Role of SES on the association between childhood parental death and adulthood suicidal ideation: a mediation analysis using longitudinal dataset in South Korea

Abstract

Background: We sought to examine the association between childhood experience of parental death (CEPD) and adulthood suicidal ideation, and the mediating role of adulthood SES in the association.

Methods: We analyzed a nationally representative dataset of 8609 adults from the Korea Welfare Panel Study, which is a longitudinal cohort dataset in South Korea. CEPD was measured using a question: "During your childhood (0-17 years old), have you experienced the death of parents?" We classified responses of CEPD during 2006-2011 into 'yes,' and the others into 'no.' Suicidal ideation over the past year was assessed annually during 2012-2019. As a potential mediator, adulthood educational attainment and household income in 2011 were included in the analysis. Logistic regression was applied to examine the association of CEPD with adulthood suicidal ideation across age groups (early adulthood, 19-39 years old; middle adulthood, 40-59 years old; late adulthood, ≥60 years old), after excluding people who reported lifetime suicidal ideation in 2011. Causal mediation analysis using a parametric regression model was applied to examine the mediating role of adulthood SES in the association between CEPD and adulthood suicidal ideation.

Results: After adjusting for potential confounders including childhood SES, CEPD was significantly associated with adulthood suicidal ideation among the late adulthood group (OR: 1.43; 95% CI: 1.13-1.81), while the association was not statistically significant among the early; and middle adulthood groups. In mediation analysis of adulthood household income, both indirect association (OR^NIE: 1.05; 95% CI: 1.02-1.09) and direct association (OR^NDE: 1.37; 95% CI: 1.09-1.73) were statistically significant among the late adulthood group. In the mediation analysis of adulthood education attainment among the late adulthood, only a direct association was statistically significant (OR^NDE: 1.43; 95% CI: 1.14-1.80).

Conclusions: These results suggest that CEPD could be a risk factor for adulthood suicidal ideation. Furthermore, the findings imply that income security policy might be necessary to reduce suicide among the late adulthood group.

Keywords: Childhood adversities; Life-course; Mediation analysis; Mental health; Suicide.