Prevalence, distribution, and associated factors of suicide attempts in young adolescents: School-based data from 40 low-income and middle-income countries

Suicide attempts are the most important known predictor of death by suicide. The aim of this study is to examine the prevalence, distribution, and associated factors of suicide attempts among young adolescents in 40 low-income and middle-income countries. We used data from the Global School-Based Student Health Survey (2009–2013) and a nationally representative study in China (2010), which are school-based surveys of students primarily aged 12–18 years that assess health behaviors using an anonymous, standardized, self-reported questionnaire. We calculated the prevalence of suicide attempts in young adolescents from 40 low-income and middle-income countries using the surveys. Multilevel logistic models were used to estimate the associations between suicide attempts and potential risk factors, adjusting for gender, age, school and survey year. Results show that the mean 12-month prevalence of suicide attempts was 17.2%, ranging from 6.7% in Malaysia to 61.2% in Samoa. The overall prevalence of suicide attempts was higher for girls than for boys (18.2% vs 16.2%, P<0.05). Among the suicide attempts, the proportion of suicide attempts with a plan was higher for girls than for boys (62.7% vs 53.2%, P<0.05). Both the prevalence of suicide attempts and the proportion of suicide attempts with a plan increased with age. Factors associated with suicide attempts included poor socioeconomic status, history of bullying, loneliness and anxiety, tobacco and alcohol use, and weak family and social relationships. In conclusion, suicide attempts are frequent among young adolescents in low-income and middle-income countries. Girls and older adolescents tend to make suicide attempts with a plan. The data demonstrate the need to strengthen suicide intervention and prevention programs for young adolescents in low-income and middle-income countries.