Research Article: Suicidal ideation and associated factors among school going adolescents in Swaziland

Date Published: December , 2017

Publisher: Makerere Medical School

Author(s): Aseel M Almansour, Seter Siziya.


Suicide among children has been a major issue and the statistics are considerably alarming. However, no studies have been conducted in Swaziland on suicidal ideation which is a starting point for committing suicide. The objective of the study was to determine the prevalence of suicidal ideation and its correlates.

A secondary analysis of data was conducted using data collected in a Swaziland 2013 Global School-based Student Health Survey (GSHS). The survey assessed among other factors, mental health of the students using a self-administered questionnaire. We considered factors that have been reported to be associated with suicidal ideation in the literature. Unadjusted odds ratios (OR) and adjusted odds ratios (AOR) together with their 95 confidence intervals (CI) are reported.

The overall proportions of students who considered suicide were 18.3% of 1866 females and 15.6% of 1672 males. In bivariate models the risk factors for suicidal ideation were feeling lonely, anxiety, using drugs and smoking marijuana. In multivariate model to include age, gender, food security, close friends, truancy, bullied, attacked, physical fight, drugs, marijuana, parental understanding anxiety and loneliness, all the considered factors were significantly associated with suicide except close friends.

The rate of suicidal ideation was high among adolescents in Swaziland and intervention considering violence, social support from friends and parents, and drug abuse should be designed to prevent suicidal thoughts.

Partial Text

Suicidal behavior is a significant public health burden throughout the world1 since it is a leading cause of death globally. Africa is the world’s largest and second most populous continent, with a population of over one billion people. However, “less than 10% of African countries reporting mortality data to World Health Organization (WHO), official statistics are available for only 15% of the continent’s total population”3. In South Africa, suicide estimates vary from 11.5 per 100,000 to 25 per 100,000 of the whole society, depending on sampling techniques and research approaches2. From most of the unusual deaths, around 11% are suicide related with 9.5% from adolescents2. In addition, suicide mortality is under-reported, and purposely concealed due to religious belief and cultural behaviors which lead to underestimate the true association of the suicide prevalence3. Suicide among children has been a major point of issue and the statistics are considerably alarming. For instance, suicidal studies among adolescents from low and middle income countries showed considerable rates of prevalence of suicidal ideation: 19.6% in Uganda4, 23.1% in Botswana, 27.9% in Kenya, 31.9% in Zambia5 and 18.4% in Guyana6.

The data for Swaziland 2013 were collected from the published global school-based student health survey (GSHS). The survey was conducted on school students particularly students in grades 6 and 7 and forms 1, 2, 3, and 4, aged from <11 to 18+ years. This survey is considered as collaborative observation plan intended to aid countries to measure and evaluate the behavioral risk factors and protective factors among young people. The data on young people's health behavior and protective factors were collected from GSHS which is a fairly low-cost self-managed school survey to attain data related to the primary causes of morbidity and mortality for children and adults globally. The GSHS uses a uniform scientific sample selection procedure; mutual school-based methodology; and core survey modules, core-extended questions, and country-explicit questions that are integrated to set up a self-managed survey which can be handled during one regular class period. A total of 3,680 students participated in the Swaziland Global School-based student Health Survey in 2013. Table 1 shows the distributions of proposed risk factors by gender among school students aged from <11 to 18+ years. The majority of the sample was female (51.2%). Most of the male students were in the age group 18+ years (29.5%), while most of the female students were of age 15 years (18.8%). The overall prevalence of suicidal ideation was 17.0% (15.6% among males and 18.3% among females). The overall prevalence of suicidal ideation in the current study was 17.0% (15.6% among males and 18.3% among females). Protective factors for suicidal ideation that were identified in the present study were age less than 14 years, male gender and parental understanding; and risk factors were lack of food security, anxiety, loneliness, truancy, bullied, attacked, in a fight, drug use and marijuana in particular. The students who participated in the survey were the one attending school, leaving the drop-outs. Thus, caution should be taken in generalizing the findings to the general population of adolescents. The study analyses focused on both genders together without looking at the differences. Only, a partial series of risk factors for suicidal behavior were incorporated in this initial study. Factors such as sexual violence and parents' supervision were not examined in this study. Exploring these and other issues continues to be a vital direction for forthcoming research. Finally, the role of ethnicity was not examined in explaining suicidal ideation for adolescent population. Evidence from the US suggests that suicide rates might differ as a function of ethnicity10. The weight of suicidal ideation in Swaziland and the limited research work on suicidal ideation highlights the necessity for suicide avoidance program based on this study results as a domestic priority. The study identified the spread of suicidal ideation and studied its associated risk factors in order to give deeper insight for partnerships among government agencies in public health and education to develop a protective national plan to stop suicidal ideation in the immediate and future against adolescents in Swaziland. Over 18.3% of the female students who ever seriously considered attempting suicide through the past 12 months of the survey time, and 15.6% was the percentage of boys who ever had suicide ideation. The findings of this analysis provide us with important suggestions to pay more attention to immediate and future suicide prevention and response programs.   Source:


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