Correlates of 12-Month Suicide Ideation, Plan and Attempts Among Middle and High School Students in Ghana

Background and Purpose

Suicide is a serious public health issue with more deaths worldwide than malaria, and HIV/AIDS in 2019 according to the World Health Organization. Almost nine out of ten adolescents who died by suicide in 2019 were from low- and middle-income countries. In Ghana, there is a crisis of non-fatal suicide behaviors among younger ages. We know little about the epidemiology of suicide ideation, plan and attempts among middle school students in Ghana including the years preceding high school. This study explores the onset, characteristics, and recent patterns of suicide behavior in the last 12-months among Ghanaian middle and high school students.

Methods

This study used the World Health Organization Global school-based student health survey (GSHS, 2012) which is a nationwide survey of middle and high school students in Ghana. The survey has self-reported measures on suicide ideation, plan and attempt in the last 12-months as well as several psychological and psychosocial factors related to mental health, substance use, poverty, sexual behavior, interpersonal relationships, and family structure. Bi-variate and Multivariate analysis analyses were performed using Statistical Package for the Social Sciences (SPSS version 25) to assess the correlates of suicide ideation, plan, and attempt. Logistic regressions were also conducted to determine predictive risk and protective factors of suicide behaviors.

Results

The study found high prevalence of 12-month suicidal ideation (19%), plan (22%) and attempt (25%) than previously reported. There was a higher prevalence of suicide ideation, plan and attempts among middle school students than high school students though only suicide attempt between the two groups were significant (28.4%>22.3%; X²=17.1, p<0.001). The study found being male [AOR=1.53; CI=1.21-1.95], worry [AOR=2.45; CI=1.84-3.26], bullying [AOR=1.58; CI=1.23-2.03] and experiencing physical attack [AOR=1.45; CI=1.13-1.85] as significant risk factors for ideation after adjusting for other factors. The study also found being worried [AOR=1.93; CI=1.50-2.49] and physical attack [AOR=1.53; CI=1.22-1.93] as significantly increasing the odds of making a suicide plan after adjusting for other factors. Among attempters, being worried [AOR=1.98; CI=1.52-2.57], bullying [AOR=1.56; CI=1.23-1.98], physical attack [AOR=2.01; CI=1.59-2.53] and early onset of sexual intercourse [AOR=1.60; CI=1.26-2.03] were significant risk factors. The study also found that the number of close friends was protective factors for suicidal plan [AOR=0.58; CI=0.43-0.80] and attempt [AOR=0.54; CI=0.39-0.74].

Conclusions and Implications

The study suggests suicide behaviors are high among middle school students in Ghana and occurring at much younger ages than previously thought. This finding highlights a potential suicide crisis among preteens which warrants attention. Additional studies are needed to observe these increasing trends, identify risk, protective and precipitating factors to help prevent suicide among these children. This study also provides the opportunity to learn more about the linkages between suicide behavior and the several psychological and psychosocial factors related to mental health, substance use, poverty, sexual behavior, interpersonal relationships, and family structure in order to design appropriate suicide intervention and prevention strategies for this population.