A network analysis of protective and risk factors for suicide attempt among adolescents in twelve low- and lower-middle-income countries

Abstract

Suicide attempts arise from an environment of many interconnected psychosocial and other factors. Yet, the relationships between these factors have not been studied widely in low- and middle-income countries, where an estimated 73% of suicides occur. We aimed to identify the patterns and complexrelationships between the factors associated with suicide attempts. We conducted a network analysis on data from 25,761 school-going adolescents across12 low- and lower middle-income countries (LLMICs), obtained from the Global School-based Health Survey. Using Ising network analysis, we examined theinterrelationships between past-year suicide attempts and several factors; we estimated centrality measures and examined network stability usingbootstrapping. Suicide attempt prevalence was 11.8%. The network analysis identified three clusters: mental health, physical harm and behavioral factors. Suicide attempts showed strong conditional associations with drug use, bullying and worrying, while having close friends was a prominent protective factor.Behavioral factors: alcohol use, drug use and smoking were the most central nodes, showing the highest expected influence. This study provides novel insightsinto the interplay between factors associated with adolescent suicide attempts in LLMICs. Comprehensive interventions could focus on clustered risk factors,while empowering protective factors and addressing behavioral factors could conditionally attenuate other associations in the network.