Suicide is an important public health issue worldwide because it has various direct and indirect effects at both the individual and the societal level. South Korea (hereafter, Korea) has the highest suicide rate among the Organization for Economic Cooperation and Development (OECD) member countries [1,2], so social intervention is necessary for suicide prevention [3]. Suicide has been viewed as a continuum of suicidal ideation, suicidal planning, and suicidal behavior [4]. Suicidal ideations are intricately associated with a variety of risk factors, including biological, psychological, and environmental factors, so a focus on preventing suicidal ideations is necessary and those preventing measures can also prevent suicidal behavior.

Employment is an important factor influencing work performance [5,6]. Korea has seen difficulties in economic development due to the global economic downturn for the past few years. Economic downturns can exacerbate anxiety by appealing to feelings of isolation and uncertainty about the future due to corporate restructuring, early retirement, and job loss [7]. Employment-related studies in some countries have shown that precarious employment patterns increase suicide rates two- or three-fold at least, and even up to five-fold in certain countries [8]. The accelerated pace of social change in Korea, compared to many other countries, can contribute to psychological challenges, including suicidal ideation, triggered by precarious employment situations [9]. The status of being unemployed is also a problem related to suicidal ideation. An irregular lifestyle after dismissal can lead to a strong tendency toward substance abuse, including alcohol consumption and smoking [10]. Unemployed people are also at risk of experiencing depression, anxiety, irritability, and aggression [11] which are important risk factors for suicidal ideation.

Previous studies found factors such as older age, female gender, low income, low education, and other sociodemographic aspects to be related to suicidal ideation [8,11-16]. Health behaviors such as smoking, physical activity, sleep, and chronic diseases have also been presented as factors related to suicidal ideation [17-20]. Furthermore, stress recognition, depression, and the lack of a sense of belonging are mental health factors related to suicidal ideation [21]. Unemployment and financial problems caused by the economic crisis were also studied [22]. But these studies, while numerous studies have explored the link between employment status and suicidal ideation, few have dissected the association between unemployment and suicidal ideation in relation to sociodemographic factors, health behaviors, and mental health conditions [23]. To address these gaps, our study utilized recent nationally representative data from the 2015, 2017, and 2019 waves of the Korea National Health and Nutrition Examination Survey (KNHANES). We aimed to examine the association between employment status and suicidal ideation while adjusting for a broad range of relevant covariates. Additionally, we explored effect modification through subgroup analyses, which allowed us to identify vulnerable populations for targeted intervention.

This study aimed to examine the association between employment status and suicidal ideation using cross-sectional survey data. The findings showed that unemployment is associated more likely to have suicidal ideation than the employed. The associations of covariates with suicidal ideation were also found to be pronounced across specific sociodemographic, health behavioral, and mental health factors.

This was consistent with the findings of an American study by Kposowa et al. [11] (2019), indicating that unemployment was significantly associated with suicidal ideation. Employment status is a means of securing economic power, which is a resource that can satisfy various needs. Kposowa et al. [11] also found that employed persons have a higher quality of life than the unemployed. It can be interpreted that suicidal ideation increases when quality of life is not satisfied by their unemployment status. In this study, we attempted to consider the influence of various covariates and subgroups when employment status is related with suicidal ideation and what kind of support should be provided accordingly.

We showed that suicidal ideation is a complex element associated with a variety of factors, including sociodemographic, health behavior, and mental health factors. Consistent with the findings of Liu et al. [25] (2017) that educational attainment is associated with suicidal ideation, our results indicated that low educational attainment (high school or below) had higher likelihood of suicidal ideation than high educational attainment. This could be explained by lower education levels leading to income inequality, which, in turn, can lead to suicidal ideation. One possible explanation is that lower educational attainment may be associated with limited access to stable employment and lower income, which in turn can contribute to increased psychosocial stress and vulnerability to suicidal ideation. This interpretation is supported by prior research highlighting education as a key social determinant of mental health outcomes [26]. Furthermore, although our study does not establish causality, previous studies suggest that lower educational attainment may contribute to poverty and related psychosocial stress, which are known risk factors for suicidal ideation [27,28]. Given that subjective health conditions are closely linked to overall well-being and perceived quality of life, our results showed that participants with poor subjective health had 1.79 times higher odds of suicidal ideation than those with good subjective health. Our findings align with previous research, such as Arria et al. [18] (2009), which emphasized the significant role of mental health conditions—particularly perceived stress and depressive symptoms—in the context of suicidal ideation. Among mental health factors, stress recognition was associated with higher odds of suicidal ideation, and depression was similarly associated with increased odds, after adjusting for covariates. Previous research has noted the important effects of mental health on suicidal ideation [1,15]. Taken together with our findings on employment status and other socioeconomic and health-related factors, suicide prevention strategies should comprehensively address individuals’ unemployment, low educational attainment, low income, poor subjective health status, and mental health conditions such as stress and depression.

The subgroup analysis presented how individual covariates modified the association between employment status and suicidal ideation. Except the categories of women, no alcohol use, and underweight, all other covariates showed significant association with suicidal ideation when unemployed. In comparing the ORs, men, aged between 40 and 50 years, currently smoking, obese, and with stress recognition showed much more higher odds for suicidal ideation. These findings are in line with Kposowa et al. [11] (2019) work noting that middle-aged people had a high association with suicidal ideation. This may reflect that unemployment-related stressors—such as financial strain and disrupted social relationships—are associated with increased psychosocial burden, which has been linked to suicidal ideation in prior studies. The finding that occupation and socioeconomic status are related to suicidal ideation is particularly notable in Korea, where an environment in which social and financial resources cannot be secured or situations in which social inclusion is interrupted can lead to loss of self-esteem and chronic stress, which in turn leads to behaviors closely related to suicide [29]. Moreover, middle-aged individuals are likely to have considerable responsibilities as the center of the family economy, such as supporting children’s education and retirement preparation. Under these circumstances, any unemployment environment threatening the family economy might be related with suicidal ideation.

In the current smoking subgroup, the association between unemployment and suicidal ideation was notably stronger. One possible explanation is that smoking is often associated with heightened impulsivity and emotion regulation difficulties, which may compound the psychological burden of unemployment and increase vulnerability to suicidal thoughts [30]. Similarly, among individuals with high levels of perceived stress, the impact of unemployment on suicidal ideation was amplified. While the mechanism is not fully clear, it is possible that the additional strain of unemployment may exacerbate existing psychological stress, contributing to elevated risk for suicidal ideation.

Dutton et al. [31] (2013) explored the association between obesity and suicidal ideation. Rather than being a direct cause, obesity may be associated with suicidal ideation through its links to chronic disease burden, body dissatisfaction, and increased psychosocial stress—all of which have been reported as correlates of suicidal ideation in prior research. Obesity is associated with metabolic syndrome, which often entails ongoing medical costs and financial burden—particularly for socioeconomically disadvantaged individuals. This added strain may contribute to psychosocial stress, a known risk factor for suicidal ideation [32,33].

Our study has several strengths. First, the study is composed of nationally representative sample data, and it can be used to identify vulnerable subgroups that could benefit from targeted mental health and employment support strategies. Second, the study examined data from three separate years (2015, 2017, and 2019) within the same nationally representative survey framework, allowing for temporal robustness in findings and ensuring that observed associations are not limited to a single year’s data. This design enhances the reliability of the results despite the cross-sectional nature of each wave. However, this study also has several limitations. Although the association between employment status and suicidal ideation is shown in this cross-sectional study, the causal association cannot be confirmed. In addition, because the institutionalized population was excluded, severe psychological symptoms related with suicidal ideation might not have been addressed adequately. Moreover, even if participants are categorized in the same employment status, there can be differences in the mental state of workers depending on factors such as their occupation, working environment, and social position. Lastly, while the KNHANES is nationally representative, the exclusion of individuals with missing data may affect the representativeness of the analytic sample. Subsequent research should consider a more detailed approach, incorporating a detailed examination of the nature and characteristics of individual occupations.

Based on these findings, targeted support strategies—such as job training programs, mental health counseling, and public education on health behaviors—may help address the elevated risk of suicidal ideation among unemployed individuals. In order to alleviate the problem of suicidal ideation among unemployed individuals, professional technical training is needed to enable them to enter the labor market, and the impact of health behaviors such as smoking and alcohol drinking needs to be emphasized through public service announcements. In addition, since obesity is related to mental problems such as stress and will to work, community-level attention will be needed to manage the health of unemployed obese individuals.

This study demonstrated a significant association between employment status and suicidal ideation using nationally representative data from the 2015, 2017, and 2019 KNHANES. While unemployment was associated with increased odds of suicidal ideation, our findings also suggest that multiple sociodemographic, health behavior, and mental health factors are involved. These results highlight the need for a better understanding of the relationship between employment and mental health. Further research and policy consideration are warranted to better support the mental well-being of unemployed individuals.