Clustering of lifestyle risk factors in relation to suicidal thoughts and behaviors in young adolescents: a cross-national study of 45 low- and middle-income countries

Zhan Y 1 , Wang P 2 , Zhan Y 3 , Lu Z 4 , Guo Y 5 , Ahmad NA 6 Show all authors , Owusu A 7 , Chher T 8 , Hinneh JT 9 , Aryal KK 10 , Darwish N 11 , Senanayake SJ 12 , Mufadhal BAA 13 , Rady A 14 , Bassier-Paltoo M 15 , Batbaatar S 16

Affiliations 

  • 1 Department of Surgery, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong, China
  • 2 Department of Statistics, Miami University, Oxford, OH, USA. wangp33@miamioh.edu
  • 3 School of Mathematics, Sun Yat-Sen University, Guangzhou, China
  • 4 Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences, School of Basic Medicine, Peking Union Medical College, Beijing, China
  • 5 School of Mathematical and Statistical Sciences, Clemson University, Clemson, SC, USA
  • 6 Institute for Public Health, Ministry of Health, Putrajaya, Malaysia
  • 7 Department of Health and Human Performance, Middle Tennessee State University, Murfreesboro, TN, USA
  • 8 Preventive Medicine Department, Ministry of Health, Phnom Penh, Cambodia
  • 9 Ministry of Education, Monrovia, Liberia
  • 10 Bergen Centre for Ethics and Priority Setting in Health, University of Bergen, Bergen, Norway
  • 11 Ministry of Public Health of Afghanistan, Kabul, Afghanistan
  • 12 Australian Centre for Health Services Innovation, Queensland University of Technology, Brisbane, QLD, Australia
  • 13 Consultant of Public Health, School Health & Nutrition, Sana'a, Yemen
  • 14 World Health Organization Country Office, Beirut, Lebanon
  • 15 Health Programs and Delivery Division, Ontario Ministry of Health, Toronto, ON, Canada
  • 16 National Center for Public Health, Ministry of Health, Ulaanbaatar, Mongolia
BMC Glob Public Health, 2024 Apr 12;2(1):24.
PMID: 39681898 DOI: 10.1186/s44263-024-00055-4

Abstract

BACKGROUND: Prior research has reaffirmed lifestyle risk behaviors to cluster among adolescents. However, the lifestyle cluster effect on suicidal thoughts and behaviors (STBs) was unclear among adolescents in low- and middle-income countries (LMICs). No comparison of such associations was conducted across nations.

METHODS: Data from 45 LMICs were obtained from the Global School-based Student Health Survey (GSHS) between 2009 and 2019. Lifestyle behavior factors were collected through a structured questionnaire. Suicidal ideation, plan, and attempt were ascertained by three single-item questions. Lifestyle risk scores were calculated via a sufficient dimension reduction technique, and lifestyle risk clusters were constructed using a latent class analysis. Generalized linear mixed models with odds ratio (OR) and 95% confidence interval (CI) were used to estimate the lifestyle-STB associations.

RESULTS: A total of 229,041 adolescents were included in the final analysis. The weighted prevalence of suicidal ideation, plan, and attempt was 7.37%, 5.81%, and 4.59%, respectively. Compared with the favorable lifestyle group, the unfavorable group had 1.48-, 1.53-, and 3.11-fold greater odds of suicidal ideation (OR = 1.48, 95%CI: 1.30-1.69), plan (OR = 1.53, 95%CI 1.34-1.75), and attempt (OR = 3.11, 95%CI 2.64-3.65). Four clusters of lifestyle risk behaviors were identified, namely healthy lifestyles (H-L), insufficient intake of vegetables and fruit (V-F), frequent consumption of soft drinks and fast food (D-F), and tobacco smoking and alcohol drinking (S-A) clusters. Compared with H-L cluster, V-F cluster was associated with 43% and 42% higher odds of suicidal ideation and plan, followed by S-A cluster (26% for ideation and 20% for plan), but not significant in D-F cluster (P > 0.05). D-F cluster was associated with 2.85-fold increased odds of suicidal attempt, followed by V-F cluster (2.43-fold) and S-A cluster (1.18-fold).

CONCLUSIONS: Clustering of lifestyle risk behaviors is informative for risk stratification of STBs in resource-poor settings. Lifestyle-oriented suicide prevention efforts should be initiated among school-attending adolescents in LMICs.

* Title and MeSH Headings from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.

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