Objective: This study aimed to investigate the prevalence, clinical characteristics, and the correlates of nonsuicidal self-injury (NSSI) in firefighters. We also investigated the mediating role of NSSI frequency in the association between posttraumatic stress disorder (PTSD), depression, and suicidal behavior. Methods: A total of 51,505 Korean firefighters completed a web-based self-reported survey, including demographic and occupational characteristics, NSSI, PTSD, depression, and suicidal behavior. Multivariable logistic regression analyses and serial mediation analyses were performed. Results: The 1-year prevalence of NSSI was 4.67% in Korean firefighters. Female gender, the presence of recent traumatic experience, and PTSD and depression symptoms were correlated with NSSI. Serial mediation analyses revealed that NSSI frequency mediated the association between PTSD, depression, and suicidal behavior; it indicates more severe PTSD was sequentially associated with more severe depression symptoms and more frequent NSSI, leading to higher risk of suicidal behavior. Conclusion NSSI is prevalent and may play a significant mediating role when PTSD is associated with suicidal behavior in firefighters. Our results imply the need for screening and early intervention of NSSI in firefighters.

Background: Suicide is one of the leading causes of death in the military as in the general population. To mitigate such a serious public health problem, identifying the risk or protective factors of suicide behaviors is crucial. Methods: We analyzed the representative data of the 2014 Korean Armed Forces to explore the relationship between past year adverse events (PAE), accumulated lifetime trauma (ALT), mental illness vulnerability, perceived social support, and suicidal ideation in the previous year. Results: Among the 6,377 subjects, 3.7% of males and 6.2% of females reported suicidal ideation in the previous year. Multivariate analytic models identified significant associations of PAE and ALT with suicidal ideation with a dose-response pattern. The mental illness vulnerability showed the most significant association with suicidal ideation even after controlling PAE or ALT. We found that perceived social support may be potentially linked with a reduced risk of suicidal ideation. Conclusion This Korean military representative data demonstrates mental illness vulnerability; PAE; and lifetime trauma as significant risk factors of suicidal ideation, while perceived social support was found as a potential protective factor. Given the importance of the prevention of suicide in the military, those risk and protective factors may be used to screen soldiers at risk of suicide and provide further support on mental health services as needed.

Background: Suicide is one of the leading causes of death in the military as in the general population. To mitigate such a serious public health problem, identifying the risk or protective factors of suicide behaviors is crucial. Methods: We analyzed the representative data of the 2014 Korean Armed Forces to explore the relationship between past year adverse events (PAE), accumulated lifetime trauma (ALT), mental illness vulnerability, perceived social support, and suicidal ideation in the previous year. Results: Among the 6,377 subjects, 3.7% of males and 6.2% of females reported suicidal ideation in the previous year. Multivariate analytic models identified significant associations of PAE and ALT with suicidal ideation with a dose-response pattern. The mental illness vulnerability showed the most significant association with suicidal ideation even after controlling PAE or ALT. We found that perceived social support may be potentially linked with a reduced risk of suicidal ideation. Conclusion This Korean military representative data demonstrates mental illness vulnerability; PAE; and lifetime trauma as significant risk factors of suicidal ideation, while perceived social support was found as a potential protective factor. Given the importance of the prevention of suicide in the military, those risk and protective factors may be used to screen soldiers at risk of suicide and provide further support on mental health services as needed.

Objective: To examine the relationship between problematic alcohol use and contributing factors among Korean professional soldiers. Methods: Cross-sectional data of 2,646 participants collected by 2014 military-wide representative health survey was analyzed. Multivariate logistic models were used to identify contributing factors for problematic alcohol use. Problematic alcohol use was defined by the Alcohol Use Disorders Identification Test (AUDIT) questionnaire as hazardous (8≤ AUDIT <16) or harmful (AUDIT ≥16). Tolerant drinking culture was measured by the Drinking Culture Questionnaire. Results: Hazardous alcohol use was found in 56.9% of men and 46.8% of women and harmful use in a further 16.2% of men and 5.4% of women. In univariate analyses, perceived health status, subjective sleep quality, depression, and drinking culture were related to the outcome variable. In multivariate models controlling covariates, the likelihood of problematic alcohol use was significantly increased by man gender, being single, current/past smoking, and tolerant/permissive drinking culture. In those with harmful alcohol consumption, tolerant drinking culture was a particularly powerful influence. Conclusion A substantial proportion of Korean professional soldiers demonstrated problematic alcohol use. Tolerant drinking culture was shown to have a significant influence on problematic alcohol use in the military. Our findings underscore the need for public health policies that address this drinking culture to mitigate negative health consequences and preserve the forces’ combat readiness.

OBJECTIVE: Depression is a major risk factor for suicide, and several psychological factors such as low self-esteem are involved in suicide. The aim of this study was to investigate the difference in self-esteem between non suicide attempters and suicide attempters with major depressive disorder. METHODS: The study subjects consisted of 52 patients who received inpatient or outpatient treatments at the Hallym University Sacred Heart Hospital. All participants were diagnosed as major depressive disorder by Korean version of the Mini-International Neuropsychiatric Interview. Columbia Suicide Severity Rating Scale (C-SSRS) was used to evaluate patient's suicide attempt. They completed a questionnaire that included Rosenberg Self-Esteem Scale, Beck Depression Inventory (BDI) and Beck Scale for Suicide Ideation (BSI). RESULTS: A total of 52 subjects were evaluated by C-SSRS, and among them, 32 were non suicide attempters and 20 were suicide attempters. Compared to non suicide attempters, suicide attempters showed significantly lower levels of self-esteem (t=3.492, p=0.001) and higher levels of BSI (t=-4.890, p<0.001). Although there was no significant difference between two groups for severity of overall depressive symptoms, negative attitude subscale of BDI was higher in suicide attempters than non suicide attempters (t=-2.596, p=0.014). A stepwise multivariate logistic regression analysis showed that low self-esteem was significant association with suicide attempt after adjusted by negative attitude subscale of BDI and BSI (odds ratio=0.779, p=0.042). CONCLUSION: The present study indicated that low self-esteem plays a significant role in suicide attempters with major depressive disorder. Assessment of suicide risk should include not only suicide ideation and severity of overall depressive symptoms but also low self-esteem.
Depression ; Depressive Disorder, Major* ; Heart ; Humans ; Inpatients ; Logistic Models ; Outpatients ; Pilot Projects* ; Psychology ; Surveys and Questionnaires ; Risk Factors ; Suicide*