Changes in Mental Health Networks Among High-Risk Suicide Groups in Korea Before and After the COVID-19 Pandemic

Suicide remains a critical global public health issue, and the coronavirus disease 2019 (COVID-19) pandemic has intensified mental health challenges, potentially increasing suicide risk. This study aimed to analyze the changes in mental health networks of high-risk suicide groups in Korea before and after the COVID-19 pandemic.

Using data from the Korean Cohort for the Model Predicting Suicide and Suicide-Related Behavior, we analyzed 1,179 participants, including individuals with recent suicide attempts and those experiencing suicidal ideation. Network analysis was conducted using EBICglasso algorithms separately for men and women before and after the COVID-19 pandemic, to examine the relationships between key mental health variables including depression (Patient Health Questionnaire-9), anxiety (Beck Anxiety Inventory), stress (Stress Questionnaire for Korean National Health and Nutrition Examination Survey-Short Form), impulsivity (Barratt Impulsiveness Scale-11), and suicidal ideation (Columbia-Suicide Severity Rating Scale).

After the pandemic, significant increases in the severity and intensity of suicidal ideation were observed in both sexes (P < 0.001). Overall network connectivity decreased, while strong interconnections between depression, anxiety, and stress persisted in both sexes. After the pandemic, betweenness centrality increased for anxiety in women and depression in men. The bootstrapped edge-weighted confidence intervals mostly remained within acceptable thresholds (< 0.2), ensuring network reliability.

The COVID-19 pandemic has led to structural changes in the mental health network of high-risk suicide groups, with anxiety emerging as a more central factor in women and depression in men, highlighting them as key intervention targets. These findings underscore the need for tailored mental health strategies to mitigate suicide risk in populations affected by the pandemic.