Global Risks of Suicidal Behaviours and Being Bullied and Their Association in Adolescents: School-Based Health Survey in 83 Countries

Abstract

Background: Global risks of suicidal behaviours (SB) and being bullied and their association among adolescents have been poorly understood. We aimed to determine the risks of suicidal ideation (SI), suicide plan (SP) and suicide attempt (SA) and being bullied in adolescents and their association worldwide, and to investigate regional variations and gender differences in the risks and the association. Methods: We examined data from the Global School-based Health Survey (GSHS) of 2003-2014, which recoded health behaviors among adolescents aged 12 to 15 years from 83 countries. We computed prevalence rates of SI, SP and SA and their 95% confidence intervals (CIs). Multilevel models were employed to estimate the association of being bullied with increased risk of SI, SP and SA. Results: The overall prevalence of SI was 16·5%, SP 16·5%, SA 16·4%, and being bullied 35·3%. The highest risks of SB and being bullied were in Africa (SI 19·9%, SP 23·2%, SA 20·8%, being bullied 48·0%). Compared to boys, girls had increased SI (18·2%) and SP (17·3%) but similar SA (16·7%) and being bullied (33·3%). Being bullied was associated with SA (adjusted odds ratio ‒ aOR 2·14, 95%CI 2·06-2·23), more strongly than SI (1·83, 1·78-1·89) and SP (1·70, 1·65-1·76). The strongest association was in the Western Pacific with SA (2·68, 2·45-2·92) and in Southeast Asia with SI (2·04, 1·74-2·39) and SP (1·81, 1·68-1·95). There were no gender differences in aOR for SI and SP, but the aOR for SA in boys (2·28, 2·14-2·42) was significantly greater than girls (2·04, 1·93-2·15). Interpretation: SB and being bullied among adolescents were common worldwide. The findings of inequalities in SB, being bullied and their association would help design global prevention programme to reduce the risks of SI, SP and SA in adolescents. Funding: This work was partly supported by the Higher Education Research Project of Guangzhou (JJT, 1201610188), the Guangdong Natural Science Foundation (JJT, 2015A030313455), and the National Natural Science Foundation of China (JJT, 81773457&81302445). Declaration of Interest: We declare no competing interests. Ethical Approval: All GSHS surveys were approved in each country, by both the national government administration, usually by the Ministry of Health or Education, and an institutional review board or ethics committee. Verbal or written consent was obtained from the participants and their parents.