Does food insecurity link to suicidal behaviors among in-school adolescents? Findings from the low-income country of sub-Saharan Africa

Food insufficiency and its associated factors: Experiences of in-school adolescents in Sagamu Township, southwest Nigeria

Background: The burden of hunger, food insecurity and malnutrition in sub-Saharan Africa is enormous. A higher proportion of the population suffer the consequences of food insecurity, hunger and undernourishment than previously assumed. Food insecurity among adolescents has been documented to be associated with malnutrition, poor health outcomes, low educational attainment and other negative consequences. Aim: This study therefore assessed food insecurity and its associated factors among adolescents in Sagamu, Ogun State, Nigeria. Methods: A cross-sectional study was conducted among 1300 in-school adolescents in Sagamu Township, Ogun State in southwestern Nigeria, selected via multi-stage sampling. A semi-structured, self-administered questionnaire was used for data collection. Data were analyzed with the aid of SPSS 20.0. Relevant descriptive and inferential statistics were calculated, with p < 0.05. Result: The prevalence of food insecurity was 45%, of which 34.6% had mild food insecurity, 34.7% had moderate food insecurity, while others experienced the severe form of food insecurity. Gender, age; maternal occupation, maternal education, living arrangement, low sense of self-worth, alcohol intake and cigarette smoking were associated (p < 0.05) with food insecurity. Predictors of food insecurity were: age; maternal education, living arrangement and some behavioral factors. Conclusion: The prevalence of food insecurity among adolescents in Sagamu was high. Multi-sectorial action is essential in tackling the challenges of food insecurity and its numerous consequences among adolescents, at all levels of governance.

Co-occurrence of Overweight, Stunting, and Anemia among Adolescents (10-19 Years) in Tanzania Mainland: A School-Based Cross-Sectional Study

Background

Evidence on double and triple burdens of malnutrition among adolescents is an essential key to informing policy design, implementation, and tracking progress of adolescent nutritional programs. Tanzania has a scarcity of studies on the double and triple burden of malnutrition among adolescents.

Objective

The aim of this study was to assess the co-occurrence of malnutrition (overweight, stunting, and anemia) among adolescents (10-19 y) in mainland Tanzania.

Methods

A school-based cross-sectional study was conducted among 44,120 primary school adolescents aged 10 to 19 y in mainland Tanzania. Anthropometric assessments (weight, height, and body mass index), dietary assessments, and hemoglobin levels were used to calculate the single, double, and triple burden of malnutrition. Data were analyzed using Stata software 15. The chi-square test was used to test the association between the nutrition condition and social demographic variables, physical activity, and dietary quality. Log-binomial models were used to determine factors associated with stunting, overweight, and anemia. Multivariable log-binomial models were used to control confounders. All analyses were 2-tailed, and the significance level was set at 5%.

Results

The prevalence of anemia was 34.1%, while stunting and overweight had a prevalence of 32% and 4.2%, respectively. Approximately 41.7%, 13.5%, and 0.3% had single, double, and triple burden malnutrition-related conditions, respectively. Females were found to have a higher risk of being overweight compared with males (relative risk [RR]: 1.33; 95% confidence interval [CI]: 1.21, 1.45), while engaging in moderate to low levels of physical activity was associated with a decreased risk of being overweight. Additionally, residing in urban areas was linked to a decreased risk of stunting (RR: 0.78; 95% CI: 0.75, 0.80) and a 27% lower risk of anemia when compared with participants from rural areas.

Conclusion

The findings from this study suggest that the complex nature of malnutrition among school adolescents warrants consideration when designing policies and interventions to reduce the burden of malnutrition.

Cyberbullying victimization and suicidal ideation among in-school adolescents in three countries: implications for prevention and intervention

BACKGROUND

Countries in South and Central America and the Caribbean are among the countries with the highest adolescent cyberbullying crimes. However, empirical evidence about the effect of cyberbullying victimization on suicidal ideation among in-school adolescents in these countries remains limited. The present study examined the association between cyberbullying victimization and suicidal ideation among in-school adolescents in Argentina, Panama, St Vincent, and the Grenadines.

METHODS

A representative cross-sectional data from 51,405 in-school adolescents was used. Hierarchical logistic regression analysis was used to estimate the association between cyberbulling victimization and suicidal ideation.

RESULTS

Overall, 20% and 21.1% of the adolescents reported cyberbullying victimization and suicidal ideation, respectively in the past year before the survey. Suicidal ideation was higher among adolescents who experienced cyberbullying victimization (38.4%) than those who did not experience cyberbullying victimization (16.6%). Significantly higher odds of suicidal ideation were found among adolescents who had experienced cyberbullying victimization than those who had not experienced cyberbullying victimization [aOR = 1.88, 95% CI: 1.77-1.98].

CONCLUSION

This finding calls for developing and implementing evidence-based programs and practices by school authorities and other relevant stakeholders to reduce cyberbullying victimization among adolescents in this digital age. Protective factors such as parental support and peer support should be encouraged.

The global burden of suicidal behavior among people experiencing food insecurity: A systematic review and meta-analysis

BACKGROUND

Food insecurity has become a growing burden within a global context where climate change, catastrophes, wars, and insurgencies are increasingly prevalent. Several studies have reported an association between suicidal behaviors (i.e., suicide ideation, plans, and attempts) and food insecurity. This meta-analytic review synthesized the available literature to determine the pooled prevalence of suicidal behaviors among individuals experiencing food insecurity, and examined the strength of their association.

METHODS

Databases (Ovid, PubMed, Web of Science, and CINAHL) were searched from inception to July 2022 using appropriate search terms. Eligible studies reporting the number/prevalence of suicidal behaviors among individuals experiencing food insecurity or the association between food insecurity and suicidal behaviors were included. The pooled prevalence of suicidal behaviors was determined using the random-effects model. The review was registered with PROSPERO (CRD42022352858).

RESULTS

A total of 47 studies comprising 75,346 individuals having experienced food insecurity were included. The pooled prevalence was 22.3 % for suicide ideation (95 % CI: 14.7-29.9; I2 = 99.6 %, p < 0.001, k = 18), 18.1 % for suicide plans (95 % CI: 7.0-29.1; I2 = 99.6 %, p < 0.001, k = 4), 17.2 % for suicide attempts (95 % CI: 9.6-24.8; I2 = 99.9 %, p < 0.001, k = 12), and 4.6 % for unspecified suicidal behavior (95 % CI: 2.8-6.4; I2 = 85.5 %, p < 0.001, k = 5). There was a positive relationship between experiencing food insecurity and (i) suicide ideation (aOR = 1.049 [95 % CI: 1.046-1.052; I2 = 99.6 %, p < 0.001, k = 31]), (ii) suicide plans (aOR = 1.480 [95 % CI: 1.465-1.496; I2 = 99.1 %, p < 0.001, k = 5]), and (iii) unspecified suicide behaviors (aOR = 1.133 [95 % CI: 1.052-1.219; I2 = 53.0 %, p = 0.047, k = 6]). However, a negative relationship was observed between experiencing food insecurity and suicide attempts (aOR = 0.622 [95 % CI: 0.617-0.627; I2 = 98.8 %, p < 0.001, k = 15]). The continent and the countries income status where the study was conducted were the common causes of heterogeneity of the differences in the odds of the relationships between experiencing food insecurity and suicidal behaviors - with North America and high-income countries (HICs) having higher odds. For suicide attempts, all non HICs had a negative relationship with food insecurity.

LIMITATIONS

There was significant heterogeneity among the included studies.

CONCLUSION

There is a high prevalence of suicidal behaviors among individuals experiencing food insecurity. Initiatives to reduce food insecurity would likely be beneficial for mental wellbeing and to mitigate the risk of suicidal behaviors among population experiencing food insecurity. The paradoxical finding of suicide attempts having a negative relationship with food insecurity warrants further research.

Prevalence, correlates and common methods of non-suicidal self-injury in South Asia: a systematic review

INTRODUCTION

The dynamics of self-harm vary substantially around the world, yet it is severely under-researched outside of a small number of high-income 'Western' countries. South Asia is disproportionately impacted by suicide, yet we know less about non-suicidal self-injury (NSSI) in the region.

OBJECTIVE

To review and summarise evidence on the prevalence, correlates and common methods of NSSI in South Asia.

METHODS

We searched Medline, Embase and PsycINFO for the period 1 January 2000 to 31 August 2023, for peer-reviewed observational studies. A total of 11 studies from eight South Asian countries that reported prevalence and/or correlates of NSSI were included in this review. We assessed the quality of the studies using the Study Quality Assessment Tools for Observational Cohort and Cross-Sectional Studies. We used meta-regression to describe the sources of heterogeneity. Abstracted data were summarised using thematic synthesis.

RESULTS

For non-clinical populations, the 12-month prevalence of NSSI ranged from 3.2% to 44.8%, and the lifetime prevalence ranged from 21% to 33%. For clinical populations, the 12-month prevalence of NSSI ranged from 5% to 16.4%, while the lifetime prevalence ranged from 2% to 27%. Male sex, unemployment, financial stress, history of suicidal behaviour and depression were associated with a higher risk of NSSI. Better access to counselling services, higher self-esteem and self-knowledge were associated with a lower risk of NSSI.

CONCLUSION

The burden of NSSI in South Asia appears to be high in both clinical and non-clinical populations. Further research, especially with general population samples, is needed to build evidence on the epidemiology, context and meaning of NSSI in South Asia to inform the design of context-specific interventions.

PROSPERO REGISTRATION NUMBER

CRD42022342536.

Suicide risk among undergraduate students in Brazil in the periods before and during the COVID-19 pandemic: results of the SABES-Grad national survey

BACKGROUND

Undergraduate students present high rates of psychological distress, including suicide risk. Due to the coronavirus disease 2019 (COVID-19) pandemic, this scenario may have been aggravated. Thus, the objective of the current study was to evaluate changes in the suicide risk rate from the period before to during the COVID-19 pandemic, as well as the factors associated with this outcome among Brazilian undergraduate students.

METHODS

This was a nationwide survey carried out in Brazil with a cross-sectional design, including two data collection periods: a single-center in-person collection in 2019 and another multicenter online collection in 2020/2021. Data were collected using self-administered instruments. The outcome was a high risk of suicide, measured through the Mini International Neuropsychiatric Interview. Analyses were carried out on data from two periods, i.e. before and during the pandemic (bivariate analysis and interaction tests), and a model of associated factors (multivariate analysis using Poisson regression) was developed including all participating universities distributed in the five regions of Brazil.

RESULTS

In total, 6716 Brazilian undergraduate students participated (996 in 2019 and 5720 in 2020/2021). The prevalence of a high suicide risk rose from 11.3% to 17.0%, especially among women and poorer individuals. The prevalence of a high risk of suicide among Brazilian undergraduates was 19.6% and was associated with several socioeconomic, academic, pandemic, and mental health factors.

CONCLUSIONS

The prevalence of a high suicide risk increased from prepandemic to during the pandemic, appearing to be largely influenced by social determinants, in conjunction with the implications of the COVID-19 pandemic.

Association of food insecurity and sleep difficulty among 189,619 school-going adolescents: a study from the global in-school students survey

Introduction

Adolescents' sleep disturbances are associated with chronic and dramatic physical, emotional, and mental development and school performance consequences. Although food insecurity could significantly contribute to these effects, few studies have explored the effect of food insecurity on sleep disturbances among adolescents. The study aimed to examine the relationship between adolescents' food insecurity and sleep disturbance.

Methods

Data on 189,619 adolescents were drawn from the cross-sectional global adolescent health surveys conducted between 2015 and 2018 in 35 countries and territories. Univariate and multivariable multinomial regression models were fitted to examine the hypothesized associations.

Results

Overall pooled prevalence of moderate [45.2% (95%CI = 43-47)] and severe [5.8% (95%CI = 5-6)] food insecurity levels were reported. About [52.6% (95%CI = 51-54)] moderate and [8.6% (95%CI = 8-9)] severe worry-induced sleep disturbances were found. Considering the fully adjusted multinomial logistic model, moderate food insecurity was significantly associated with moderate (AOR = 1.70 CI = 1.59-1.81; p < 0.0001) and severe (AOR = 1.63 CI = 1.42-1.87; p < 0.0001) sleep disturbances. Also, adolescents reporting severe levels of food insecurity had moderate (AOR = 1.88 CI = 1.68-2.11; p < 0.0001) and severe (AOR = 4.07 CI = 4.74-6.11; p < 0.0001) sleep disturbances. Females and those aged between 15 and 17 years and 18 or more were at higher risk of moderate and severe sleep disturbances in the context of food insecurity.

Conclusion

Reducing food insecurity could be an effective policy strategy for enhancing adolescent sleep quality.

Food insufficiency, adverse childhood experiences and mental health: results of the Singapore Mental Health Study 2016

OBJECTIVE

This study aimed to investigate the prevalence and correlates of food insufficiency and its association with mental disorders and adverse childhood experiences (ACE) in Singapore.

DESIGN

This analysis utilised data from the Singapore Mental Health Study (SMHS 2016).

SETTING

SMHS 2016 was a population-based, psychiatric epidemiological study conducted among Singapore residents.

PARTICIPANTS

Interviews were conducted with 6126 respondents. Respondents were included if they were aged 18 years and above, Singapore citizens or permanent residents and able to speak in English, Chinese or Malay.

RESULTS

The prevalence of food insufficiency was 2·0 % (95 % CI (1·6, 2·5)) among adult Singapore residents. Relative to respondents who did not endorse any ACE, those with ACE (OR: 2·9, 95 % CI (1·2, 6·6)) had higher odds of food insufficiency. In addition, there were significant associations between lifetime mental disorders and food insufficiency. Bipolar disorder (OR: 2·7, 95 % CI (1·2, 6·0)), generalised anxiety disorder (OR: 4·5, 95 % CI (1·5, 13·5)) and suicidal behaviour (OR: 2·37, 95 % CI (1·04, 5·41)) were shown to be significantly associated with higher odds of food insufficiency.

CONCLUSIONS

The prevalence of food insufficiency is low in Singapore. However, this study identifies a vulnerable group of food-insufficient adults that is significantly associated with mental disorders, including suicidality. Government-funded food assistance programmes and multi-agency efforts to deal with the social determinants of food insufficiency, such as income sufficiency and early detection and intervention of mental distress, are key to ensuring a sustainable and equitable food system.

The association between nation-level social and economic indices and suicide rates: A pilot study

Ever since the pioneering work of Emile Durkheim, it has been known that regional or national suicide rates can be influenced by a variety of social and economic factors. Recent research has found a robust association between two country-level economic indices-gross national product and unemployment rate-and suicide rates, particularly in men. However, the association between other country-level social indices-such as measures of social integration, inequality, environmental preservation and political freedom-and suicide rates has not been studied at the cross-national level. In the current study, national suicide rates for men and women were examined in relation to seven indices measuring subjective wellbeing, sustainable development, type of political regime, economic and gender inequality, and social capital. It was found that the Happy Planet Index, a composite measure of subjective wellbeing and sustainable development, was negatively associated with suicide rates independent of gender, and even after adjusting for possible confounding factors. Economic inequality was associated with suicide in men, and social capital was associated with suicide in women. Moreover, the strength and direction of the associations observed between socioeconomic indices and suicide varied across income groups. These results highlight the need for a closer evaluation of the link between large-scale ("macro") social factors and individual ("micro") psychological factors, as well as the importance of integrating these factors into suicide prevention programmes at the national level.

Food insecurity is associated with multiple psychological and behavioural problems among adolescents in five Caribbean countries

The study aimed to assess associations between food insecurity and multiple psychological and behavioural problems among adolescents in five Caribbean countries. Data from national and cross-sectional school health surveys from 9,956 adolescents (15 years, median age) in Trinidad and Tobago, Suriname, Jamaica, Anguilla and the Dominican Republic in 2016-2017 were analyzed in 2016-2017. Results show that the prevalence of moderate (rarely or sometimes) past-month food insecurity was 35.9% and severe (mostly or always) food insecurity was 4.6%. Severe food insecurity among adolescents ranged from 2.9% in Dominican Republic to 11.2% in Suriname. In adjusted logistic regression analyses, the higher severity of food insecurity was associated with negative psychological outcomes (loneliness, suicidal ideation, suicide plan, suicide attempt, anxiety, current tobacco use and any trouble from alcohol use) and negative behavioural outcomes (truancy, bullied, physically attacked, physical injury, and multiple sexual partners). Two out of five adolescents experienced some form of food security. Food interventions, such as school feeding programmes, are warranted to reduce negative psychosocial outcomes.

Epidemiology of suicidal behaviors among junior and senior high school adolescents: Exploring the interactions between bullying victimization, substance use, and physical inactivity

Suicide is a pandemic among global youths and adolescents. Still, there is insufficient evidence to show whether the interactions between bullying victimization, physical inactivity, substance use, and mental health illness aggravate suicidal behaviors among high school students. Based on the Global School-Based Student Health Survey, we analyzed the individual and interaction impacts of bullying victimization, physical inactivity, substance use, and suicidal behaviors among 3,632 adolescents. The 12-month prevalence of suicidal thoughts and plans among senior high school students was over fifty percent. Junior high school students had higher rates of suicide attempts and bullying victimization than senior high school students. Multivariate results indicate that bullying victimization, substance use, and physical inactivity were significantly associated with suicidal thoughts, plans, and attempts among high school students. The interaction of physical inactivity and alcohol was significantly associated with suicidal thoughts in junior high school. In contrast, the interaction of bullying and alcohol was associated with suicidal plans among senior high school adolescents. We hope the findings from this study will generate interventions toward reducing the suicide epidemic in Ghana.

Prevalence and factors associated with loneliness among Indonesian female adolescents: a cross-sectional study

Background

Loneliness, or the perception of social disconnectedness, is a public health concern and is reported to be a frequent experience during adolescence (10–19 years). This study investigates the prevalence of loneliness and associated health-risk behaviors among Indonesian female adolescents.

Methods

This was a cross-sectional study, data for which were extracted from the WHO’s Global School-based Student Health Survey (GSHS), which uses a globally standardized cross-sectional methodology to provide accurate data on behaviors and protective factors among students. Data from 4993 female students aged 13–17 years old from 74 schools were extracted from the 2015 survey in Indonesia and analyzed. Loneliness was used as a single measure, as happens in other studies using GSHS data. Descriptive analysis was done for age, socioemotional issues, health-risk behaviors, and contextual factors. This was followed by multiple logistic regression analysis to identify loneliness-associated factors.

Results

Approximately 6.5% of Indonesian female adolescents experience loneliness most of the time or always. Adolescents experiencing loneliness had a higher rate of sleep disturbance (37.6%), suicide ideation (21%), suicide plan (20.8%), smoking behavior (15%), and alcohol use (15.7%) than the general population. Multiple regression analysis confirms that adolescents who have no close friends, have been bullied during the past month, experience sleep disturbance, have had suicide ideation and suicide plans, are always feeling hungry, are exposed to passive smoking, and are engaged in a sedentary lifestyle are at a higher likelihood of suffering from loneliness (p < 0.05). On the other hand, having kind and helpful classmates served as a useful protection against loneliness (p < 0.05).

Conclusions

The rate of loneliness in Indonesian female adolescents is relatively lower than previously reported elsewhere. Several health-risk behaviors and contextual factors are associated with loneliness. It is important to gain insight into the exact interplay between factors and loneliness since that could inform future intervention development and lead to better well-being among female adolescents.

Food Insecurity and Suicidal Behaviors Among US High School Students

BACKGROUND

Food insecurity (FI) rates in the United States are particularly high among households with children. This research set aims to analyze if high school students experiencing FI had higher risk for mental health and suicidal behaviors.

METHODS

Using combined data from 11 states that conducted the 2017 Youth Risk Behavior Survey, a total of 26,962 and 24,051 high school students were used to estimate race/ethnicity and sex-stratified prevalence ratios (PRs) from Poisson regression models. A single-question was used to measure the exposure of FI and outcomes of mental health and suicidal behaviors.

RESULTS

Overall, 10.8% of students reported FI. Students experiencing FI had increased risk for all mental health and suicide behavior outcomes, regardless of their race/ethnicity or sex. PRs ranged from 1.9 (95% confidence interval [CI]:1.8, 2.0) to 3.1 (CI: 2.7, 3.6). Among males, PRs for the association between FI and all outcomes were highest among non-Hispanic black students (PRs ranged from 2.4 [CI: 1.7, 3.2] to 5.5 [CI: 2.3, 13.3]). Among females, PRs were highest among non-Hispanic white students (PRs ranged from 1.9 [CI:1.7, 2.1] to 3.6 [CI:2.9, 4.5]).

CONCLUSIONS

FI is consistently associated with mental health and suicidal behaviors among different subgroups of students.

Association of food insecurity with suicidal ideation and suicide attempts in adults aged ≥50 years from low- and middle-income countries

BACKGROUND

The aim of the present study was to investigate associations between food insecurity with suicidal ideation and suicide attempts in adults aged ≥50 years from six low- and middle-income countries (LMICs).

METHODS

Cross-sectional, community-based data from the World Health Organisation's Study on Global Aging and Adult Health were analyzed. Self-reported information on past 12-month suicidal ideation and suicide attempts was collected. Past 12-month food insecurity was assessed with two questions on frequency of eating less and hunger due to lack of food. Multivariable logistic regression analysis was conducted to assess the association between food insecurity and suicidal ideation or suicide attempts.

RESULTS

The final analytical sample included 34,129 individuals aged ≥50 years [mean (SD) age 62.4 (16.0) years; 52.1% females]. Compared to no food insecurity, severe food insecurity was associated with a significant 2.78 (95%CI = 1.73-4.45) times higher odds for suicidal ideation, while moderate and severe food insecurity were associated with 2.59 (95%CI = 1.35-4.97) and 5.15 (95%CI = 2.52-10.53) times higher odds for suicide attempts, respectively.

LIMITATIONS

The cross-sectional design, the use of self-reported wish to die as a measure of suicide ideation, and that suicidal ideation and suicide attempts were only assessed among those who had depressive symptoms, could be considered limitations of our study.

CONCLUSIONS

Food insecurity was positively associated with suicidal ideation and suicide attempts. Targeting food insecurity among older adults in LMICs may lead to reduction in suicidal ideation and suicide attempts, although future longitudinal studies are warranted to confirm this.

The association between food insecurity and gun violence in a major metropolitan city

BACKGROUND

Food insecurity (FI) is an important social determinant of health that is associated with many forms of violence. We hypothesized that FI would be associated with gun violence.

METHODS

Firearm injury data was collected from 2016 to 2020 (n = 3115) at a single institution that serves as the only Level I trauma center in a major southern US city. The data were linked with Map the Meal Gap data, a publicly available data set, which estimates rates of county-level FI based on state-level FI and social determinants, including unemployment, poverty, disability, and other factors. Regression analysis was utilized to examine the relationship between FI with rates of overall gun trauma and odds of gun-related violence. Food insecurity by county of patient residence was categorized by rates less than the national average of 11.5% (low), between the national and state average (16.5%) (moderate), and greater than the state average (high). Out of state residents were excluded from the analyses.

RESULTS

Of the 3,115 patients with firearm injuries identified, 138 (4.4%) resided in counties with low FI rates, 1048 (33.6%) in moderate FI, and 1929 (62.0%) in counties with high FI. Patients in regions of high FI were more likely to be a Level I trauma activation, a victim of assault, and have Medicaid or be self-pay. There was no significant difference in mortality by levels of FI. Food insecurity was significantly associated with firearm injury, with each percent increase in FI being related to approximately 56 additional gun-related injuries per 100,000 people (95% confidence interval, 54-59) and increased odds of the injury classified as assault (odds ratio, 1.13; 95% confidence interval, 1.07-1.19).

CONCLUSION

Violence prevention initiatives targeting food insecure communities may help alleviate the US gun violence epidemic. Further, trauma center screening for household FI and in-hospital interventions addressing FI may help reduce gun violence recidivism.

LEVEL OF EVIDENCE

Prognostic and Epidemiologic; Level IV.

Do Global Adolescents With Food Insecurity Feel Lonely?

As a proxy measure of socioeconomic status, food insecurity is understudied in mental health-related research. This study aimed to explore the association between food insecurity and loneliness in adolescents. Using cross-sectional data from the Global Student Health Survey (GSHS), 164,993 adolescent participants were included in this study. Food insecurity, loneliness, and other covariates were assessed by self-reported questionnaire. Multivariable logistics regression considering complex survey was used to explore the association between food insecurity and loneliness. The prevalence of loneliness was 10.8% in adolescents. With higher levels of food insecurity, the prevalence of loneliness in general increased, but "most of the time" was the most frequently reported item in terms of food insecurity. Adolescents who reported severe food insecurity had significantly greater odds for loneliness: (1) being most of the time [odd ratio (OR) = 2.54, 95% CI = 2.13-3.02]; (2) always hungry (OR = 1.97, 95% CI = 1.55-2.51). Of all the 53 countries, adolescents from 39 countries reported significantly higher prevalence of loneliness when exposed to food insecurity. The pooled OR was 1.74 (1.60-1.89) with a negligible heterogeneity (higher I-squared was 34.2%). Adolescents with food insecurity were more likely to be exposed to be lonely. Eliminating socioeconomic disparities in adolescents might be a good approach to promote mental health in adolescents. Future studies are encouraged to utilize longitudinal studies to confirm or negate our study findings.

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

BACKGROUND

Children and young people living in post-conflict contexts are at an increased risk of suicidal behaviours (ideations and attempts). Not much is known about the extent of suicidal behaviours amongst adolescents in most notable post-conflict countries in sub-Saharan Africa, including Sierra Leone.

METHODS

We performed a secondary analysis of data from the 2017 Sierra Leone World Health Organisation Global School-based Student Health Survey conducted amongst students in secondary schools nationwide. We estimated the 12-month prevalence and performed bivariable and multivariable analyses to assess the correlates of suicidal behaviours.

RESULTS

Of the 2,798 analytic sample, 14.6% (males = 15.1%, females = 14.0%) reported suicidal ideation, and the 12-month prevalence estimate of suicide attempt was 19.6% (male = 20.9%, females =17.8%). The factors associated with suicidal behaviours were multi-layered. While no statistically significant gender association with suicide ideation or attempt was observed at the personal level, being aged 18 or older, loneliness, and health risk behaviours (cannabis use, and leisure time sedentary behaviour) were associated with increased odds of suicidal behaviours. Within the family context, parental monitoring was associated with increased odds of suicidal ideation, but parental supervision was associated with reduced odds of suicide ideation.

LIMITATIONS

The cross-sectional nature of the data did not support causal inferences.

CONCLUSIONS

Taken together, professional mental healthcare would be helpful in treating adolescent emotional problems (e.g., depression and loneliness) related to suicidal behaviours; but prevention and intervention programmes targeted at addressing adolescent health risk behaviours, and familial and interpersonal problems may yield more favourable outcomes.

The Double Burden of Malnutrition and Associated Factors among South Asian Adolescents: Findings from the Global School-Based Student Health Survey

The health and nutrition of the global adolescent population have been under-researched, in spite of its significant size (1.2 billion). This study investigates the prevalence and associated factors of malnutrition (stunting, thinness and overweight) among adolescents living in South Asia. The sample analysed was 24,053 South Asian schooled adolescents aged 12-15 years that participated in the cross-sectional Global School-Based Student Health Survey (GSHS) between 2009 and 2016. The prevalence of stunting, thinness and overweight was calculated using the World Health Organization (WHO) Child Growth Reference 2007. Associations between the three forms of malnutrition and their possible associated factors were assessed with binary logistic regression analysis using bootstrapping as a resampling method. The overall prevalence of stunting in South Asia was 13%, thinness was 10.8% and overweight was 10.8%. In the logistic regression model of the overall pooled sample, the factors associated with adolescent malnutrition were: age, hygiene behaviours, social support, sedentary behaviour, and tobacco use. A substantial proportion of stunting, thinness and overweight was found among school-going South Asian adolescents, indicating that the double burden of malnutrition is present in this population. Future research should seek to further understand the relationship between all forms of malnutrition and its associated factors in the adolescent population.

Food Insecurity and Psychological Distress: a Review of the Recent Literature

PURPOSE OF REVIEW

Food insecurity is the lack of sufficient food in quantity and/or quality. Psychological distress includes mental health issues such as depression and anxiety. This review provides current information on research examining the association between food insecurity and psychological distress.

RECENT FINDINGS

Among studies published in the previous 5 years, food insecurity was significantly and positively associated with multiple indicators of psychological distress. This included cross-sectional and longitudinal studies, as well as primary data collection and secondary data analyses, from countries of varying income levels. Articles also provided evidence within various populations, such as adults of all ages, college students, those living with chronic disease, and parents. Food insecurity and psychological distress are interconnected health issues. Future research should consider a number of important gaps in the literature, with the most important being the development of interventions to improve food insecurity and psychological health concurrently.

The prevalence of suicidal behaviors and their mental risk factors among young adolescents in 46 low- and middle-income countries

BACKGROUND

To describe the prevalence of suicidal behaviors (ideation, planning, and attempt) and their associated factors in young adolescents in low- and middle-income countries (LMICs).

METHODS

We used the latest data from the Global School-Based Health Survey (GSHS) for adolescents aged 12-15 years during 2009-2015. The weighted prevalence and 95% confidential intervals (CIs) of suicidal behaviors were calculated using a random-effects model. The factors associated with suicidal behaviors were examined using logistic regression analysis.

RESULTS

Data from 130,488 adolescents (48.13% boys) in 46 LMICs were included in the study. Across all countries, the pooled 12-month prevalence of suicidal ideation, planning, and attempt were 14.5%, 14.6%, and 12.7%, respectively. The highest prevalence of suicidal ideation, planning, and attempt were all in Africa (16.7%, 19.3% and 17.0%), and the lowest prevalence were all in South-East Asia (8.2%, 10.5% and 7.4%). The overall prevalence of three suicidal behaviors were higher in girls (all P < 0.001). Suicidal ideation and planning were more common in the 14-15 age group than 12-13 age group (both P < 0.001). The factors associated with suicidal behaviors were being female, older age, loneliness, anxiety, a lack of close friends, and having family supportive (all P < 0.001).

LIMITATIONS

The GSHS data were obtained from a self-report questionnaire and the participants included in the GSHS were adolescents in school.

CONCLUSIONS

The prevalence of suicidal behaviors remains high among young adolescents in LMICs, especially in Africa. These countries should be intervention priorities.

Holes in the wall: Examining gaps in knowledge in child and adolescent mental health in Tanzania - Scoping review

OBJECTIVES

To perform scoping review of the existing literature available specific to child and adolescent mental health in Tanzania.

METHODS

An extensive literature search of PubMed, Scopus, MEDLINE and EMBASE was undertaken to identify studies that focussed specifically on mental illness in children and young people in Tanzania. This included neurological and functional disorders, affective disorders, psychosis, epidemiological, intervention and treatment-based studies. Qualitative analysis of the studies was then undertaken to assess what is currently known about the subject and how reliable this information is and to identify areas for further research.

RESULTS

Of 23 studies were included in the final synthesis, which could be broadly split into studies focussing on the prevalence and incidence of child and adolescent mental illness, hypothesised causes and correlations, identified treatments and interventions and qualitative studies of human experience.

CONCLUSION

There is a dearth of published research regarding child and adolescent mental health in Tanzania. Although some high-quality studies allow us good insight into the epidemiology of mental illness, interventional studies are often small and low-power, and significant correlational relationships are yet to be drawn. There is significant scope for further child and adolescent mental health research in Tanzania.

Suicide Attempts Among 1,437 Adolescents Aged 12-17 Years Attending Junior High Schools in Ghana

Background: Emerging research on suicidal behaviors among adolescents in Ghana has been conducted mainly among senior high school students. Aims: We aimed to estimate the 12-month prevalence of suicide attempts and describe some of the general and gender-specific associated factors among adolescents attending junior high schools (JHSs) in Ghana. Method: We analyzed data from the 2012 Ghana Global School-Based Student Health Survey. The sample consisted of 1,437 adolescents aged 12-17 years. We performed bivariate and multivariable analyses to assess the associations between 12-month suicide attempts and some psychosocial factors. Results: The overall 12-month prevalence estimate of suicide attempts was 27.6%, with comparable estimates between males (26.4%) and females (28.8%). In the final adjusted multivariable models, bullying victimization (AOR = 2.57; 95% CI = 1.53, 4.31), alcohol use (AOR = 1.94; 95% CI = 1.10, 3.41), and having no close friends (AOR = 0.36; 95% CI = 0.17, 0.75) were associated with increased odds of suicide attempts among males, whereas anxiety (AOR = 2.57; 95% CI = 1.54, 4.29) and being sexually active (AOR = 2.42; 95% CI = 1.25, 4.68) were associated with increased odds of suicide attempts in females. Limitations: The correlational nature of this study did not allow for causal inferences. Conclusion: The study underscores adolescent suicide attempts as a public health concern in Ghana.

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.

How bad is it? Suicidality in the middle of the COVID-19 pandemic

OBJECTIVE

The current paper examines the intersection between social vulnerability, individual risk, and social/psychological resources with adult suicidality during the COVID-19 pandemic.

METHOD

Data come from a national sample (n = 10,368) of U.S. adults. Using an online platform, information was gathered during the third week of March 2020, and post-stratification weighted to proportionally represent the U.S. population in terms of age, gender, race/ethnicity, income, and geography.

RESULTS

Nearly 15 percent of sampled respondents were categorized as high risk, scoring 7+ on the Suicide Behaviors Questionnaire-Revised (SBQ-R). This level of risk varied across social vulnerability groupings: Blacks, Native Americans, Hispanics, families with children, unmarried, and younger respondents reported higher SBQ-R scores than their counterparts (p < .000). Regression results confirm these bivariate differences and also reveal that risk factors (food insecurity, physical symptoms, and CES-D symptomatology) are positive and significantly related to suicidality (p < .000). Additionally, resource measures are significant and negatively related to suicidality (p < .000).

CONCLUSIONS

These results provide some insight on the impact COVID-19 is having on the general U.S.

POPULATION

Practitioners should be prepared for what will likely be a significant mental health fall-out in the months and years ahead.

Psychosocial distress among in-school adolescents in Mozambique: a cross-sectional study using the Global School-Based Health Survey data

BACKGROUND

Poor mental health remains the leading cause of disability, with considerable negative impacts in low- and middle-income countries. In this study, we examined the prevalence and correlates of psychosocial distress among in-school adolescents in Mozambique.

METHODS

This was a cross-sectional study of 1918 in-school adolescents, using data from the 2015 Mozambique Global School-Based Health Survey. Descriptive and inferential statistics were adopted in analysing the data. Statistical significance was set at p < 0.05.

RESULTS

The prevalence of psychosocial distress was 21.2% (24.1% females and 18.5% males). Older adolescents [AOR = 1.681, 95% CI = 1.233-2.292] had higher odds of experiencing psychosocial distress, compared with younger adolescents. In terms of sex, males [AOR = 0.755, 95% CI 0.601-0.950] had lower odds of experiencing psychosocial distress, compared with females. Adolescents who were bullied [AOR = 1.451, 95% CI 1.150-1.831], physically attacked [AOR = 1.802, 95% CI 1.404-2.313], and engaged in a physical fight [AOR = 1.376, 95% CI 1.070-1.769] were respectively more likely to experience psychosocial distress than those who did not. Conversely, adolescents who had close friends [AOR = 0.503, 95% CI 0.372-0.681] had lower odds of being psychosocially distressed than those who did not have close friends.

CONCLUSION

The prevalence of psychosocial distress among in-school adolescents in Mozambique is relatively high. The country may not be able to meet the Sustainable Development Goal 3.4 target of promoting mental health and wellbeing of all by the year 2030 if current rates of psychosocial distress persist among in-school adolescents. Mental health education and counselling as well as social support from friends should be intensified to reduce mental health problems and enable adolescents to effectively deal with the psychosocial challenges encountered in their transition from childhood to adulthood.

Suicidal behaviours among in-school adolescents in Mozambique: Cross-sectional evidence of the prevalence and predictors using the Global School-Based Health Survey data

Introduction

Despite interventions by low and middle-income countries toward the achievement of the global Sustainable Development Goal (SDG) on promoting mental health and well-being of their populace by the year 2030, suicidal behaviours continue to be major causes of premature mortality, especially among young people. This study examined the prevalence and predictors of suicidal behaviours among in-school adolescents in Mozambique.

Materials and methods

This was a cross-sectional study of 1918 in-school adolescents using data from the 2015 Global School-based Health Survey (GSHS) of Mozambique. The outcome variables (suicidal ideation, suicidal plan, and suicidal attempt) were measured with single items in the survey. Both bivariate and multivariate analyses were performed using chi-square test of independence and binary logistic regression respectively. Results are presented as Adjusted Odds Ratios for the binary logistic regression analysis. Statistical significance was set at p<0.05.

Results

The prevalence of suicidal behaviours 12 months prior to the survey were 17.7%, 19.6% and 18.5% for suicidal ideation, suicidal plan, and suicidal attempt respectively. Adolescents who experienced anxiety had higher odds of suicidal ideation [AOR = 1.616, 95%CI = 1.148–2.275], suicidal plan [AOR = 1.507, 95%CI = 1.077–2.108], and suicidal attempt [AOR = 1.740, 95%CI = 1.228–2.467]. Adolescents who were physically attacked in school were also more likely to ideate [AOR = 1.463, 95%CI = 1.115–1.921], plan [AOR = 1.328, 95%CI = 1.020–1.728], and attempt [AOR = 1.701, 95%CI = 1.306–2.215] suicide. Having close friends was, however, an important protective factor against suicidal ideation [AOR = 0.694, 95%CI = 0.496–0.971], plan [AOR = 0.625, 95%CI = 0.455–0.860], and attempt [AOR = 0.529, 95%CI = 0.384–0.729]. Peer support also reduced the risk of suicidal ideation [AOR = 0.704, 95%CI = 0.538,0.920] and plan [AOR = 0.743, 95%CI = 0.572,0.966] among the in-school adolescents.

Conclusion

Suicidal behaviours constitute major public health challenges among in-school adolescents in Mozambique. The behaviours are predominant among adolescents who are physically attacked and those who experience anxiety. Conversely, having close friends serves as a protective factor against suicidal behaviours. To ensure that Mozambique meets the SDG target of promoting the mental health of all by the year 2030, the Government of Mozambique and educational authorities should urgently design and implement innovative interventions and strengthen existing ones that seek to address physical attacks and anxiety among in-school adolescents. School administrations should also incorporate programmes that seek to congregate students and offer platforms for social interaction and cohesion.

Food Insecurity and Psychological Distress: a Review of the Recent Literature

PURPOSE OF REVIEW

Food insecurity is the lack of sufficient food in quantity and/or quality. Psychological distress includes mental health issues such as depression and anxiety. This review provides current information on research examining the association between food insecurity and psychological distress.

RECENT FINDINGS

Among studies published in the previous 5 years, food insecurity was significantly and positively associated with multiple indicators of psychological distress. This included cross-sectional and longitudinal studies, as well as primary data collection and secondary data analyses, from countries of varying income levels. Articles also provided evidence within various populations, such as adults of all ages, college students, those living with chronic disease, and parents. Food insecurity and psychological distress are interconnected health issues. Future research should consider a number of important gaps in the literature, with the most important being the development of interventions to improve food insecurity and psychological health concurrently.

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.

Integrating Urban Adolescent Mental Health Into Urban Sustainability Collective Action: An Application of Shiffman & Smith's Framework for Global Health Prioritization

The majority (55%) of the world's population lives in urban environments. Of relevance to global mental health, the rapid growth in urban populations around the world and the attendant risks coincide with the presence of the largest population of adolescents the global community has seen to date. Recent reviews on the effects of the urban environment on mental health report a greater risk of depression, anxiety, and some psychotic disorders among urban dwellers. Increased risk for mental disorders is associated with concentrated poverty, low social capital, social segregation, and other social and environmental adversities that occur more frequently in cities. To address these problems, urban adolescent mental health requires attention from decision makers as well as advocates who seek to establish sustainable cities. We examine opportunities to increase the prominence of urban adolescent mental health on the global health and development agenda using Shiffman and Smith's framework for policy priorities, and we explore approaches to increasing its relevance for urban health and development policy communities. We conclude with suggestions for expanding the community of actors who guide the field and bridging the fields of mental health and urban development to meet urban adolescent mental health needs.

Does bullying predict suicidal behaviors among in-school adolescents? A cross-sectional finding from Tanzania as an example of a low-income country

BACKGROUND

Bullying and suicidal behaviors are a silent public health problem among adolescents. Little is known about the link between bullying and suicidal behaviors in low-income countries such as Tanzania. In the current study, we estimated the prevalence of being bullied and determined its association with suicidal behaviors among in-school adolescents.

METHODS

We performed a secondary analysis of the Tanzania Global School-based Student Health Survey (GSHS) conducted in 2014. This was the first nationally representative survey conducted to a sample of 3793 in-school adolescents. The primary independent variable was being bullied, while the outcome variables of interest were suicide ideation and suicide attempt. We used a chi-square χ2 test for group variables comparisons and multivariate logistic regression for statistical associations between independent and outcome variables. In our analysis, a p < 0.05 was considered statistically significant at 95% confidence intervals.

RESULTS

The prevalence of being bullied among 3793 surveyed in-school adolescents was 27.0%. In an adjusted multivariate regression model, being bullied was independently associated with suicidal ideation and suicide attempt: [AOR; 1.9, 95% C.I; 1.5-2.4], and [AOR; 3.6, 95% C.I; 2.9-4.5] respectively, p < 0.001.

CONCLUSIONS

Bullying is prevalent and possibly a potential predictor of suicidal behaviors among in-school adolescents in Tanzania. There is a need for all educational stakeholders: teachers, parents, students, mental health professionals, and policymakers to design a program for mitigating the problem of bullying in schools.

Prevalence and correlates of sexual intercourse among sexually active in-school adolescents: an analysis of five sub-Sahara African countries for the adolescent's sexual health policy implications

BACKGROUND

Early and unprotected sex with multiple partners among adolescents carries a high risk of acquiring HIV infections, other sexually transmitted infections as well as high rates of teenage pregnancy. Sub-Saharan Africa (SSA) has a higher burden of HIV/AIDS: the leading cause of deaths among adolescents. We estimated the prevalence and examined the correlates of sexual intercourse among in-school adolescents of SSA. The purpose is to inform the public health programs dedicated to tackling the burden of HIV/AIDS.

METHODS

We did a secondary analysis of the Global School-based Student Health Surveys (GSHS) datasets pooled from five SSA countries Benin, Mozambique, Namibia, Seychelles, and Tanzania. Our current analysis included a sample of 15,318 in-school adolescents. The primary independent variables were ever had sexual intercourse and sex with multiple partners, while the dependent variables were smoking cigarettes, alcohol use, use of marijuana and amphetamine, and parental connectedness. We performed descriptive statistics, and multivariate logistic regression stratified by gender using SPSS Complex Sample Statistics. A p-value of less than 0.05 was considered statistically significant at 95% confidence intervals.

RESULTS

Out of 15,318 participants, the overall prevalence of ever had sexual intercourse and sex with multiple partners were 43·5% (6670) and 20·9% (3204), respectively. In overall and across each country, male adolescents had a significantly higher proportion of sex with multiple partners than female adolescents, p < 0·001. The predictors of sexual intercourse with multiple partners in both male and females were smoking cigarettes, alcohol use, and use of marijuana and amphetamine. Female adolescents who smoked cigarettes and used marijuana had a significant likelihood of sex with multiple partners than male adolescents: [aOR 3.6, 95% CI: 2.6-5.1] vs [aOR 2.1, 95% CI: 1.7-2.7] and [aOR 2.4, 95% CI: 1.6-3.7] vs [aOR 1.9, 95% CI: 1·3-2·7], respectively.

CONCLUSIONS

Adolescents sexual intercourse and more especially sex with multiple partners was prevalent and strongly correlated with substance use. However, the correlation was higher among female adolescents than male adolescents. A customized public health intervention that targets multiple risk factors concurrently may benefit adolescents with clustering of sexual and non-sexual risk-taking behaviors.