Leisure-time sedentary behavior and suicide attempt among 126,392 adolescents in 43 countries

Prevalence of unhealthy behaviors and their associations with non-suicidal self-injury, suicidal ideation and suicide attempt among Chinese adolescents

BACKGROUND

Unhealthy lifestyle behaviors among adolescents have emerged as a significant public health concern worldwide, however, there is little investigation on the impact of unhealthy behaviors on non-suicidal self-injury (NSSI), suicidal ideation (SI) and suicide attempt (SA). This study aimed to investigate the prevalence of seven unhealthy behaviors as well as their associations with NSSI, SI and SA, and to explore whether the aforementioned associations differ across sex.

METHODS

A total of 74,152 adolescents were included in this study via a multi-stage, stratified cluster, random sampling method in 2021. Information about unhealthy behaviors (insufficient physical activity, current smoking, current drinking, excessive screen time, long homework time, insufficient sleep and unhealthy BMI), NSSI, SI, SA and other demographics was collected. Sampling weights were used to estimate the prevalence, and the weighted logistic regression models were performed. Stratified analyses by sex and sensitive analyses were conducted.

RESULTS

Overview, the weighted prevalence of adolescents had more than five unhealthy behaviors were 5.2%, with boys showing a higher prevalence than girls (6.5% vs.3.8%). Current smoking, current drinking, excessive screen use, long homework time, insufficient sleep, and unhealthy BMI were significantly associated with NSSI, SI and SA. Moreover, adolescents with high lifestyle risk scores were associated with an increased risk of NSSI (5-7 vs. 0: OR 6.38, 95% CI 5.24-7.77), SI (5-7 vs. 0: OR 7.67, 95% CI 6.35-9.25), and SA (5-7 vs. 0: OR 9.57, 95% CI 6.95-13.17). Significant sex differences were found in the associations of unhealthy behaviors with NSSI, SI and SA.

CONCLUSION

Unhealthy behaviors are quite common among Chinese adolescents. Adolescents with multiple unhealthy behaviors are associated with increased risks of NSSI, SI, and SA. The implementation of school and family-based interventions to promote healthy lifestyles is recommended as a preventive measure against self-injurious behavior and suicidality in adolescents.

Association between a changeable lifestyle, sedentary behavior, and suicide risk: A systematic review and meta-analysis

BACKGROUND

Suicide and self-injury have become increasingly serious public health crises. Yet current evidence about the association between sedentary behavior (SB) and suicide is inconclusive. We explore the relationship between SB and suicide behavior to provide intervention measures to change the risk factors of the latter.

METHODS

We searched PubMed, Embase, Cochrane Library, and Web of Science from database inception to September 10, 2023. Adjusted odds ratios (ORs) with 95 % confidence intervals (CIs) were used as effect measures. Subgroup analysis was conducted based on gender, regions and countries, age, and study type.

RESULTS

A total of 13 studies were included. According to the meta-analysis of suicide type, compared with individuals without sedentary behavior, individuals with sedentary behavior have a higher risk of suicide attempt (OR = 1.23, 95%CI: 1.15-1.37, p < 0.001), suicide ideation (OR = 1.47, 95%CI:1.28-1.68, p < 0.001) and suicide plan (OR = 1.30, 95%CI:1.16-1.44, p < 0.001). We conducted multiple subgroup analyses for different suicidal behaviors. The analysis found that SB can increase the risk of suicide attempt in different subgroups of different genders, different research centers, Africa, and adolescents; SB can increase the risk of suicide ideation in the subgroups of different genders and ages, different research centers, Asia and Africa; SB can increase the risk of suicide plan in the subgroups of different genders, multi-center study, Africa, and adolescents.

LIMITATIONS

Future research should focus on objective SB measurement and explore its dose-response relation and time limit.

CONCLUSION

A sedentary lifestyle is associated with suicide behavior risk, with varying effects across age groups and regions, as evidenced in both single-center and multi-center studies.

Long-term impact of the Fostering Healthy Futures for Preteens program on suicide-related thoughts and behaviors for youth in out-of-home care: A randomized controlled trial

Youth in out-of-home care are at high risk for suicide-related thoughts and behaviors (STB), yet there are no known efficacious interventions that reduce STB for this population. Fostering Healthy Futures for Preteens (FHF-P) is a 9-month community-based mentoring and skills training preventive intervention for children in out-of-home care. A randomized controlled trial enrolled 156 participants aged 9-11 years who were placed in out-of-home care over the prior year. Participants were 48.9% female, 54.1% Hispanic, 30.1% Black, and 27.1% American Indian. Follow-up interviews, conducted 7-12 years postintervention (85.2% retention rate), asked young adult participants, aged 18-22, to self-report lifetime STB as indexed by non-suicidal self-injury, suicidal thoughts, plans, and/or attempts. There was a nonsignificant reduction in the odds of STB for the intervention group at follow-up (OR = 0.74; CI, 0.32, 1.69). However, FHF-P significantly moderated the effect of baseline STB; control youth who reported baseline STB had 10 times the odds of young adult STB (OR = 10.44, CI, 2.28, 47.78), but there was no increase in the odds of adult-reported STB for intervention youth. Findings suggest that FHF-P buffers the impact of pre-existing STB on young adult STB for care-experienced youth. Further research is needed to identify mechanisms that may reduce STB in this population.

Originalarbeiten / Original Articles. Die Bedeutung der Freizeitgestaltung für die Suizidalität bei Jugendlichen und jungen Erwachsenen

The Importance of Leisure Activities for Suicidality in Adolescents and Young Adults Leisure time is important for the development of adolescents. It influences adolescents' psychological well-being and psychosocial development. It may also have a protective effect on suicidality. This study investigates how adolescents' leisure time is related to suicidality, distinguishing between general aspects and various specific leisure time activities. Data from adolescents in counseling (n = 25) and the general population (n = 57) were analyzed. Adolescents who spend most of their leisure time alone are more suicidal than adolescents who spend their leisure time with others. General aspects of leisure activities were related to suicidality; among specific activities, only sports activities were found to be significant.The strongest association with suicidality was shared activities with others. Based on these results, it can be shown that leisure time activities could be effective as a preventive measure. In particular, social activities in leisure time should be encouraged.

The prevalence of suicidal behaviour and its associated risk factors among school-going adolescents resident in the United Arab Emirates

Suicidal behaviour which includes suicidal ideation, having a plan to commit suicide and suicide attempts remains a global public health issue as it substantially impacts adolescent health and wellbeing. Suicidal behaviour, however, remains understudied in Middle Eastern contexts. This study analysed data from the 2016 Global School-based Student Health Survey collected in the United Arab Emirates (UAE). A sample of 5826 adolescents aged between 11 and 18 years were sampled. Potential risk factors associated with an elevated risk for engagement in suicidal behaviour were examined. These factors were stratified into categories for analysis (demographics, psychosocial, risky health, and socio-environmental). The age-adjusted prevalence of suicidal behaviour amongst the school-going adolescent population in the UAE was 54%. Analyses indicated that elevated risk was significantly associated with anxiety difficulties, the experience of loneliness, and amongst those who smoked tobacco. None of the socio-environmental factors emerged as significant. A dose-dependent relationship was evident in that the degree of risk that was evident appeared to compound as the number of adverse risk factors increased. The data suggest that suicidal behaviour may be highly prevalent in this location. Findings highlight the immense need to develop preventative interventions, some of which may be school-delivered and targeted at parents. Our findings provide initial indications as to which risk factors could be targeted for remediation in developing these interventions.

Development and validation of a nomogram to predict suicidal behavior in female patients with mood disorder

Introduction

This study aims to explore the risk factors associated with suicidal behavior and establish predictive models in female patients with mood disorders, specifically using a nomogram of the least absolute shrinkage and selection operator (LASSO) regression.

Methods

A cross-sectional survey was conducted among 396 female individuals diagnosed with mood disorders (F30-F39) according to the International Classification of Diseases and Related Health Problems 10th Revision (ICD-10). The study utilized the Chi-Squared Test, t-test, and the Wilcoxon Rank-Sum Test to assess differences in demographic information and clinical characteristics between the two groups. Logistic LASSO Regression Analyses were utilized to identify the risk factors associated with suicidal behavior. A nomogram was constructed to develop a prediction model. The accuracy of the prediction model was evaluated using a Receiver Operating Characteristic (ROC) curve.

Result

The LASSO regression analysis showed that psychotic symptoms at first-episode (β = 0.27), social dysfunction (β = 1.82), and somatic disease (β = 1.03) increased the risk of suicidal behavior. Conversely, BMI (β = -0.03), age of onset (β = -0.02), polarity at onset (β = -1.21), and number of hospitalizations (β = -0.18) decreased the risk of suicidal behavior. The area under ROC curve (AUC) of the nomogram predicting SB was 0.778 (95%CI: 0.730-0.827, p < 0.001).

Conclusion

The nomogram based on demographic and clinical characteristics can predict suicidal behavior risk in Chinese female patients with mood disorders.

Subjective and objective sleep and circadian parameters as predictors of depression-related outcomes: A machine learning approach in UK Biobank

BACKGROUND

Sleep and circadian disruption are associated with depression onset and severity, but it is unclear which features (e.g., sleep duration, chronotype) are important and whether they can identify individuals showing poorer outcomes.

METHODS

Within a subset of the UK Biobank with actigraphy and mental health data (n = 64,353), penalised regression identified the most useful of 51 sleep/rest-activity predictors of depression-related outcomes; including case-control (Major Depression (MD) vs. controls; postnatal depression vs. controls) and within-case comparisons (severe vs. moderate MD; early vs. later onset, atypical vs. typical symptoms; comorbid anxiety; suicidality). Best models (of lasso, ridge, and elastic net) were selected based on Area Under the Curve (AUC).

RESULTS

For MD vs. controls (n_(MD) = 24,229; n_(control) = 40,124), lasso AUC was 0.68, 95 % confidence interval (CI) 0.67-0.69. Discrimination was reasonable for atypical vs. typical symptoms (n_(atypical) = 958; n_(typical) = 18,722; ridge: AUC 0.74, 95 % CI 0.71-0.77) but poor for remaining models (AUCs 0.59-0.67). Key predictors across most models included: difficulty getting up, insomnia symptoms, snoring, actigraphy-measured daytime inactivity and lower morning activity (~8 am). In a distinct subset (n = 310,718), the number of these factors shown was associated with all depression outcomes.

LIMITATIONS

Analyses were cross-sectional and in middle-/older aged adults: comparison with longitudinal investigations and younger cohorts is necessary.

DISCUSSION

Sleep and circadian measures alone provided poor to moderate discrimination of depression outcomes, but several characteristics were identified that may be clinically useful. Future work should assess these features alongside broader sociodemographic, lifestyle and genetic features.

Parental role and peer support in adolescent suicidal behavior in eight South-East Asian countries

BACKGROUND

This study aimed to estimate the prevalence of suicidal behaviors, i.e. suicidal ideation (SI), suicidal plan (SP), and suicidal attempt (SA) among adolescents with a focus on parental and peer support in eight South-East Asian countries including Bangladesh, Bhutan, Indonesia, Maldives, Myanmar, Nepal, Sri Lanka and Thailand.

METHOD

Data were drawn from Global School-based Student Health Survey (GSHS) covering 42,888 adolescents aged 11-17 years. Weighted prevalence of SI, SP, and SA along with country specific prevalence was computed and binary logistic regression was used to identify associated risk factors.

RESULTS

Among 42,888 adolescents 19,113 (44.9 %) were males and 23,441 (55.1 %) females. Overall prevalence of SI, SP and SA is 9.10 %, 10.42 % and 8.54 %, respectively. Myanmar demonstrated the lowest SI (1.07 %) and SP (0.18 %) whereas lowest SA was found in Indonesia (3.79 %). Maldives had the highest prevalence of SI, SP and SA which were 14.13 %, 19.02 % and 13.38 % respectively. Overall suicidal behaviors were associated with being female [AOR:SI-1.26(1.06,1.50), SP-1.34(1.14,1.57),], high levels of sedentary behavior [AOR:SI-2.08(1.62,2.66), SP-1.86(1.49,2.32), SA-1.96(1.45,2.64)], involvement in physical fighting [AOR:SI-1.30(1.07,1.58), SP-1.37(1.14,1.65), SA-1.50(1.17,1.90)], being seriously injured [AOR:SI-1.40(1.17,1.67), SP-1.44(1.22,1.69), SA-1.74(1.39,2.17)], being bullied [AOR:SI- 1.68(1.39,2.02), SP-1.34(1.12,1.60), SA-1.88(1.50,2.36)], feeling lonely(most of time or always) [AOR:SI-3.41(2.60,4.46), SP-1.92(1.48,2.47), SA-2.25(1.62,3.13)], lack of parental support(never checking homework) [AOR:SI-1.59(1.25,2.02), SP-1.52(1.22,1.90)] and not having close friends [AOR:SI-2.19(1.66,2.89), SP-2.26(1.74,2.94), SA-4.23(3.10,5.78)].

CONCLUSION

Though prevalence of suicidal behaviors varies, a range of cross-cutting risk factors exists that warrant further examination. We recommend focusing on strengthening parental and peer support, targeted programs addressing physical activity, bullying, loneliness and mental-health of adolescents.

Association between Sedentary Behavior during Leisure Time and Excessive Weight in Chinese Children, Adolescents, and Adults

(1) Background: Sedentary behavior is increasing in all age groups and is one of the most common lifestyles that is a risk factor for overweight and obesity; however, few studies have evaluated the impact of leisure-time sedentary behavior on overweight and obesity. This study aims to examine the distribution characteristics of different leisure-time sedentary behaviors and their effects on excessive weight in different age groups in the Chinese population to provide evidence for the development of behavioral interventions. (2) Methods: This study utilizes data from the 2004 to 2011 China Health and Nutrition Survey (CHNS). Participants ranged in age from 6 to 18 years or older and were from China. Weight and height were measured in the physical examination, and the sedentary behavior times during leisure periods were collected by using a questionnaire. Logistic regression models were performed for association analyses. (3) Results: A total of 36,169 participants were included in this study. The impact of screen-based sedentary leisure time on excessive weight is greater in middle-aged and older adults. For middle-aged adults, sedentary time periods spent on the Internet or video games were found to be significantly and positively associated with excessive weight (OR, 1.122, 95% CI, 1.005-1.253). In addition, for older adults, sedentary time periods spent watching television or videos were found to be significantly and positively associated with excessive weight (OR, 1.065, 95% CI, 1.035-1.095). (4) Conclusions: This study helps grasp the target population and provide evidence for the development of behavioral intervention guidelines.

Breakfast habits, sedentary behavior, and suicide among Korean adolescents: A cross-sectional national study

This study aims to identify the relationships between breakfast habits, leisure-time sedentary behavior, and suicidal behaviors among Korean adolescents, including the mediating effect of leisure-time sedentary behavior on the relationship between breakfast habits and suicidal behaviors. We conducted a cross-sectional national study using secondary data from the 2017-2019 (13-15th) Korea Youth Risk Behavior Web-Based Surveys, analyzing data from a final sample of 153,992 Korean adolescents using multivariate logistic regression. No breakfast habits were statistically significantly related to suicidal ideation (crude OR [COR], 95% CI = 1.218, 1.172-1.265), suicidal plans (COR, 95% CI = 1.305, 1.228-1.385), and suicide attempts (COR, 95% CI = 1.533, 1.432-1.642). The effects of breakfast habits (independent variable) on suicidal behaviors (outcome variables) were mediated by leisure-time sedentary behavior (mediating variable). Leisure-time sedentary behavior had a statistically significant indirect effect on breakfast habits and suicidal behaviors (p < 0.05). The mediating effect size of breakfast habits mediated by leisure-time sedentary behavior was 3.46% for suicidal ideation, 2.48% for suicidal plans, and 1.06% for suicide attempts. Adolescents who did not consume breakfast demonstrated a significantly higher possibility of suicidal ideation, suicidal plans, and suicide attempts. Parents and teachers should be aware of and monitor adolescents' leisure-time sedentary behavior and breakfast habits to prevent suicidal behavior among this age group.

The Association of Soft Drink Consumption and the 24-Hour Movement Guidelines with Suicidality among Adolescents of the United States

Background: Evidence is lacking for the association of the behaviors of the 24 h movement guidelines including sleep duration, physical activity, screen time, and soft drink consumption with suicidality among adolescents. Methods: Data were extracted from a national representative sample of Youth Risk Behavior Surveys (YRBS) in the United States from 2011 to 2019. Binary logistic regression models with complex sampling designs were used to explore the association of the recommendations of the 24 h movement guidelines and soft drink consumption with suicidality. Results: The total prevalence of suicidal ideation, suicide plan, suicide attempt, and suicide attempt with medical treatment was higher among adolescents who did not meet all the recommendations in the 24 h movement guidelines and had a higher level of soft drink consumption. Totally, not meeting all the recommendations of the 24 h movement guidelines was significantly associated with an increased risk of suicidal ideation (OR: 1.69, 95% CI: 1.30–2.19) and suicide plan (OR: 1.76, 95% CI: 1.34–2.33) compared with adolescents who meet all the recommendations. Soft drink consumption of ≥3 times/day was associated with an increased risk of suicidality including suicidal ideation, suicide plan, suicide attempt, and suicide attempt with medical treatment, regardless of sex. Soft drink consumption of ≥3 times/day was significantly associated with an increased risk of suicide attempt and suicide attempt with medical treatment, regardless of whether the recommendations of physical activity, screen time, and sleep duration were met. Conclusion: Age-appropriate sleep duration, no more than 2 h of screen time per day, at least 1 h of physical activity per day as contained in the 24 h movement guidelines and less than one soft drink consumption per day are good targets to prevent involvement in suicidality. More actions for intervening in the movement and dietary behaviors among adolescents are needed to maintain physical and mental health.

Leisure sedentary time and suicide risk among young adolescents: Data from 54 low- and middle-income countries

BACKGROUND

The dose-response association between sedentary time and suicidal ideation and planning among adolescents is unclear. This study examined the association between leisure sedentary time and suicidal ideation, planning and attempts among adolescents in low- and middle-income countries (LMICs).

METHODS

We used the most recent data (2009-2016) from the Global School-based Student Health Survey (GSHS) in 54 LMICs. Leisure sedentary time and suicidal ideation, planning and attempts were assessed using a standardized questionnaire. A total of 146,345 young adolescents aged 12-15 years were included.

RESULTS

Among adolescents in the 54 LMICs, the prevalence of suicidal ideation was 14.8%, planning was 14.5%, and attempts was 13.0%. Compared with those who had less than 1 h/day of sedentary time, those who had 3, 4 h/day sedentary time were at higher odds ratio (OR) of suicidal ideation OR=1.21 (95% confidence interval (CI) =1.14-1.29), planning OR=1.15 (95%CI=1.07-1.22) and attempts OR=1.17 (95%CI=1.09-1.26), and those who had more than 8 h/day sedentary time were at OR=1.58 (95%CI=1.44-1.72), OR=1.44 (95%CI=1.31-1.58) and OR=1.27 (95%CI=1.16-1.40), respectively.

LIMITATIONS

Suicidal behaviors and sedentary time were assessed by a self-reported questionnaire, which might be prone to recall bias.

CONCLUSIONS

Higher amounts of leisure sedentary time are associated with suicidal ideation, planning and attempts among adolescents. Adolescents should spend less than 2 h/day of their sedentary time to reduce the likelihood of suicide.

Associations between mild depression and anxiety and physical inactivity among school-going Ugandan adolescents aged 14 to 17 years

Objective: The aim of this cross-sectional study was to investigate associations between physical activity levels and emotional and behavioural problems in school-going adolescents aged 14 to 17 years in Uganda.Methods: Two-hundred and five adolescents [median (interquartile range) age = 16.0 (1.0) years; female = 61.9%] completed the interviewer-administered Strengths and Difficulties Questionnaire (SDQ), Patient Health Questionnaire-9 (PHQ-9), the Generalised Anxiety Disorder-7 questionnaire (GAD-7), and the Physical Activity Vital Sign (PAVS) measure. Spearman's rho correlations and Mann-Whitney U-tests were applied.Results: Among 205 adolescents, 97.1% were physically inactive (PAVS < 420min/week), while 64.4% reported either mild depressive (PHQ-9 ≥ 5) or anxiety (GAD-7 ≥ 5) symptoms. Higher PAVS scores correlated significantly with lower SDQ emotional problems (ρ = -0.23, p < 0.001), lower PHQ-9 (ρ = -0.26, p < 0.001), and lower GAD-7 (ρ = -0.22, p < 0.001) scores. Those with emotional problems (SDQ ≥ 5) (n = 86) were significantly less physically active than those without (n = 119) [30.0 (62.5) versus 60.0 (105.0) min/week, p < 0.001]. Those with depressive symptoms (PHQ-9 ≥ 5) were significantly less physically active than those without [35.0 (70.0) versus 60.0 (120.0) min/week, p < 0.001].Conclusion: Physical inactivity and mental health problems are related important public health concerns in school-going adolescents in low-income countries such as Uganda. The efficacy and effectiveness of school-based mental health literacy programs, including physical activity promotion, should be explored in these low-resource settings.

Prevalence and correlates of multiple suicide attempts among adolescents aged 12-15 years from 61 countries in Africa, Asia, and the Americas

Suicide is the fourth leading cause of death worldwide in young people aged 15-19 years. However, little is known about the correlates of multiple suicide attempts in adolescents, especially from a global perspective. Therefore, the aim of the present study was to investigate the association of putative physical, behavioral, and social correlates with multiple suicide attempts among adolescents aged 12-15 years from 61 countries. Data from the Global school-based Student Health Survey (2009-2017) were analyzed. Multiple suicide attempts was classified as having attempted suicide at least twice in the past 12 months. Multivariable logistic regression analyses were conducted to assess the potential correlates. Data on 162,994 adolescents [mean (SD) age 13.8 (0.9) years; 50.8% boys] were analyzed. The overall prevalence of multiple suicide attempts was 4.4% [range 1.2% (Laos) to 13.8% (Ghana)]. Among those who had attempted suicide at least once in the past 12 months, in the overall sample, food insecurity, smoking, alcohol consumption, cannabis use, amphetamine use, sedentary behavior, sexual intercourse, sleep problems, loneliness, no close friends, and bullying victimization were all independently associated with higher odds for multiple suicide attempts although some regional differences were observed. Our study results indicate potential target factors that could be addressed amongst those who had attempted suicide in the past to reduce future suicide attempts and possibly completed suicides. Furthermore, it is possible that region-specific interventions are necessary.

Association between physical activity and leisure-time sedentary behavior among 140,808 adolescents aged 12 to 15 from 47 low- and middle-income countries

OBJECTIVES

Data from high-income countries (HICs) indicate that sedentary behavior is negatively associated with moderate-to-vigorous physical activity (MVPA) in young people. We examined associations between leisure-time sedentary behavior (LTSB) and MVPA in adolescents from 47 low- and middle-income countries (LMICs).

STUDY DESIGN

Cross-sectional study.

METHODS

Data from the Global school-based Student Health Survey were analyzed in 140,808 adolescents (13.8 ± 1.0 years; 49% girls). Time spent in LTSB was a composite variable assessing time spent sitting and playing computer games, watching TV, talking with friends during a typical day. The PACE + Adolescent Physical Activity Measure assessed MVPA levels. The association between ≥3 h/day of LTSB and adequate physical activity levels (every day last week 60 min MVPA) was explored with multivariable logistic regression analyses.

RESULTS

The prevalence of ≥3 h/day of LTSB and 60 min of MVPA/day last week were 26.3% (girls 26.2%; boys 26.5%) and 15.3% (girls 12.1%; boys 18.4%), respectively. LTSB of ≥3 h/day versus <3 h/day was associated with a 35% increased odds for adequate levels of MVPA in boys [OR = 1.35 (95%CI = 1.23-1.48)] and 22% in girls [1.22 (95%CI = 1.10-1.36)].

CONCLUSIONS

Our data indicate that being physically active 60 min per day every day and at moderate-to-vigorous intensity and being sedentary ≥3 h/day during leisure-time might co-exist in adolescents in some LMICs.

Prevalence and correlates of suicidal behavior among a national population-based sample of adults in Kiribati

INTRODUCTION

Suicidal behavior is an underresearched cause of death in the Western Pacific region. The study aimed to investigate the prevalence and associated factors of suicidal behavior in a population-based survey among 18-69 year-old persons in Kiribati.

METHOD

Cross-sectional nationally representative data of 2156 18-69 year old persons (37 years were the median age) from the "2015-16 Kiribati STEPS survey" were analyzed.

RESULTS

The results indicate that 5.1% of participants had ever attempted suicide and 9.5% engaged in past 12-month suicidal behavior (ideation, planning, and/or attempts). In adjusted logistic regression analysis, cohabiting, psychological distress, and having had a heart attack, angina, or stroke were associated with lifetime suicide attempts. Female sex, younger age, lower education, psychological distress, heart attack, angina or stroke, and high physical activity were positively associated with past 12-month suicidal behavior. In addition, in unadjusted analysis, alcohol family problems, alcohol dependence, family members attempted suicide, and sedentary behavior (3 to <6 hours/day) were associated with lifetime suicide attempts and/or past 12-month suicidal behavior.

CONCLUSION

Almost one in 10 participants were engaged in suicidal behavior in the past 12 months and several factors were detected which could be targeted in intervention activities.

A Latent Class Analysis of Health Lifestyles in Relation to Suicidality among Adolescents in Mauritius

Suicidality, which includes suicidal thoughts, planning, and suicide attempts, results mainly from a combination of psychological, sociological, and environmental factors. Despite a high prevalence of suicidality among adolescents in Africa, only a few studies have considered these factors simultaneously. The objective of the study was to identify the prevalence of suicidality, to draw up profiles of concomitant risks, and to examine the associations between these profiles and suicidality in Mauritius. This study used data from the 2017 Mauritian Global School-based Student Health Survey including 3012 adolescents with a mean age of 14.9 ± 1.4 years. Factors related to lifestyle such as consumptions of alcohol and tobacco, physical activity, violence, parental support, anxiety, and loneliness were considered. A latent class analysis was performed to identify the profiles. Finally, a modified Poisson regression analysis with generalized estimating equations, adjusted with sociodemographic characteristics, was used to assess the association between these profiles and suicidality. Overall, more than one in ten adolescents had at least one of the suicidality behaviors. Three profiles were identified: 1 = "low risk group" (63.9%); 2 = "problems with violence" (15.2%); 3 = "problems with violence, alcohol, tobacco and psychological distress" (20.9%). Profiles 2 and 3 were mainly made up of males. Adolescents under 15 represented the majority of individuals in profile 2. Finally, the risk of suicidality was higher in adolescents belonging to profiles 2 and 3 compared to profile 1 for the three suicidality behaviors (profile 3: Prevalence ratio (PR) for suicidal thoughts = 1.26, 95% CI = 1.19-1.34; PR for planning = 1.23, 95% CI = 1.17-1.30; PR for attempt = 1.23, 95% CI = 1.17-1.29). This study highlights the high prevalence of suicidality and a list of concomitant risks, emphasizing this suicidality in Mauritian adolescents. Therefore, these results recommend focusing preventive efforts toward a simultaneous consideration of these factors.

Prevalence and correlates of suicidal behaviour among adults in Malawi: a nationally representative cross-sectional survey in 2017

Background

The study aimed to assess the prevalence and associated factors of suicidal behaviour (SB) among adults in Malawi.

Methods

Data were analysed from 4187 persons aged 18–69 years (median age: 32 years) that took part in the nationally representative cross-sectional “2017 Malawi STEPS survey.”

Results

The prevalence of ever suicide attempt was 0.8%, and the prevalence of SB (ideation, plan and/or attempt) in the past year was 7.9% (6.0% among men and 9.6% among women). In adjusted logistic regression analysis, among men, being 30 years and older and having an alcohol family problem were positively and obesity was negatively associated with SB in the past year. Moreover, in univariate analysis, early smoking initiation was positively and not using active transportation was negatively associated with SB in the past year. Among women, having an alcohol family problem, death from suicide of a close family member, having a cardiovascular incident (heart attack, stroke, or angina) and not using active transportation increased the odds of SB in the past year. In addition, in univariate analysis, low systolic blood pressure (< 100 mmHg), not taking antihypertensive medication, and current alcohol use were associated with past year SB.

Conclusion

Almost one in ten participants engaged in SB in the past year and several associated factors were identified that can inform intervention programmes.

Supplementary Information

The online version contains supplementary material available at 10.1186/s13033-021-00483-x.

Prevalence and correlates of suicidal behaviour among a national population-based sample of adults in Zambia

Background

Suicide is a major public health issue.

Aim

This study aimed to assess the prevalence and correlates of lifetime suicide attempts and past 12-month suicidal behaviour (ideation, plans and/or attempts) among adults (18–69 years).

Setting

Zambia.

Method

National cross-sectional data from 4302 adults (median age: 31 years) who took part in the ‘2017 Zambia STEPS survey’ were analysed.

Results

The results indicate that 2.3% of participants had ever attempted suicide and 8.5% engaged in past 12-month suicidal behaviour (ideation 7.8%, plan 3.6% and/or attempt 1.1%). In adjusted logistic regression analysis, having a family member who died from suicide, having had a heart attack, angina or stroke and daily tobacco smoking were associated with ever suicide attempt. In adjusted logistic regression, female sex, non-paid work status (including student, homeworker and retired), alcohol use-related family problem, passive smoking, heart attack, angina or stroke and alcohol dependence were positively associated with past 12-month suicidal behaviour, and belonging to other ethnic groups was negatively associated with past 12-month suicidal behaviour. In addition, in an unadjusted analysis, 18–24-year-old participants, those who were never married, separated, divorced or widowed, having urban residence, family members died from suicide, having lower systolic blood pressure and daily smokeless tobacco use, were associated with past 12-month suicidal behaviour.

Conclusion

Almost 1 in 10 participants was engaged in suicidal behaviour in the past 12 months, and several associated indicators were found that can assist in planning interventions.

Does More Sedentary Time Associate With Higher Risks for Sleep Disorder Among Adolescents? A Pooled Analysis

Purpose: To investigate the association between sedentary behavior and anxiety-induced sleep disorder at a global perspective. Methods:A total of 254,924 adolescents (mean age: 14.45 ± 1.42 years; 52.8% girls) who participated in the Global School-Based Student Health Survey were included for analysis. Self-reported questionnaires assessed anxiety-induced sleep disorder and sedentary behavior. Multivariable logistic regression analysis and countrywide meta-analysis were used for investigating the association between sedentary behavior and anxiety-included sleep disorder. Results:The results showed that sedentary time was linearly associated with higher OR of anxiety-related sleep disorder in adolescents across the countries and that 8 h or more per day increased the OR by 2.17 times. Countrywide meta-analysis showed that 8 h or more per day of sedentary behavior yielded an OR = 1.40 (95% CI = 1.34-1.46) of anxiety-induced sleep disorder. Moreover, the association between sedentary behavior and sleep anxiety was significant in adolescents over the age of 11 years regardless of sex. Conclusions:The findings from this study suggest that as sedentary behavior increases, sleep disorders also increase, independently of sex among adolescents. Effective preventive strategies are needed to be taken to decrease sedentary behavior that could be used to improve mental health and sleep quality among adolescents.

Active school travel is associated with fewer suicide attempts among adolescents from low-and middle-income countries

Background/Objective: This study explored the association between active school travel (AST) and suicide attempts among adolescents in low- and middle-income countries (LMICs). Method: We used the data from the Global School-based Health Survey, including 127,097 adolescents aged 13-17 years from 34 LMICs. A self-reported survey was used to collect data on AST and suicide attempts as well as some variables. Multivariable logistic regression was performed to assess the association between AST and suicide attempts. A meta-analysis with random effects was undertaken to identify the difference in the association between AST and suicide attempts. Results: Across all the adolescents, the prevalence of AST was 37% and the prevalence of suicide attempts was 11.60%. Adolescents who engaged in AST were less likely to have suicide attempts irrespective of gender. The country-wise analysis indicated a large inconsistency in the association between AST and suicide attempt across the countries. Conclusions: AST would appear to be a protective factor for reducing suicide attempts among adolescents. However, the association between AST and suicide attempts varied greatly across the countries. Future studies should confirm the association between AST and suicide attempts.

Suicidal behaviours among adolescents in Liberia

BACKGROUND

Whereas suicide remains in the top 12 leading causes of death among young people aged 10-24 in sub-Saharan Africa, little is known about suicidal behaviours among adolescents in Liberia. We aimed to estimate the 12-month prevalence and describe some of the correlates of suicide behaviours (ideation, planning, and attempt) among school-going adolescents in Liberia.

METHODS

We analysed data from the 2017 Liberia Global School-based Student Health Survey conducted nationwide among secondary school students. We performed bivariate and multivariable analyses to assess the correlates of suicidal ideation, planning, and attempt in the previous 12 months.

RESULTS

Of the 2744 students, 26.8% reported suicidal ideation, 36.5% made a specific plan to attempt suicide and 33.7% attempted suicide during the 12 months preceding the survey. In the final adjusted logistic models, bullying victimisation and food insecurity were associated with increased odds of ideation, planning, and attempt. Whereas no factor was uniquely associated with suicidal ideation, having many close friends, and parental monitoring were associated with the increased odds of suicidal planning only. Leisure-time sedentary behaviour was associated with increased odds of suicidal planning and attempt. Cannabis use, alcohol drunkenness, being physically attacked, and parental supervision were uniquely associated with increased odds of suicidal attempt, while parental understanding and having a smaller number of close friends were uniquely associated with reduced odds of suicidal attempt.

CONCLUSIONS

The relatively high prevalence estimates of suicide behaviours and the multi-contextual nature of the associated factors warrant the need for the design and implementation of universal and multi-level, collaborative targeted intervention efforts towards the prevention of the onset of ideation, planning, and attempt, and the possible transition to deaths by suicide among school-going adolescents in Liberia.

The Prevalence and Correlates of Suicidal Ideation, Plans and Suicide Attempts among 15- to 69-Year-Old Persons in Eswatini

The study aimed to assess the prevalence and associated factors of ever suicide attempt and past 12-month suicidal ideation, plans and/or attempts among persons aged 15–69 years in Eswatini. Cross-sectional nationally representative data from 3281 persons (33 years median age, range 15–69) of the 2014 Eswatini STEPS Survey were analysed. Results indicate that 3.6% of participants had attempted suicide, and 10.1% engaged in past 12-month suicidal ideation, plan and/or attempts. In adjusted logistic regression analysis, having family members who died from suicide and childhood sexual abuse were associated with ever suicide attempt. In addition, in unadjusted analysis, female sex, adult sexual abuse, threats and family member attempted suicide were associated with ever suicide attempt. In adjusted logistic regression, female sex, childhood sexual abuse, adult sexual abuse, threats, family alcohol problems and having family members who died from suicide were associated with past 12-month suicidal ideation, plan and/or attempts. In addition, in unadjusted analysis, 25–34-year-old participants, unemployed and other, childhood physical abuse, violent injury, family member attempted suicide and having had a heart attack, angina or stroke were associated with past 12-month suicidal ideation, plans and/or attempts. One in ten participants were engaged in suicidal ideation, plans and/or attempts in the past 12 months, and several associated factors were identified that can inform intervention programmes.

Suicidal behaviors and sedentary lifestyles among adolescents: A cross-sectional epidemiological study in Latin American and Caribbean countries

OBJECTIVES

To verify the association between suicidal behaviors (ideation, planning, and attempts) and sedentary behaviors among adolescents from four Latin American and Caribbean countries.

METHODS

A cross-sectional epidemiological study was conducted in four countries in Latin America and the Caribbean (Bahamas, Curação, El Salvador, and Guatemala). The sample comprised 6,813 adolescents aged 11-18 years, of which, 3,559 were females. The three suicidal behaviors considered were ideation, planning, and attempts. Sedentary behavior was regarded as the time that adolescents spent sitting, excluding time at school. Crude and adjusted logistic regression were used to estimate the odds ratio (OR) and 95% confidence interval (CI).

RESULTS

Suicidal ideation was present in 10.7% of males and 22.7% of females. Suicidal planning was present in 8.6% of males and 16.3% of females. Suicidal attempt was present in 9.3% of males and 16.3% of females. Sedentary behavior was present in 39.6% of males and 45.7% of females. It was identified that male adolescents who reported spending ≥3 hours/day in sedentary behavior were more likely to have suicidal ideation (OR: 1.42; 95% CI: 1.13-1.80), whereas female adolescents who reported spending ≥3 hours/day in sedentary behavior were more likely to have suicidal ideation (OR: 1.55; 95% CI: 1.30-1.83), planning (OR: 1.54; 95% CI: 1.28-1.86), and attempts (OR: 1.31; 95% CI: 1.09-1.57).

CONCLUSION

Adolescents of both sexes who reported spending ≥3 hours/day in sedentary behaviors were more likely to have some suicidal behaviors than those who spent less time in sedentary behaviors.

High prevalence of health and social risk behaviours among men experiencing suicidal thoughts and behaviour: The imperative to undertake holistic assessments

OBJECTIVE

We aimed to examine whether suicidal thoughts and behaviour were independently associated with a wide range of health and social risk behaviours.

METHODS

We conducted cross-sectional analyses of data collected from 13,763 adult males who participated in The Australian Longitudinal Study on Male Health. We fit generalised linear models to estimate the relative risk of engaging in a range of health and social risk behaviours across several domains by suicidal thoughts and behaviour status.

RESULTS

Men with recent suicidal ideation (relative risk range, 1.10-5.25) and lifetime suicide attempts (relative risk range, 1.10-7.65) had a higher risk of engaging in a broad range of health and social risk behaviours. The associations between suicidal thoughts and behaviour and health and social risk behaviours were typically independent of socio-demographics and in many cases were also independent of depressive symptoms.

CONCLUSION

Suicidal thoughts and behaviour overlaps with increased risk of engagement in a wide range of health and social risk behaviours, indicating the need for an alignment of broader public health interventions within clinical and community-based suicide prevention activities. The experience of suicidality may be an important catalyst for a broader psychosocial conversation and assessment of health and social risk behaviours, some of which may be modifiable. These behaviours may not carry an imminent risk of premature death, such as from suicide, but they carry profound health and social consequences if left unaddressed.

Self-harm with suicidal and non-suicidal intent in young people in sub-Saharan Africa: a systematic review

BACKGROUND

Self-harm, whether attributed to suicidal or non-suicidal motives, is associated with several poor outcomes in young people, including eventual suicide. Much of our understanding of self-harm in young people is based on literature from Europe (particularly, the UK), North America, and Australia. We aimed to synthesise the available evidence on prevalence, the commonly reported self-harm methods, correlates, risk and protective factors, and reasons for self-harm, in adolescents (aged 10-25 years) in sub-Saharan Africa.

METHOD

We searched MEDLINE, PsycINFO, PubMed, African Journals OnLine, and African Index Medicus for records from 1950 through August 2019, without language restrictions. We supplemented the database searches by searching relevant portals for postgraduate theses, reference harvesting, contacting authors for unpublished studies, and hand searching relevant print sources. We applied narrative synthesis to the evidence.

RESULTS

Seventy-four studies from 18 sub-Saharan African countries met the inclusion criteria. The median lifetime prevalence estimate was 10·3% (interquartile range [IQR] 4·6% - 16·1%); median 12-month prevalence estimate was 16·9% (IQR: 11·5% - 25·5%); median 6-month prevalence estimate was 18·2% (IQR: 12·7% - 21·8%); and the median 1-month prevalence estimate was 3·2% (IQR: 2·5-14·8%). Studies from Western sub-Saharan Africa reported the highest 12-month prevalence estimates (median = 24·3%; IQR = 16·9% - 27·9%). Clinical samples commonly reported overdose, whereas self-cutting was most commonly reported in non-clinical samples. Academic failure, sexual, emotional, and physical abuse, romantic relationship problems, family conflict, depression, and previous self-harm were identified as key correlates of self-harm. No study reported protective factors against self-harm.

CONCLUSION

Variation in estimates was explained by small sample sizes and variation in definitions and measures used. Exploration of associations, risks and protective factors was based upon concepts and measures derived from high income countries. More detailed and culturally sensitive research is needed to understand the context-specific risks and protective factors for self-harm in adolescents in sub-Saharan Africa.

Cannabis use and leisure-time sedentary behavior among 94,035 adolescents aged 12-15 years from 24 low- and middle-income countries

Adolescents spend a high proportion of their leisure time in sedentary behavior, which is associated with adverse physical and mental health outcomes. Exploring factors associated with leisure-time sedentary behavior (LTSB) is important for the development of targeted interventions. The aim of this study was to explore associations between cannabis use and LTSB in adolescents from 24 low- and middle-income countries. Data from the Global School-based Student Health Survey were analyzed. Data on past month cannabis use and LTSB during a typical day were collected. Multivariable logistic regressions were conducted to assess the associations. Among 94,035 adolescents aged 12-15 years [age = 13.7 ± SD 0.9 years; 49.2% female], the prevalence of high LTSB (≥3 h/day) was 26.6%, while 2.8% used cannabis at least once in the past 30 days. In adjusted analyses, compared to those who did not consume cannabis in the past 30 days, the OR (99%CI) for high LTSB among those who used cannabis 1-2 times, 3-9 times, 10-19 times, and ≥20 times were 0.89 (0.58-1.35), 1.96 (1.26-3.07), 1.97 (0.71-5.47), and 2.34 (0.95-5.78), respectively (test for trend p < 0.01). Our data suggest that frequent cannabis use is associated with increased odds for being more sedentary in adolescence. Future longitudinal data are required to confirm/refute the findings to inform public health campaigns.

Preventing suicide, promoting resilience: Is this achievable from a global perspective?

Suicide continues to be a major health concern globally despite many initiatives to identify risk factors and methods for suicide prevention. We have carried out a detailed narrative review of the literature from 2016 to 2019 using the headings of Personal resilience (P1), People (P2), Places (P3), Prevention (P4), Promoting collaboration (P5), and Promoting research (P6) in order to support an integrated approach to suicide prevention and the promotion of personal and population resilience. We have made 10 key recommendations on how this can be moved forward.

Factors Associated with Physical Fitness among Overweight and Non-Overweight Austrian Secondary School Students

The aim of the study was to evaluate factors associated with physical fitness (PF) among overweight and non-overweight Austrian secondary school students. PF was measured using the German motor test (DMT) 6-18 and students were asked about sex, migration background, weekly leisure time physical activity and daily electronic media use. In total 560 adolescents (56.6% female) with a mean age of 15.4 ± 1.4 years and a mean body mass index (BMI) of 22.5 ± 4.2 kg/m² were evaluated with 130 (23.2%) students classified as overweight or obese. For the total cohort, results of the multiple linear regression analysis (R2 = 0.34) revealed that a younger age (β = -0.16), no migration background (β = 0.13), a lower BMI (β = -0.29), a higher weekly leisure time physical activity (β = 0.34) and a lower daily electronic media use (β = -0.15) were associated with increased PF. Separate regression analyses for non-overweight and overweight students showed similar regression coefficients except for BMI. In conclusion, the positive influence of modifiable factors such as lower BMI, higher self-reported weekly leisure time sports activity and lower self-reported daily electronic media use should be considered already at young ages to increase physical fitness in overweight and non-overweight youth.

Leisure-Time Sedentary Behavior Is Associated with Psychological Distress and Substance Use among School-Going Adolescents in Five Southeast Asian Countries: A Cross-Sectional Study

Sedentary behavior has been found to be associated with poorer mental health. The aim of this study was to estimate associations of sedentary behavior with psychological distress and substance use among adolescents in five Southeast Asian countries. The cross-sectional sample included 32,696 nationally representative samples of school-going adolescents (median age 14 years) from Indonesia, Laos, Philippines, Thailand and Timor-Leste. Leisure-time sedentary behavior, physical activity, psychological distress and substance use were assessed by self-report. Overall, the students engaged in <1 h (35.7%), 1-2 h (31.6%), 3-4 h (18.2%), 5-6 h (7.2%), and 7 or more hours (7.2%) of sedentary time a day. The prevalence of psychological distress was 14.6% single and 8.6% multiple psychological distress, and the prevalence of current tobacco use was 13.9% and current alcohol use 12.5%. In fully adjusted multinomial logistic regression analysis, compared to students who spent less than one hour a day engaged in sedentary leisure time, students who spent three or more hours engaged in leisure-time sedentary behavior were more likely to have single and multiple psychological distress. In fully adjusted logistic regression analysis, five or more hours of leisure-time sedentary behavior was associated with current tobacco use and one or more hours of leisure-time sedentary behavior with current alcohol use. Findings suggest an association of leisure-time sedentary behavior with psychological distress and with substance use in this adolescent population.