Mental health in South Korea

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South Korea

Mental health issues are prevalent in South Korea, with the highest suicide rate in the OECD [1] and the highest rate of hospitalizations for mental illness among OECD (Organisation for Economic Co-operation and Development) countries. [2] South Korea has state-funded mental health services, the majority of which are inpatient hospital facilities, but they are largely underfunded and underutilized. [3] [4] Despite the prevalence of mental illness, social stigma remains prevalent throughout the South Korean population, which discourages sufferers from seeking treatment. [5] Mental illness, while present across all demographic groups, is most common among the elderly and adolescents in South Korea. [6] [7]

Contents

History

Western medicine was first introduced to South Korea by missionary doctors, and led to the transition of mental healthcare from shamanistic healers and traditional Korean medicine to mental hospitals sponsored by the Japanese government, which was occupying Korea, by 1910. Missionary hospitals, which tended to be more humane, also existed, but the isolation of patients by government mental hospitals contributed to the development of stigma in Korean society. [8] Recently, the basis of mental healthcare in South Korea has shifted from long-term hospital stays to community-based healthcare, [3] [9] but the length of admission of those staying in mental hospitals is on an upward trend. [2] [10] This calls into question the effectiveness of South Korean health infrastructure, as the average length of stay in other OECD countries was less than a quarter of that in South Korea in 2011. [2] Some experts question how well treatment methods in South Korean mental hospitals are working compared to that of other OECD countries. [2]

Societal perceptions of mental illness

South Koreans have been found to have comparatively higher levels of internalized stigma, which relates to higher rates of mental illness and more severe symptoms. [5] [11] Seeking treatment for mental health conditions is largely frowned upon in Korean culture, with reports stating that only seven percent of those affected by mental illness seek psychiatric help. [12] As a culture heavily influenced by Confucianism, the honor of the family is prioritized over the individual, leading Koreans to forgo treatment to preserve their family's face. [13] It is also said by Korean doctors that Confucian culture emphasizes individual will and self-discipline which creates a social prejudice against mental health. [14] Traditional Confucian ideals state that mental illnesses/disorders are meant to be tolerated, not treated. Studies have shown that those above 70 were less likely to seek treatment than those within the 19-29 years old age group because of such Confucian ideals. Gender also seems to affect those seeking help for mental illnesses. Women are more likely to seek medical attention to attend to their mental health needs than men, most likely because men have higher perceived stigma of mental health. [15] Those who turn to therapy often pay out-of-pocket and in cash to avoid the stigma associated with mental health services on one's insurance record. [13] Stigma also hinders the ability of those recovering from mental illness to reintegrate into society. [12]

Mental healthcare

South Korean law prohibits workplace discrimination based on mental health conditions, but discrimination persists due to the lack of enforcement of such legislation. [16] Psychiatrists and other mental health professionals are well-trained and numerous, but mental healthcare remains isolated from primary care, still a major contributor to South Korea's strong stigma against mental healthcare. [16] Mental health medication is widely available, and almost all medications available to patients in the West are available in South Korea. The universal health coverage as provided by the state means that the majority of South Koreans can afford medicine and treatment for mental illness, [17] but stigma often discourages people from utilizing their health coverage. [18]

Public spending on mental healthcare remained low, at 3%, most of which goes to inpatient mental hospitals despite the fact that most people receive treatment from outpatient facilities. [16] As of 2005, the Korean government did not officially allot any funds towards mental healthcare in the national budget. [17] There has been an increase in the recent years. In 2019, the mental health budget in South Korea was 253.4 million in USD: US$90.3 million came from the general fund, US$63.8 million came from the National Health Promotion Fund, and the last US$97.3 million came from the special account for national mental hospitals. In 2020, the national budget allocated for mental health was 301 billion South Korean won, a 49.5 increase from the budget for mental health treatment in 2017. However, a study has shown that the burden of mental health and behavioral disorders (MBDs) created challenges on the Korean healthcare system that could not be repaired efficiently by this current budget.

The South Korean government passed the Mental Health Act in 1995. [19] The Mental Health Act expanded the number of national mental hospitals and community mental health centers with the goal of making mental healthcare more accessible to communities. [17] However, the act also made involuntary hospitalizations significantly easier. [19] In 2017, the Mental Health Act was amended to protect the individual rights and liberties of those admitted to inpatient mental hospitals. [20] The 1999 Medical Protection Act and Welfare Law for the Handicapped protect the rights of disabled persons, and the mentally ill have qualified for protection under these laws since 2000. [17]

Mental illness

Contributing factors

Economic hardship during the late 1990s led to a sharp increase in mental illness and suicide in South Korea, as well as almost all other Asian countries that the economic depression affected. [21] [22] Social stigma within the South Korean population likewise discourages people from initially seeking treatment, exacerbating the severity of mental illness. [5] [11] Cultural factors other than stigma, such as binge-drinking, may also contribute to mental health issues within South Korean society. Due to Korea's societal, academic and corporate structure, Koreans are placed under substantial stress from a relatively young age. Korean children and adolescents are placed in an education system that has a relentless focus on intellectual excellence, with anything less than such considered unacceptable. Suicide is the leading cause of death for adolescent Koreans, making suicide a suffocating reality in school systems. Korean students face not only academic pressure, but also the common stressors that the average student faces in any school setting. Social exclusion is a contributing factor to depression amongst Koreans aged from 10 to 19. In school systems children are victimized for their economic status or for other trivial reasons. Korean students are encouraged to excel above their peers which encourages a competitive environment welcoming hostility amongst peers. Korean students who have been bullied are said to have lower tests scores, lower self-esteem and increased levels of anxiety, making them more likely to become victims of depression.

Depression

In 2001, between 3 and 4.2 percent of the South Korean population was estimated to have major depressive disorder as outlined in the DSM-IV, a number which has been increasing. [6] The latest number recorded of the percent of the population diagnosed with depression, 6.7%, was recorded in 2011. Women, smokers, shift workers, those with poor health, those who exercise in the evenings, those who perceive their lives to be stressful, and those that were underweight were more likely to have major depressive disorder. [6] A potential reason that this statistic has risen within the last decade could be from the low access rate to health care services for depression. A study reported that the average percent annual treatment rate for depression was 39.2%. Within the population of those diagnosed with depression, only 16.0% seek treatment. Among those in the population that seek treatment, individuals with a college education are more likely to undergo depression treatment, 16.0%, than those without an education. Educational level has been shown to have an association with those seeking treatment for depression; with more education, individuals are more exposed to health information and actively respond to this new knowledge. Individuals that are above the age of 70 are also less likely to receive depression consultation than those aged between 19 and 29 years.

Alcohol use disorder

Compared to the United States and other East Asian countries, alcohol use disorder is more prevalent in Korea, and treatment is four times less likely to be sought out in Korea. [23] The 2009 Korea National Health and Nutrition Examination Survey found that less than 2% of those with alcohol use disorder had received any form of treatment or intervention by a professional. [24] Kye-Song Lee found in a 2013 study that nearly 7% of South Koreans have alcohol use disorder, the highest rate of any country in the world. [24] South Koreans drink more alcohol by volume per capita than the residents of any other country in the world, consuming twice as much alcohol and 1.5 times as much hard alcohol per person as Russians, the next highest consumers. [25] The prevalence of alcohol use disorder is increased by the expectation of businesspeople to engage in heavy drinking with their colleagues after work. [13] In addition to being seen as a method of bonding with friends and colleagues, drinking alcohol is also viewed as a method of stress-relief. [25]

Other mental illness

Maeng-Je Cho et al. found that over one-third of the South Korean population has had a mental disorder at any point in their lives, and over one-fifth have experienced a disorder in the past year. [26] 17% of the South Korean population has insomnia, which is a rate comparable to that of insomnia in the United States. [27] 6.6% of Koreans have nicotine dependence disorder, 2% have a mood disorder, and 5.2% have an anxiety disorder, all of which are less frequent among Koreans than among Americans. [23]

Post-traumatic stress disorder (PTSD) is especially prevalent among refugees from North Korea living in South Korea. [28] In a 2005 study, Jeon et al. found that 29.5% of North Korean refugees in South Korea were found to suffer from PTSD. [28] A higher rate was found among female refugees than male refugees. [28]

Demographics of mental illness

Mental illness in the elderly

Between 17.8 and 27.9 percent of those aged 65 or older in South Korea are likely to suffer from depression, significantly higher than the rate in other countries. [29] Factors associated with late life depression in Korea include living alone, smoking, financial hardships and intellectual disability. [29] The high rate of depression among Korean elders may be a result of the rapidly aging population and the dissolution of the tradition of children caring for their aging parents. [29] Government social services for the elderly, such as the Law of Elderly Welfare, are inadequate to provide for the growing population's needs, contributing to mental illness within the demographic. [7]

Among a sample of elderly Koreans living in the United States, 34% were found to have depression, less than a fifth of which had ever seen a mental health professional. The majority of older Koreans living in the United States exhibited a negative perception of mental health services. [30]

Mental illness in adolescents

More than 10% of Seoul adolescents have been found at high risk for internet addiction disorder. [31] Internet addiction is positively correlated with family factors including child abuse and a harsh parenting style. [31] Depression and obsessive-compulsive disorder are both correlated with internet addiction among adolescents. [32]

The 2009 study named, Addictive Internet Use among Korean Adolescents:A National Survey, found that a reason why internet addiction disorder is so prominent in Seoul adolescents, is due to a large number of students using the internet primarily for online gaming. In middle school males, 67.0% listed online gaming as their primary use of the internet. High school males listed online gaming as their primary use of the internet at 44.8%. When females of the same age are taken into account, 23% listed their primary use for blogging/ updating personal homepages. High school females listed searching information at 23.9% as their primary use of the internet. [33] A reason why males are more exposed to internet addiction disorder is the idea of internet shops called PC bangs, where the common customers are male from mid teens to late twenties. [34]

Hyun-Sook Park et al. have found a gender difference in predictors of suicide ideation among Korean youth; with the main predictors for females being bullying, sexual orientation, depression, low self-esteem, and hostility; and the primary predictors for males being history of suicide attempt, parental alcohol abuse, smoking, hostility, and low self-esteem. [35]

Suicide

Suicide in South Korea occurs at the 12th highest rate in the world (4th highest for female cases) and the highest rate among the OECD counties. In 2013, the suicide rate in South Korea was 29.1 per 100,000, a decrease from 33.3 per 100,000 in 2011. This rate is more than twice the OECD average. [2] Between 2000 and 2011, South Korea's suicide rate more than doubled, contrary to the international trend of a steadily decreasing suicide rate. [2] The OECD reported that in 2019, the rate of suicide was 24.6 per 100,000. This is a decrease from past reported years, but still noticeably high among other listed countries, such as the United States, Canada, Sweden, and more. [36] This rise in suicides is potentially linked to the economic wellbeing of South Koreans, as suicides have historically been higher during times of economic strife. [7] The increase in suicides has been most significant among women, adolescents, and the elderly. [6] [7]

Related Research Articles

A mental disorder, also referred to as a mental illness, a mental health condition, or a psychiatric disorder, is a behavioral or mental pattern that causes significant distress or impairment of personal functioning. A mental disorder is also characterized by a clinically significant disturbance in an individual's cognition, emotional regulation, or behavior, often in a social context. Such disturbances may occur as single episodes, may be persistent, or may be relapsing–remitting. There are many different types of mental disorders, with signs and symptoms that vary widely between specific disorders. A mental disorder is one aspect of mental health.

<span class="mw-page-title-main">Postpartum depression</span> Mood disorder experienced after childbirth

Postpartum depression (PPD), also called postnatal depression, is a type of mood disorder experienced after childbirth, which can affect both sexes. Symptoms may include extreme sadness, low energy, anxiety, crying episodes, irritability, and changes in sleeping or eating patterns. PPD can also negatively affect the newborn child.

Suicide is the second leading cause of death for people in the United States from the ages of 9 to 56.

<span class="mw-page-title-main">Mental health</span> Level of human psychological well-being

Mental health encompasses emotional, psychological, and social well-being, influencing cognition, perception, and behavior. According to World Health Organization (WHO), it is a "state of well-being in which the individual realizes his or her abilities, can cope with the normal stresses of life, can work productively and fruitfully, and can contribute to his or her community". It likewise determines how an individual handles stress, interpersonal relationships, and decision-making. Mental health includes subjective well-being, perceived self-efficacy, autonomy, competence, intergenerational dependence, and self-actualization of one's intellectual and emotional potential, among others. From the perspectives of positive psychology or holism, mental health may include an individual's ability to enjoy life and to create a balance between life activities and efforts to achieve psychological resilience. Cultural differences, personal philosophy, subjective assessments, and competing professional theories all affect how one defines "mental health". Some early signs related to mental health difficulties are sleep irritation, lack of energy, lack of appetite, thinking of harming oneself or others, self-isolating, and frequently zoning out.

<span class="mw-page-title-main">Suicidal ideation</span> Thoughts, ideas, or ruminations about the possibility of ending ones life

Suicidal ideation, or suicidal thoughts, is the thought process of having ideas, or ruminations about the possibility of committing suicide. It is not a diagnosis but is a symptom of some mental disorders, use of certain psychoactive drugs, and can also occur in response to adverse life events without the presence of a mental disorder.

Gender is correlated with the prevalence of certain mental disorders, including depression, anxiety and somatic complaints. For example, women are more likely to be diagnosed with major depression, while men are more likely to be diagnosed with substance abuse and antisocial personality disorder. There are no marked gender differences in the diagnosis rates of disorders like schizophrenia and bipolar disorder. Men are at risk to suffer from post-traumatic stress disorder (PTSD) due to past violent experiences such as accidents, wars and witnessing death, and women are diagnosed with PTSD at higher rates due to experiences with sexual assault, rape and child sexual abuse. Nonbinary or genderqueer identification describes people who do not identify as either male or female. People who identify as nonbinary or gender queer show increased risk for depression, anxiety and post-traumatic stress disorder. People who identify as transgender demonstrate increased risk for depression, anxiety, and post-traumatic stress disorder.

<span class="mw-page-title-main">Healthcare in Pakistan</span> Overview of the health care system in Pakistan

The healthcare delivery system of Pakistan is complex because it includes healthcare subsystems by federal governments and provincial governments competing with formal and informal private sector healthcare systems. Healthcare is delivered mainly through vertically managed disease-specific mechanisms. The different institutions that are responsible for this include: provincial and district health departments, parastatal organizations, social security institutions, non-governmental organizations (NGOs) and private sector. The country's health sector is also marked by urban-rural disparities in healthcare delivery and an imbalance in the health workforce, with insufficient health managers, nurses, paramedics and skilled birth attendants in the peripheral areas. Pakistan's gross national income per capita in 2021 was $4,990 and the total expenditure on health per capita in 2021 was Rs 657.2 Billion, constituting 1.4% of the country's GDP. The health care delivery system in Pakistan consists of public and private sectors. Under the constitution, health is primarily responsibility of the provincial government, except in the federally administered areas. Health care delivery has traditionally been jointly administered by the federal and provincial governments with districts mainly responsible for implementation. Service delivery is being organized through preventive, promotive, curative and rehabilitative services. The curative and rehabilitative services are being provided mainly at the secondary and tertiary care facilities. Preventive and promotive services, on the other hand, are mainly provided through various national programs; and community health workers’ interfacing with the communities through primary healthcare facilities and outreach activities. The state provides healthcare through a three-tiered healthcare delivery system and a range of public health interventions. Some government/ semi government organizations like the armed forces, Sui Gas, WAPDA, Railways, Fauji Foundation, Employees Social Security Institution and NUST provide health service to their employees and their dependants through their own system, however, these collectively cover about 10% of the population. The private health sector constitutes a diverse group of doctors, nurses, pharmacists, traditional healers, drug vendors, as well as laboratory technicians, shopkeepers and unqualified practitioners.

<span class="mw-page-title-main">College health</span> Health of individuals enrolled in college

College health is a desired outcome created by a constellation of services, programs and policies directed at advancing the health and wellbeing of individuals enrolled in an institution of higher education, while also addressing and improving both population health and community health. Many colleges and universities worldwide apply both health promotion and health care as processes to achieve key performance indicators in college health. The variety of healthcare services provided by any one institution range from first aid stations employing a single nurse to large, accredited, multi-specialty ambulatory healthcare clinics with hundreds of employees. These services, programs and policies require a multidisciplinary team, the healthcare services alone include physicians, physician assistants, administrators, nurses, nurse practitioners, mental health professionals, health educators, athletic trainers, dietitians and nutritionists, and pharmacists. Some of the healthcare services extend to include massage therapists and other holistic health care professionals. While currently changing, the vast majority of college health services are set up as cost centers or service units rather than as parts of academic departments or health care delivery enterprises.

Mental distress or psychological distress encompasses the symptoms and experiences of a person's internal life that are commonly held to be troubling, confusing or out of the ordinary. Mental distress can potentially lead to a change of behavior, affect a person's emotions in a negative way, and affect their relationships with the people around them.

<span class="mw-page-title-main">Health in South Korea</span> Overview of health in South Korea

Life expectancy has been rising rapidly and South Korea ranked 3rd in the world for life expectancy. South Korea has among the lowest HIV/AIDS adult prevalence rate in the world, with just 0.1% of the population being infected, significantly lower than the U.S. at 0.6%, France's 0.4%, and the UK's 0.3% prevalence rate. South Korea has a good influenza vaccination rate, with a total of 43.5% of the population being vaccinated in 2019. A new measure of expected human capital calculated for 195 countries from 1920 to 2016 and defined for each birth cohort as the expected years lived from age 20 to 64 years and adjusted for educational attainment, learning or education quality, and functional health status was published by the Lancet in September 2018. South Korea had the sixth highest level of expected human capital with 26 health, education, and learning-adjusted expected years lived between age 20 and 64 years.

Various topics in medicine relate particularly to the health of lesbian, gay, bisexual, transgender, queer, intersex and asexual (LGBTQIA) individuals as well as other sexual and gender minorities. According to the US National LGBTQIA+ Health Education Center, these areas include sexual and reproductive health, mental health, substance use disorders, HIV/AIDS, HIV-related cancers, intimate partner violence, issues surrounding marriage and family recognition, breast and cervical cancer, inequities in healthcare and access to care. In medicine, various nomenclature, including variants of the acronym LGBTQIA+, are used as an umbrella term to refer to individuals who are non-heterosexual, non-heteroromantic, or non-cis gendered. Specific groups within this community have their own distinct health concerns, however are often grouped together in research and discussions. This is primarily because these sexual and gender minorities groups share the effects of stigmatization based on their gender identity or expression, and/or sexual orientation or affection orientation. Furthermore there are subpopulations among LGBTQIA+ groups based on factors such as race, ethnicity, socioeconomic status, geographic location, and age, all of which can impact healthcare outcomes.

<span class="mw-page-title-main">Depression in childhood and adolescence</span> Pediatric depressive disorders

Major depressive disorder, often simply referred to as depression, is a mental disorder characterized by prolonged unhappiness or irritability. It is accompanied by a constellation of somatic and cognitive signs and symptoms such as fatigue, apathy, sleep problems, loss of appetite, loss of engagement, low self-regard/worthlessness, difficulty concentrating or indecisiveness, or recurrent thoughts of death or suicide.

<span class="mw-page-title-main">Suicide in South Korea</span> Statistics and causes of suicide

Suicide in South Korea occurs at the 12th highest rate in the world. South Korea has the highest recorded suicide rate in the OECD. In South Korea, it is estimated to affect 0.02 percent of the population by the WHO. In 2012, suicide was the fourth-highest cause of death. The suicide rate has consistently declined between 2012 and 2019, the year when the latest data are available.

<span class="mw-page-title-main">Mental health in education</span>

Mental health in education is the impact that mental health has on educational performance. Mental health often viewed as an adult issue, but in fact, almost half of adolescents in the United States are affected by mental disorders, and about 20% of these are categorized as “severe.” Mental health issues can pose a huge problem for students in terms of academic and social success in school. Education systems around the world treat this topic differently, both directly through official policies and indirectly through cultural views on mental health and well-being. These curriculums are in place to effectively identify mental health disorders and treat it using therapy, medication, or other tools of alleviation.

Mental health inequality refers to the differences in the quality, access, and health care different communities and populations receive for mental health services. Globally, the World Health Organization estimates that 350 million people are affected with depressive disorders. Mental health can be defined as an individual's well-being and/or the absence of clinically defined mental illness. Inequalities that can occur in mental healthcare may include mental health status, access to and quality of care, and mental health outcomes, which may differ across populations of different race, ethnicity, sexual orientation, sex, gender, socioeconomic statuses, education level, and geographic location. Social determinants of health, more specifically the social determinants of mental health, that can influence an individual's susceptibility to developing mental disorders and illnesses include, but are not limited to, economic status, education level, demographics, geographic location and genetics.

In colleges and universities in the United States, suicide is one of the most common causes of death among students. Each year, approximately 24,000 college students attempt suicide while 1,100 students succeed in their attempt, making suicide the second-leading cause of death among U.S. college students. Roughly 12% of college students report the occurrence of suicide ideation during their first four years in college, with 2.6% percent reporting persistent suicide ideation. 65% of college students reported that they knew someone who has either attempted or died by suicide, showing that the majority of students on college campuses are exposed to suicide or suicidal attempts.

<span class="mw-page-title-main">LGBT health in South Korea</span>

The health access and health vulnerabilities experienced by the lesbian, gay, bisexual, transgender, queer or questioning, intersex, asexual (LGBTQIA) community in South Korea are influenced by the state's continuous failure to pass anti-discrimination laws that prohibit discrimination based on sexual orientation and gender identity. The construction and reinforcement of the South Korean national subject, "kungmin," and the basis of Confucianism and Christian churches perpetuates heteronormativity, homophobia, discrimination, and harassment towards the LGBTQI community. The minority stress model can be used to explain the consequences of daily social stressors, like prejudice and discrimination, that sexual minorities face that result in a hostile social environment. Exposure to a hostile environment can lead to health disparities within the LGBTQI community, like higher rates of depression, suicide, suicide ideation, and health risk behavior. Korean public opinion and acceptance of the LGBTQI community have improved over the past two decades, but change has been slow, considering the increased opposition from Christian activist groups. In South Korea, obstacles to LGBTQI healthcare are characterized by discrimination, a lack of medical professionals and medical facilities trained to care for LGBTQI individuals, a lack of legal protection and regulation from governmental entities, and the lack of medical care coverage to provide for the health care needs of LGBTQI individuals. The presence of Korean LGBTQI organizations is a response to the lack of access to healthcare and human rights protection in South Korea. It is also important to note that research that focuses on Korean LGBTQI health access and vulnerabilities is limited in quantity and quality as pushback from the public and government continues.

<span class="mw-page-title-main">Mental health during the COVID-19 pandemic</span> Psychological aspect of viral outbreak

The COVID-19 pandemic has impacted the mental health of people across the globe. The pandemic has caused widespread anxiety, depression, and post-traumatic stress disorder symptoms. According to the UN health agency WHO, in the first year of the COVID-19 pandemic, prevalence of common mental health conditions, such as depression and anxiety, went up by more than 25 percent. The pandemic has damaged social relationships, trust in institutions and in other people, has caused changes in work and income, and has imposed a substantial burden of anxiety and worry on the population. Women and young people face the greatest risk of depression and anxiety.

The social determinants of mental health (SDOMH) are societal problems that disrupt mental health, increase risk of mental illness among certain groups, and worsen outcomes for individuals with mental illnesses. Much like the social determinants of health (SDOH), SDOMH include the non-medical factors that play a role in the likelihood and severity of health outcomes, such as income levels, education attainment, access to housing, and social inclusion. Disparities in mental health outcomes are a result of a multitude of factors and social determinants, including fixed characteristics on an individual level – such as age, gender, race/ethnicity, and sexual orientation – and environmental factors that stem from social and economic inequalities – such as inadequate access to proper food, housing, and transportation, and exposure to pollution.

People who are LGBT are significantly more likely than those who are not to experience depression, PTSD, and generalized anxiety disorder.

References

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