{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,12]],"date-time":"2026-11-12T13:48:05Z","timestamp":1794491285143,"version":"4.9.1"},"reference-count":51,"publisher":"BMJ","issue":"1","license":[{"start":{"date-parts":[[2026,1,19]],"date-time":"2026-01-19T00:00:00Z","timestamp":1768780800000},"content-version":"unspecified","delay-in-days":18,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2026,1,6]]},"published-print":{"date-parts":[[2026,1]]},"abstract":"<jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>This study aimed to examine the prevalence of suicide attempts among Korean adolescents before, during and after the COVID-19 pandemic and explore cross-sectional associations with demographic, psychological, behavioural and academic characteristics.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>Cross-sectional analysis of three nationally representative survey waves.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>The Korean Youth Risk Behavior Survey (KYRBS), an annual school-based nationwide survey in South Korea.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Participants<\/jats:title>\n                    <jats:p>Adolescents with available data on key variables who participated in the 2017 (n=61\u2009861), 2020 (n=54\u2009809) and 2023 (n=52\u2009802) KYRBS.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Primary and secondary outcome measures<\/jats:title>\n                    <jats:p>The primary outcome was a suicide attempt in the past 12 months. Secondary measures included age, sex, perceived socioeconomic status, sadness, perceived stress, alcohol use, tobacco use, lifetime drug use and subjective academic performance. These variables were measured using standardised single-item questions in the KYRBS, whereas associations were examined using multivariable logistic regression models adjusting for all covariates.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Several characteristics demonstrated consistent associations with suicide attempts. In 2017, suicide attempts were most strongly associated with sadness (OR 6.47, 95% CI 5.68 to 7.37), drug use (OR 5.60, 95%\u2009CI 4.34 to 7.24) and stress (OR 1.74, 95%\u2009CI 1.63 to 1.85). During the pandemic (2020), sadness (OR 6.35, 95%\u2009CI 5.39 to 7.48), drug use (OR 4.56, 95%\u2009CI 3.38 to 6.14) and stress (OR 2.10, 95%\u2009CI 1.94 to 2.28) preserved the strong association. In 2023, the associations persisted for sadness (OR 5.06, 95%\u2009CI 4.48 to 5.71), drug use (OR 5.31, 95%\u2009CI 4.42 to 6.39) and tobacco use (OR 2.53, 95%\u2009CI 2.15 to 2.98). Socioeconomic status showed no significant association in 2017 (OR 0.98, 95%\u2009CI 0.93 to 1.04) but demonstrated modest associations in 2020 (OR 0.91, 95%\u2009CI 0.85 to 0.97) and 2023 (OR 0.89, 95%\u2009CI 0.84 to 0.94). Subjective academic performance showed inverse associations in 2017 (OR 0.92, 95%\u2009CI 0.88 to 0.96) and 2020 (OR 0.92, 95%\u2009CI 0.87 to 0.97) but not in 2023 (OR 0.96, 95%\u2009CI 0.92 to 1.00).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Across three survey years, suicide attempts among Korean adolescents co-occurred with multiple emotional, behavioural and contextual characteristics. The magnitude of these associations varied before, during and after the pandemic, suggesting that broader social and educational conditions may shape patterns of distress linked with suicidal behaviour. Integrated approaches addressing overlapping emotional, behavioural and socioeconomic challenges may support youth suicide prevention efforts.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2025-110297","type":"journal-article","created":{"date-parts":[[2026,1,19]],"date-time":"2026-01-19T16:30:30Z","timestamp":1768840230000},"page":"e110297","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":1,"title":["Suicide attempts among Korean adolescents before, during and after the COVID-19 pandemic: a cross-sectional study"],"prefix":"10.1136","volume":"16","author":[{"given":"Sol I","family":"Kim","sequence":"first","affiliation":[{"name":"Chung-Ang University, Seoul, Korea (the Republic of)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8128-2879","authenticated-orcid":false,"given":"Jeong Soo","family":"Kim","sequence":"additional","affiliation":[{"name":"Rochester Institute of Technology, Rochester, New York, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sun Mi","family":"Kim","sequence":"additional","affiliation":[{"name":"Chung-Ang University, Seoul, Korea (the Republic of)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8314-0767","authenticated-orcid":false,"given":"Doug","family":"Hyun Han","sequence":"additional","affiliation":[{"name":"Chung-Ang University, Seoul, Korea (the Republic of)"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2026,1,19]]},"reference":[{"key":"2026011908301546000_16.1.e110297.1","doi-asserted-by":"publisher","DOI":"10.1111\/jcap.12295"},{"key":"2026011908301546000_16.1.e110297.2","unstructured":"World Health Organization . Suicide worldwide in 2021: global health estimates. Geneva: WHO, 2025."},{"key":"2026011908301546000_16.1.e110297.3","unstructured":"Curtin SC , Heron MP . Death Rates Due to Suicide and Homicide Among Persons Aged 10-24: United States, 2000-2017. NCHS Data Brief 2019;1\u20138."},{"key":"2026011908301546000_16.1.e110297.4","unstructured":"Organisation for Economic Co-Operation and Development . Health at a glance 2021: OECD indicators. Paris: OECD Publishing, 2021."},{"key":"2026011908301546000_16.1.e110297.5","doi-asserted-by":"crossref","first-page":"132","DOI":"10.5124\/jkma.2023.66.2.132","article-title":"Cause-of-death statistics in 2020 in the Republic of Korea","volume":"66","author":"Noh","year":"2023","journal-title":"J Korean Med Assoc"},{"key":"2026011908301546000_16.1.e110297.6","doi-asserted-by":"crossref","first-page":"737","DOI":"10.1007\/s00787-020-01570-z","article-title":"Suicidality in children and adolescents: lessons to be learned from the COVID-19 crisis","volume":"29","author":"Hoekstra","year":"2020","journal-title":"Eur Child Adolesc Psychiatry"},{"key":"2026011908301546000_16.1.e110297.7","doi-asserted-by":"crossref","first-page":"460","DOI":"10.1111\/jcpp.12831","article-title":"Annual Research Review: Suicide among youth \u2013 epidemiology, (potential) etiology, and treatment","volume":"59","author":"Cha","year":"2018","journal-title":"Child Psychology Psychiatry"},{"key":"2026011908301546000_16.1.e110297.8","doi-asserted-by":"publisher","DOI":"10.1111\/jcpp.13106"},{"key":"2026011908301546000_16.1.e110297.9","doi-asserted-by":"crossref","DOI":"10.1111\/ijn.12930","article-title":"Risk factors for teen suicide and bullying: An international integrative review","volume":"27","author":"Cuesta","year":"2021","journal-title":"Int J Nurs Pract"},{"key":"2026011908301546000_16.1.e110297.10","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpsychires.2021.02.053"},{"key":"2026011908301546000_16.1.e110297.11","doi-asserted-by":"crossref","first-page":"134","DOI":"10.1111\/camh.12400","article-title":"Risk factors for suicide attempt in children, adolescents, and young adults hospitalized for mental health disorders","volume":"26","author":"Ong","year":"2021","journal-title":"Child Adoles Ment Health"},{"key":"2026011908301546000_16.1.e110297.12","doi-asserted-by":"crossref","DOI":"10.3389\/fpsyt.2019.00898","article-title":"Associations of Suicide Rates With Socioeconomic Status and Social Isolation: Findings From Longitudinal Register and Census Data","volume":"10","author":"N\u00e4her","year":"2019","journal-title":"Front Psychiatry"},{"key":"2026011908301546000_16.1.e110297.13","doi-asserted-by":"crossref","first-page":"78","DOI":"10.1176\/appi.prcp.20230067","article-title":"History of Suicidality and Pandemic Outcomes: Longitudinal Associations with Anxiety Symptoms, Depressive Symptoms, and Problematic Drinking","volume":"6","author":"Luk","year":"2024","journal-title":"Psychiatr Res Clin Pract"},{"key":"2026011908301546000_16.1.e110297.14","doi-asserted-by":"crossref","DOI":"10.1002\/smi.3403","article-title":"Longitudinal associations between self-compassion, depression, and suicidal ideation in adolescent boys and girls","volume":"40","author":"Pang","year":"2024","journal-title":"Stress Health"},{"key":"2026011908301546000_16.1.e110297.15","doi-asserted-by":"publisher","DOI":"10.1177\/2167702613497473"},{"key":"2026011908301546000_16.1.e110297.16","doi-asserted-by":"publisher","DOI":"10.1002\/ajmg.b.32880"},{"key":"2026011908301546000_16.1.e110297.17","doi-asserted-by":"crossref","first-page":"423","DOI":"10.1007\/s10519-025-10234-0","article-title":"Genetic Overlap Between DSM-IV Major Depressive Disorder and Suicidal Behaviors: Evidence from Polygenic Risk Scores in Young Adult Twins","volume":"55","author":"Gillespie","year":"2025","journal-title":"Behav Genet"},{"key":"2026011908301546000_16.1.e110297.18","doi-asserted-by":"crossref","first-page":"S73","DOI":"10.12669\/pjms.36.COVID19-S4.2638","article-title":"Coronavirus Disease 2019 (COVID-19) Pandemic and Economic Impact","volume":"36","author":"Ahmad","year":"2020","journal-title":"Pak J Med Sci"},{"key":"2026011908301546000_16.1.e110297.19","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0277562","article-title":"Mental health during the COVID-19 pandemic: Impacts of disease, social isolation, and financial stressors","volume":"17","author":"Kraut","year":"2022","journal-title":"PLoS ONE"},{"key":"2026011908301546000_16.1.e110297.20","doi-asserted-by":"crossref","DOI":"10.1186\/s12992-020-00589-w","article-title":"Prevalence of stress, anxiety, depression among the general population during the COVID-19 pandemic: a systematic review and meta-analysis","volume":"16","author":"Salari","year":"2020","journal-title":"Global Health"},{"key":"2026011908301546000_16.1.e110297.21","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajp.2020.102092"},{"key":"2026011908301546000_16.1.e110297.22","doi-asserted-by":"crossref","DOI":"10.1016\/j.jvb.2020.103439","article-title":"The impact of the COVID-19 pandemic on marginalized populations in the United States: A research agenda","volume":"119","author":"Kantamneni","year":"2020","journal-title":"J Vocat Behav"},{"key":"2026011908301546000_16.1.e110297.23","unstructured":"Narayan A , Cojocaru A , Agrawal S , et al . COVID-19 and economic inequality: short-term impacts with long-term consequences: The World Bank. 2022."},{"key":"2026011908301546000_16.1.e110297.24","first-page":"1","article-title":"The difference between emergency remote teaching and online learning","volume":"27","author":"Hodges","year":"2020","journal-title":"Educause Rev"},{"key":"2026011908301546000_16.1.e110297.25","doi-asserted-by":"crossref","DOI":"10.3389\/fpsyg.2021.642593","article-title":"Changes and Adaptations: How University Students Self-Regulate Their Online Learning During the COVID-19 Pandemic","volume":"12","author":"Biwer","year":"2021","journal-title":"Front Psychol"},{"key":"2026011908301546000_16.1.e110297.26","doi-asserted-by":"crossref","first-page":"78","DOI":"10.1016\/j.jad.2021.06.021","article-title":"Prevalence of mental health problems among children and adolescents during the COVID-19 pandemic: A systematic review and meta-analysis","volume":"293","author":"Ma","year":"2021","journal-title":"J Affect Disord"},{"key":"2026011908301546000_16.1.e110297.27","doi-asserted-by":"crossref","first-page":"72","DOI":"10.1186\/s43045-020-00075-4","article-title":"Impact of COVID-19 on adolescents\u2019 mental health: a systematic review","volume":"27","author":"Octavius","year":"2020","journal-title":"Middle East Curr Psychiatry"},{"key":"2026011908301546000_16.1.e110297.28","doi-asserted-by":"crossref","DOI":"10.1542\/peds.2022-058375","article-title":"Youth Suicide During the First Year of the COVID-19 Pandemic","volume":"151","author":"Bridge","year":"2023","journal-title":"Pediatrics"},{"key":"2026011908301546000_16.1.e110297.29","unstructured":"Korea Disease Control and Prevention Agency . Korea youth risk behavior survey 2017, 2020. 2023. Available: https:\/\/www.kdca.go.kr\/yhs"},{"key":"2026011908301546000_16.1.e110297.30","doi-asserted-by":"crossref","DOI":"10.3389\/fped.2021.694819","article-title":"Associations Between Sad Feelings and Suicide Behaviors in the 2019 Youth Risk Behavior Survey: A Call for Action","volume":"9","author":"Trimble","year":"2021","journal-title":"Front Pediatr"},{"key":"2026011908301546000_16.1.e110297.31","doi-asserted-by":"crossref","first-page":"43","DOI":"10.1177\/070674379403900109","article-title":"Stressful life events associated with adolescent suicide attempts","volume":"39","author":"Adams","year":"1994","journal-title":"Can J Psychiatry"},{"key":"2026011908301546000_16.1.e110297.32","doi-asserted-by":"crossref","first-page":"243","DOI":"10.1080\/13811119508258986","article-title":"Suicidal behaviour and the co-occurrence of behavioural, emotional and cognitive problems among adolescents","volume":"1","author":"Garnefski","year":"1995","journal-title":"Arch Suicide Res"},{"key":"2026011908301546000_16.1.e110297.33","doi-asserted-by":"crossref","first-page":"274","DOI":"10.1007\/s10862-014-9451-0","article-title":"Suicide Ideation and Attempts are Associated with Co-occurring Oppositional Defiant Disorder and Sadness in Children and Adolescents with ADHD","volume":"37","author":"Mayes","year":"2015","journal-title":"J Psychopathol Behav Assess"},{"key":"2026011908301546000_16.1.e110297.34","doi-asserted-by":"publisher","DOI":"10.4088\/JCP.10m06673"},{"key":"2026011908301546000_16.1.e110297.35","doi-asserted-by":"publisher","DOI":"10.1016\/j.drugalcdep.2003.10.004"},{"key":"2026011908301546000_16.1.e110297.36","doi-asserted-by":"crossref","first-page":"179","DOI":"10.12799\/rcphn.2024.00535","article-title":"Patterns of Adolescent Substance Use: A Comparative Study among the United States, Canada, England, and South Korea from 2014-2021","volume":"35","author":"Kim","year":"2024","journal-title":"Res Community Public Health Nurs"},{"key":"2026011908301546000_16.1.e110297.37","doi-asserted-by":"crossref","DOI":"10.1186\/s12939-021-01582-4","article-title":"A systematic review of racial\/ethnic and socioeconomic disparities in COVID-19","volume":"20","author":"Khanijahani","year":"2021","journal-title":"Int J Equity Health"},{"key":"2026011908301546000_16.1.e110297.38","doi-asserted-by":"publisher","DOI":"10.1136\/jech-2017-209784"},{"key":"2026011908301546000_16.1.e110297.39","article-title":"COVID-19-related financial strain and adolescent mental health","volume":"16","author":"Argabright","year":"2022","journal-title":"Lancet Reg Health Am"},{"key":"2026011908301546000_16.1.e110297.40","doi-asserted-by":"crossref","first-page":"893","DOI":"10.1080\/01411926.2010.506945","article-title":"Families\u2019 social backgrounds matter: Socio\u2010economic factors, home learning and young children\u2019s language, literacy and social outcomes","volume":"37","author":"Hartas","year":"2011","journal-title":"British Educational Res J"},{"key":"2026011908301546000_16.1.e110297.41","doi-asserted-by":"crossref","DOI":"10.3390\/ijerph20021625","article-title":"Family Socioeconomic Status and Adolescent Mental Health Problems during the COVID-19 Pandemic: The Mediating Roles of Trait Mindfulness and Perceived Stress","volume":"20","author":"Yuan","year":"2023","journal-title":"Int J Environ Res Public Health"},{"key":"2026011908301546000_16.1.e110297.42","doi-asserted-by":"crossref","first-page":"455","DOI":"10.1080\/01443410120090830","article-title":"An Evaluation of Factors Influencing the Academic Self-concept, Self-esteem and Academic Stress for Direct and Re-entry Students in Higher Education","volume":"21","author":"Michie","year":"2001","journal-title":"Educ Psychol (Lond)"},{"key":"2026011908301546000_16.1.e110297.43","doi-asserted-by":"crossref","first-page":"12","DOI":"10.18844\/gjgc.v10i1.4874","article-title":"Effects of academic results on the perception of competence and self-esteem in students\u2019 training","volume":"10","author":"Radid","year":"2020","journal-title":"GJGC"},{"key":"2026011908301546000_16.1.e110297.44","first-page":"126","article-title":"Relationship of academic performance and well-being in university students","volume":"56","author":"Bukhari","year":"2017","journal-title":"Pak J Med Res"},{"key":"2026011908301546000_16.1.e110297.45","first-page":"3812","article-title":"Impact of Covid-19 Pandemic on Higher Education","volume":"14","author":"Tarkar","year":"2020","journal-title":"Jxu"},{"key":"2026011908301546000_16.1.e110297.46","doi-asserted-by":"crossref","first-page":"133","DOI":"10.1177\/2347631120983481","article-title":"A Literature Review on Impact of COVID-19 Pandemic on Teaching and Learning","volume":"8","author":"Pokhrel","year":"2021","journal-title":"Higher Educ Future"},{"key":"2026011908301546000_16.1.e110297.47","doi-asserted-by":"crossref","first-page":"643443","DOI":"10.3389\/fpsyg.2021.643443","article-title":"Stress-Related Growth in Adolescents Returning to School After COVID-19 School Closure","volume":"12","author":"Waters","year":"2021","journal-title":"Front Psychol"},{"key":"2026011908301546000_16.1.e110297.48","doi-asserted-by":"crossref","DOI":"10.1080\/20008066.2025.2488700","article-title":"Mental health during and after the COVID-19 pandemic - a longitudinal study over 42 months in five European countries","volume":"16","author":"Zrni\u0107 Novakovi\u0107","year":"2025","journal-title":"Eur J Psychotraumatol"},{"key":"2026011908301546000_16.1.e110297.49","doi-asserted-by":"crossref","first-page":"536","DOI":"10.62345\/jads.2025.14.3.45","article-title":"Effects of Online Learning on Adolescent Mental Health: A Post-Pandemic Perspective","volume":"14","author":"Gul","year":"2025","journal-title":"J Asian Dev Studies"},{"key":"2026011908301546000_16.1.e110297.50","doi-asserted-by":"crossref","first-page":"8","DOI":"10.1016\/j.jad.2021.03.009","article-title":"Socioeconomic inequality in child mental health during the COVID-19 pandemic: First evidence from China","volume":"287","author":"Li","year":"2021","journal-title":"J Affect Disord"},{"key":"2026011908301546000_16.1.e110297.51","doi-asserted-by":"crossref","first-page":"1643145","DOI":"10.3389\/fpsyt.2025.1643145","article-title":"Suicidality and self-harm in adolescents before and after the COVID-19 pandemic: a systematic review","volume":"16","author":"Ferreira","year":"2025","journal-title":"Front Psychiatry"}],"container-title":["BMJ Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjopen-2025-110297","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,1,19]],"date-time":"2026-01-19T16:30:36Z","timestamp":1768840236000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmjopen.bmj.com\/lookup\/doi\/10.1136\/bmjopen-2025-110297"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,1]]},"references-count":51,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,1,19]]},"published-print":{"date-parts":[[2026,1]]}},"alternative-id":["10.1136\/bmjopen-2025-110297"],"URL":"https:\/\/doi.org\/10.1136\/bmjopen-2025-110297","relation":{},"ISSN":["2044-6055","2044-6055"],"issn-type":[{"value":"2044-6055","type":"print"},{"value":"2044-6055","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,1]]}}}