Suicidal expression among school-attending adolescents in a middle-income sub-Saharan country.

Michael L Wilson,Andrea C Dunlavy,Bharathi Viswanathan,Pascal Bovet

doi:10.3390/ijerph9114122

Abstract

We investigated correlates for suicidal expression among adolescents in the Seychelles. Data on 1,432 students (52% females) were derived from the Global School-based Health Survey. Participants were divided into three groups: those with no suicidal behavior (N = 1,199); those with suicide ideation/SI (N = 89); and those reporting SI with a plan to carry out a suicide attempt/SISP (N = 139), each within a 12-month recall period. Using multinomial logistic regression, we examined the strength of associations with social, behavioral and economic indicators while adjusting for covariates. Sixteen percent of school-attending adolescents reported a suicidal expression (10% with a plan/6.2% without). Those reporting SI were younger (relative risk ratio RRR = 0.81; CI = 0.68–0.96), indicated signs of depression (RRR = 1.69; CI = 1.05–2.72) and loneliness (RRR=3.36; CI =1.93–5.84). Tobacco use (RRR = 2.34; CI = 1.32–4.12) and not having close friends (RRR = 3.32; CI = 1.54–7.15) were significantly associated with SI. Those with SISP were more likely to be female (RRR = 0.47; 0.30–0.74), anxious (RRR = 3.04; CI = 1.89–4.88) and lonely (RRR = 1.74; CI = 1.07–2.84). Having no close friends (RRR = 2.98; 1.56–5.69) and using tobacco (RRR = 2.41; 1.48–3.91) were also strongly associated. Having parents who were understanding was protective (RRR = 0.50; CI = 0.31–0.82). Our results suggest that school health promotion programs may benefit from targeting multiple factors associated with suicidal expression. More research, particularly multilevel designs are needed to identify peer and family influences which may modify associations with suicidality.

Highlights

Suicide ranks as the third leading cause of mortality among adolescents worldwide [1], and according to recent research, suicidal expression may be on the rise [2]
Suicidal expression has long been associated with several psychosocial indicators, many of which are intensified during adolescence [4]
Our results suggest that school health programs in the Seychelles may benefit from simultaneously targeting multiple factors associated with suicidal expression

Summary

Introduction

Suicide ranks as the third leading cause of mortality among adolescents worldwide [1], and according to recent research, suicidal expression may be on the rise [2]. Suicidal expression has long been associated with several psychosocial indicators, many of which are intensified during adolescence [4]. Some of these include poor mental health, poverty, being bullied, substance use and having poor relationships with parents [5,6,7,8]. While most suicide attempters are female, males are overrepresented in suicide completions [9]. These indicators are largely representative of adolescents in high-income country (HIC) settings where surveillance data have generally greater accuracy. Even the ascertainment of suicide by health care professionals is not uniform in all settings [9,11]

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