Cross-national examination of adolescent suicidal behavior: a pooled and multi-level analysis of 193,484 students from 53 LMIC countries

Abstract

Introduction Suicide is a leading cause of adolescent mortality worldwide. We aimed to estimate the prevalence and identify individual-level and country-level factors which might explain the variability in suicidal behavior among students in 53 low to middle income countries. Methods We used data on adolescents aged 12–16 years from the Global School-based Student Health Surveys from 2009–2016. The suicidal behaviors investigated included suicide ideation, suicidal planning and suicide attempt. The prevalence was estimated for 53 countries, while a multilevel logistic regression analysis (33 countries) was used to investigate the associations of these behaviors with individual and country-level contextual risk factors. The contextual variables included the Gini Coefficient, Gross Domestic Product per capita, pupil-to-teacher ratios, population density, homicide rates, law criminalizing suicide and the night light index. Results The overall prevalence of suicide ideation, making a plan and suicide attempt were 10.4%, 10.3% and 11.0%, respectively. The highest prevalence rates reported were from the Americas. The strongest risk factors associated with suicidal behavior included anxiety, loneliness, no close friends and the substance abuse. Among the country level variables, the night light index was associated with making a suicide plan and attempting suicide. Conclusion The non-significant country level findings were not entirely surprising given the mixed results from prior studies. Additional knowledge is thus achieved with regard to country level factors associated with suicidal behavior across adolescent populations.

Neurogenetics and Epigenetics of Loneliness

“… 44 A study of adolescents, 45 uncovered persistent loneliness and paucity of meaningful friendships in 18.1% (95% CI: 16.4–20.0%) with girls, in comparison to boys, displaying greater propensity for feeling lonely (14.6% vs 9.2%), while boys were more concerned about not having close friends (8.7% vs 7.2%). These data may partially inform the Global School-based Student Health Surveys 46 implicating loneliness as a significant risk factor for suicidal behavior among adolescents; similar trends have been observed in adults. 8 The ongoing recognition of loneliness’ societal costs has naturally spurred the development of therapeutic interventions targeting social skills, social support, social contacts, and social cognition.…”

Prevalence of suicidal behaviour among students living in Muslim-majority countries: systematic review and meta-analysis

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Suicidal ideation and behavior in youth in low- and middle-income countries: A brief review of risk factors and implications for prevention

“…Youth are particularly susceptible to social influences, and feelings of loneliness were the strongest individual risk factor among adolescents who made a suicide plan within 53 LMIC countries ( 56 ). Loneliness may result from various negative interpersonal situations that reduce youth’s sense of connection to family and friends.…”