Prevalence and Factors Associated with Suicide Among Indonesia Adolescents in Sumatra

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RESEARCH ARTICLE

Prevalence and Factors Associated with Suicide Among Indonesia Adolescents in Sumatra: A Cross-Sectional Study

Rizka Puspitasari

^1,*

, Yolanda

²

, and Tibyan Asyukri

³

1 2309200140001 (Graduate Program in Disaster Science, Universitas Syiah Kuala, 23111, Indonesia).

*Corresponding author: [email protected]

Introduction

An estimated 700,000 suicide fatalities occur worldwide each year, with low- and middle-income nations accounting for 77% of these deaths. Suicide is a significant global public health concern. Reducing suicide has been given priority under UN Sustainable Development Goal 3.4.2 because of its significant social and economic effects. Suicide is becoming a more serious public health concern in both industrialised and developing nations

[1]. According to estimates from the World Health Organization (WHO), 804,000 persons worldwide died by suicide in 2012, with a suicide rate of 11.4 per 100,000 people. The rate varied by gender (with males reporting a suicide rate of 15.0 and females reporting an 8.0) ^[2]. Additionally, it was responsible for 1.4% of all causes of death globally, with 75% of cases occurring in low- and middle-income nations ^[3].Suicide accounted for 6% of all deaths among young people aged 10 to 24 and was the second most common cause of death for women and the third most common cause of death for men ^[4]. Furthermore, it is a significant factor in the years of life lost among adolescents with disabilities adjusted for life ^[5]. If action is not taken as soon as feasible to address this problem, teenage suicide behaviour may contribute significantly to serious public health issues in the future.

Suicidal ideation or thinking, planning, attempting, and committing suicide are all considered forms of suicidal behaviour ^{[2], [6]}. Suicidal ideation is the term for contemplating or thinking about suicide or self-harm ^[7], which increases the chance of attempted or actual suicide ^{[8], [9]} and can cause serious mental health issues. Suicidal thoughts and attempts are not yet nationally measured in Indonesia; in fact, the country's suicide rate is underreported ^[10], and police department reports are frequently the source of information about suicide ^[11]. According to WHO estimates, Indonesia had 2.9 suicide deaths for every 100,000 people in the general population

Abstract

This cross-sectional study explores the prevalence and contributing factors of suicidal ideation among adolescents in Sumatra, Indonesia. Utilizing data from the 2015 Indonesian Global School-based Student Health Survey (GSHS), the study included a representative sample of 3,631 junior and senior high school students aged 13-17 years. Data collection involved a standardized, anonymous self-administered questionnaire covering demographic characteristics, psychosocial distress, health risk behaviors, and protective factors. The prevalence of suicidal ideation was found to be 4.79%, with a higher incidence among females (5.89%) compared to males (3.40%). Significant psychosocial stressors included being physically attacked, involvement in physical fights, bullying, feelings of loneliness, and sleep disturbances. Health risk behaviors such as substance use (tobacco, alcohol, and marijuana) and passive smoking also showed strong associations with suicidal thoughts. Protective factors identified included supportive peer relationships and parental involvement. The findings highlight the urgent need for targeted interventions that address both the psychosocial and behavioral health needs of adolescents to mitigate the risk of suicide. Strategies that enhance social support systems within schools and involve parents more deeply in the lives of adolescents are crucial for preventing suicidal behavior in this vulnerable population.

Keywords: adolescent health, suicide prevention, psychosocial distress, health risk behaviors, Indonesia.

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in 2017 ^[12]. The national burden of disease is expected to increase due to mental health issues, which include suicidal behaviours, notwithstanding the lack of statistics on suicide. According to Riset Kesehatan Dasar (Basic Health Research), the Ministry of Health (MoH) Indonesia reported a rise in the national prevalence of emotional and mental issues from 6% in 2013 to 9.8% in 2018 [13], suggesting a possible rise in suicide behaviours.

However, it is impossible to accurately specify the estimate of suicide for particular age groups, such as adolescents. However, there is evidence to imply that the number of teenage suicides in Indonesia is rising every

[14]. It is consistent with a high frequency of mental health issues that have been linked to an increased risk of suicide behaviour among Indonesian adolescents, as previously found in studies: depression ^[15], ^[16], and mental- emotional symptoms ^[17]. Apart from this restricted data, the Indonesian Global School-based Student Health Survey (GSHS) recorded suicidal conduct among teenagers.

Suicidal thoughts were more common in women than in men during the previous 12 months, rising from 4.2% in 2007 to 5.1% in 2015. The incidence of suicide attempts was only known in 2015, at 3.8% [18], [19]. Although Indonesia's teenage suicide ideation and attempt rates were lower than those of other nations, its grave consequences nevertheless need to be taken into account. In addition to the death toll, there is also the long- term psychological stress on family members and other close relatives, as well as the society's overall economic production ^[20]. As a result, it's critical to pinpoint the variables linked to suicidal thoughts and attempts among teenagers in Indonesia.

Methods

This study employs a cross-sectional analysis to explore the prevalence and factors associated with suicidal ideation among adolescents in Sumatra, Indonesia. The dataset for this analysis was sourced from the 2015 Indonesian Global School-based Student Health Survey (GSHS), which offers comprehensive data on health behaviours and associated factors among students. The GSHS utilised a two-stage cluster sampling method to ensure a representative sample of junior and senior high school students aged 13-17 across Sumatra. In the first stage, schools were selected with a probability proportional to their enrolment size. In the second stage, classes within these schools were randomly chosen, and all students in the selected classes were invited to participate.

This sampling technique ensures that the sample accurately represents the adolescent population of Sumatra.

Data collection was conducted using a standardised, anonymous, self-administered questionnaire. This questionnaire included demographic characteristics, psychosocial distress, health risk behaviours, and protective factors, allowing students to respond honestly without fear of identification or repercussion. The demographic characteristics gathered included age, gender, and school grade. Suicidal ideation was assessed by asking students if they had seriously considered attempting suicide during the past 12 months. Psychosocial distress measures included experiences of being physically attacked, involvement in physical fights, serious injuries, bullying, feelings of loneliness, and sleep disturbances. Health risk behaviours examined in the survey included current smoking, tobacco use, exposure to passive smoking, alcohol use, marijuana use, amphetamine use, sexual activity, and sedentary behaviour. Protective factors were also considered, such as having supportive peers, parental involvement (e.g., checking homework), and parental understanding of the student’s problems.

Descriptive statistics were used to summarise the demographic characteristics and prevalence of suicidal ideation among the respondents. Chi-square tests were employed to examine associations between suicidal ideation and various psychosocial and behavioural factors. To identify significant predictors of suicidal ideation, multiple logistic regression analyses were performed, calculating both unadjusted and adjusted odds ratios (ORs and AORs) along with 95% confidence intervals (CIs). A significance level of p<0.05 was used for all analyses, and the statistical analyses were conducted using SPSS software.

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Results

In this study, a total of 3,631 adolescents participated, comprising 1,587 males (43.71%) and 1,952 females (53.76%), reflecting a diverse demographic composition. The overall prevalence of suicidal ideation among adolescents was 4.79%, with females reporting significantly higher rates (5.89%) compared to males (3.40%). This gender disparity aligns with global observations where females typically exhibit higher susceptibility to suicidal thoughts ^[21].

A detailed analysis of psychosocial distress revealed that 25.83% of the students experienced physical attacks, with 8.10% of these individuals considering suicide. Similarly, involvement in physical fights was reported by 20.13% of students, and 8.62% of these reported suicidal ideation. Significant correlations were also observed between serious injuries and suicidal thoughts, with 21.76% of students reporting injuries and 8.23% considering suicide. The incidence of bullying was particularly notable, reported by 14.51% of students, with a higher prevalence of suicidal ideation at 12.33%. Noteworthy is the impact of loneliness and sleep disturbances: 4.41%

felt lonely, with 18.75% considering suicide, and 3.64% reported sleep disturbances, with 19.70% considering suicide. These findings underscore the profound influence of psychosocial stressors on the mental health of adolescents ^[22].

The investigation into health risk behaviours also highlighted strong associations with suicidal ideation. For instance, among current smokers, 8.51% considered suicide, and for those using other tobacco products, the rate was 17.00%. Alcohol use showed a similar pattern; 2.78% of adolescents currently using alcohol reported a 14.85% rate of considering suicide. Moreover, the most alarming associations were observed with harder substance use; 1.24% of adolescents reported amphetamine use, with a striking 31.11% among them considering suicide. The pattern extends to marijuana use, where 1.49% of the users reported a 25.93% incidence of suicidal ideation ^[23].

Protective factors played a crucial role in mitigating the risk of suicidal ideation. The presence of helpful peers significantly reduced the likelihood of suicidal thoughts, with 37.79% of students acknowledging peer support and only 4.01% of them reporting suicidal ideation. Parental involvement, indicated by activities such as checking homework, was associated with lower rates of suicidal thoughts, with only 2.65% of such students considering suicide. This highlights the critical role of supportive environments in fostering adolescent mental health and resilience against suicide ^[24]. These results reveal critical insights into the factors influencing suicidal ideation among adolescents in Sumatra, emphasising the urgent need for targeted interventions to address the identified psychosocial and behavioural risk factors.

Discussion

The findings of this study provide critical insights into the prevalence of suicidal ideation among adolescents in Sumatra, highlighting a significant public health issue. Notably, the higher prevalence of suicidal ideation among female adolescents aligns with global trends and underscores the need for gender-sensitive approaches in mental health interventions. The robust association between psychosocial distress and suicidal ideation emphasizes the detrimental impact of bullying, physical assaults, and social isolation on adolescent mental health. These factors were strongly correlated with an increased risk of suicidal thoughts, suggesting that interventions should prioritize the creation of supportive and safe school environments, alongside programs that promote resilience and emotional coping skills among youths ^[26].

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Table 1. Demographic Characteristics, The Rate and Associated Factors of Considered Suicide.

Variable Sample

n (%)

Consider Suicide n (%)

𝑐ℎ𝑖

− 𝑠𝑞𝑢𝑎𝑟𝑒𝑑 𝜌

All 3631 (100.00) 174 (4.79)

Gender

Male 1587 (43.71) 54 (3.40) 11.92

0.001

Female 1952 (53.76) 115 (5.89)

Psychosocial distress

Physically attacked 938 (25.83) 76 (8.10) 29.164 0.000

Physical fight 731 (20.13) 63 (8.62) 27.720 0.000

Seriously injured 790 (21.76) 65 (8.23) 28.245 0.000

Being bullied 527 (14.51) 65 (12.33) 89.007 0.000

Felt lonely 160 (4.41) 30 (18.75) 71.399 0.000

Sleep disturbance 132 (3.64) 26 (19.70) 64.653 0.000

Health risk behaviours

Currently smoking cigarettes 309 (8.51) 29 (9.39) 15.948 0.000

Currently using tobacco products 100 (2.75) 17 (17.00) 33.014 0.000

Passive smoking 2568 (70.72) 146 (5.69) 13.503 0.000

Current alcohol use 101 (2.78) 15 (14.85) 23.774 0.000

Ever drank alcohol 86 (2.37) 14 (16.28) 25.369 0.000

Trouble from alcohol 55 (1.51) 12 (21.82) 38.692 0.000

Ever used marijuana 54 (1.49) 14 (25.93) 53.576 0.000

Currently using marijuana 39 (1.07) 9 (23.08) 28.750 0.000

Ever used amphetamines 45 (1.24) 14 (31.11) 66.408 0.000

Ever had sexual intercourse 146 (4.02) 22 (15.07) 33.644 0.000

Had intercourse with multiple partners 30 (0.83) 9 (30.00) 41.198 0.000

Sedentary time over 3 hrs per day 815 (22.45) 61 (7.48) 14.081 0.000

Protective factors

Missed classes without permission 642 (17.68) 60 (9.35) 31.980 0.000

Helpful students 1372 (37.79) 55 (4.01) 4.626 0.031

Parent checks homework 1282 (35.31) 34 (2.65) 22.691 0.000

Parent understands problems 1264 (34.81) 49 (3.88) 4.677 0.031

The significant associations between health risk behaviours and suicidal ideation further reinforce the need for targeted interventions. Adolescents engaging in smoking, alcohol use, marijuana use, and other substance use reported higher rates of suicidal ideation, consistent with existing literature that links substance use with increased suicide risk ^[27]. The high prevalence of passive smoking among adolescents and its association with suicidal ideation calls for robust tobacco control measures to protect young people from secondhand smoke exposure ^[28].

Protective factors such as parental involvement and supportive peer interactions were associated with lower rates of suicidal ideation, indicating the crucial role of positive social networks in mitigating the risk of suicide. These findings advocate for policies that foster family engagement in adolescent welfare and encourage peer support mechanisms within schools. By integrating these insights, policymakers, educators, and mental health professionals can better tailor their strategies to prevent suicidal behaviors among adolescents, ultimately

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reducing the incidence of suicide in this vulnerable population and enhancing the overall well-being of young individuals in Indonesia ^[29].

Table 2. Regression Analysis of Considering Suicide Associated Factor.

Variable Unadjusted Odds (95% CI) Adjusted Odds (95% CI)

Psychosocial distress

Physically attacked 2.65 (1.73-4.07)*** 1.80 (1.04-3.14)*

Physical fight 2.16 (1.35-3.45)*** 0.87 (0.46-1.63)

Seriously injured 2.19 (1.41-3.40)*** 1.34 (0.80-2.24)

Being bullied 4.52 (2.91-7.01)*** 2.87 (1.73-4.78)***

Felt lonely 5.56 (3.05-10.13)*** 3.42 (1.70-6.88)**

Sleep disturbance 5.70 (2.94-11.06)*** 2.92 (1.34-6.37)**

Health risk behaviours

Currently smoking cigarettes 1.17 (0.53-2.59)*** 2.94E+08 (0.00-Na) Currently using tobacco products 2.34 (0.70-7.79)*** 6.20 (0.84-45.77)

Passive smoking 2.24 (1.21-4.15)*** 1.52 (0.80-2.88)

Current alcohol use 2.71 (0.94-7.78)*** 0.94 (0.17-5.30)

Ever drank alcohol 3.05 (1.06-8.82)*** 0.39 (0.03-6.23)

Trouble from alcohol 7.58 (2.42-23.73)*** 7.41 (0.42-129.97)

Ever used marijuana 8.06 (1.60-40.48)*** 0.00 (0.00-Na)

Currently using marijuana 7.98 (0.82-77.45)*** 2.75E+08 (0.00-Na)

Ever used amphetamines 48.45 (4.35-539.33)*** 1.67E+25 (0.00-Na)

Ever had sexual intercourse 2.10 (0.89-4.98)*** 1.88 (0.69-5.13)

Had intercourse with multiple partners 5.98 (0.66-54.05)*** 0.00 (0.00-Na) Sedentary time over 3 hrs per day 1.85 (1.20-2.85)*** 1.32 (0.82-2.12) Protective factors

Missed classes without permission 1.89 (1.15-3.10)*** 1.52 (0.87-2.66)

Helpful students 0.93 (0.61-1.42)* 1.31 (0.82-2.07)

Parent checks homework 0.41 (0.25-0.69)*** 0.43 (0.25-0.76)**

Parent understands problems 0.68 (0.43-1.07)* 0.89 (0.54-1.47)

Conclusions

This study illuminates the concerning prevalence of suicidal ideation among adolescents in Sumatra, Indonesia, revealing pivotal insights that underscore the urgent need for targeted mental health interventions. Our findings indicate a pronounced prevalence of suicidal thoughts, particularly among female adolescents, which mirrors global observations but also highlights specific regional vulnerabilities. The significant associations identified between psychosocial distress factors—such as bullying, loneliness, and sleep disturbances—and suicidal ideation accentuate the necessity for immediate and culturally relevant preventive measures within educational and community settings.

Moreover, the study delineates a clear link between various health risk behaviors, including substance use and unprotected sexual activities, with an increased risk of suicidal ideation, suggesting that comprehensive behavior modification programs could substantially mitigate these risks. Conversely, the protective effects of positive peer relationships and parental involvement in mitigating suicidal ideation are evident, advocating for initiatives that strengthen family bonds and peer support systems.

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In conclusion, addressing the multifaceted aspects of adolescent mental health through integrated, multi-sectoral approaches is critical. These should include enhancing access to mental health services, improving the school environment, promoting family engagement in adolescent health issues, and implementing robust public health campaigns that raise awareness about mental health and suicide prevention. By taking proactive steps towards these objectives, stakeholders can significantly reduce the risk of suicide among adolescents in Indonesia and contribute to global efforts to improve adolescent health outcomes. Policymakers, educators, and mental health professionals must collaborate to implement effective prevention strategies that promote the well-being of adolescents and reduce the incidence of suicide in this vulnerable population ^[30].

Acknowledgements

We extend our deepest gratitude to the Graduate Program in Disaster Science at Universitas Syiah Kuala for their unwavering support and resources that significantly contributed to the execution and completion of this study.

We would also like to acknowledge the contributions of the World Health Organization (WHO) for providing indispensable data through the Global School-based Student Health Survey (GSHS), which formed the basis of our analysis. Furthermore, we are immensely thankful to all participating schools, students, and their guardians in Sumatra for their cooperation and willingness to engage in this vital research. Lastly, we express our appreciation to Dr.rer. med. Ns. Marthoenis, M.Sc., MPH, whose expert advice was instrumental in refining our research methodology and analysis. Their profound expertise in adolescent mental health has been an invaluable asset to this study.

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