Prevalence and correlates of multiple suicide attempts among adolescents aged 12–15 years from 61 countries in Africa, Asia, and the Americas

Lee Smith, Jae Il Shin, Christina Carmichael, Hans Oh, Louis Jacob, Guillermo F. López Sánchez, Mark A. Tully, Yvonne Barnett, Laurie Butler, Daragh T. McDermott, Ai Koyanagi

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Suicide is the fourth leading cause of death worldwide in young people aged 15-19 years. However, little is known about the correlates of multiple suicide attempts in adolescents, especially from a global perspective. Therefore, the aim of the present study was to investigate the association of putative physical, behavioral, and social correlates with multiple suicide attempts among adolescents aged 12-15 years from 61 countries. Data from the Global school-based Student Health Survey (2009-2017) were analyzed. Multiple suicide attempts was classified as having attempted suicide at least twice in the past 12 months. Multivariable logistic regression analyses were conducted to assess the potential correlates. Data on 162,994 adolescents [mean (SD) age 13.8 (0.9) years; 50.8% boys] were analyzed. The overall prevalence of multiple suicide attempts was 4.4% [range 1.2% (Laos) to 13.8% (Ghana)]. Among those who had attempted suicide at least once in the past 12 months, in the overall sample, food insecurity, smoking, alcohol consumption, cannabis use, amphetamine use, sedentary behavior, sexual intercourse, sleep problems, loneliness, no close friends, and bullying victimization were all independently associated with higher odds for multiple suicide attempts although some regional differences were observed. Our study results indicate potential target factors that could be addressed amongst those who had attempted suicide in the past to reduce future suicide attempts and possibly completed suicides. Furthermore, it is possible that region-specific interventions are necessary. [Abstract copyright: Copyright © 2021 Elsevier Ltd. All rights reserved.]
Original languageEnglish
Pages (from-to)45-53
Number of pages9
JournalJournal of Psychiatric Research
Early online date25 Sept 2021
Publication statusPublished (in print/issue) - Dec 2021

Bibliographical note

Funding Information:
This paper uses data from the Global School-Based Student Health Survey (GSHS). GSHS is supported by the World Health Organization and the US Centers for Disease Control and Prevention .

Publisher Copyright:
© 2021 Elsevier Ltd


  • Multiple suicide attempts
  • Repeated suicide attempts
  • Adolescents
  • Correlates
  • Epidemiology
  • Multi-country study


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