Unequal Distribution of Global Risk and Protective Factors for Suicidal Burden Among 251,763 Adolescents in 77 Countries: Assessing Global, Regional and National Variations and the Effect of Demographic, Psychosocial, and Lifestyle Factors

Abstract

Background: Adolescent suicide is a global public health concern, and the second leading cause of adolescent death worldwide. There is a lack of knowledge concerning specific risk factors such as physical violence and unintentional injury, lifestyle related factors, and food security across geographical distribution. This study aimed to measure the burden of adolescent suicidal behaviour and its association with violence and unintentional injury, and psychosocial (e.g., anxiety and loneliness), protective (e.g., peer support and parental regulation and monitoring), and lifestyle related (e.g., obesity, sedentary behaviours and food security) factors, amongst school going adolescents across 77 countries. Methods: This study comprised a sample of 251,763 adolescents drawn from the latest Global School-based Student Health Survey of school children, aged 11-17 years (2003 and 2016), across 77 countries in the six World Health Organization regions. Logistic regression analyses were employed to estimate the adjusted effect of independent factors on adolescent suicidal behaviours. Findings: The population weighted prevalence of suicidal ideation, suicidal planning and suicidal attempts amongst adolescents was 18%, 18% and 16%, respectively. Adolescent suicidal behaviours (ideation, planning, and attempts) were respectively associated with being physically attacked (OR = 1·28, 95% CI: 1·23-1·33; OR = 1·30, 1·24-1·35; and OR = 1·45, 1·39-1·52), physical fighting (OR = 1·34, 1·29-1·39; OR = 1·35, 1·30-1·41, and OR = 1·55, 1·48-1·62), high levels of anxiety (OR = 2·48, 2·34-2·63, OR = 2·23, 2·10-2·37; and OR = 2·57, 2·40-2·75), feeling lonely (OR = 2·90, 2·74-3·07; OR = 2·19, 2·07-2·32; and OR = 1·97, 1·85-2·11), being bulled (OR = 1·56, 1·50-1·62; OR = 1·53, 1·47-1·59; and OR = 1·87, 1·79-1·96), not having parental support (OR = 1·44, 1·36-1·51; OR = 1·45, 1·38-1·53; OR = 1·41, 1·32-1·49), poor peer support (OR = 1·29, 1·22-1·37; OR = 1·19, 1·12-1·26; and OR = 1·16, 1·09-1·24), not having close friends (OR = 1·54, 1·45-1·65; OR = 1·91, 1·80-2·04; OR = 1·95, 1·82-2·10), and high levels of sedentary behaviours (OR = 1·54, 1·46-1·62; OR = 1·42, 1·35-1·49; and OR = 1·19, 1·12-1·26). Overall, these association also extended to the context of food insecurity, where the magnitude of association slightly varied from 1·25 times to 3·13. Interpretation: The burden of adolescent suicidal thoughts, suicide planning, and suicide attempts is of particular concern in low resource countries. Comprehensive suicide prevention programs for school going adolescents in LMICs are needed that address socio-cultural inequities related to violence and unintentional injury, social support. and psychological, factors, protective, and lifestyle related factors. Funding Statement: None. Declaration of Interests: The authors declare no competing interests.