An Ecological Understanding of Youth Suicide in South Korea

School Psychology International
http://spi.sagepub.com/ An ecological understanding of youth suicide in South Korea

Seung-yeon Lee, Jun Sung Hong and Dorothy L. Espelage School Psychology International 2010 31: 531 DOI: 10.1177/0143034310382724 The online version of this article can be found at: http://spi.sagepub.com/content/31/5/531
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Article
An ecological understanding of youth suicide in South Korea

Seung-yeon Lee
Department of Psychology, Ewha Womans University, Seoul, Korea
School Psychology International 31(5) 531546 ! The Author(s) 2010 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav DOI: 10.1177/0143034310382724 spi.sagepub.com
Jun Sung Hong

School of Social Work, University of Illinois, Urbana-Champaign, Urbana, IL, USA
Dorothy L. Espelage
Department of Educational Psychology, Child Development Division, University of Illinois, Urbana-Champaign, Urbana, IL, USA
Abstract This article reviews risk factors for youth suicide in South Korea (hereafter referred to as Korea), based on the ecological systems theory. Although youth suicide is a major concern for Korean society, understanding of this phenomenon has been limited since most of the empirical studies address personal characteristics without much consideration to larger environmental contexts for Korean adolescents. This review integrates many empirical findings on Korean adolescents suicidal ideation or behaviours within the context of micro-, meso-, exo-, macro-, and chrono-systems that surround an individual. Finally, it draws implications on assessment and intervention strategies for youth suicide that school psychologists and other mental health professionals in Korean schools can utilize. Keywords children, ecological systems theory, Korea, suicidal ideation, suicide, youth
Corresponding author: Seung-yeon Lee, Assistant Professor, Department of Psychology, Ewha Womans University, 111 Daehyundong, Seodaemun-gu, Seoul 120750, Korea Email: slee1@ewha.ac.kr
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School Psychology International 31(5)
In recent years, South Korea became the country with the highest suicide rate among the Organization for Economic Cooperation and Development (OECD) countries (World Health Organization, n.d.). According to the Korea National Statistics Oce (NSO), 26.0 out of 100,000 people committed suicide in 2008. Suicide was the second leading cause of death (4.6 out of 100,000) among youth aged 1019 in 2008. As youth suicide has become a major public health concern, an important component of suicide prevention and intervention eorts has included a need to understand risk factors. Individual, family, peer, and school level risk factors for youth suicide in Korea have been examined by a number of researchers (e.g. Kim & Kim, 2008; Ra et al., 2006). Unfortunately, these studies have not considered the broader ecological level factors, such as cultural beliefs and values, which are inherently relevant to youth suicide. Youth suicide in Korea must be understood within the context of all levels of the ecological system because youth are part of inter-related systems, which situate them at the centre and move out from the centre to include all systems that aect them (Bronfenbrenner, 1994). The focus of this article is to examine youth suicide in Korea within the context of Bronfenbrenners ecological systems theory and to provide practitioners (e.g. school psychologists) and school ocials in Korea with concrete strategies for suicide prevention and intervention that consider the ecological levels.
Ecological systems analysis

How can we best understand suicidal phenomena among adolescents in Korea? There is no one single factor, nor is there a single answer. Youth suicide must be understood as emerging from across multi-layered ecological contexts. The most recent ecological systems theory maintains that the individual is part of inter-related systems (e.g. family, school) that expand to broader environmental contexts (e.g. neighbourhood, culture) that aect individual attitudes and behaviours. Developed by Urie Bronfenbrenner, the ecological systems theory posits that individuals can be situated within micro-, meso-, exo-, macro-, and chrono-system levels.
Youth characteristics
Gender and age. Research has consistently shown that females are more likely to experience suicidal ideation and attempts than males (e.g. Weissman et al., 1999). However, studies in Korea have been inconsistent in terms of gender. Many studies have supported gender dierences in an expected direction (Cho et al., 2002; Korean Youth Counseling Institute, 2007). However, other studies found no gender dierences in suicidal ideation (Kim & Noh, 2003; Sim & Kim, 2005) and in suicidal attempts (Kim, 2005). Lee, Kweon, and Kims (2007) study found males had greater suicidal ideation than females in middle schools. Interestingly, Kim (2002) found that among juvenile delinquents, boys were at greater risk of attempted suicide than girls. Another interesting nding is among students victimized by their peers; females who were victims over a two-week period were more
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likely to have suicide ideation than males; however, there was little gender dierence when victimization was long-term (Kim, Koh, & Leventhal, 2005). With regard to age dierences, Cho et al. (2002) found no signicant dierences between middle and high school students suicidal ideation whereas high school students attempted suicide more frequently than middle school students. Kim (2002) found 1718 years of age to be the peak age for suicide attempts. Depression. A majority of Korean researchers found that depressive symptoms were signicant risk factors for suicidal attitudes and behaviours (i.e. suicidal ideation, suicidal attempts or completed suicide) among Korean adolescents (Cho et al., 2002; Kim, 2005; Lee, 2003; Lee et al., 2007; Park, 2007; Park & Noh, 2007; Shin, Park, & Oh, 1991; Sim & Kim, 2005). About 87% of adolescent patients admitted to the emergency room for suicide attempts during 19982002 periods manifested psychiatric symptoms and approximately 66% of those individuals were diagnosed as clinically depressed (Lee, 2003). Among adolescent populations, the strongest and most consistent risk factor for suicidal ideation has been depressive symptoms (Chun & Lee, 2000; Lee et al., 2007; Sim & Kim, 2005). On the contrary, Kim (2005) found that depressive symptoms did not predict suicidal attempts although adolescents with history of suicidal attempts displayed more serious psychiatric symptoms than their non-suicidal counterparts. Along with the current movement that emphasizes early intervention for youth suicide, the entire Korean society, including mental health professionals, have focused on depression as a single marker for suicide risk, which can be misleading in that only a small percentage of depressed individuals commit suicide (Ayyash-Abdo, 2002). Park and Noh (2007) also warned against exclusively focusing on depression or depressive symptoms in relation to youth suicidal behaviours. They suggested that non-depressed youth were also vulnerable to suicide attempts and behaviours. Hopelessness. Hopelessness can also be a signicant risk factor for adolescent suicidal ideation in Korea (e.g. Lee & Cho, 2004; Sim & Kim, 2005) although the ndings have not been consistent (Ayyash-Abdo, 2002). In a study of Korean high school students, Shin, Park, and Oh (1991) found that that depressive mood was more strongly associated with suicidal ideation than hopelessness. More recently, Park (2004) found hopelessness to be a signicant predictor of suicidal ideation only for male high school students. Impulsivity. People commonly believe that adolescents attempt suicide impulsively despite the fact that there are only a handful of studies on the role of impulsivity in Korean youth suicide. Impulsivity was not a signicant predictor for suicidal ideation (Lee & Cho, 2004; Shin et al., 1991); however, adolescents who attempted suicide were more impulsive than those without attempts (Song, Lee, Chun, & Joung, 1996). On the other hand, Shin et al. (1991) reported that impulsivity alone did not predict suicidal attempts in their study of high school students. However, a signicant interaction between impulsivity and suicidal ideation was found. In other words, the impulsive group with suicidal ideation was more likely to attempt suicide than the non-impulsive group with suicidal ideation.
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Substance use. Substance use was not a major social problem in Korea until the early 1980s when drug abuse and drug tracking increased substantially (Chung et al., 2004). Substance use among adolescents has become a serious public health concern, as adolescents have easy access to tobacco, alcohol, and drugs, such as amphetamines and marijuana (Kim & Kim, 2007). Although studies on substance use and suicidal behaviours in Korea are limited, one study indicated that substance abusing adolescent males reported twice as many suicidal ideations compared to their non-substance abusing counterparts (Kim, Kim, & Park, 2007). According to Kim et al. (2007), religion increases suicide attempts and selfdestructive behaviours among substance abusing male adolescents while selfesteem, positive relationships with teachers and peer support reduce the likelihood of suicidal behaviour. In a study of male juvenile delinquents aged 12 to 20 years, depression and substance use signicantly predicted suicidal ideation (Lee, Shin, & Lee, 2006). Cho et al. (2002) also found that female students with depressive symptoms and alcohol dependency were most likely to attempt suicide whereas only alcohol dependency was associated with suicide attempts among males. Academic stress. Academic stress has received much research attention in relation to youth suicidal behaviour in Korea (Cho et al., 2002; Moon, 2006), which is unique compared to research trends in other countries. Suicidal high school students in Korea reported the most signicant stressor in their life to include diculties with career choice, low academic achievement, amount of academic work and lack of rest (Im & Jung, 2002). In addition, receiving results on the university entrance examination was reported as a major trigger for suicide attempts from 1994 through 1999 (Kim & Chun, 2000). It is also reported that poor academic performance contributes to depression and suicidal ideation among adolescents (Moon, 2006; Oh, Park, & Choi, 2008; Park, 2009). One study found that depressive symptoms stemming from academic stress lead to suicidal ideation among adolescents (Park, 2009). However, Moons (2006) study using a national longitudinal survey found that secure attachment with parents was associated with the lower level of suicidal impulse stemming from academic stress among middle school students. Internet addiction. Internet has become a major part of youth culture since Korea emerged as the most wired nation in the world (Lee, OKeefe, & Yun, 2003). Internet has been an important tool for youth in acquiring information for educational and social purposes. Consequently, internet addiction among youth has become a serious social problem in Korea. In recent years, a number of researchers in Korea have investigated the relation between the internet addiction and psychological health problems, which may induce youths suicidal ideation. Shon (2005) found that internet use for more than three hours a day signicantly predicted suicidal ideation among 6th to 8th graders. Several studies (Kim et al., 2006; Ryu, Choi, Seo, & Nam, 2004) reported that Korean high school students who were addicted to the internet were at greater risk of psychological problems, which lead to suicidal behaviours than those who were not addicted to the internet.
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Micro-system
The most immediate inuences on youth suicidal behaviour are within the microsystem level, which consists of individuals and groups of individuals with whom the individual have interactions and contacts. The interactions within the micro-system consistently shape the individual. Relevant micro-system level factors include parent-child relationships, parent-child communication, peer support, peer victimization and school satisfaction. Parent-child relationships. Negative parentchild relationship is a salient risk factor for suicidal tendencies among Korean youth (Chun, 2001; Lee & Heo, 2003; Park, 2005; Shon, 2005). Shon (2005) reported that negative parenting strategies such as harsh discipline and physical abuse increased suicidal ideation among Korean youth. In particular, Chun (2001) found that negative parenting strategies contribute to suicidal ideation among male adolescents. Parks (2005) study indicated that parental abuse, emotional abuse, and neglect signicantly predicted suicidal ideation among high school students. In addition, two studies found that lack of parental support is associated with the heightened risk of suicide among elementary school students (Lee & Heo, 2003) and high school students (Park & Noh, 2007). On the other hand, secure attachment with parents reduced suicidal ideation due to academic stress (Moon, 2006). Similarly, family harmony (Kim & Noh, 2003) or support (Huh, 2007) were protective factors in that they mitigated youth suicidal ideation. Parent-child communication. Oh et al. (2008) reported that both father-child and mother-child communication have negative associations with suicidal ideation among middle school students. Open and positive communication between children and their parents, particularly positive mother-child communication decreased youth suicidal thoughts. Such parent-child communication partially mediated the relation between stress and suicidal ideation; in other words, even after parent-child communication was controlled, the inuence of stress on suicidal ideation was still signicant (Park & Gu, 2009). Chun (2001) found that clinically depressed female youth who have poor communication with their parents during adolescence were likely to have suicidal thoughts. Peer support. Peer support (and lack thereof) is also a risk factor for suicidal behaviour among youth in several countries (e.g. Gould, Greenberg, Velting, & Shaer, 2003), including Korea (Kim et al., 2007; Moon, 2006; Park, 2007). Park (2007) reported that lack of peer support increases the likelihood of youth suicidal ideation. Among male middle and high school students with substance use problems, lack of peer support also signicantly predicted suicidal behaviours (Kim et al., 2007). According to Moon (2006), although peer attachment did not mediate the relation between academic stress and suicidal ideation, high level of peer attachment was associated with lower the level of suicidal ideation among youth. More specically, Hong (2004) found a sense of isolation directly inuenced suicidal ideation among males whereas it indirectly inuenced suicidal ideation through depressive symptoms among females. This result is similar to Kopper, Osman,
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Osman, and Homans (1998) nding that sense of isolation is the most signicant predictor for male suicidal risk while depression is for female suicidal risk. On the other hand, Huh (2007) found that peer support was not a predictor for suicidal ideation while family and teacher support were predictors. Peer victimization. Peer victimization in school is another major risk factor for youth suicidal behaviour. Youth who experience negative peer relationships and those who are victimized by their peers in school are likely to exhibit suicidal tendencies, as indicated by a number of researchers in several countries (e.g. Carney, 2000; Espelage & Swearer, 2003; Kaltiala-Heino, Rimpela, Marttunen, Rimpela, & Rantanen, 1999). In the US, results of the 1998 Wisconsin Youth Risk Behavior Survey of all high school students found that 50% of them had seriously considered suicide as a result of peer victimization and despair (Garbarino & deLara, 2002). A number of researchers in Korea also found that peer victimization was related to suicidal ideation and behaviour. According to Kim and Noh (2003), Korean youth reported that the most signicant reasons for suicidal ideation were being socially excluded by their peers, being victims of violence and feeling betrayed by their friends. Accordingly, Lee et al. (2007) and Shon (2005) found that youth victimized by their peers in school were likely to report greater suicidal ideation than non-victimized youth. Another study by Kim et al. (2005), however, found that victim-perpetrators (i.e. victim turn perpetrator) had the highest risk for suicidal ideation compared to victims, perpetrators or uninvolved youth School satisfaction. School satisfaction is another risk factor for youth suicide; suicidal behaviour is linked to school performance and satisfaction, as indicated by Thompson, Eggert, Randell, and Pike (2001). In Korea, most students spend on average more than ten hours a day at school due to heavy emphasis on academic excellence. The amount of time spent on school work increases if they are attending academic institutions after school. It is not surprising that school satisfaction (Kim & Noh, 2003) or school adjustment (Kim, 2008) has been reported as a signicant predictor for youth suicide in Korea. Huhs (2007) study found that academic stress, negative relationships with teachers and negative peer relationships increased the likelihood of suicidal ideation among high school students. Chung, Ahn, and Kim (2003) also reported that greater school-related stress signicantly predicts suicidal ideation among adolescents. Academic stress as a determinant of school satisfaction is a risk factor for suicidal ideation among Korean youth as previously discussed. On the other hand, positive relationship with teachers mitigated suicidal behaviour for male adolescents (Kim et al., 2007). Of note, Park (2006) reported that school-related stressors explained suicidal ideation of females signicantly more than that of males.
Meso-system
A meso-system consists of the interrelationships between two or more microsystem in which the child is involved (e.g. the relationship between family and
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school) (Bronfenbrenner, 1994). Meso-system is essentially a system of microsystem. Experiences in one micro-system, such as home environment, may inuence activities and interventions in another, such as peer relationships in school or vice versa (Eamon, 2001). Two studies support this proposition. Ra et al. (2006) revealed in a sample of high school students that the risk of suicidal ideation was highest among those with poor relationships with their divorced parents, which was found to aect their relationships with their peers at school. Students who lacked positive relationships with their parents were likely to disclose their suicidal thoughts to their peers at school. Jung, Im, and Gos (2001) study also found that youth who experienced conicts with family members were most likely to have suicidal ideations, which also aect their relationship with friends and peers at school.
Exo-system
The exo-system is composed of interactions between two or more settings, but the individual is embedded in only one (Bronfenbrenner, 1994). Therefore, exo-system consists of settings in which youth are not directly involved in but those aecting them. For example, parents diculties at work would indirectly aect a childs life at home. A change in national policy on education would inuence each schools educational system or structure, which in turn aects a childs school life. Mass media and internet sites are examples of exo-systems. Mass media. It has been a consistent concern that the sensational and dramatic nature of the media coverage on youth suicide contributes to copycat suicide (Hazell, 1991). News articles on celebrities suicide or TV programs that describe suicide of an adolescent were followed by a rise in the number of youth suicide during the following one or two weeks (Shaer, 1988). In fact, Nam (2008) reported that the rate of completed suicides in Seoul increased on average from 0.84 to 2.13 per day during one month after the suicide of Eun-ju Lee, a famous female actress in 2005. He also found that Korean media covered an average of 55 suicide-related news articles a day, which is a major concern in that the more exposure to suicide-related media coverage, the stronger the ripple eects of completed suicide becomes, as Stack (2000) noted. The rate of youth copycat suicides at that time increased up to 30.6%. According to Parks (2006) study, celebrity suicide was found to be one of the most signicant predictors for youth suicidal ideation among high school students in Korea. Suicide internet sites. In Korea, the rst completed suicide among youth who were exposed to suicide internet sites (i.e. internet suicide clubs, pro-suicide websites) was reported in 2000. Since then, a signicant increase in suicide attempts or suicide through internet sites have been noted (Moon, 2002). Joo (2003) referred to the result of a national survey by Seoul Family Court in 2002. Among 2,807 Korean students in elementary to high schools, 30% had access to suicide internet sites and 34% had planned suicide. Park (2006) found that visiting suicide websites was a signicant predictor for suicidal ideation among male high school students.
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Moons (2002) analysis of suicide cases mediated by the online suicide community indicated that male youth attempted suicide much more than female youth.
Macro-system
The macro-system is commonly referred to as a cultural blueprint that may determine the social structures and activities in the immediate system level (Bronfenbrenner, 1994). Macro-system-level factors ultimately aect the particular conditions and processes in the micro-system (Bronfenbrenner, 1994). Parenting practices. Culturally and socially dened role expectations concerning childrearing practices inuence children and youth developmental outcomes, according to Ogbu (1981). Parenting practices in South Korea have been characterized as aectionate, but overprotective and controlling (Doh, 2002; Yang & Shin, 2008) and abusive (Park, 2005). Under the Confucian tradition, Koreans have considered corporal punishment (referred to as a rod of love) as an appropriate discipline strategy (Jang, Bang, & Oak, 2005). In fact, about 92% of Korean teachers as well as most parents rely on corporal punishment as a way of discipline (Korean Educational Development Institute, 1997; cited in Yoon, 2000). Harsh parental disciplinary methods are risk factors for suicidal attempts, as indicated in Parks (2005) study. Collectivism versus individualism. Korean society has been characterized as collectivistic where the basic unit of a society consists of groups and where inter-dependency or in-group harmony is emphasized (Lee, 2003). In order to explain the lower levels of suicidal behaviours in collectivistic societies such as China or Ghana, researchers have suggested that suicide may be considered as a disrespectful or shameful act to ones family (Ayyash-Abdo, 2002). It is assumed that the emphasis on interconnectedness or responsibility to the family might serve as a protective factor for suicidal behaviours. However, studies have shown that Korean society is moving toward individualism (Lee, 2003) and many Korean adolescents tend to have more individualistic tendencies than previous generations (Nam, 2008). Therefore, youth with strong individualistic tendencies and those who value selfreliance and independence may feel trapped between two opposite cultures and struggle with their cultural identity, which could lead to suicidal behaviours (Nam, 2008). This explanation might explain why Korea, as a typical example of collectivistic cultures, is at the top of the list in terms of suicide rates in recent years. Emphasis on academic achievement. Academic success has been considered a key to success and is viewed as a survival response in highly competitive societies, such as Korea. Korean parents, especially mothers, pressure their children to perform well on national university entrance exams in order to enter a prestigious university, making Korea an examination hell. Within the extremely competitive educational environment, academic underachievement is considered as failure, leading to depression, anxiety, substance abuse, delinquency and suicide (Hwang, 2003; Yang & Shin, 2008). In recent years, many Korean parents have sent their children to other countries such as Canada or the United States in order to educate their
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children in less competitive educational environment and to reduce nancial burden of Korean education. These children are characterized as parachute children who lack parental monitoring and support. They frequently struggle with loneliness, depression and adjustment diculties (Chun & Sue, 1998). It may be necessary to examine the association between psychosocial diculties and suicide among Korean youth while taking into consideration their unique circumstances.
Chrono-system
The nal system of ecological system analysis, a chrono-system level consists of change or consistency over time in the characteristics of the individual and the environment. Chrono-system is characterized by changes in the event (e.g. divorce, historical events, social conditions) as well as the changes in the individual (e.g. life transitions) (Bronfenbrenner, 1994). In 1997, Asia-Pacic countries, such as South Korea had undergone a major nancial crisis, which resulted in the devaluation of local currency and increase in unemployment rate. These events increased the income gap between the rich and poor, which consequently broke down the countrys social fabric. Consequently, youth-related social problems, such as delinquency, and suicide increased during this period (Kim, Song, Yi, Chung, & Nam, 2004; Shim, 1998). These observations suggest that historical events over the life course can impact youth behaviours such as suicide.
Assessments and interventions

As this analysis indicates, the risk factors for youth suicide in Korea are complex and multifaceted. Because these risk factors are related to particular behaviours, identifying and understanding these factors can inform eective intervention and prevention strategies (Gorman-Smith, Tolan, & Henry, 2000). Despite the importance of understanding the multiple layers of risk factors for youth suicide, suicide prevention and intervention strategies in Korea are limited and thus identifying school-based suicide prevention programs in Korea is complex. The following section draws implications for assessment, prevention, and intervention for youth suicide within the Korean context. Youth characteristics. Proper assessment requires moving beyond focusing exclusively on depression as a risk factor. It should include psychosocial factors such as hopelessness, impulsivity, substance use, academic-related stress and internet addiction. It is also important to recognize that certain socio-demographic characteristics, such as gender might not be relevant to Korean youth. Eective intervention strategies might include family-based substance abuse treatment (Koh, 2006), counselling that reinforces proper coping strategies for academic stress (Kim, Won, Liu, Liu, & Kitanishi, 1997) and anonymous and multimodal counselling for internet addiction (Jang, Hwang, & Choi, 2008). Micro-system. The micro-system level analysis suggests that assessment of suicidal risk must consider the quality of relationships with parents, peers,
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and teachers. Depending on the assessment and available resources, practitioners in Korea working with youth who are at-risk of suicide should utilize skill-building programs for communication, problem-solving, and conict resolution. Parent education programs that promote pro-social parenting practices (e.g. Doh et al., 2003) would make suicide prevention highly eective. In addition, suicide and violence prevention eorts need to be combined (Nickerson & Slater, 2009). For example, Choi (2002) developed a program that teaches peer victimized Korean youth in conict resolution. Such programs should include suicide prevention eorts, considering that there is a signicant association between suicide and peer victimization. Establishing a safe school environment that reduces violence or social exclusion and fosters a sense of belonging to the school would decrease suicidal behaviours among Korean youth. Providing students a variety of social activities is important for developing social support networks. Furthermore, training teachers as a gatekeeper for suicide prevention (Lee, 2007) should be seriously considered since teachers have the most frequent contacts with youth. Meso-system. Research on two or more micro-system factors that inuence youth behaviour is so rare that it oers little practical guidance (Eamon, 2001). The eect of negative parent-child relationships, for example, may result in negative peer relationships in school, which in turn can induce youth suicidal behaviour. Therefore, assessing meso-system level factors (i.e. dynamic interactions between micro-systems) may facilitate choosing the appropriate system in which to intervene (Eamon, 2001). Exo-system. Evaluating the amount of time youth spend viewing suicide-related internet sites or television programs may provide important assessment data for intervention planning. Recognizing media inuence in suicidal behaviour is an important rst step in suicide prevention (Mann et al., 2005). Thus, practitioners should attempt to raise parents and teachers awareness of the relation between media exposure and youth suicide. They might suggest methods to monitor such viewing. They might also collaborate with school ocials in enforcing policies that would prohibit television programs and internet sites that are potentially detrimental to students. At the same time, it is important to increase the number of information on suicide prevention in the internet (Moon, 2002). Macro-system. Feasible and eective assessment and intervention strategies are possible only if they are consistent with the familys lifestyle and culture (Eamon, 2001). Assessing parenting practices and achievement orientation is relevant at this level. Practitioners in Korea can assist parents in learning non-physical and less harsh parenting strategies and encourage them to provide more emotional support to their children. Because educational success of children is important in Korea, Korean parents often overlook their childrens physical or psychological needs (Yang & Shin, 2008). Thus, practitioners must educate parents on the importance of youths developmental needs that are non-academically related. Likewise, strong emphasis on academic excellence makes teachers less willing to deal with mental health issues of students. In fact, about half of Korean high school teachers report that mental health issue is not a primary concern for
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school ocials who have limited knowledge on youth suicide (Lee, 2007). It is critical to raise teachers awareness of the relation between academic performance and mental health issues, such as suicide. Although changing academically-oriented Korean society is a long process, one way to start is for all relevant stakeholders to work collaboratively with the Ministry of Education in revising policies on university entrance examinations so that admission criteria becomes holistic. Chrono-system. Practitioners have little direct inuence over historical events (e.g. economic crises) that can create problems such as stress within families, youth delinquency, and suicidal behaviour. However, practitioners and professional organizations can advocate on behalf of youth and families by educating government elected representatives about the association between social conditions and detrimental outcomes, such as suicidal behaviours. They also can advocate for school mental health programs to assist youth in coping with major life events that result in problems within the micro-system.
Conclusion
Suicidal ideation, suicide attempts, and successful completion among Korean youth are all serious concerns. It is evident from this literature review that the etiology of youth suicide is complex. This complexity requires the development of eective prevention and intervention strategies that address the individual psychological characteristics within larger contexts that youth are embedded infamilies, peers, schools, and communities. However, it is important to consider these contextual factors as both buering and exacerbating environments, in that peers, families, and school personnel can play an important role in preventing suicidal ideation from becoming suicidal behaviours. Only when we apply the social-ecological perspective to youth suicide prevention and intervention will the number of suicides decrease. References
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Seung-yeon Lee, PhD, is an Assistant Professor of Department of Psychology at the Ewha Womans University, Seoul, Korea. She earned her PhD in School Psychology from the University of Iowa in 2004. Her research interests focus on
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adolescent suicide, school violence and crisis intervention. In the area of youth suicide, she has published a number of articles on the eects of reasons for living in suicidal ideation (in press), the role of maladaptive perfectionism, the relationships among eating attitudes, body dissatisfaction, and suicidal ideation, teachers misconception on youth suicide, and suicide postvention in schools. Jun Sung Hong, MSW, MA, is a Doctoral Student in the School of Social Work at the University of Illinois at Urbana-Champaign. His research interests include school violence, school-based intervention, juvenile delinquency, child welfare, and cultural competency in social work practice. He is a CSWE Minority Fellow and a Fulbright recipient. Dorothy L. Espelage, PhD, is a Professor of Child Development and Associate Chair in the Department of Educational Psychology at the University of Illinois, Urbana-Champaign. She was recently named University Scholar and has fellow status in Division 17 (Counseling Psychology) of the American Psychological Association. She earned her PhD in Counseling Psychology from Indiana University in 1997. She presents regularly at national conferences and is author of over 70 professional publications. She is co-author of Bullying Prevention & Intervention: Realistic Strategies for Schools (Guilford Press). She is co-editor of the 2nd edition of a published book entitled Bullying in North American Schools: A Social-Ecological Perspective on Prevention and Intervention (Routledge, in press). She is PI on two US federally funded grants to prevent bullying in schools.

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