The Factor Associated with Suicide Risk of High School Students Using the Adolescent Mental Health and Problem Behavior Screening Questionnaire-II

Hwa-Jin Oh; Keun-Mi Lee; Seung-Pil Jung

doi:10.15384/kjhp.2016.16.3.162

Korean J Health Promot > Volume 16(3); 2016 > Article

Oh, Lee, and Jung: The Factor Associated with Suicide Risk of High School Students Using the Adolescent Mental Health and Problem Behavior Screening Questionnaire-II

Original Article

Korean Journal of Health Promotion 2016;16(3):162-173.

Published online: January 20, 2016

DOI: https://doi.org/10.15384/kjhp.2016.16.3.162

The Factor Associated with Suicide Risk of High School Students Using the Adolescent Mental Health and Problem Behavior Screening Questionnaire-II

Department of Family Medicine, Yeungnam University College of Medicine, Daegu, Korea

Hwa-Jin Oh, Keun-Mi Lee, Seung-Pil Jung

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

Received September 25, 2015 Accepted August 24, 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.

요약

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.

Keywords: Adolescent behaviors, Depression, Suicide, Suicidal ideation, Family conflict

Table 1.

General characteristics of study subjects

Characteristics	Total (n=776)		Characteristics	Total (n=776)
Characteristics	N	%	Characteristics	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 factor^a
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.

^aAvailable for multiple answers.

Table 2.

Difference of each scale according to risk of AMPQ-II

	Total		Low risk (<cut-off^a) (n=703)		High risk (≧cut-off) (n=73)		P
	N	%	N	%	N	%	P
BDI score^b	9.19±7.77		8.12±6.48		19.44±11.09		<0.001^c
BDI group							<0.001^d
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 score^b	37.21±14.03		36.02±12.88		48.64±18.84		<0.001^c
IAS group							<0.001^d
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 score^b	15.99±10.78		13.48±7.19		40.12±9.77		<0.001^c
Suicidal ideation							<0.001^d
No	665		85.7	635	90.3	30	41.1
Yes	111		14.3	68	9.7	43	58.9
Excessive sexual thought^b	0.49±1.01		0.38±0.85		1.51±1.67		<0.001^c
No	581	74.9	550	78.2	31	42.5	<0.001^d
Yes	195		25.1	153	21.8	42	57.5
Family conflict							<0.001^d
No	484		62.4	457	65.0	27	37.0
Yes	292		37.6	246	35.0	46	63.0
AMPQ-II factor 1^b	4.53±3.74		3.83±2.94		11.25±4.01		<0.001^c
AMPQ-II factor 2^b	4.55±3.76		3.80±2.83		11.75±3.94		<0.001^c
AMPQ-II factor 3^b	3.56±2.30		3.19±1.90		7.14±2.70		<0.001^c
AMPQ-II factor 4^b	0.52±1.08		0.38±0.82		1.93±1.96		<0.001^c
Non-victim	561	72.3	541	77.0	20	27.4	<0.001^c
Victim	215	27.7	162	23.0	53	72.6
AMPQ-II Factor 5^b	0.41±1.08		0.28±0.72		1.74±2.36		<0.001^c

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

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

^bData are presented as mean±SD.

^cCalculated by t-test.

^dCalculated by chi-square test.

Table 3.

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	%	P
AMPQ-II score^a	15.99±10.78		13.58±9.17		18.91±11.18		35.35±14.56		<0.001^b
AMPQ-II group									<0.001^c
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									0.002^c
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 thought^a	0.49±1.01		0.33±0.81		0.67±1.10		2.00±2.29		<0.001^b
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									0.002^c
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 1^a	4.53±3.74		3.71±3.12		5.55±3.96		10.76±5.84		<0.001^b
AMPQ-II factor 2^a	4.55±3.76		4.15±3.54		4.94±3.79		9.18±5.40		<0.001^b
AMPQ-II factor 3^a	3.56±2.30		2.91±1.96		4.45±2.24		7.35±3.30		<0.001^b
AMPQ-II factor 4^a	0.52±1.08		0.41±0.91		0.70±1.29		0.88±1.17		0.001^b
Non-victim	561	72.3	370	77.4	183	65.1	8	47.1	<0.001^c
Victim	215	27.7	108	22.6	98	34.9	9	52.9
AMPQ-II factor 5^a	0.41±1.08		0.37±1.00		0.47±1.20		0.65±1.12		0.324^b
BDI score^a	9.19±7.77		8.13±7.11		10.36±8.10		19.47±9.79		<0.001^b
BDI group									<0.001^c
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.

^aData are presented as mean±SD.

^bCalculated by One-way ANOVA.

^cCalculated by chi-square test.

Table 4.

Difference of each scale according to severity of depression

	Total		No depression		Mild depression		Moderate depression S		Severe depression		P
	Total		(n=474)		(n=159)		depression (n=103)		(n=40)
	N	%	N	%	N	%	N	%	N	%
AMPQ-II score^a	15.99±10.78		12.01±8.15		17.39±7.14		24.65±11.37		35.20±13.52		<0.001^b
AMPQ-II group											<0.001^c
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											<0.001^c
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 thought^a	0.49±1.01		0.43±0.99		0.44±0.82		0.63±1.23		1.00±1.24		0.002^b
No	581	74.9	374	78.9	116	73.0	70	68.0	21	52.5	0.001^c
Yes	195	25.1	100	21.1	43	27.0	33	32.0	19	47.5
Family conflict											<0.001^c
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 1^a	4.53±3.74		3.19±2.84		5.30±3.13		7.20±3.78		10.43±4.95		<0.001^b
AMPQ-II factor 2^a	4.55±3.76		3.24±2.73		5.00±3.12		7.49±3.80		10.70±5.41		<0.001^b
AMPQ-II factor 3^a	3.56±2.30		3.04±2.04		3.61±1.72		4.88±2.54		6.18±3.25		<0.001^b
AMPQ-II factor 4^a	0.52±1.08		0.35±0.80		0.62±1.19		0.87±1.43		1.35±1.70		<0.001^b
Non-victim	561	72.3	374	78.9	109	68.6	61	59.2	17	42.5	<0.001^c
Victim	215	27.7	100	21.1	50	31.4	42	40.8	23	57.5
AMPQ-II factor 5^a	0.41±1.08		0.35±1.03		0.33±0.81		0.59±1.26		1.00±1.73		0.001^b
IAS score^a	37.21±14.03		34.75±12.28		39.86±13.91		41.37±16.27		45.10±19.86		<0.001^b
IAS group											<0.001^d
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.

^aData are presented as mean±SD.

^bCalculated by One-way ANOVA.

^cCalculated by chi-square test.

^dCalculated by Fisher's exact tests.

Table 5.

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	%	P
BDI score^a	9.19±7.77		8.19±6.94		11.80±9.12		<0.001^b
BDI group							<0.001^c
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 score^a	37.21±14.03		35.59±13.13		41.44±15.39		<0.001^b
IAS group							<0.001^c
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 score^a	15.99±10.78		12.96±8.30		23.89±12.41		<0.001^b
AMPQ-II group							<0.001^c
Low risk	703	90.6	541	96.4	162	75.3
High risk	73	9.4	20	3.6	53	24.7
Sucidal ideation							<0.001^c
No	665	85.7	512	91.3	153	71.2
Yes	111	14.3	49	8.7	62	28.8
Excessive sexual thought^a	0.49±1.01		0.35±0.87		0.84±1.25		<0.001^b
No	581	74.9	454	80.9	127	59.1	<0.001^c
Yes	195	25.1	107	19.1	88	40.9
Family conflict							0.001^c
No	484	62.4	370	66.0	114	53.0
Yes	292	37.6	191	34.0	101	47.0
AMPQ-II factor 1^a	4.53±3.74		3.73±3.13		6.60±4.37		<0.001^b
AMPQ-II factor 2^a	4.55±3.76		3.83±3.22		6.43±4.37		<0.001^b
AMPQ-II factor 3^a	3.56±2.30		3.10±2.02		4.78±2.52		<0.001^b
AMPQ-II factor 5^a	0.41±1.08		0.32±0.95		0.66±1.32		0.001^b

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

^aData are presented as mean±SD.

^bCalculated by t-test.

^cCalculated by chi-square test.

Table 6.

Difference of each scale according to suicidal ideation

	Total (n=776)		No (n=665)		Yes (n=111)		P
	N	%	N	%	N	%	P
BDI score^a	9.19±7.77		8.03±6.40		16.14±11.00		<0.001^b
BDI group							<0.001^c
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 score^a	37.21±14.03		36.45±13.28		41.73±17.27		0.003^b
IAS group							0.002^c
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 score^a	15.99±10.78		13.91±8.55		28.41±14.00		<0.001^b
AMPQ-II group							<0.001^c
Low risk	703	90.6	635	95.5	68	61.3
High risk	73	9.4	30	4.5	43	38.7
Family conflict							<0.001^c
No	484	62.4	434	65.3	50	45.0
Yes	292	37.6	231	34.7	61	55.0
Excessive sexual thought^a	0.49±1.01		0.41±0.92		0.95±1.36		<0.001^b
No	581	74.9	517	77.7	64	57.7	<0.001^c
Yes	195	25.1	148	22.3	47	42.3
AMPQ-II factor 1^a	4.53±3.74		3.95±3.29		7.97±4.41		<0.001^b
AMPQ-II factor 2^a	4.55±3.76		3.80±2.98		8.99±4.75		<0.001^b
AMPQ-II factor 3^a	3.56±2.30		3.34±2.12		4.91±2.83		<0.001^b
AMPQ-II factor 4^a	0.52±1.08		0.40±0.91		1.29±1.60		<0.001^b
Non-victim	561 72.3		512 77.0		49 44.1		<0.001^c
Victim	215 27.7		153 23.0		62 55.9
AMPQ-II factor 5^a	0.41±1.08		0.31±0.88		1.05±1.73		<0.001^b

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

^aData are presented as mean±SD.

^bCalculated by t-test.

^cCalculated by chi-square test.

Table 7.

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.

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