title: 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).
abstract: 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.
  
  
  
  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.
  
  
  
  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).
  
  
  
  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.
authors.affiliation: Department of Public Health, Graduate School, Yonsei University, Seoul, Republic of Korea Institute of Health Services Research, College of Medicine, Yonsei University, Seoul, Republic of Korea Department of Preventive Medicine, College of Medicine, Yonsei University, Seoul, Republic of Korea.
authors.forename: Jaeyong
authors.initials: J
authors.lastname: Shin
authors.affiliation: Department of Public Health, Graduate School, Yonsei University, Seoul, Republic of Korea Institute of Health Services Research, College of Medicine, Yonsei University, Seoul, Republic of Korea.
authors.forename: Jae Woo
authors.initials: JW
authors.lastname: Choi
authors.affiliation: Department of Public Health, Graduate School, Yonsei University, Seoul, Republic of Korea Institute of Health Services Research, College of Medicine, Yonsei University, Seoul, Republic of Korea Department of Preventive Medicine, College of Medicine, Yonsei University, Seoul, Republic of Korea.
authors.forename: Sung-in
authors.initials: SI
authors.lastname: Jang
authors.affiliation: Department of Public Health, Graduate School, Yonsei University, Seoul, Republic of Korea Institute of Health Services Research, College of Medicine, Yonsei University, Seoul, Republic of Korea.
authors.forename: Young
authors.initials: Y
authors.lastname: Choi
authors.affiliation: Department of Hospital Management, Graduate School of Public Health, Yonsei University, Seoul, Republic of Korea.
authors.forename: Sang Gyu
authors.initials: SG
authors.lastname: Lee
authors.affiliation: Department of Economics, College of Arts and Sciences, University of Washington, Seattle, Washington, USA.
authors.forename: Tae Hwan
authors.initials: TH
authors.lastname: Ihm
authors.affiliation: Institute of Health Services Research, College of Medicine, Yonsei University, Seoul, Republic of Korea Department of Preventive Medicine, College of Medicine, Yonsei University, Seoul, Republic of Korea.
authors.forename: Eun-Cheol
authors.initials: EC
authors.lastname: Park
mesh_terms: D000328:Adult; D000368:Aged; D017281:Cost of Illness; D003430:Cross-Sectional Studies; D003866:Depressive Disorder / Q000191:economics / Q000523:psychology; D005260:Female; D005102:Health Expenditures; D006801:Humans; D007182:Income; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D056910:Republic of Korea; D059020:Suicidal Ideation
keywords: economic burden; health expenditure; household; korea; suicidal ideation; suicide