Global Comparison of Predictors of Suicide Ideation in Youth

Purpose: Suicide is increasingly considered a crisis in countries throughout the world with rates of adolescent suicide on the rise in many regions of the world. The present study examined gender and age differences in suicide ideation as a function of depression and anxiety in youth from 21 different countries.  The study also explored how family and peer variables influence depression and anxiety, and, in turn, suicide ideation. A comparative analysis was conducted for five different regions of the world. The universality of age and gender differences in depression, anxiety, and suicide ideation was evaluated as well as the protective effects of supportive families and peer support.

Method: Data were from the WHO’s Global School-Based Student Health Survey, a self-administered questionnaire given to students across the world (N=93,487).  Exhaustive school based sampling was used with standard scientific sample selection strategies across all countries. Suicide ideation was measured by asking adolescents (12 to 16) whether in past 12 months they ever seriously considered attempting suicide (0-No, 1-Yes). Anxiety was measured by asking how often in the past 12 months adolescents had been so worried about something that they could not sleep at night (Scale 1-5, Never-Always). Depression was measured by asking whether during the past 12 months, if the adolescent ever felt so sad or hopeless almost every day for two weeks or more in a row that they stopped doing their usual activities (0-No, 1-Yes). The data were analyzed using robust multi-level structural equation modeling in Mplus.   

Results: A common path model was evolved that yielded a good model fit for each of the 21 countries individually as reflected by both global fit indices (e.g., RMSEA, CFI, standardized RMR) and focused tests of fit (e.g., modification indices). A multi-level version of the model was applied to evaluate country differences in the magnitude of specific path coefficients in the common model.  Country commonalities and differences in the magnitude of path coefficients were modeled as a function of country characteristics and regions of the world.  Both anxiety and depression tended to show independent effects on suicide ideation across countries, implicating both mental health constructs across diverse cultures. For example, in China, the path coefficients for feelings of depression and anxiety on suicide ideation were 0.189 and 0.049, respectively, and in Kenya, they were 0.104 and .040, respectively (all p < 0.05). There also were reasonably consistent gender differences in depression, anxiety, and suicide ideation across countries as well as age differences. Finally, parental empathy but not parental involvement was a consistent predictor of suicide ideation across countries.

Implications: This is the first study to comparatively examine predictors of adolescent suicide ideation in 21 countries.  Striking across-country similarities and differences were documented and then interpreted using world systems theory.  The results support universal screening for suicide ideation among youth experiencing symptoms consistent with anxiety and/or depression.  The consistency of age/gender differences as well as select parental predictors invite interesting theoretical accounts of the development of anxiety, depression and suicidal tendencies in youth.