Epidemiology of suicidal behaviours amongst school-going adolescents in post-conflict Sierra Leone

Prevalence and predictors of school truancy among adolescents in Sierra Leone: evidence from the 2017 Global School-based Health Survey

BACKGROUND

School truancy, deliberately skipping school without permission, is a complex issue with far-reaching consequences for individual students, education systems, and entire communities. While this phenomenon is not unique to Sierra Leone, the specific context of the post-conflict nation raises concerns about its potential impact on the country's fragile rebuilding process. This study examines the prevalence and predictors of school truancy among adolescents in Sierra Leone.

METHODS

The study analysed the cross-sectional 2017 Global School-based Health Survey (GSHS) data in Sierra Leone, a nationally representative survey conducted among adolescents aged 10-19 years using a multistage sampling methodology. A weighted sample of 2,769 adolescents in Sierra Leone was included in the study. A multivariable binary regression analysis was used to examine the predictors of school truancy among adolescents. The regression results were presented using an adjusted odds ratio (AOR) with 95% confidence intervals (CI).

RESULTS

The prevalence of school truancy was 35% among adolescents in Sierra Leone. Adolescents who use alcohol (AOR = 2.28, 95% CI = 1.45, 3.58) and who have ever had sexual intercourse (AOR = 1.67, 95% CI = 1.10, 2.53) had higher odds of being associated with school truancy. Adolescents who planned suicide (AOR = 0.58, 95% CI = 0.36, 0.93) and whose parents did not intrude on their privacy (AOR = 0.66, 95% CI = 0.45, 0.97) had lower odds of being associated with school truancy.

CONCLUSION

School truancy is a critical issue in Sierra Leone, demanding multi-pronged interventions at policy and practice levels. Addressing underlying causes like alcohol use, sexual behaviour, planned suicide, and parent's intrusion of privacy is crucial. Key strategies include fostering positive school environments, providing mental health support, and improving parent-child communication.

Prevalence and predictors of lifetime amphetamine use among in-school adolescents in Sierra Leone

OBJECTIVE

This study examined the prevalence of amphetamine use and its associated factors among in-school adolescents in Sierra Leone.

DESIGN

Data for the study was sourced from the 2017 Sierra Leone Global School-based Health Survey. Percentages with confidence intervals (CIs) were used to present the prevalence of amphetamine use among in-school adolescents. A multivariable binary logistic regression analysis was employed to examine the factors associated with amphetamine use. The results were presented using adjusted odds ratios (aORs) with 95% CIs.

SETTING

Sierra Leone.

PARTICIPANTS

A weighted sample of 1,314 in-school adolescents in Sierra Leone.

OUTCOME MEASURE

Lifetime amphetamine use.

RESULTS

The prevalence of amphetamine use was 6.1% (3.9%-9.5%). In-school adolescents who planned suicide were more likely to use amphetamine compared with those who did not (aOR 2.54; 95% CI 1.02 to 6.31). Also, the odds of amphetamine use were higher among in-school adolescents who received support from their peers (aOR 3.19, 95% CI 1.71 to 5.96), consumed alcohol (aOR 4.85, 95% CI 2.61 to 9.03), and those who had previously used marijuana (aOR 13.31, 95% CI 6.61 to 28.78) compared with those who did not receive any support, never consumed alcohol, and never used marijuana, respectively.

CONCLUSION

Amphetamine use is prevalent among in-school adolescents in Sierra Leone. There is a need to implement comprehensive public health policies that extend beyond school-based psychobehavioural therapies. These policies should specifically address the considerable risk factors associated with amphetamine use among in-school adolescents in Sierra Leone.

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.

Bullying victimization among in-school adolescents in Sierra Leone: A cross-sectional analysis of the 2017 Sierra Leone Global School-Based Health Survey

Adolescent bullying victimization is recognized as a public health and mental health problem in many countries. However, data on bullying victimization's prevalence and risk factors is scarce in sub-Saharan Africa Sierra Leone. This research aimed to determine bullying victimization prevalence and its associated factors among Sierra Leonean school-going adolescents. The Sierra Leone 2017 Global School-based Health Survey (GSHS) dataset was analyzed. The outcome variable was the respondent's self-report of bullying victimization ("How many days in the previous 30 days were you bullied?"). Descriptive, Pearson chi-square and binary logistic regression analyses were conducted. The regression analysis yielded adjusted odds ratios (aOR) with 95% confidence intervals (CIs) and a significance level of p 0.05. Bullying victimization was prevalent among 48.7% of the in-school adolescents. Adolescents who drank alcohol [aOR = 2.48, 95% CI = 1.50-4.10], who reported feelings of loneliness [aOR = 1.51, 95% CI = 1.07-2.14] and who had attempted suicide [aOR = 1.72, 95% CI = 1.03-2.87] were also more likely to be bullied. Also, school truancy [aOR = 1.53, 95% CI = 1.24-1.88] among teenagers was associated with an increased risk of being bullied. Our findings suggest that bullying is a widespread problem among Sierra Leonean school-aged youth, and alcohol drinking, loneliness, suicide attempt and school truancy are potential risk factors. In light of the aforementioned causes of bullying in schools, policymakers and school administrators in Sierra Leone need to develop and execute anti-bullying policies and initiatives that target the underlying risk factors of bullying among teenagers.

Factors Associated With Suicide in Four West African Countries Among Adolescent Students: An Analysis Using the Global School-Based Student Health Survey

PURPOSE

Globally, suicide is a leading cause of death among adolescents, with the highest burden of suicide occurring in Africa. Despite this, little is known about the epidemiology of suicide among adolescents in West Africa. In this study, we explore suicidality among West African adolescents.

METHODS

Using pooled data from the Global School-Based Student Health Survey in four West African countries (Ghana, Benin, Liberia, and Sierra Leone), we investigated the prevalence of suicidal ideation and suicide attempt and examined associations with 15 covariates using univariate and multivariable logistic regression.

RESULTS

Overall, 18.6% of adolescents in the pooled sample (N = 9,726) had considered suicide, while 24.7% reported attempting suicide. Significant correlates of suicide attempt included older age (16+ years; odds ratio [OR]: 1.70, confidence interval [CI]: 1.09-2.63), difficulty sleeping due to worry (OR: 1.27, CI: 1.04-1.56), loneliness (OR: 1.65, CI: 1.39-1.96), truancy (OR: 1.38. CI: 1.05-1.82), being a target of bullying (OR: 1.53, CI: 1.26-1.85), getting physically attacked (OR: 1.73, CI: 1.42-2.11), physical fighting (OR: 1.47, CI: 1.21-1.79), current cigarette use (OR: 2.71, CI: 1.88-3.89), and initiation of drug use (OR: 2.19, CI: 1.71-2.81). Conversely, having close friends was associated with lower odds of suicide attempt (OR: 0.67, CI: 0.48-0.93). Several covariates were also significantly associated with suicidal ideation.

DISCUSSION

Suicidal ideation and attempts are highly prevalent among school-going adolescents in these West African countries. Multiple modifiable risk and protective factors were identified. Programs, interventions, and policies aimed at addressing these factors may play a significant role in preventing suicides in these countries.

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.

Cannabis use in sub-Saharan Africa: A systematic review and meta-analysis

BACKGROUND AND AIMS

The most available data on the prevalence of cannabis use come from population surveys conducted in high-income countries in North America, Oceania and Europe. Less is known about the prevalence of cannabis use in Africa. This systematic review aimed to summarize general population-level cannabis use in sub-Saharan Africa since 2010.

METHODS

A comprehensive search was conducted in PubMed, EMBASE, PsycINFO and AJOL databases in addition to Global Health Data Exchange and grey literature without language restriction. Search terms related to 'substance', 'Substance-Related Disorders' and 'Prevalence' and 'Africa South of the Sahara' were used. Studies that reported cannabis use in the general population were selected, while studies from clinical populations and high-risk groups were excluded. Prevalence data on cannabis use in the general population of adolescents (10-17 years) and adults (≥ 18 years) in sub-Saharan Africa were extracted.

RESULTS

The study included 53 studies for the quantitative meta-analysis and included 13 239 participants. Among adolescents, the life-time, 12-month and 6-month prevalence of cannabis use were 7.9% [95% confidence interval (CI) = 5.4-10.9%], 5.2% (95% CI = 1.7-10.3%) and 4.5% (95% CI = 3.3-5.8%), respectively. The corresponding life-time, 12-month and 6-month prevalence of cannabis use among adults were 12.6% (95% CI = 6.1-21.2%), 2.2% (95% CI = 1.7-2.7%, with data only available from Tanzania and Uganda) and 4.7% (95% CI = 3.3-6.4%), respectively. The male-to-female life-time cannabis use relative risk was 1.90 (95% CI = 1.25-2.98) among adolescents and 1.67 (CI = 0.63-4.39) among adults.

CONCLUSIONS

Life-time cannabis use prevalence in sub-Saharan Africa appears to be approximately 12% for adults and just under 8% for adolescents.

Association between increased inflammatory cytokine expression in the lateral habenular nucleus and depressive-like behavior induced by unpredictable chronic stress in rats

Depression induced by unpredictable chronic stress (UCS) has been widely studied using animal models. However, its underlying pathological mechanisms remain unclear. Increased inflammatory cytokines (ICs) in the central nervous system (CNS) are closely related to depressive disorder. UCS was used as an animal model in this study to investigate how UCS-induced changes in cytokine signaling lead to depression. We found that UCS could increase ICs in the CNS, especially in the habenular nucleus (Hb). UCS resulted in decreased expression of Menin in Hb and increased the activation of the NF-κB signaling pathway. Local administration of tumor necrosis factor-α in the lateral Hb (LHb) could induce depressive-like behavior in rats. The anti-inflammatory drug aspirin and the NF-κB inhibitor pyrrolidine dithiocarbamate could alleviate depressive-like behavior. This phenomenon was not observed for local administration in the dorsal raphe nucleus and paraventricular nucleus. These results indicate that LHb is the main central target for ICs to regulate depressive-like behaviors. We also found that LHb lesions could improve the inflammatory response in the hippocampus, reduce the activation of the NF-κB signaling pathway and the expression of ICs, and increase the expression of brain-derived neurotrophic factor and its receptor tropomyosin receptor kinase B, collectively improving the neuroinflammation caused by UCS. Moreover, LHb lesions improve not only hippocampal neurogenesis damage caused by UCS by activating the PI3K/mTOR signaling pathway but also hippocampal function by reducing the expression of apoptosis-related proteins, including phosphorylated p53, Bax, Bcl2, and cleaved-caspase3. In conclusion, our study sheds light on the pathogenesis of ICs-induced depression. Anti-inflammation in the CNS could be a new strategy in the treatment of depression.