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

The role of psychotic-like experiences, depressive symptoms, and anxiety symptoms in suicide ideation among college students with self-injurious behavior

OBJECTIVE

Suicide is associated with a myriad of psychiatric symptoms, including psychotic-like experiences, depressive symptoms, and anxiety symptoms. However, few studies have simultaneously explored the specific role of these symptoms in different aspects of suicide behavior. This study aimed to reveal differential associations between various psychopathological symptoms and both the frequency of suicidal ideation and severity of suicidal ideation during self-injury through network analysis.

METHODS

Using logistic regression and network analysis approach, the present study examined the association between psychotic-like experiences (PLEs), anxiety symptoms, depressive symptoms, the frequency of suicidal ideation (SF), and the severity of suicidal ideation during self-injury (SS) in a sample of college students with self-injurious behavior (n = 651, age 16-23, 65.1%female).

RESULT

Logistic regression results showed that depressive symptoms were associated with the frequency of suicidal ideation (OR = 11.66, 95%CI:7.45-18.25), while psychotic-like experiences (OR = 1.57, 95%CI:1.15-2.72) and anxiety symptoms were associated with the severity of suicidal ideation during self-injury (OR = 1.77, 95%CI:1.01-2.43). The results of the network analysis further indicated that the item "persecutory ideation" of the PLEs community was the key bridge symptom linking SS, while self-reproach is the key bridge symptom linking SF.

CONCLUSIONS

Although psychotic-like experiences, depressive symptoms, and anxiety symptoms were all predictors of suicide, they may play distinct roles in suicidal ideation and suicidal behavior, which require further research to verify their relationship as well as to explore the potential mechanisms.

The distribution of frequent perceived loneliness and its association with suicidal behaviors in adolescents: a school-based study across 93 countries/territories

Adolescent loneliness is prevalent and poses a significant risk for youth mental health. This study aimed to estimate the global prevalence and distribution of frequent perceived loneliness in adolescents and its associations with suicidal ideation, planning, and attempts. We analyzed data from the Global School-based Student Health Survey (GSHS) across 93 countries/territories (2003-2021) for adolescents aged 11-18. Weighted prevalence of frequent perceived loneliness was estimated for each country/territory, with pooled prevalence calculated by sex, age, WHO regions, and economic groups. Binary logistic regressions were employed to assess the associations between loneliness perception and suicidal behaviors in each country/territory, with overall estimates derived by random-effects meta-analysis. Among 388,093 adolescents included, 13.2% (95% CI 12.2-14.3%) reported frequent perceived loneliness, with the lowest observed in Europe (North Macedonia and Tajikistan) at 4.6% (95% CI 1.1-8.1%) and the highest in the Eastern Mediterranean at 16.1% (95% CI 14.7-17.6%). Girls and older adolescents had higher prevalence of frequent perceived loneliness. Frequent perceived loneliness was significantly associated with increased odds of suicidal ideation (overall OR: 2.41, 95% CI 2.25-2.58), planning (overall OR: 2.06, 95% CI 1.92-2.21), and attempts (overall OR: 2.08, 95% CI 1.95-2.20). These associations were consistent across most countries/territories, sexes, age, regions, and economic groups. These findings highlight frequent perceived loneliness in adolescents as a global public health concern strongly linked to suicidal behaviors, underscoring the urgent need for targeted interventions to address loneliness and its mental health consequences.

Tobacco and alcohol use; suicide ideation, plan, and attempt among adolescents; and the role of legal purchase age restrictions: a pooled population-based analysis from 58 countries

BACKGROUND

We aimed to evaluate the potential independent and interactive associations of tobacco and alcohol use with suicide ideation, plan, and attempt among adolescents, and the role of legal purchase age restrictions among these associations.

METHODS

A pooled cross-sectional analysis was conducted with data from the Global School-based Student Health Survey (GSHS) (2013-2019), the US Youth Risk Behavior Surveillance System (YRBSS) (2021), and a Chinese school-based health survey (2017). Self-reported use of tobacco and alcohol during the past 30 days, and suicide ideation, plan, and attempt during the past year, were collected from questionnaires. Country-level purchase age restrictions on tobacco and alcohol products were obtained from official government websites.

RESULTS

Among the 211,022 adolescents from 58 countries, 46.7% were boys. Compared with adolescents who used neither tobacco nor alcohol, those who used both tobacco and alcohol had the highest odds of suicide ideation (boys: 2.42 [95% CI: 2.25-2.61]; girls: 3.19 [95% CI: 2.98-3.40]; P difference < 0.001), suicide plan (boys: 2.39 [95% CI: 2.21-2.58]; girls: 3.33 [95% CI: 3.11-3.57]; P difference < 0.001), and suicide attempt (boys: 3.24 [95% CI: 3.00-3.51]; girls: 4.03 [95% CI: 3.75-4.33]; P difference < 0.001). In countries with higher suicide plan prevalence, boys who use tobacco and who live in countries with tobacco purchase age restrictions had lower odds of suicide plan (1.86 [95% CI: 1.64-2.12]) than those who lived in countries without restrictions (2.81 [95% CI: 2.32-3.42]). Similarly, girls who use tobacco and who live in countries with legal age purchase restrictions displayed lower odds of suicide plan (2.20 [95% CI: 1.98-2.45]) compared to those who live in countries without restrictions (4.61 [95% CI: 3.65-5.83]). However, our study revealed no subgroup differences in whether countries have legal tobacco or alcohol purchase age restrictions in association with suicide ideation, plan, and attempt risk in countries with a lower prevalence of suicide behaviors.

CONCLUSIONS

Tobacco and alcohol consumption are strongly associated with the risk of suicide behaviors among adolescents, particularly among girls. Country-level tobacco control strategies may have the potential to reduce risks of suicide behaviors associated with tobacco use among adolescents.

The Association Between Internet Addiction and the Risk of Suicide Attempts in Chinese Adolescents Aged 11-17 Years: Prospective Cohort Study

BACKGROUND

Suicide is a critical public health issue in adolescents worldwide. Internet addiction may play a role in the increased rate of suicide attempts in this population. However, few studies have explored the relationship between pathological internet use and suicide attempts among adolescents.

OBJECTIVE

This study aimed to conduct a prospective cohort study to examine whether higher severity of pathological internet use was associated with an increased risk of suicide attempts among Chinese adolescents.

METHODS

A total of 782 adolescents were recruited from a middle school from November 2020 to December 2020 and followed up for 6 months. An online self-reported questionnaire was used to collect the participants' demographic data and assess their mental health. The Depression, Anxiety, and Stress Scale-21 items (DASS-21) was used to evaluate depression, anxiety, and stress. The Chen Internet Addiction Scale-Revised (CIAS-R) was used to assess the symptoms and severity of pathological internet use. χ2 test and ANOVA were used for intergroup comparison, and logistic regression analysis was used to examine the relationship between the severity of pathological internet use and suicide attempts. We also used a restricted cubic splines model to investigate the pattern of the association.

RESULTS

The participants had an average age of 12.59 (SD 0.64) years, with the majority being of Han ethnicity (743/782, 95.01%) and more than half being male (426/782, 54.48%). Most participants had no previous history of depression (541/782, 69.18%), anxiety (415/782, 53.07%), or stress (618/782, 79.03%). The rate of newly reported suicide attempts was 4.6% (36/782). A significant positive association was observed between internet addiction and suicide attempts (odds ratio 3.88, 95% CI 1.70-8.82), which remained significant after adjusting for age, sex, ethnicity, anxiety, depression, and stress (odds ratio 2.65, 95% CI 1.07-6.55). In addition, this association exhibited a linear pattern in the restricted cubic spline regression model.

CONCLUSIONS

This study suggested that internet addiction, rather than internet overuse, was associated with a higher likelihood of suicide attempts, which highlighted the importance of addressing internet addiction symptoms among Chinese adolescents for suicide prevention.

Investigating the Impact of Traditional Bullying and Cyberbullying on Suicidal Attempts in Chinese Youth: A Prospective Cohort Study

Aims: It is unknown whether bullying exposure is independently associated with suicide attempts incidence. This study aims to investigate the association between traditional bullying, cyberbullying, and subsequent risk of suicide attempts among Chinese adolescents. Methods: In this prospective cohort study, 1162 participants (mean age, 12.59, 54.5% male) were recruited from November 2020 to December 2020 in Changsha Hunan Province. In total, 782 of them completed the follow-up in May and June 2021 and were included in the final analysis. Logistic regression was utilized to calculate the odds ratio (OR) with 95% confidence intervals (95% CIs). Gender differences in these associations were further explored by stratified analysis. Results: Adolescents who engaged in bullying perpetration (BP) and experienced cyberbullying victimization (CV) were significantly associated with an increased risk of suicide attempts in the 6-month follow-up even after adjusting for age, ethnicity, single child, depression, anxiety, and stress in the baseline (BP: adjusted OR [aOR] = 3.337, 95% CI: 1.463-7.611, p=0.004; CV: aOR = 3.338, 95% CI: 1.468-7.590, p=0.004). Furthermore, the association between BP and suicide attempts was found to be statistically significant only among male adolescents (aOR = 6.692, 95% CI: 1.566-28.601, p=0.01), while CV was significantly associated with a heightened risk of suicide attempts among female adolescents (aOR = 4.452, 95% CI: 1.684-11.771, p=0.003). Conclusions: BP and CV were longitudinally associated with an increased risk of suicide attempts in Chinese youth, and these associations vary across genders.

Country-specific psychopharmacological risk of reporting suicidality comparing 38 antidepressants and lithium from the FDA Adverse Event Reporting System, 2017-2023

Background

The United States Food and Drug Administration (FDA) maintains a black-box warning for antidepressants warning of an increased risk of suicidality in children and young adults that is based on proprietary clinical trial data from study sponsors that were submitted for regulatory approval. This article aimed to assess whether the black-box warning for antidepressants is still valid today using recent drug safety data.

Methods

Post-marketing adverse drug event data were obtained from the US FDA's Adverse Event Reporting System (FAERS) for the years 2017 through 2023. Logistic regression analysis was conducted using the case versus non-case methodology and adjusted for gender, age group, drug role (primary drug, secondary drug, interacting drug, and concomitant drug), initial FDA reporting year, reporter country, and a drug*gene*age group interaction.

Results

In the multivariate analysis, compared to fluoxetine and patients aged 25 to 64 years, children [adjusted reporting odds ratio (aROR) = 7.38, 95% CI, 6.02-9.05] and young adults (aROR = 3.49, 95% CI, 2.65-4.59) were associated with an increased risk of reporting suicidality, but not for the elderly (aROR = 0.76, 95% CI, 0.53-1.09). Relative to fluoxetine, esketamine was associated with the highest rate of reporting suicidality in children (aROR = 3.20, 95% CI, 2.25-4.54); however, esketamine was associated with a lower risk of reporting suicidality in young adults (aROR = 0.59, 95% CI, 0.41-0.84), but not significantly in the elderly (aROR = 0.77, 95% CI, 0.48-1.23). For country-specific findings, relative to the USA, the Slovak Republic, India, and Canada had the lowest risk of reporting suicidality. For the overall study population, desvenlafaxine (aROR = 0.61, 95% CI, 0.46-0.81) and vilazodone (aROR = 0.56, 95% CI, 0.32-0.99) were the only two antidepressants associated with a reduced risk of reporting suicidality.

Conclusion

This study shows that with recent antidepressant drug safety data, the US FDA's black-box warning for prescribing antidepressants to children and young adults is valid today in the USA. However, relative to the USA, 15 countries had a significantly lower risk of reporting suicidality, while 16 countries had a higher risk of reporting suicidality from 38 antidepressants and lithium.

Trends in Adolescent Health: Successes and Challenges From 2010 to the Present

PURPOSE

This review considers trends in some of the major adolescent health outcomes and contextual influences since 2010, and explores the relevance of recent cultural, societal, and public health developments on adolescent well-being.

METHODS

Based on a review of major reports published since 2010, we identified key topics of impact on adolescent health and development across several domains (education, economic opportunity, sexual and reproductive health, nutrition, and mental health) and ecological levels (from individual- to macro-level influences). Within these areas, we synthesized findings to describe recent trends, noting variation across countries/regions, gender/sex, and other social stratifications when possible.

RESULTS

Since 2010, progress in several areas of sexual and reproductive health has been most striking, with notable global declines in female genital mutilation/cutting, child marriage, HIV transmission, and adolescent childbearing. Participation and retention in school has increased, although the COVID-19 pandemic interrupted positive progress for many adolescents and contributed to social isolation and economic insecurity. The mental health and nutrition domains have clear challenges. Increased internalizing mental health issues have been observed cross-culturally, especially among girls. The prevalence of anemia has remained stagnant, while overweight and obesity rates are rising. Within domains, we highlight uneven progress across and within countries.

DISCUSSION

Based on recent successes and emerging challenges in adolescent well-being, we find that more and better research is needed that consistently takes an intersectional perspective, and critically, action must be taken to consolidate the gains in sexual and reproductive health and extend them to other areas of adolescent health.

Role of sleep problem on suicidal behaviour and non-suicidal self-injury among adolescents in Pokhara, Nepal

INTRODUCTION

Sleep is a fundamental human requirement, considered one of the major contributing factors to physical and mental health, especially among adolescents. Poor quality sleep has many potential consequences including non-suicidal self-injury (NSSI), suicidal thoughts or behaviour and complete suicide. The NSSI and suicidal behaviour are increasing in Nepal. Thus, this study aimed to assess the role of sleep problem on suicidal behaviour and non-suicidal self-injury among adolescents in Pokhara metropolitan, Nepal.

METHODS

A cross-sectional analytical study was conducted among 673 adolescents using a multistage cluster sampling technique from private and public schools in Pokhara Metropolitan. Self-administered questionnaire was used for data collection. Collected data was entered and managed in EpiData (version 3.1) and analysed in IBM SPSS (version 23). Binary logistic regression was used to identify the association of sleep problem with NSSI and suicidal behaviour.

RESULTS

The study found that sleep problem (65.2%, 439), suicidal behaviour (18.6%, 125) and NSSI (57.9%, 390) were prevalent among adolescents in study setting. The presence of sleep problem significantly influenced the suicidal behavior (AOR = 3.88, 95% CI = 2.27-6.63) alongside the sex of student (AOR = 1.96, 95% CI = 1.28-3.00), adolescents from family having monthly income less than NPR 40,000 (AOR = 1.97 95% CI = 1.16-3.35) and private schools students (AOR = 2.99, 95% CI = 1.84-4.86). Likewise, sleep problem was also associated with non-suicidal self-injury (AOR = 3.24, 95% CI = 2.26-4.65), in addition to attending private school (AOR = 2.52, 95% CI = 1.71-3.72).

CONCLUSION

This study concludes that sleep problem is prevalent among the adolescents and increase the risk of NSSI and suicidal behaviour. Therefore, parents and teachers need to assess their conditions and help them maintain sound sleep. Additionally, suicide prevention strategies need to be adopted to mitigate further risk.

Middle school students' psychological health on suicide ideation: based on latent profile analysis

Introduction

This study identifies potential categories of mental health for adolescents in different school years and further analyzes the relationship between these categories and suicidal ideation.

Methods

A total of 1944 middle school students completed SCL-90 and Self-rating Idea of Suicide Scale on November 29, 2022, selecting via a whole-group sampling method. Latent profile analysis was used to analyze the psychological health subtypes of students from a middle school in Southwest China. The R3step method and the DU3step method were conducted to analyze the predictive role of demographic variables and the effects of different profiles on suicidal ideation.

Results

Different potential categories of psychological health were observed among middle school students. Junior middle school students can be classified into three types: Psychological Health Type (62.3%), Low-risk Type (27.1%) and High-risk Type (10.7%). Senior middle school students can be classified into four types: Psychological Health Type (43.3%), Low-risk Type (33.9%), Medium -risk Type (16.8%), and High-risk Type (6.0%). Gender and subjective family atmosphere are predictors of psychological health, and they also influence the population distribution of psychological health patterns in different sections of middle school students. Girls and students with poor subjective family atmosphere are more prone to experiencing psychological problems. There were significant differences in suicidal ideation among different potential categories of psychological health of different sections middle school students (χ 2 = 1178.71, 1174.85, p<0.001). Among senior high school students classified as High-risk Type, they exhibited the highest score for suicidal ideation.

Conclusion

There is obvious group heterogeneity in psychological health of different sections middle school students. Older students are more likely to have suicidal thoughts.

Associations of nighttime light exposure during pregnancy with maternal and neonatal gut microbiota: A cohort study

BACKGROUND

Nighttime light (NTL) pollution has been reported as a risk factor for human health. However, the relationship between NTL and gut microbiota has not been reported in pregnant women and neonates. This study was conducted to investigate the relationship between NTL and gut microbial diversity and composition in mothers and their neonates.

METHODS

This study analyzed 44 mothers and 28 newborns. The composition of gut microbiota was evaluated using 16S rRNA V3-V4 sequencing. The monthly mean NTL exposure during pregnancy was respectively calculated based on each participant's residential address (NTLpoint) and a concentric 1 km radius buffer zone around their address (NTL1000m). The relationships between NTL exposure and gut microbiota of mothers and newborns were assessed using generalized linear models.

RESULTS

NTL exposure during pregnancy was not associated with alpha diversity of mothers or neonates. For mothers, results revealed that after adjusting for covariates, NTLpoint was negatively correlated with Prevotella_2 (p = 0.004, FDR-adjusted p = 0.030) and norank_o__Gastranaerophilales (p = 0.018, FDR-adjusted p = 0.049) at the genus level. In addition, Lachnospira (p = 0.036, FDR-adjusted p = 0.052) and Coprococcus_3 (p = 0.025, FDR-adjusted p = 0.052) were positively correlated with NTLpoint. The association between Coprococcus_3 (p = 0.01, FDR-adjusted p = 0.046) and NTLpoint persisted even after controlling for covariates. For neonates, Thauera was positively associated with NTLpoint (p = 0.015) and NTL1000m (p = 0.028), however, after adjusting for covariates and FDR correction, Thauera was not significantly associated with NTLpoint and NTL1000m.

CONCLUSIONS

This study found that NTL exposure was associated with maternal gut microbiota composition. Our findings provide a foundation for the potential impact of NTL exposure on maternal gut microbiota from a microbiological perspective. More population-based validation of the effects of NTL exposure on human gut microbiota is needed in future.

Prevalence of suicide attempts across the African continent: A systematic review and meta-analysis

BACKGROUND

Over 700,000 people worldwide lose their lives through suicide every year. The prevalence of suicide has increased, especially in low- and middle-income countries such as many African countries. For every fatal suicidal attempt, there are approximately 20 other non-fatal suicide attempts within the population. The purpose of this study is to investigate the prevalence of attempts of suicides in the African continent through a systematic review and meta-analysis.

METHODS

To identify relevant sources, the PubMed, Scopus, Web of Science, Embase, ScienceDirect and Google Scholar repositories and databases were systematically searched without a lower time limit and until July 2023. The heterogeneity of the studies was checked with the I2 index, and accordingly random effects model was adopted to perform the analysis. Data analysis was conducted within the Comprehensive Meta-Analysis software (v.2).

RESULTS

In the review of 48 studies with a sample size of 244,701 people, the prevalence of suicide attempts in Africa was found to be 9.9% (95%CI: 8.5%-11.6%). With the increase in the year of study, the prevalence of suicide attempt in the African continent increases. Also, with the increase in the sample size, the prevalence of suicide attempts in Africa decreases. The suicide attempt prevalence among African men and woman slightly differed with 7.6% and 8.2%, respectively.

CONCLUSION

Suicide attempt is an important public health concern in Africa. The findings of this study are important not only for African health policy making, but also to contribute to the accuracy of global estimates with respect to suicide attempts.

Neurogenetics and Epigenetics of Loneliness

Loneliness, an established risk factor for both, mental and physical morbidity, is a mounting public health concern. However, the neurobiological mechanisms underlying loneliness-related morbidity are not yet well defined. Here we examined the role of genes and associated DNA risk polymorphic variants that are implicated in loneliness via genetic and epigenetic mechanisms and may thus point to specific therapeutic targets. Searches were conducted on PubMed, Medline, and EMBASE databases using specific Medical Subject Headings terms such as loneliness and genes, neuro- and epigenetics, addiction, affective disorders, alcohol, anti-reward, anxiety, depression, dopamine, cancer, cardiovascular, cognitive, hypodopaminergia, medical, motivation, (neuro)psychopathology, social isolation, and reward deficiency. The narrative literature review yielded recursive collections of scientific and clinical evidence, which were subsequently condensed and summarized in the following key areas: (1) Genetic Antecedents: Exploration of multiple genes mediating reward, stress, immunity and other important vital functions; (2) Genes and Mental Health: Examination of genes linked to personality traits and mental illnesses providing insights into the intricate network of interaction converging on the experience of loneliness; (3) Epigenetic Effects: Inquiry into instances of loneliness and social isolation that are driven by epigenetic methylations associated with negative childhood experiences; and (4) Neural Correlates: Analysis of loneliness-related affective states and cognitions with a focus on hypodopaminergic reward deficiency arising in the context of early life stress, eg, maternal separation, underscoring the importance of parental support early in life. Identification of the individual contributions by various (epi)genetic factors presents opportunities for the creation of innovative preventive, diagnostic, and therapeutic approaches for individuals who cope with persistent feelings of loneliness. The clinical facets and therapeutic prospects associated with the current understanding of loneliness, are discussed emphasizing the relevance of genes and DNA risk polymorphic variants in the context of loneliness-related morbidity.

Suicides among Children and Adolescents in Paraguay: An 18-year National Exploratory Study (2004-2022)

BACKGROUND

Suicide and suicide attempts are impacting events for patients and their relatives, and these behaviors are still taboo among adults and may be even more traumatic when involving children and adolescents.

AIM

In this study we aimed to describe suicide rates among children and adolescents in Paraguay over the last decades as well as associated factors such as sociodemographic characteristics and methods used for suicide.

METHODS

This was an observational and exploratory study describing the frequency and characteristics of suicide among children and adolescents in Paraguay between 2004 and 2022. Official records of all deaths by suicide were reviewed, and statistical analyses were performed. In addition, an attempt was made to predict the number of suicides in the next 5 years using a mathematical model based on simple linear regression.

RESULTS

In the 18-year period observed, 940 suicides among children and adolescents were recorded. The mean age was 15.05 ± 1.8 years old. Of these, 51.17% were male, 74.6% were from urban areas, and 22.2% were from the Greater Asunción and Central Department of Paraguay. The most frequently used method of suicide was intentional self-inflicted injury by hanging, strangulation, or suffocation, which all represented 75.3% of the cases. Our mathematical modeling based on simple linear regression determined that the expected yearly number of national suicides in the pediatric population for the following years, from 2023 to 2027, will range between 72 and 81.

CONCLUSION

This study is the first large national epidemiological report on the emerging issue of suicide among children and adolescents in Paraguay. It may be a relevant source of information for mental health professionals, health authorities, and decision makers to develop national prevention strategies and actions against suicide among youths.

Clinico-Epidemiological Profile and Short-Term Outcomes of Patients with Acute Poisoning Presenting to an Emergency of a Tertiary Care Center in Western Rajasthan

BACKGROUND

This research aimed to evaluate the clinico-epidemiological profile and short-term outcomes of patients admitted to the emergency department of a tertiary hospital.

MATERIALS AND METHODS

This prospective observational cross-sectional study was conducted between January 1, 2021, and June 30, 2022, in the Emergency Department of a tertiary hospital. Patients of either gender of any age attending the emergency department with acute poisoning were included. These cases were analyzed for their epidemiological profiles, poisoning characteristics, and various clinical variables influencing patient outcomes.

RESULTS

Out of a total of 236 patients, 190 patients (80.5%) were aged more than 18 years. Comorbidities were present in 32 (13.5%) patients, and psychiatric illness was the most common comorbidity. The intention of poisoning was suicidal in 185 patients (78.4%) and accidental in 51 patients (21.6%). Organophosphate was the most common poisoning seen in 55 patients (23.3%), followed by drug ingestion seen in 44 patients (18.6%). Twenty-eight patients (11.8%) were transferred to the intensive care unit. Nineteen patients (8.1%) required mechanical ventilation. There were ten deaths (4.2%) in the study population. Aluminum phosphide poisoning was associated with the highest mortality rate, followed by organophosphate poisoning.

CONCLUSIONS

This study indicates that most poisoning cases involved young people, mainly males. Organophosphorus poisoning was one of the most common poisonings, followed by the ingestion of drugs in this part of the world. Aluminum phosphide had the highest fatality rate.

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

BACKGROUND

Assessing suicidal behaviours among students would help to understand the burden and enhance suicide prevention.

AIMS

We aimed to determine the prevalence of suicidal behaviour among students living in Muslim-majority countries.

METHOD

We followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A systematic search was conducted in Medline, EMBASE and PsycINFO. Meta-analyses were performed to pool the lifetime, 1-year and point prevalence rates for suicidal ideation, plans and attempts.

RESULTS

From 80 studies, 98 separate samples were included in this analysis. The majority (n = 49) were from the Eastern Mediterranean, and 61 samples were of university students. The pooled prevalence of suicidal ideation was 21.9% (95% CI 17.4%-27.1%) for lifetime, 13.4% (95% CI 11.1%-16.1%) for the past year and 6.4% (95% CI 4.5%-9%) for current. The pooled prevalence of suicide plans was 6.4% (95% CI 3.7%-11%) for lifetime, 10.7% (95% CI 9.1%-12.4%) for the past year and 4.1% (95% CI 2.7%-6.2%) for current. The pooled prevalence of suicide attempts was 6.6% (95% CI 5.4%-8%) for lifetime and 4.9% (95% CI 3.6%-6.5%) for the past year. The lifetime prevalence of suicidal ideation was highest (46.2%) in South-East Asia, but the 12-month prevalence was highest (16.8%) in the Eastern Mediterranean.

CONCLUSIONS

The study revealed notably high rates of suicidal behaviours among students living in Muslim-majority countries. However, the quality of studies, differences in regional and cultural factors, stages of studentship and methods of measurement should be considered when generalising the study results.

Adolescent suicidal behaviour in Namibia: a cross-sectional study of prevalence and correlates among 3,152 school learners aged 12-17 years

BACKGROUND

While adolescent suicidal behaviour (ideation, planning, and attempt) remains a global public health concern, available county-specific evidence on the phenomenon from African countries is relatively less than enough. The present study was conducted to estimate the 12-month prevalence and describe some of the associated factors of suicide behaviour among school-going adolescents aged 12-17 years old in Namibia.

METHODS

Participants (n = 4531) answered a self-administered anonymous questionnaire developed and validated for the nationally representative Namibia World Health Organization Global School-based Student Health Survey conducted in 2013. We applied univariate, bivariable, and multivariable statistical approaches to the data.

RESULTS

Of the 3,152 analytical sample, 20.2% (95% confidence interval [CI]: 18.3-22.2%) reported suicidal ideation, 25.2% (95% CI: 22.3-28.4%) engaged in suicide planning, and 24.5% (95% CI: 20.9-28.6%) attempted suicide during the previous 12 months. Of those who attempted suicide, 14.6% (95% CI: 12.5-16.9%) reported one-time suicide attempt, and 9.9% (95% CI: 8.1-12.1%) attempted suicide at least twice in the previous 12 months. The final adjusted multivariable models showed physical attack victimisation, bullying victimisation, loneliness, and parental intrusion of privacy as key factors associated with increased likelihood of suicidal ideation, planning, one-time suicide attempt, and repeated attempted suicide. Cannabis use showed the strongest association with increased relative risk of repeated attempted suicide.

CONCLUSION

The evidence highlights the importance of paying more attention to addressing the mental health needs (including those related to psychological and social wellness) of school-going adolescents in Namibia. While the current study suggests that further research is warranted to explicate the pathways to adolescent suicide in Namibia, identifying and understanding the correlates (at the individual-level, family-level, interpersonal-level, school context and the broader community context) of adolescent suicidal ideations and non-fatal suicidal behaviours are useful for intervention and prevention programmes.

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

Although global rates of suicide have dropped in the last 30 years, youth in low- and middle-income countries (LMICs) continue to be highly represented in suicide statistics yet underrepresented in research. In this review we present the epidemiology of suicide, suicidal ideation, and suicide attempts among youth in LMICs. We also describe population-level (attitudes toward suicide, socioeconomic, and societal factors) and individual-level clinical and psychosocial risk factors, highlighting specific considerations pertaining to youth in LMICs. These specific considerations in risk factors within this population can inform how multi-level prevention strategies may be targeted to meet their specific needs. Prevention and intervention strategies relying on the stepped-care framework focusing on population-, community-, and individual level targets while considering locally- and culturally relevant practices are key in LMICs. In addition, systemic approaches favoring school-based and family-based interventions are important among youth. Cross-culturally adapted multimodal prevention strategies targeting the heterogeneity that exists in healthcare systems, suicide rates, and risk factors in these countries should be accorded a high priority to reduce the burden of suicide among youth in LMICs.