Adolescent Suicidality in Bangladesh: A Need for Policy, Infrastructure, and Social Change

Background/Purpose: The World Health Organization (WHO) identifies suicide prevention as a key public health indicator. Suicide is the third leading cause of death worldwide among persons ages 15-19 and is concentrated in low- and middle-income countries. Because Bangladesh lacks data sources such as a national suicide mortality registry system, empirical information and knowledge regarding suicide and suicidality are limited. This is magnified by stigma surrounding reporting and identifying suicide.

Bullying, greater age, sex, anxiety, psychiatric disorders, and poorer access to mental health services have been identified as risk factors for adolescent suicide generally. In Bangladesh specifically, previous estimates of suicide among adults have varied substantially. For adolescents, studies have generally been constrained to investigation of adjacent countries or have suffered from limited sample size or generalizability. Further, prior identification of risk factors for this population has been limited, and research has largely been retrospective, based on completed rather than attempted suicide, or suicidality. To address this knowledge gap, we aimed to: A) assess the incidence of suicidality and suicide attempt among Bangladeshi adolescents, as well as B) identify risk factors associated with these outcomes.

Methods: Data and Sample - We utilized data from the 2014 Global School-based Student Health Survey to identify the incidence of suicidality and suicide attempt(s) as well as model related risk and protective factors for (n=2,883) youth in Bangladesh. Measures – Suicide was based on past-year history and was used as both a count and dichotomized, yes/no variable. Suicidality was dichotomous, indicated by past-year history of suicide plan or serious consideration. We also assessed the role of sex, age, experiencing bullying, anxiety, and friendship as predictors. Analysis - We calculated univariate frequency population incidence rate estimates of suicidality and suicide attempt based on sample weighting from the representative survey. Then logistic and negative binomial regressions were used to identify and model associated risk and protective factors.

Results: Incidence rates of past-year suicidality (9.3%) and past-year suicide attempt (5.79%) were higher than some neighboring countries and consistent with the elevated rates observed in the United States. Adjusting for sex and age, any subjection to bullying and experiencing anxiety most or all of the time were each associated with 2-5 times greater odds of past-year suicidality and suicide attempt, as well as incidence rate ratio of suicide attempt count. Having at least one friend was a substantial protective factor across all outcomes (58-71% odds reduction).

Conclusion and Implications: Our findings provide strong evidence that suicidality and suicide attempt are a widespread health concern among adolescents in Bangladesh. Policy and intervention programming targeting bullying, friendship development, and anxiety are warranted. Findings also show a need for increasing healthcare resources and implementing WHO guidelines on improving broader social conditions which underlie risk factors. Such social change may be critical to fostering mental health and preventing death among youth in Bangladesh.