Suicide risk in high school students: who are the most vulnerable groups?

To investigate the prevalence and factors associated with suicide risk among high school students from a federal educational institution in Rio Grande do Sul (IFRS).

Methods:

This is a cross-sectional study based on a census of students (n=510) enrolled in IFRS, campus Rio Grande, in the second half of 2019. Data were collected through a self-administered questionnaire. Suicide risk was measured with the instrument Mini-International Neuropsychiatric Interview, and data were analyzed using Poisson regression with robust variance adjustment.

Results:

The prevalence of high suicide risk was 17.3% (95% confidence interval — 95%CI 14.0–20.0), with the following independent associated factors: female gender, higher socioeconomic status, alcohol consumption, less social support, attempt to lose weight, self-harm behavior, and increased risk of depression, anxiety, and stress.

Conclusions:

One in six students showed a high suicide risk. The identification of factors associated with the outcome is useful for detecting the most severe cases and referring them to specialized care.

Keywords:
Suicide; Health risk behavior; Adolescents; Cross-sectional studies; Mental health

		n	%
Gender
	Male	257	50.6
	Female	251	49.4
Age (years)
	14–15	98	19.4
	16–17	247	48.8
	18–20	161	31.8
Ethnicity
	White	390	77.1
	Other	116	22.9
Maternal schooling
	Elementary school	66	13.7
	High school	178	36.8
	Higher education	239	34.5
Goods index
	1^st, 2^nd, and 3^rd quartile	379	75.3
	4^th quartile (richer)	124	24.7
Physical activity
	No	394	79.3
	Yes	103	20.7
Tobacco use
	No	473	93.5
	Yes	33	6.5
Alcohol consumption
	No	259	51.0
	Yes	249	49.0
Excessive use of social media
	No	322	63.6
	Yes	184	36.4
Overweight
	No	346	69.5
	Yes	152	30.5
Social support
	1^st, 2^nd, and 3^rd quartile	382	76.4
	4^th quartile (less support)	118	23.6
Attempt to lose weight
	No	365	71.6
	Yes	145	28.4
Bullying
	No	330	64.7
	Yes	180	35.3
Self-harm behavior
	No	414	81.2
	Yes	96	18.8
Depression, anxiety, stress
	Lower risk	394	80.1
	Higher risk	98	19.9

Level			Suicide risk (%)	Crude analysis		Adjusted analysis
Level			Suicide risk (%)	PR (95%CI)	p-value	PR (95%CI)	p-value
1	Gender
		Male	11.3	1.00	0.001	1.00	<0.001
		Female	23.1	2.05 (1.36–3.09)	0.001	2.20 (1.45–3.35)	<0.001
1	Age (years)
		14–15	13.3	1.00	0.244	1.00	0.226
		16–17	19.8	1.50 (0.85–2.63)		1.72 (0.92–3.22)
		18–20	14.9	1.12 (0.60–2.10)		1.46 (0.73–2.90)
1	Ethnicity
		White	15.1	1.00	0.037	1.00	0.042
		Other	23.3	1.54 (1.03–2.31)	0.037	1.52 (1.02–2.28)	0.042
1	Maternal schooling
		Elementary school	13.6	1.00	0.576	1.00	0.655
		High school	18.5	1.36 (0.69–2.69)		1.30 (0.69–2.48)
		Higher education	15.5	1.14 (0.58–2.23)		1.11 (0.59–2.11)
1	Goods index
		1^st, 2^nd, and 3^rd quartile	14.8	1.00	0.041	1.00	0.012
		4^th quartile (richer)	22.6	1.53 (1.02–2.29)	0.041	1.67 (1.12–2.48)	0.012
2	Physical activity
		No	19.0	1.00	0.053	1.00	0.199
		Yes	10.7	0.55 (0.31–1.01)	0.053	0.68 (0.38–1.23)	0.199
2	Tobacco use
		No	15.6	1.00	<0.001	1.00	0.063
		Yes	42.4	2.71 (1.73–4.25)	<0.001	1.64 (0.97–2.77)	0.063
2	Alcohol consumption
		No	11.6	1.00	0.001	1.00	0.039
		Yes	23.3	2.01 (1.34–3.02)	0.001	1.57 (1.02–2.42)	0.039
2	Excessive use of social media
		No	13.4	1.00	0.003	1.00	0.066
		Yes	23.9	1.79 (1.23–2.62)	0.003	1.45 (0.98–2.15)	0.066
3	Overweight
		No	16.2	1.00	0.538	1.00	0.957
		Yes	18.4	1.14 (0.75–1.72)	0.538	0.99 (0.67–1.46)	0.957
3	Social support
		1^st, 2^nd, and 3^rd quartile	10.7	1.00	<0.001	1.00	<0.001
		4^th quartile (less support)	38.1	3.55 (2.46–5.14)	<0.001	3.45 (2.28–5.21)	<0.001
3	Attempt to lose weight
		No	13.7	1.00	0.001	1.00	0.004
		Yes	26.2	1.91 (1.31–2.79)	0.001	1.86 (1.22–2.82)	0.004
4	Bullying
		No	12.7	1.00	<0.001	1.00	0.931
		Yes	25.6	2.01 (1.38–2.93)	<0.001	1.02 (0.71–1.45)	0.931
4	Self-harm behavior
		No	10.4	1.00	<0.001	1.00	<0.001
		Yes	46.9	4.51 (3.17–6.43)	<0.001	2.20 (1.50–3.24)	<0.001
	Depression, anxiety, stress
		Lower risk	7.6	1.00	<0.001	1.00	<0.001
		Higher risk	54.1	7.10 (4.81–10.5)	<0.001	3.47 (2.11–5.71)	<0.001

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[1] *Corresponding author. E-mail: lauras6810@gmail.com Laura Silva da Silva