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  • The temporal association of excessive health expenditure with suicidal ideation among primary income earners: a cross-sectional design using the Korean Welfare Panel Survey (KoWePS)

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The temporal association of excessive health expenditure with suicidal ideation among primary income earners: a cross-sectional design using the Korean Welfare Panel Survey (KoWePS)
  1. Jaeyong Shin1,2,3,*,
  2. Jae Woo Choi1,2,*,
  3. Sung-in Jang1,2,3,
  4. Young Choi1,2,
  5. Sang Gyu Lee4,
  6. Tae Hwan Ihm5,
  7. Eun-Cheol Park2,3
  1. 1Department of Public Health, Graduate School, Yonsei University, Seoul, Republic of Korea
  2. 2Institute of Health Services Research, College of Medicine, Yonsei University, Seoul, Republic of Korea
  3. 3Department of Preventive Medicine, College of Medicine, Yonsei University, Seoul, Republic of Korea
  4. 4Department of Hospital Management, Graduate School of Public Health, Yonsei University, Seoul, Republic of Korea
  5. 5Department of Economics, College of Arts and Sciences, University of Washington, Seattle, Washington, USA
  1. Correspondence to Dr Eun-Cheol Park; ecpark{at}yuhs.ac

Abstract

Objective Excessive health expenditure (EHE) is a global issue for households suffering from high-cost medical conditions, low incomes and limited insurance coverage. After the international financial crisis of 2008, EHE became a social problem in developed countries. Such economic crisis might induce severe mental stress, resulting in suicidal ideation.

Methods We used the Korean Welfare Panel Study (KoWePS) from 2011 to 2013 and selected primary income earners, who were defined as practical and economic representatives of households; the total number of analysed samples was 4247 of 5717 households in the database. We only included households that had never experienced EHE before 2011. To examine the temporal relationship between EHE and suicidal ideation, we conducted a logistic regression analysis.

Results Among 4247 participants, 146 (3.4%) experienced suicidal ideation, whereas 4101 (96.6%) did not. One scale of depression score (OR=1.28, CI 1.23 to 1.34, p<0.001) was associated with increased suicidal ideation. Such ideation was influenced to a greater extent by a recent EHE above 10% of disposable income (OR=1.91, CI 1.16 to 3.15, p=0.012) than by either a remote EHE (OR=1.29, CI 0.71 to 2.32) or one in 2011 and 2012 (OR=1.67, CI 1.01 to 2.78, p=0.048).

Conclusions In this study, more recent EHE resulted in more suicidal ideation. In conclusion, we suggest that recent household EHE might be considered as an important factor to prevent suicidal ideation and to improve the mental health of individuals.

  • health expenditure
  • suicidal ideation
  • economic burden
  • household
  • suicide
  • korea

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

https://doi.org/10.1136/bmjopen-2014-007421

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