National Trends in Sadness, Suicidality, and COVID-19 Pandemic–Related Risk Factors Among South Korean Adolescents From 2005 to 2021

Abstract

ImportanceDespite the COVID-19 pandemic’s effect on daily life, limited research exists on the prevalence and risk factors of suicidality and sadness among South Korean adolescents.ObjectivesTo examine whether the observed sadness and suicidality in the early to middle periods of the COVID-19 pandemic differed from the expected level and to investigate changes in risk factors for sadness and suicidality.Design, Setting, and ParticipantsThis nationwide serial cross-sectional survey study used data on 1 109 776 Korean adolescents aged 13 to 18 years from the Korea Youth Risk Behavior Web-based Survey from 2005 to 2021.ExposureThe COVID-19 pandemic.Main Outcomes and MeasuresThe pattern of changes in the percentage or proportion of sadness or suicidality, as well as the risk factors for sadness or suicidality. The transitional effect of the COVID-19 pandemic was assessed using weighted odds ratios (wORs) or weighted beta coefficients with 95% CIs.ResultsBetween 2005 and 2021, 1 109 776 adolescents (mean [SD] age, 15.0 [1.7] years; 51.5% male adolescents; and 51.7% in grades 7-9 and 48.3% in grades 10-12) were included in the Korea Youth Risk Behavior Web-based Survey. The slope of the long-term trends in sadness and suicidality decreased in the prepandemic period (sadness: from 37.8% [95% CI, 37.4%-38.2%] in 2005-2007 to 26.1% [95% CI, 25.9%-26.4%] in 2016-2019; suicidality: from 23.0% [95% CI, 22.7%-23.3%] in 2005-2007 to 12.3% [95% CI, 12.1%-12.5%] in 2016-2019), whereas the slope increased during the COVID-19 pandemic (sadness: from 25.0% [95% CI, 24.5%-25.6%] in 2020 to 26.6% [95% CI, 26.1%-27.1%] in 2021; trend difference in β, 0.249 [95% CI, 0.236-0.262]; suicidality: from 10.7% [95% CI, 10.3%-11.1%] in 2020 to 12.5% [95% CI, 12.1%-12.9%] in 2021; trend difference in β, 0.328 [95% CI, 0.312-0.344]). The trends presented a similar tendency in the subgroups according to sex, school grade, residential area, smoking status, and current alcohol use. Compared with the prepandemic period, the risk factors associated with sadness during the pandemic were younger age (wOR, 0.907; 95% CI, 0.881-0.933), female sex (wOR, 1.031; 95% CI, 1.001-1.062), urban residence (wOR, 1.120; 95% CI, 1.087-1.153), current smoking status (wOR, 1.134; 95% CI, 1.059-1.216), and current alcohol use (wOR, 1.051; 95% CI, 1.002-1.102). Female sex (wOR, 1.064; 95% CI, 1.021-1.109), urban residence (wOR, 1.117; 95% CI, 1.074-1.162), and low economic status (wOR, 1.286; 95% CI, 1.180-1.403) were the risk factors significantly associated with suicidality after the COVID-19 pandemic began.Conclusions and RelevanceIn this nationwide serial cross-sectional survey study of South Korean adolescents, the slope of the prevalence of sadness and suicidality increased during the COVID-19 pandemic after a decrease prior to the pandemic. The findings suggest that public health measures are needed to recognize vulnerable groups with risk factors and to prevent an increase in sadness and suicidality among adolescents during the COVID-19 pandemic.

National prevalence of smoking among adolescents at tobacco tax increase and COVID-19 pandemic in South Korea, 2005–2022

“…The influence of the tobacco tax increase and the COVID-19 pandemic on adolescent CSP have been demonstrated in several studies 14 , 18 . Our study showed consistent results with most previous studies; USA 31 (n = 10,981), England (n = 274,890) 32 , China 33 (n = 419,875), Sweden 34 (n = 1818), and China (n = 31,273) 35 .…”

“…We observed that a rise in tobacco taxes was associated with an immediate reduction in both DSP and CSP. These outcomes can be attributed to the notion that a tobacco tax increase establishes economic deterrents to smoking, thereby contributing to the overall reduction in smoking prevalence among adolescents 14 , 28 . Moreover, the advent of the COVID-19 pandemic resulted in an immediate decrease in CSP, potentially due to strict restrictions on outdoor activities and the necessity for social distancing 15 , 29 .…”

“…However, most previous studies did not focus on the prevalence of daily smokers among those who currently smoke. Furthermore, the significant impact of the tobacco tax increase was not consistently factored into most COVID-19 pandemic-related studies 14 . With this background, we undertook an approach by devising and implementing an interrupted time-series model that accounted for the influence of both the tobacco tax increase and the COVID-19 pandemic as interventions.…”

“…Subsequently, sample schools were allocated based on urban/rural locations and sex compositions, considering female-only, male-only, and mixed-sex schools. Finally, in the nationwide study, a total of 800 sample schools were selected, and to determine the sample classes, the class information of these sample schools was registered 13 , 14 . Subsequently, the investigation was conducted targeting these sample classes.…”

“…This study aimed to investigate the association of the COVID-19 pandemic with the trend of CSP and DSP across 18 years. To achieve this objective, a comparative evaluation of adolescent smoking was undertaken by contrasting the trends during the pandemic (2020–2022) with the pre-pandemic (2005–2019) 14 . However, a discernible inflection point around 2015, potentially caused by the impact of the increase in tobacco tax in South Korea, necessitated a partitioning of the pre-pandemic into two distinct sub-periods: the pre-tax-increase period (2005–2014) and the post-tax-increase period (2015–2019) 21 .…”