Bullying and other risk factors related to adolescent suicidal behaviours in the Philippines: a look into the 2011 GSHS Survey

Prevalence of suicide attempts and related factors among adolescents in Taiwan using a nationally representative survey

PURPOSE

This study aimed to apply stress-diathesis model to investigate the prevalence of suicide attempts and associated factors in a nationally representative sample of adolescents.

METHODS

A cross-sectional design and secondary data analysis were conducted using the parent study "Taiwan Youth Health Survey" data. A total of 5511 junior high school students were included. The outcome variable was self-reported suicide attempts, and the independent variables included self-reported stress and diathesis factors.

RESULTS

The prevalence of suicide attempts among adolescents was 7.7 %, with rates of 6.1 % for boys and 9.4 % for girls. The multiple logistic regression revealed that girls, loneliness, suicide ideation and plans, smoking, drinking alcohol, consumption of carbonated soft drinks (CSDs), eating fast food, experiencing a severe injury, being bullied, and lacking close friends were associated with an increased risk for attempting suicide. For boys, anxiety, smoking, experiencing severe injuries were identified as significant risk factors. For girls, loneliness, drinking alcohol, consuming CSDs, eating fast food, being bullied, and less parental supervision were identified as significant risk factors. The derived prediction score for the total group, boys, and girls yielded areas under the cure of 0.85, 0.82, and 0.87, respectively. The regression model, which incorporated interaction terms, demonstrated that loneliness, consumption of CSDs, and less parental supervision are gender-specific risk factors.

CONCLUSION

It is essential to consider gender differences in preventive measures. Appropriate interventions should be tailored to address both predispositions and stress unique to each gender, ensuring that gender-specific risk factors are managed more comprehensively.

Adverse childhood experiences and suicidality in low-income and middle-income countries: a systematic review and meta-analysis

INTRODUCTION

Suicide is an important public health problem with a complex aetiology; this includes adverse childhood experiences (ACEs). Common to suicide and ACEs research is a lack of evidence from low-income and middle-income countries (LMICs). This review aims to evaluate associations between ACEs and suicidality in LMICs.

METHODS

In this systematic review and meta-analysis, a search for articles investigating associations between any ACEs and suicidal outcomes in LMICs was conducted using Medline, Embase, PsycINFO, CINAHL and Web of Science on 2 December 2022; updated on 14 January 2025. Cross-sectional or cohort study research articles investigating ACEs prior to age 18 and using population-based, probabilistic or total population, sampling were eligible for inclusion. Suicidal outcomes across the spectrum were eligible for inclusion. Identified records underwent two-step screening by two independent reviewers; data extraction and risk of bias assessment using Joanna Briggs Institute Critical Appraisal tools were also completed in duplicate. Random-effects models were used to calculate pooled ORs. Articles that could not be meta-analysed were narratively synthesised. Reporting of this review was guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 statement.

RESULTS

Ultimately, 118 articles were included; all were of low or moderate risk of bias and none reported on suicide mortality. Six ACEs were significantly associated with increased odds of suicidal outcomes: (1) bullying-victimisation, (2) emotional, verbal or psychological abuse victim, (3) parental separation, divorce or death, (4) physical abuse or violence victim, (5) physical attack victim and (6) sexual abuse victim. Significant ORs ranged from 1.19 to 2.61. Positive associations were found across subgroup and sensitivity analyses. Narrative review found statistically significant positive and non-significant associations between ACEs and suicidal outcomes.

CONCLUSIONS

ACEs are associated with suicidal outcomes in LMICs, highlighting the need for early intervention strategies and multisector public health approaches to reducing ACEs and their potential impacts.

The mediating effect of bullying on parental-peer support matching and NSSI behaviour among adolescents

BACKGROUND

Being subjected to bullying is a significant risk factor for non-suicidal self-injury (NSSI) among adolescents. Parental support, peer support, and social connectedness play protective roles in mitigating NSSI in this population. However, the precise impact of the combined effects of parental and peer support on bullying and NSSI requires further investigation.

METHODS

This study employed the Child and Adolescent Social Support Scale, Delaware Bullying Victimisation Scale, Social Connectedness Scale, and the Ottawa Self-Injury Inventory to survey 1277 Chinese adolescents. Polynomial regression analysis and response surface analysis were applied to examine the mediating role of bullying and social connectedness in the relationship between parental and peer support matching and NSSI.

RESULTS

The results indicate that parental support (r = 0.287, P < 0.001), peer support (r = 0.288, P < 0.001), and social connectedness (r = 0.401, P < 0.001) were protective factors against NSSI in adolescents. Conversely, bullying (r = 0.425, P < 0.001) acts as a risk factor for NSSI in this population. Adolescents with low parental and peer support experienced more bullying than those with high parental and peer support, while those with low parental but high peer support experienced less bullying than those with high parental but low peer support (R^2 = 0.1371, P < 0.001). Social connectedness moderated the effect between bullying and NSSI in this model (β = 0.006, P < 0.001).

LIMITATIONS

Due to the under-representation of participants and lack of longitudinal data support, the explanatory power of causality between variables was limited. Future studies should include national samples and incorporate longitudinal studies to enhance the generalisability and robustness of the findings.

CONCLUSION

This study reveals the influence mechanism of parental and peer support matching experienced by adolescents on bullying and NSSI and the moderating role of social connectedness. These findings enrich the developmental theory of adolescent NSSI and provide reference for the prevention and intervention of adolescent NSSI behaviour.

[Bullying victimization and associated factors among schoolchildren in a city in the south of Brazil]

The objective was to assess the prevalence of bullying victimization and associated factors among adolescents in the city of Pelotas, Rio Grande do Sul. A cross-sectional school-based study was conducted with 795 ninth grade students from 25 urban municipal schools linked to the School Health Program. Bullying was assessed using questions that addressed the occurrence, frequency, location, type of violence suffered and how much it bothers the victims. Gross and adjusted analyses were performed by Poisson regression. Approximately 71% of the students reported having suffered bullying, and school was the location of greatest occurrence (86.7%). Among the types of aggression suffered, "nicknames" was the most recurrent complaint (88.4%), followed by exclusion or isolation (26.6%). Victimization was more frequent among girls (PR 1.13; 95%CI 1.02-1.27), students with non-white skin color/race (PR 1.16; 95%CI 1.05-1.29), who have already tried tobacco (PR 1.14; 95%CI 1.03-1.27), dissatisfied (PR 1.42; 95%CI 1.27-1.58) or indifferent (PR 1.21; 95%CI 1.02-1.43) about their bodies, and who were overweight (PR 1.15; 95%CI 1.04-1.27). The results show that bullying is a frequent practice in the school environment, pointing to the need for educational practices aimed at reducing and preventing this type of violence.

Identification of risk factors for attempted suicide by self-poisoning and a nomogram to predict self-poisoning suicide

Purpose

Suicide is a global concern, especially among young people. Suicide prediction models have the potential to make it easier to identify patients who are at a high risk of suicide, but they have very little predictive power when there is a positive value for suicide mortality. Therefore, the aim of the study is to uncover potential risk factors associated with suicide by self-poisoning and further to provide a trustworthy nomogram to predict self-poisoning suicide among poisoned patients.

Methods

This study prospectively enrolled 237 patients who were treated for poisoning at the Fifth Medical Center of PLA General Hospital (Beijing) between May 2021 and May 2022. Patient's basic characteristics, daily activities, mental health status, and history of psychological illnesses were gathered to examine their predictive power for self-poisoning suicide. On developing a prediction model, patients were split 8:2 into a training (n = 196) group and a validation (n = 41) group at random via computer. The training group worked on model development, while the validation group worked on model validation. In this study, the Hosmer and Lemeshow test, accuracy, and area under the curve were the primary evaluation criteria. Shapley Additive exPlanations (SHAP) was determined to evaluate feature importance. To make the prediction model easy for researchers to utilize, it was presented in nomogram format. Two risk groups of patients were identified based on the ideal cut-off value.

Results

Of all poisoned patients, 64.6% committed suicide by self-poisoning. With regard to self-poisoning attempted suicide, multivariate analysis demonstrated that female gender, smoking, generalized anxiety disorder-7 (GAD-7), and beck hopelessness scale-20 (BHS-20) were significant risk factors, whereas married status, relatively higher education level, a sedentary time of 1–3 h per day, higher sport frequency per week, higher monthly income were significant protective features. The nomogram contained each of the aforementioned nine features. In the training group, the area under curve (AUC) of the nomogram was up to 0.938 (0.904–0.972), whereas in the validation group, it reached a maximum of 0.974 (0.937–1.000). Corresponding accuracy rates were up to 0.883 and 0.927, respectively, and the P-values for the Hosmer and Lemeshow test were 0.178 and 0.346, respectively. SHAP demonstrated that the top three most important features were BHS-20, GAD-7, and marital status. Based on the best cut-off value of the nomogram (40%), patients in the high-risk group had a nearly six-time larger likelihood of committing suicide by self-poisoning than patients in the low-risk group (88.68 vs. 15.38%, P &lt; 0.001). The dynamic nomogram was made available at the following address: https://xiaobo.shinyapps.io/Nomogramselfpoisoningsuicide/.

Conclusions

This study proposes a prediction model to stratify patients at a high risk of suicide by self-poisoning and to guide individual preventive strategies. Patients in the high-risk group require further mental health counseling to alleviate anxiety and hopelessness, healthy lifestyle like quitting smoking and exercising more, and restriction of access to poison and psychiatric drugs.