 [Accessed September 9, 2016]. Available from: http://cdc.go.kr/CDC/info/CdcKrIn fo0301.jsp?menuIds=HOME001-MNU1154-MNU0005-MNU 0037-MNU1380&cid=12455. Kim G Ahn J Ha K Lee CH Woo JM Lee JK National evidencebased collaborating agency (NECA) round-table conference consensus statement: multidisciplinary responses to suicide, the first ranked cause of death in adolescents J Korean Med Assoc 201356 2 1119 Foundation for Preventing Youth Violence 2011 National Survey Report on School Violence in Korea [Internet] Reston Foundation for Preventing Youth Violence 2011 [Accessed September 9, 2016]. Available from: http://blog.naver.com/bakbht/127377763 Kim YS Leventhal BL Koh YJ Boyce WT Bullying increased suicide risk: prospective study of Korean adolescents Arch Suicide Res 200913 1 1530 Luukkonen AH Räsänen P Hakko H Riala K STUDY-70 Workgroup Bullying behavior is related to suicide attempts but not to self-mutilation among psychiatric inpatient adolescents Psychopathology 200942 2 1318 Kwon M Kim DJ Internet addiction and suicide J Korean Med Assoc 201255 4 33540 Lee TH Lee YJ Prevalence and related risk factors of suicidal ideation in urban adolescents Sleep Med Psychophysiol 201421 2 618 Cho SJ Jeon HJ Kim JK Suh TW Kim SU Hahm BJ Prevalence of suicide behaviors (suicidal ideation and suicide attempts) and risk factors of suicide attempts in junior and high school adolescents J Korean Neuropsychiatr Assoc 200241 6 114255 Kim GM Kim JW Kim JH Current state of research on youth depression and suicide prevention J Korean Med Assoc 201255 4 35661 Tables

General characteristics of study subjects

Characteristics Total (n=776) Characteristics Total (n=776)
N % N %
Gender     Communication of family    
Boys 315 40.6 Well 369 47.6
Girls 461 59.4 Ordinary 368 47.4
School, Location     Rare 39 5.0
A, Jung-gu 225 29.0 Rank in class    
B, Suseong-gu 278 35.8 Best (≦5th) 79 10.2
C, Dalseo-gu 273 35.2 Good (6–10th) 120 15.5
Grade     Mediocre (11–20th) 359 46.3
1st 293 37.8 Lack (≧21th) 218 28.1
2nd 483 62.2 Parent marital status    
BMI     Living together 665 85.7
Underweight 184 23.7 Separation or Divorced 83 10.7
Normal 434 55.9 Death (one or both) 28 3.6
Overweight 73 9.4      
Obese 85 11.0 Allowance, per week    
Religion     <10,000 Won 263 33.9
None 446 57.5 10,000–19,999 Won 374 48.2
Buddhist 134 17.3 20,000–29,999 Won 78 10.1
Catholic 56 7.2 ≧30,000 Won 61 7.9
Protestant 136 17.5 Current stress factora    
Other 4 0.5 Record and university 622 80.2
Siblings     Friendship problem 118 15.2
1 74 9.5 Family conflict 72 9.3
2 566 72.9 Worry about future 442 57.0
3 126 16.2 Health problem 61 7.9
≧4 10 1.3 Opposite sex problem 57 7.3
Order of birth     Look or diet 18 2.3
1st 397 51.2 Economic problem 6 0.8
2nd 336 43.3 Others 8 1.0
3rd 41 5.3 No stress 6 0.8
≧4th 2 0.3 Alcohol use    
Residence place     No 674 86.9
Dalseo-gu 239 30.8 Yes 102 13.1
Suseong-gu, Dong-gu 366 47.2 Smoking    
Jung-gu, Nam-gu 109 14.0 Non-smoker 714 92.0
Seo-gu, Buk-gu 24 3.1 Current smoker 62 8.0
Gyeongsangbuk-do 38 4.9      

Abbreviation: BMI, body mass index.

Available for multiple answers.

Difference of each scale according to risk of AMPQ-II

  Total Low risk (<cut-offa) (n=703) High risk (≧cut-off) (n=73) P
  N % N % N %
BDI scoreb 9.19±7.77 8.12±6.48 19.44±11.09 <0.001c
BDI group             <0.001d
No depression 474   61.1 459 65.3 15 20.5
Mild depression 159   20.5 153 21.8 6 8.2
Moderate depression 103   13.3 76 10.8 27 37.0
Severe depression 40   5.2 15 2.1 25 34.2
IAS scoreb 37.21±14.03 36.02±12.88 48.64±18.84 <0.001c
IAS group             <0.001d
Non addiction 478   61.6 451 64.2 27 37.0
Possible addiction 281   36.2 244 34.7 37 50.7
Addicted 17   2.2 8 1.1 9 12.3
AMPQ-II scoreb 15.99±10.78 13.48±7.19 40.12±9.77 <0.001c
Suicidal ideation             <0.001d
No 665   85.7 635 90.3 30 41.1
Yes 111   14.3 68 9.7 43 58.9
Excessive sexual thoughtb 0.49±1.01 0.38±0.85 1.51±1.67 <0.001c
No 581 74.9 550 78.2 31 42.5 <0.001d
Yes 195   25.1 153 21.8 42 57.5
Family conflict             <0.001d
No 484   62.4 457 65.0 27 37.0
Yes 292   37.6 246 35.0 46 63.0
AMPQ-II factor 1b 4.53±3.74 3.83±2.94 11.25±4.01 <0.001c
AMPQ-II factor 2b 4.55±3.76 3.80±2.83 11.75±3.94 <0.001c
AMPQ-II factor 3b 3.56±2.30 3.19±1.90 7.14±2.70 <0.001c
AMPQ-II factor 4b 0.52±1.08 0.38±0.82 1.93±1.96 <0.001c
Non-victim 561 72.3 541 77.0 20 27.4 <0.001c
Victim 215 27.7 162 23.0 53 72.6  
AMPQ-II Factor 5b 0.41±1.08 0.28±0.72 1.74±2.36 <0.001c

Abbreviations: AMPQ-II, adolescent mental heath and problem behavior screening questionnaire-II; IAS, internet addiction scale; BDI, Beck's depression inventory.

Cut-off score: 32 (boy), 30 (girl).

Data are presented as mean±SD.

Calculated by t-test.

Calculated by chi-square test.

Difference of each scale according to internet addiction

  Total Non-addiction 20–39 (n=478) Possible addiction 40–69 (n=281) Addicted ≧70 (n=17) P
  N % N % N % N %
AMPQ-II scorea 15.99±10.78 13.58±9.17 18.91±11.18 35.35±14.56 <0.001b
AMPQ-II group                 <0.001c
Low risk 703 90.6 451 94.4 244 86.8 8 47.1  
High risk 73 9.4 27 5.6 37 13.2 9 52.9  
Suicidal ideation                 0.002c
No 665 85.7 419 87.7 236 84.0 10 58.8  
Yes 111 14.3 59 12.3 45 16.0 7 41.2  
Excessive sexual thoughta 0.49±1.01 0.33±0.81 0.67±1.10 2.00±2.29 <0.001b
No 581 74.9 388 81.2 185 65.8 8 47.1  
Yes 195 25.1 90 18.8 96 34.2 9 52.9  
Family conflict                 0.002c
No 484 62.4 320 66.9 157 55.9 7 41.2  
Yes 292 37.6 158 33.1 124 44.1 10 58.8  
AMPQ-II factor 1a 4.53±3.74 3.71±3.12 5.55±3.96 10.76±5.84 <0.001b
AMPQ-II factor 2a 4.55±3.76 4.15±3.54 4.94±3.79 9.18±5.40 <0.001b
AMPQ-II factor 3a 3.56±2.30 2.91±1.96 4.45±2.24 7.35±3.30 <0.001b
AMPQ-II factor 4a 0.52±1.08 0.41±0.91 0.70±1.29 0.88±1.17 0.001b
Non-victim 561 72.3 370 77.4 183 65.1 8 47.1 <0.001c
Victim 215 27.7 108 22.6 98 34.9 9 52.9  
AMPQ-II factor 5a 0.41±1.08 0.37±1.00 0.47±1.20 0.65±1.12 0.324b
BDI scorea 9.19±7.77 8.13±7.11 10.36±8.10 19.47±9.79 <0.001b
BDI group                 <0.001c
No depression 474 61.1 327 68.4 144 51.2 3 17.6  
Mild depression 159 20.5 82 17.2 74 26.3 3 17.6  
Moderate depression 103 13.3 51 10.7 46 16.4 6 35.3  
Severe depression 40 5.2 18 3.8 17 6.0 5 29.4  

Abbreviations: AMPQ-II, adolescent mental heath and problem behavior screening questionnaire-II; IAS, internet addiction scale; BDI, Beck's depression inventory.

Data are presented as mean±SD.

Calculated by One-way ANOVA.

Calculated by chi-square test.

Difference of each scale according to severity of depression

  Total No depression Mild depression Moderate depression S Severe depression P
  (n=474) (n=159) depression (n=103) (n=40)
  N % N % N % N % N %
AMPQ-II scorea 15.99±10.78 12.01±8.15 17.39±7.14 24.65±11.37 35.20±13.52 <0.001b
AMPQ-II group                     <0.001c
Low risk 703 90.6 459 96.8 153 96.2 76 73.8 15 37.5  
High risk 73 9.4 15 3.2 6 3.8 27 26.2 25 62.5  
Suicidal ideation                     <0.001c
No 665 85.7 438 92.4 136 85.5 76 73.8 15 37.5  
Yes 111 14.3 36 7.6 23 14.5 27 26.2 25 62.5  
Excessive sexual thoughta 0.49±1.01 0.43±0.99 0.44±0.82 0.63±1.23 1.00±1.24 0.002b
No 581 74.9 374 78.9 116 73.0 70 68.0 21 52.5 0.001c
Yes 195 25.1 100 21.1 43 27.0 33 32.0 19 47.5  
Family conflict                     <0.001c
No 484 62.4 330 69.6 94 59.1 47 45.6 13 32.5  
Yes 292 37.6 144 30.4 65 40.9 56 54.4 27 67.5  
AMPQ-II factor 1a 4.53±3.74 3.19±2.84 5.30±3.13 7.20±3.78 10.43±4.95 <0.001b
AMPQ-II factor 2a 4.55±3.76 3.24±2.73 5.00±3.12 7.49±3.80 10.70±5.41 <0.001b
AMPQ-II factor 3a 3.56±2.30 3.04±2.04 3.61±1.72 4.88±2.54 6.18±3.25 <0.001b
AMPQ-II factor 4a 0.52±1.08 0.35±0.80 0.62±1.19 0.87±1.43 1.35±1.70 <0.001b
Non-victim 561 72.3 374 78.9 109 68.6 61 59.2 17 42.5 <0.001c
Victim 215 27.7 100 21.1 50 31.4 42 40.8 23 57.5  
AMPQ-II factor 5a 0.41±1.08 0.35±1.03 0.33±0.81 0.59±1.26 1.00±1.73 0.001b
IAS scorea 37.21±14.03 34.75±12.28 39.86±13.91 41.37±16.27 45.10±19.86 <0.001b
IAS group                     <0.001d
Non addiction 478 61.6 327 69.0 82 51.6 51 49.5 18 45.0  
Possible addiction 281 36.2 144 30.4 74 46.5 46 44.7 17 42.5  
Addicted 17 2.2 3 0.6 3 1.9 6 5.8 5 12.5  

Abbreviations: AMPQ-II, adolescent mental heath and problem behavior screening questionnaire-II; IAS, internet addiction scale; BDI, Beck's depression inventory.

Data are presented as mean±SD.

Calculated by One-way ANOVA.

Calculated by chi-square test.

Calculated by Fisher's exact tests.

Difference of each scale according to school bullying

  Total (n=776) Non-victim (school bullying) (n=561) Victim (school bullying) (n=215) P
  N % N % N %
BDI scorea 9.19±7.77 8.19±6.94 11.80±9.12 <0.001b
BDI group             <0.001c
No depression Mild depression 474 159 61.1 20.5 374 109 66.7 19.4 100 50 46.5 23.3  
Moderate depression 103 13.3 61 10.9 42 19.5  
Severe depression 40 5.2 17 3.0 23 10.7  
IAS scorea 37.21±14.03 35.59±13.13 41.44±15.39 <0.001b
IAS group             <0.001c
Non addiction 478 61.6 370 66.0 108 50.2  
Possible addiction 281 36.2 183 32.6 98 45.6  
Addicted 17 2.2 8 1.4 9 4.2  
AMPQ-II scorea 15.99±10.78 12.96±8.30 23.89±12.41 <0.001b
AMPQ-II group             <0.001c
Low risk 703 90.6 541 96.4 162 75.3  
High risk 73 9.4 20 3.6 53 24.7  
Sucidal ideation             <0.001c
No 665 85.7 512 91.3 153 71.2  
Yes 111 14.3 49 8.7 62 28.8  
Excessive sexual thoughta 0.49±1.01 0.35±0.87 0.84±1.25 <0.001b
No 581 74.9 454 80.9 127 59.1 <0.001c
Yes 195 25.1 107 19.1 88 40.9  
Family conflict             0.001c
No 484 62.4 370 66.0 114 53.0  
Yes 292 37.6 191 34.0 101 47.0  
AMPQ-II factor 1a 4.53±3.74 3.73±3.13 6.60±4.37 <0.001b
AMPQ-II factor 2a 4.55±3.76 3.83±3.22 6.43±4.37 <0.001b
AMPQ-II factor 3a 3.56±2.30 3.10±2.02 4.78±2.52 <0.001b
AMPQ-II factor 5a 0.41±1.08 0.32±0.95 0.66±1.32 0.001b

Abbreviations: AMPQ-II, adolescent mental heath and problem behavior screening questionnaire-II; IAS, internet addiction scale; BDI, Beck's depression inventory.

Data are presented as mean±SD.

Calculated by t-test.

Calculated by chi-square test.

Difference of each scale according to suicidal ideation

  Total (n=776) No (n=665) Yes (n=111) P
  N % N % N %
BDI scorea 9.19±7.77 8.03±6.40 16.14±11.00 <0.001b
BDI group             <0.001c
No depression 474 61.1 438 65.9 36 32.4  
Mild depression 159 20.5 136 20.5 23 20.7  
Moderate depression 103 13.3 76 11.4 27 24.3  
Severe depression 40 5.2 15 2.3 25 22.5  
IAS scorea 37.21±14.03 36.45±13.28 41.73±17.27 0.003b
IAS group             0.002c
Non addiction 478 61.6 419 63.0 59 53.2  
Possible addiction 281 36.2 236 35.5 45 40.5  
Addicted 17 2.2 10 1.5 7 6.3  
AMPQ-II scorea 15.99±10.78 13.91±8.55 28.41±14.00 <0.001b
AMPQ-II group             <0.001c
Low risk 703 90.6 635 95.5 68 61.3  
High risk 73 9.4 30 4.5 43 38.7  
Family conflict             <0.001c
No 484 62.4 434 65.3 50 45.0  
Yes 292 37.6 231 34.7 61 55.0  
Excessive sexual thoughta 0.49±1.01 0.41±0.92 0.95±1.36 <0.001b
No 581 74.9 517 77.7 64 57.7 <0.001c
Yes 195 25.1 148 22.3 47 42.3  
AMPQ-II factor 1a 4.53±3.74 3.95±3.29 7.97±4.41 <0.001b
AMPQ-II factor 2a 4.55±3.76 3.80±2.98 8.99±4.75 <0.001b
AMPQ-II factor 3a 3.56±2.30 3.34±2.12 4.91±2.83 <0.001b
AMPQ-II factor 4a 0.52±1.08 0.40±0.91 1.29±1.60 <0.001b
Non-victim 561 72.3 512 77.0 49 44.1 <0.001c
Victim 215 27.7 153 23.0 62 55.9  
AMPQ-II factor 5a 0.41±1.08 0.31±0.88 1.05±1.73 <0.001b

Abbreviations: AMPQ-II, adolescent mental heath and problem behavior screening questionnaire-II; IAS, internet addiction scale; BDI, Beck's depression inventory.

Data are presented as mean±SD.

Calculated by t-test.

Calculated by chi-square test.

Odds ratio of suicidal ideation in poor communication, school bullying, family conflict, AMPQ-II high risk, internet addiction and depression

  Coefficient (β) P OR 95% CI
Communication          
Well     1    
Ordinary 0.280 0.278 1.324 0.797 2.198
Rare 0.286 0.575 1.331 0.489 3.622
School bullying          
Non-victim     1    
Victim 0.852 0.001 2.344 1.439 3.816
Family conflict          
No     1    
Yes 0.279 0.259 1.322 0.814 2.148
AMPQ-II group          
Low risk     1    
High risk 1.589 <0.001 4.900 2.546 9.433
IAS group          
Non-addiction     1    
Possible addiction –0.193 0.443 0.825 0.504 1.349
Addicted 0.000 0.999 0.999 0.301 3.320
BDI group          
No depression     1    
Mild 0.604 0.045 1.829 1.014 3.297
Moderate 0.793 0.015 2.210 1.169 4.176
Severe 1.852 <0.001 6.374 2.687 15.121

Abbreviations: AMPQ-II, adolescent mental heath and problem behavior screening questionnaire-II; OR, odds ratios; CI, confidence interval; IAS, internet addiction scale; BDI, Beck's depression inventory. Calculated by Binary logistic regression analysis.