This thesis is a presentation of my original research work submitted in fulfillment of the requirements for the degree of Master of Public Health and entitled "The Role of Parental and Peer Support in Adolescent Suicidal Behavior in Eight Southeast Asian Countries". I sincerely thank his wife and family for their acceptance and patience during the discussion I had with him about the research work and the preparation of the thesis. Raysul Haque, Bangladesh Independent University, for their suggestions and encouragement during my MPH program, which were also really crucial for the completion of this thesis.
I would further like to thank the faculty members, Department of Public Health, Independent University of Bangladesh, especially Dr. University of Bangladesh for enhancing a cohesive research environment and for the help, suggestions and advice that have been instrumental in the achievement of this MPH programme. I am very grateful to my parents, brother and sister for keeping faith in me and for their love, inspiration and blessings throughout my life.
Methods: Data were obtained from Global School-based Student Health Survey (GSHS) of adolescents aged 11 to 17 years from eight Southeast Asian countries. In order to reduce the risk of suicide, the improvement of parental and peer support, control of suicidal drugs, school- and clinic-based suicide screening and preventive programs among adolescents must be strengthened.
INTRODUCTION
Study Aim
Given the underrepresentation of Southeast Asian countries in the global evidence base for suicide-related data, this study provides new and updated information on the prevalence of suicidal behavior and associated factors among adolescents in eight Southeast Asian countries. (Bangladesh, Bhutan, Indonesia, Maldives, Myanmar, Nepal, Sri Lanka and Thailand). Furthermore, despite arguments that Southeast Asian adolescents may be at particularly high risk for negative mental health outcomes and suicidal ideation, few data are available in comparative studies to conclude whether nonfatal suicidal behaviors are relatively high or low among this group of teenagers. Jordans et al., 2018). This study aims to fill this evidence gap, specifically focusing on adolescents in eight Southeast Asian countries.
METHODS AND MATERIALS
- Study design and data source
- Sampling procedure
- Measures
- Statistical analysis
Then, in a second stage, schools were selected with a probability proportional to enrollment size, followed by a random selection of classes within these schools, so that all students in the selected class and school had an equal probability of participation. SI and SP were assessed using two yes-or-no items: "In the past 12 months, have you ever seriously thought about attempting suicide?" and "In the past 12 months, have you made a plan to attempt suicide?" SA was measured by the question "In the past 12 months, how many times have you actually tried to commit suicide?" Each response was dichotomized (1 = 'yes' if participants reported suicidal behavior in the past 12 months or 0 = 'no' otherwise). Physical violence by peers was assessed with the questions: "How many times have you been physically attacked in the last 12 months?" and.
How many times were you in a physical fight during the past 12 months?" Students' responses for being physically attacked and beaten one or more times were recoded as 'yes' or 'no' otherwise. If they reported having been severely to injury one or more times according to the question “During the past 12 months, how many times have you been seriously injured?”, their response was coded “yes,” otherwise it was coded “no.” The participant's anxiety level was assessed using the following question: “During the past 12 months, how often have you been so worried about something that you could not sleep at night?” This item indicates loss of sleep due to worry and was used as a proxy for anxiety (Biswas et al., 2020a).
The feeling of loneliness was assessed using the question "During the last 12 months, how often have you felt lonely?". Peer support was assessed using a proxy variable based on the question "During the past 30 days, how often were most students at your school kind and helpful?" For which students can.
RESULTS
Participant characteristics
Distribution of suicidal behaviors
Adolescent suicidal behaviors and associated characteristics
Parents understand the problem and the level of anxiety (ref = usually or always x anxiety level – never). Parental monitoring and level of anxiety (ref = usually or always × level of anxiety-never).
DISCUSSION
Study Limitations
Some adolescents may have had problems understanding the questionnaire (e.g. poor reading skills), therefore the answers may differ from the real picture. Second, participants were adolescents in school aged 11-17 and there is no data on adolescents aged 18-19. Ethics committees may hold the view that asking participants questions about suicidal behavior or suicidal ideation may increase their risk of non-fatal or fatal suicidal behavior, despite evidence to the contrary (Andriessen et al. CA et al., 2018).
Third, only the adolescents who were present at school on that specific date completed the survey; therefore, the results are not representative of all adolescents. Finally, suicidal behavior is often underreported (Mahfoud et al., 2011) and the sensitive nature of suicide, as well as the willingness of survey participants from different sociocultural backgrounds to respond to these items, may have influenced the results influenced.
Prevention Interventions
Addressing, screening, treating and following up patients with depression is a very important strategy to reduce suicide (Gould et al., 2003; Arafat and Kabir, 2017). Regular screening for depression, suicidal ideation, suicidal acts, drug abuse, and reducing juvenile delinquency among youth can significantly reduce suicide (Gould et al., 2003; Knox et al., 2003). Finally, the family can play an important role in suicide prevention if it is able to assist mental health care services in the early detection and management of at-risk family members.
The ubiquity of social media can influence the creation or modification of suicide methods, as well as overall suicidality. However, the media can help reduce suicide by educating family members and peers, increasing awareness and reducing negative attitudes toward mental illness and suicide.
CONCLUSION
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APPENDIX
