Suicidal ideation among school-attending adolescents in Dar es Salaam, Tanzania
Background: Suicidal ideation is an understudied risk factor for suicidal intent. The present study investigates the patterns and risk factors for suicidal ideation among a sample of school-attending adolescents in Dar es Salaam, Tanzania.
Methods: This study examined secondary data collected in 2006 through the Global School-Based Student Health Survey. The data were collected via two-stage cluster sampling representative of all secondary schools in Dar es Salaam. We compared adolescents who reported suicidal ideation (SI) and those who reported a plan to carry out a suicide attempt (SP), with those reporting neither ideation nor an attempt (controls) within the 12 months preceding the survey. Our analyses targeted demographic, behavioral, social, mental health and family factors.
Results: A total of 2,176 students aged 11-16 years participated. Within the recall period, 7% (n=149) of participants had thought about suicide with 6.3% (n=136) having created a plan to carry out an attempt. Fifty percent of those reporting SP were female. We found that significant associations existed across all categories of psychological health, substance use and among those who reported being bullied. In the multivariate analysis adolescents reporting suicidal intent were more than twice as likely to report having been lonely (RRR=2.33; CI=1.36-4.01); more likely to suffer from depressive symptoms (RRR=2.26; CI=1.56-3.27) and have previously used an illicit substance (RRR=1.97; CI=1.12-3.48). We found an inverse association with age and suicidal planning (RRR=0.74; CI=0.62-0.90) as well as poverty and SP (RRR=0.53; CI=0.29-0.98) and an increased likelihood for adolescents reporting SP to be lonely (RRR=2.76; CI=1.55-4.90) and depressed (RRR=3.98; CI=2.71-5.86). Tobacco use (RRR=2.15; CI=1.22-3.78) and illicit substance use (RRR=1.99; CI=1.10-3.60) were associated with SP as was having parents who were knowledgeable of what adolescents did during their free time (RRR=2.15; CI=1.07-4.31). Respondents who reported having no friends were also more likely to report SP (RRR=3.68; CI=2.22-6.08).
Conclusion: Our results suggest that, as in high-income settings, psychological factors, risky health behaviors such as substance use, and social and familial support impact suicidal ideation. This knowledge should be used to help inform further research as well as prevention and intervention strategies.