Global risks of suicidal behaviours and being bullied and their association in adolescents: School-based health survey in 83 countries

James Jie Tang; Yizhen Yu; Holly C Wilcox; Chun Kang; Kun Wang; Cunku Wang; Yu Wu; Ruoling Chen

doi:10.1016/j.eclinm.2019.100253

Global risks of suicidal behaviours and being bullied and their association in adolescents: School-based health survey in 83 countries

EClinicalMedicine. 2020 Jan 10:19:100253. doi: 10.1016/j.eclinm.2019.100253. eCollection 2020 Feb.

Authors

James Jie Tang^{1

2}, Yizhen Yu³, Holly C Wilcox⁴, Chun Kang³, Kun Wang⁵, Cunku Wang⁶, Yu Wu⁷, Ruoling Chen^{2

8}

Affiliations

¹ Department of Preventive Medicine, School of Public Health, Guangzhou Medical University, Xinzao, Panyu District, 511436, Guangzhou, PR China.
² Faculty of Education, Health and Wellbeing, University of Wolverhampton, Millennium City Building, Wulfruna Street, Wolverhampton, WV1 1LY, UK.
³ School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, 13th Hangkong Road, Qiaokou District, Wuhan, Hubei, 430030, PR China.
⁴ Department of Mental Health, Bloomberg School of Public Health, Johns Hopkins University, USA.
⁵ Institute of Medical Information, Chinese Academy of Medical Science, Beijing, PR China.
⁶ Center for Health Statistics and Information, National Health Commission, Beijing, PR China.
⁷ Shenzhen Centre for Disease Control and Prevention, Shenzhen, PR China.
⁸ Department of Medicine, School of Medicine, Johns Hopkins University, USA.

Abstract

Background: Global risks of suicidal behaviours (SB) and being bullied as well as their association among adolescents have been poorly understood. We aimed to determine the risks of suicidal ideation (SI), suicide planning (SP), suicide attempt (SA) and being bullied in adolescents and their related associations across gender, countries and different WHO regions.

Methods: We examined data from the Global School-based Health Survey (GSHS), which recorded health behaviours among adolescents aged 12 to 15 years from 83 countries. We computed prevalence rates of SB and being bullied and their 95% confidence intervals (CIs). Multilevel models were employed to examine the association of being bullied with risks 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 an increased risk for SI (18·2%) and SP (17·3%) but similar risk for 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 with SA was in the Western Pacific (2·68, 2·45-2·92) and with SI (2·04, 1·74-2·39) and SP (1·81, 1·68-1·95) were in Southeast Asia. There were no gender differences in aOR for SI and SP, but the aOR for SA among boys (2·28, 2·14-2·42) was significantly greater than among girls (2·04, 1·93-2·15), ratio of two odds ratios was 1.12 (P = 0.008).

Interpretation: SB and being bullied were common among adolescents worldwide. The findings of gender differences in SB, being bullied and their association could inform the design of prevention programmes to reduce the risks of SI, SP and SA in adolescents worldwide.

Keywords: Adolescent; Being bullied; Gender differences; Global health; Regional variation; Suicidal behaviours.