The COVID-19 pandemic 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.
Key Findings
Results
After the COVID-19 pandemic, significant increases in the severity and intensity of suicidal ideation were observed in both sexes.
The increase in suicidal ideation severity and intensity was statistically significant (P < 0.001) for both men and women.
The study population consisted of 1,179 participants from the Korean Cohort for the Model Predicting Suicide and Suicide-Related Behavior.
Participants included individuals with recent suicide attempts and those experiencing suicidal ideation.
Suicidal ideation was measured using the Columbia-Suicide Severity Rating Scale (C-SSRS).
Results
Overall network connectivity among mental health variables decreased after the COVID-19 pandemic in high-risk suicide groups.
Network analysis was conducted using EBICglasso algorithms separately for men and women before and after the COVID-19 pandemic.
Despite decreased overall connectivity, strong interconnections between depression, anxiety, and stress persisted in both sexes after the pandemic.
The bootstrapped edge-weighted confidence intervals mostly remained within acceptable thresholds (< 0.2), ensuring network reliability.
Results
After the COVID-19 pandemic, betweenness centrality increased for anxiety in women and for depression in men.
Betweenness centrality is a network metric indicating how central a node is in connecting other nodes within the network.
In women, anxiety became a more central (hub) node in the mental health network following the pandemic.
In men, depression became a more central (hub) node in the mental health network following the pandemic.
These sex-specific differences suggest that anxiety and depression are the key intervention targets for women and men, respectively, in the post-pandemic period.
Methods
Key mental health variables measured in the study included depression, anxiety, stress, impulsivity, and suicidal ideation, assessed with standardized instruments.
Depression was measured using the Patient Health Questionnaire-9 (PHQ-9).
Anxiety was measured using the Beck Anxiety Inventory (BAI).
Stress was measured using the Stress Questionnaire for Korean National Health and Nutrition Examination Survey-Short Form.
Impulsivity was measured using the Barratt Impulsiveness Scale-11 (BIS-11).
Suicidal ideation was measured using the Columbia-Suicide Severity Rating Scale (C-SSRS).
Discussion
The study identified sex-specific structural changes in mental health networks among high-risk suicide groups following the COVID-19 pandemic.
Network analyses were conducted separately for men and women to capture sex-specific differences in mental health network structure.
The structural changes highlight the need for tailored mental health strategies based on sex.
The authors concluded that anxiety (in women) and depression (in men) should be prioritized as intervention targets for post-pandemic suicide prevention.
What This Means
This research studied how relationships among mental health problems changed in people at high risk for suicide in Korea before and after the COVID-19 pandemic. Using data from 1,179 people who had recently attempted suicide or were experiencing thoughts of suicide, researchers mapped out how symptoms like depression, anxiety, stress, and impulsivity were connected to each other — and how those connections changed after the pandemic began. They found that after the pandemic, the severity of suicidal thoughts increased significantly in both men and women.
One of the key findings was that while the overall web of connections among mental health symptoms became less tightly linked after the pandemic, certain symptoms became more 'central' — meaning more important as bridges connecting different problems. In women, anxiety became the most central symptom in the network after the pandemic, while in men, depression became the most central. This suggests the pandemic may have reorganized mental health risk in sex-specific ways.
This research suggests that mental health interventions for people at high risk of suicide may need to be tailored differently for men and women, particularly in the aftermath of large-scale stressors like a pandemic. Targeting anxiety in women and depression in men could be especially important for reducing suicide risk in these groups. The findings highlight the value of analyzing mental health as an interconnected system rather than treating each symptom in isolation.
Yang J, Kang D, Park C, Rhee S, Kim M, Lee H, et al.. (2026). Changes in Mental Health Networks Among High-Risk Suicide Groups in Korea Before and After the COVID-19 Pandemic.. Journal of Korean medical science. https://doi.org/10.3346/jkms.2026.41.e216