Abstract
Although early life factors are associated with increased suicide risk in youth, there is a dearth of research on these associations for individuals growing up in disadvantaged socioeconomic contexts, particularly in low- and middle-income countries (LMICs). We documented the association between individual, familial, and environmental factors in childhood with suicidal ideation among South African youth. We used data from 2,020 participants in the Birth to Twenty Plus (Bt20+) study, a South African cohort following children born in Soweto, Johannesburg from birth (1990) to age 28 years (2018). Suicidal ideation was self-reported at ages 14, 17, 22, and 28 years, and the primary outcome of interest was suicidal ideation reported at any age. We assessed individual, familial, and socioeconomic characteristics at childbirth and during infancy, adverse childhood experiences (ACEs) between ages 5 and 13 years, and externalizing and internalizing problems between 5 and 10 years. We estimated odds ratios (ORs) of suicidal ideation for individuals exposed to selected childhood factors using logistic regression. Lifetime suicidal ideation was reported by 469 (23.2%) participants, with a 1.7:1 female/male ratio. Suicidal ideation rates peaked at age 17 and decreased thereafter. Socioeconomic adversity, low birth weight, higher birth order (i.e., increase in the order of birth in the family: first, second, third, fourth, or later born child), ACEs, and childhood externalizing problems were associated with suicidal ideation, differently patterned among males and females. Socioeconomic adversity (OR 1.13, CI 1.01 to 1.27, P = 0.031) was significantly associated with suicidal ideation among males only, while birth weight (OR 1.20, CI 1.02 to 1.41, P = 0.03), ACEs (OR 1.11, CI 1.01 to 1.21, P = 0.030), and higher birth order (OR 1.15, CI 1.07 to 1.243, P < 0.001) were significantly associated with suicidal ideation among females only. Externalizing problems in childhood were significantly associated with suicidal ideation among both males (OR 1.23, 1.08 to 1.40, P = 0.002) and females (OR 1.16, CI 1.03 to 1.30, P = 0.011). Main limitations of the study are the high attrition rate (62% of the original sample was included in this analysis) and the heterogeneity in the measurements of suicidal ideation. In this study from South Africa, we observed that early life social and environmental adversities as well as childhood externalizing problems are associated with increased risk of suicidal ideation during adolescence and early adulthood.
Highlights
Suicide is an important cause of mortality worldwide, accounting for 800,000 deaths each year [1]
Suicidal ideation was always higher in females than males, the sex gap decreased over time, and male–female rates were similar at age 28 (Fig 2)
As most previous longitudinal studies on the topic are based on samples from high-income countries (HICs) and countries outside the African continent, our findings add to the current literature about the prevalence and etiology of suicidal ideation in low- and middle-income countries (LMICs) in Africa that can be used by policymakers to elaborate local suicide prevention strategies
Summary
Suicide is an important cause of mortality worldwide, accounting for 800,000 deaths each year [1]. Young people in LMICs in the African region have the highest prevalence of suicidal ideation, with 1 in 5 adolescents reporting seriously considering suicide in the past 12 months [6]. Evidence suggests that these high rates are likely to be underestimated [7]. Despite this elevated prevalence, research on suicide prevention in LMICs accounts for only a small fraction of the available evidence [8]. We documented the association between individual, familial, and environmental factors in childhood with suicidal ideation among South African youth
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