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Suicide is a serious public health issue surpassing malaria and HIV/AIDS deaths globally in 2019, according to the World Health Organization. During the same year, nine out of ten adolescents died by suicide in low- and middle-income countries. In Ghana, specifically, non-fatal suicidal behaviors among adolescents are prevalent. Joiner’s Interpersonal Psychological Theory of Suicidal Behavior (IPTSB) has been widely applied to explain non-fatal suicide behaviors arising when an individual experiences perceived burdensomeness and thwarted belongingness. However, it diminishes the role of contextual factors in suicide behavior. Using a sample of 800 middle school students in Ghana and applying a theoretical-driven analytic approach, this paper seeks to examine the robustness of an enhanced IPTSB model, which includes sociocultural variables of traditional beliefs, suicide stigma, and religiosity.
Methods:
Paper-based survey with self-reported measures on suicide ideation, plan, and an attempt was administered to a sample (n=800) of middle school students in Ghana. This survey also included the Interpersonal Needs questionnaire that measured the elements of the IPTSB model. Structural Equation Modelling tested the applicability of the ITPSB model to suicidal behavior among the sample using Mplus. The analysis observed the overall fit for the model (RMSEA, CFI, TLI, and SRMR) with the cutoff points as specified by Hu & Bentler (1999). The associations among the predictors (suicide stigma, religiosity, traditional beliefs) and outcomes (suicide ideation and attempt) were tested for significance. A chi-square difference analysis was also conducted to determine the improved significance of the main ITPS model versus the modified model having the sociocultural variables.
Results:
The results demonstrated that an enhanced IPTS model was excellent at explaining 12-month (RMSEA = .03, CFI = .99, TLI = .96, and SRMR = .11) and lifetime suicide (RMSEA = .02, CFI = .99, TLI = .98, and SRMR = .09) among the sample. The chi-square difference (χ2 = 130.97, [df = 7] p < .001) was significant, hence supporting the hypothesis that the enhanced IPTSB model is better at explaining 12-month suicide risk among middle school students in Ghana than the original IPTSB model. The study also found that suicide stigma was significantly associated with increased 12-month suicide ideation (β = 0.14, CI = 0.08 – 0.20; p<0.05) and lifetime ideation (β = 0.11, CI = 0.01 – 0.06; p<0.05).
Conclusions:
This study presents the first sociocultural variables of the enhanced ITPSB model of suicide risk among an African sample of Black adolescents. The results of this study support evidence for all the components of the theory and its association with suicide behaviors, specifically the pathways of suicide behavior as explained by the model. The positive relationship between stigma and increased suicide risk suggests that the criminalization and cultural taboo of suicidal behavior foster a context in which those in psychiatric crisis experience possible increased isolation because they cannot disclose their ideation to family or kinship network while suffering. These results set the stage for future qualitative studies to understand the mechanisms by which these sociocultural variables influence suicide ideation.