Suicide attempts among Korean adolescents before, during and after the COVID-19 pandemic: a cross-sectional study

Objectives 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. Design Cross-sectional analysis of three nationally representative survey waves. Setting The Korean Youth Risk Behavior Survey (KYRBS), an annual school-based nationwide survey in South Korea. Participants Adolescents with available data on key variables who participated in the 2017 (n=61 861), 2020 (n=54 809) and 2023 (n=52 802) KYRBS. Primary and secondary outcome measures 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. Results 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% CI 4.34 to 7.24) and stress (OR 1.74, 95% CI 1.63 to 1.85). During the pandemic (2020), sadness (OR 6.35, 95% CI 5.39 to 7.48), drug use (OR 4.56, 95% CI 3.38 to 6.14) and stress (OR 2.10, 95% CI 1.94 to 2.28) preserved the strong association. In 2023, the associations persisted for sadness (OR 5.06, 95% CI 4.48 to 5.71), drug use (OR 5.31, 95% CI 4.42 to 6.39) and tobacco use (OR 2.53, 95% CI 2.15 to 2.98). Socioeconomic status showed no significant association in 2017 (OR 0.98, 95% CI 0.93 to 1.04) but demonstrated modest associations in 2020 (OR 0.91, 95% CI 0.85 to 0.97) and 2023 (OR 0.89, 95% CI 0.84 to 0.94). Subjective academic performance showed inverse associations in 2017 (OR 0.92, 95% CI 0.88 to 0.96) and 2020 (OR 0.92, 95% CI 0.87 to 0.97) but not in 2023 (OR 0.96, 95% CI 0.92 to 1.00). Conclusions 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.