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Adolescent suicide attempts in three diverse island nations: patterns, contextual differences and demographic associations

Abstract

Objective

Most epidemiological studies on suicidal behavior have been focused on high-income country settings. This study examine factors associated with suicidal behaviors among school-attending adolescents in three island nations. In this secondary analysis of the publicly available 2015 nationally representative GSHS data, we tested demographic, social, and behavioral attributes using multivariable logistic regression to association with suicide attempts.

Results

Within the recall period, 13.6% of participants reported having attempted suicide one or more times in the Cook Islands, 10.8% in Curaçao, and 9.8% in East Timor. In the Cook Islands, suicide ideation (AOR = 19.42, 95% CI = 9.11–41.41), anxiety (AOR = 2.51, 95% CI = 1.08–5.82), physical bullying (AOR = 3.3, 95% CI = 1.10–9.91), and cigarette smoking (AOR = 3.82, 95% CI = 1.38–10.54) were associated with suicide attempts. For Curaçaoo, suicide ideation (AOR = 7.88, 95% CI = 5.20–11.95) and suicide planning (AOR = 7.01, 95% CI = 4.24–11.60) were statistically significant. While for East Timor, suicide ideation (AOR = 4.59, 95% CI = 2.14–9.88), suicide planning (AOR = 3.36, 95% CI = 1.76–6.29), bullying victimization (AOR = 2.69, 95% CI = 1.02–7.12), and serious injuries (AOR = 2.22, 95% CI = 1.31–3.74) were statistically significant. Suicide attempt is relatively common in each of the three island nations. The socioeconomic context of adolescents might play a significant role in moderating suicidal behavior. Therefore, prevention efforts should be grounded in view of geographic, demographic, and socioeconomic contexts of the populations at risk.

Introduction

Suicide claims the lives of more than 800,000 people globally each year [1, 2]. Among adolescents aged 15–19 years old, suicide is the third leading cause of death. While data from low- and middle-income countries (LMICs) typically underestimate the problem, available evidence suggests that the consequences of adolescent suicide attempts (SA) are prevalent in LMICs, where over 79% of global suicide deaths in 2016 occurred [2]. While numerous studies regarding suicidal behavior (SB) among adolescents have been done in mostly high-income western and Asian countries with large domestic populations [3,4,5,6,7,8], few studies exist from LMIC island nations.

The populations of the islands in our study—Cook Islands, Curaçao, and Timor-Leste are 17,564, 164,093 and 1,318,445, respectively, as of 2020 [9]. Persons aged under 24 years make up significant proportions of the overall populations—34.82% (Cook Islands), 33.06% (Curaçao), with Timor-Leste having a very young population overall with 60.28% [10,11,12]. Island nations that are not particularly subject to high rates of migration inflows may represent useful contexts in which to examine socio-behavioral phenomena.

In Curaçao, the number of victimizations reported by in school adolescents was associated with both mental health and health risk behaviors [13]. In Timor-Leste, suicidal behavior among school attending adolescents has been previously associated with unintentional injuries [14]. In the Cook Islands there have been calls for the prioritization of mental health and suicide prevention research both of which remain underfunded [15]. The present study aimed to examine the social and demographic correlates of suicidal behaviors among school-attending adolescents in three island settings.

Main text

Publicly available data from nationally representative surveys conducted in the year 2015, from three island countries of Cook Islands, Curaçao, and East Timor were used for secondary analyses. Detailed information on the data collection methods, questionnaire procedures, response rates and data is available at http://www.cdc.gov/gshs/. Information was missing for age, sex, and both age and sex, for 3, 5, and 2 records, respectively in the Cook Islands; 10, 27, and 3 records in Curaçao; and 74, 202, and 57 records in East Timor. No cases were excluded to ensure a correct design-based analysis.

SA as a dependent variable was derived from a question in the GSHS: “during the past 12 months, how many times did you actually attempt suicide?” For this analysis, participants were classified as having attempted suicide if they reported having attempted one or more SA during the recall period. If no SA was reported, participants were classified as not having attempted suicide; for 3 records in the Cook Islands, 59 records in Curaçao, and 29 records in East Timor, this information was missing. Fifteen independent variables at the individual level were considered (age, sex, suicide ideation, suicide planning, anxiety, loneliness, bullying victimization, physical bullying victimization, involvement in physical fights, serious injury, early sexual debut, alcohol use, physical attack, marijuana use, and cigarette smoking), and six at the social level (presence of supportive parental figures, presence of helpful peers, the extent of the social network, parental smoking status, people smoked in presence, and food insecurity). Cook Islands GSHS 2015, did not ask questions about sexual experiences. Details on variable creation appear in supplement (Additional files 1, 2: Tables S1, S2).

Differences between SA involvement among the variables were screened for statistical significance using the survey version of the chi-square test, which is a design-adjusted version of Pearson’s chi-square test for categorical variables, and the design-adjusted version of the t-test for continuous variables (age and number of friends). We then created two binary logistic regression models. These were intended to model the ability of the selected independent variables to predict the dichotomized SA variable. The first model adjusted only for age and sex. While the second model included all variables significant at the bivariate level. We report the measures of association as adjusted (aOR) and unadjusted (OR) odds ratios along with 95% Confidence intervals (CI). Stata 16 (StataCorp, 2019) was used for analysis. All proportions—expressed in percentages—are weighted.

Results

Within the recall period, 13.6% (unweighted count: 98) of participants reported having attempted suicide one or more times in the past 12 months in the Cook Islands, 10.8% (unweighted count: 296) in Curaçao, and 9.8% (unweighted count: 377) in East Timor. In the Cook Islands and Curaçao, most suicide attempters were female (53.4% and 61.0%, respectively). While in East Timor males comprised 55.7% of suicide attempters.

Table 1 shows the weighted distribution of selected factors according to suicidal behavior. The bivariate analyses show that in the Cook Islands, age, sex, food deprivation, parental tobacco use, people smoked in presence, and supportive parental figures were not statistically significantly associated with involvement in physical fights. In Curaçao, age and physical bullying were not statistically significant. In East Timor, age, sex, people smoked in presence, supportive parental figures, and helpful peers were not statistically significant.

Table 1 Comparison of factors by suicide attempt status in school-attending adolescents in Cook Islands, Curaçao, and Timor Leste, GSHS 2015

Table 2 adjusts for age and sex while Table 3 shows the final multivariable model. For the Cook Islands, suicide ideation, anxiety, physical bullying, and cigarette smoking were found to be statistically significantly associated with physical fighting status at p < 0.05; while at p < 0.01, only suicide ideation was found to be significant. For Curaçao, suicide ideation and suicide planning were statistically significant at p < 0.05; and the same was also found to be statistically significant at p < 0.01. For East Timor, suicide ideation, suicide planning, bullying victimization, and serious injury were statistically significant at p < 0.05; while at p < 0.01, suicide ideation, suicide planning, and serious injury were found to be significant.

Table 2 Outcomes of multivariable analysis of variables associated with suicide attempts adjusted for age and sex, among school-attending adolescents in Cook Islands, Curaçao, and Timor Leste, GSHS 2015
Table 3 Outcomes of multivariable analysis of variables associated with suicide attempts among school-attending adolescents in Cook Islands, Curaçao, and Timor Leste, GSHS 2015

Discussion

An inquiry into the mental health and health behaviors in nations with young populations, as in the context of the current research, has implications for economic and social advancement. The rates of SA among in-school adolescents in the Cook Islands (13.6%), Curaçao (10.8%), and East Timor (9.8%) were similar to the reports from many high-income countries [16] but higher than those from the USA and Canada [17]. The rates were, however, lower than those of sub-Saharan Africa [17]. Differences in income levels and standards of living might explain this variation [18]. Stable economic and social settings may mitigate the expression of unhealthy behavior among young people. The attributes of in-school adolescents in the three island nations are similar despite their diverse history, culture, economic, and social contexts. The islands have a similar age and sex distribution, and marijuana use and physical bullying were low. However, the individual nations had some distinctive characteristics. Tobacco use, physical attack, and food deprivation were more prevalent in East Timor and the Cook Islands than in Curaçao. Also, early sexual debut, alcohol use, and supportive parental figure were more common in Curaçao relative to the other two Islands. Curaçao is a high-income economy with a higher standard of living. It is ranked 27th in the world in terms of the Gross Nominal Domestic Product per capita (nGDP per capita). Curaçao’s nGDP per capita of United States Dollars (USD) 47,020 far exceeds those of the Cook Islands (USD 17,797), and East Timor (USD 2422) [19,20,21,22]. Previous studies have suggested negative and positive adolescent attributes are disproportionately distributed in high and low- and middle-income countries (LMICs) [23,24,25,26,27].

The association of adolescent suicidal ideation and planning with suicidal attempt corroborates findings from diverse other countries and contexts [16, 28,29,30,31]. Nevertheless, suicidal ideation does not always result in suicide attempts [32, 33]. With prevention in mind it is crucial to investigate mechanisms facilitating the progression from ideation to attempt. Many hypotheses on this topic exist. The three-step theory (3ST) represents contemporary understanding within the ideation-to-attempt framework, pointing out that the capacity for SA, consisting of dispositional, acquired, and practical variables enabling the SA capability, is the main factor for transitioning from suicidal ideation to attempt. This is consistent with the interpersonal theory of suicide (IPTS). The IPTS additionally indicates the contribution of the exposure to painful and provocative events (PPEs), leading to habituation to pain and fear, to SA capacity. PPEs may also explain the significant association between SA and physical bullying and serious injury shown in our results. The lack of association between suicide planning and SA in the Cook Islands is surprising and would benefit from further exploration to determine the responsible contextual factors. Also, in the Cook Islands, anxiety, physical bullying, and smoking are associated with SA, while helpful peers are protective. These findings align with reports of previous studies [16, 18, 31, 34,35,36].

Although there was no significant association between SA and involvement in physical fights or being physically attacked, bullying was associated in Cook Islands. In East Timor, we found that bullying victimization and serious injuries had a statistically significant association with SA in keeping with previous findings [31, 36]. Previous studies have researched different forms of bullying, including verbal harassment, physical aggression, and cyberbullying, and which were all suggested to be associated with suicidal behavior [37,38,39,40,41]. However, Kodish et al. pointed out that when only SA was considered, only verbal bullying showed association [37]. It is possible that the emotional distress caused by power imbalance and being isolated among peers, not necessarily physical injury, is linked with SA as far as bullying is concerned. Adolescents’ lack of experience in coping with interpersonal conflicts and emotional fluctuations can contribute to impulsive and self-destructive behaviors as well. Furthermore, other researches indicate that mediators like depression, anxiety, low self-esteem, loneliness, and hopelessness, affect the association between bullying and suicidal behaviors during adolescence. These mediators impact directly on psychological health, but may also result from mental ill-health [34]. The victims of bullying may perceive a lack of safety and belonging with reduced social support in the school environment, potentially heightening anxiety and loneliness. In a study of young adults aged 14 to 24 years, anxiety disorder was identified as the prime risk factor for SA among various other illnesses [42, 43]. Loneliness is associated with an increased risk of substance abuse [44].

In the Cook Islands, cigarette smoking had a significant association with SA. In a 2016 meta-analysis, a significant association between current smoking and suicidal behaviors was found [45]. The cumulative results indicated parental tobacco use and cigarette smoking have a low prevalence in Curaçao, while both factors showed high prevalence in the Cook Islands and Timor Leste, where almost half of the respondents have experienced people smoking in their presence in the preceding 7 days. In a way, the smoking behaviors of the youths might have been influenced by that of family members and significant others. Measures are required to strengthen awareness among the parents on how their behaviors influence young people.

Gender had no statistically significant relationship with SA. This finding contradicts existing literature demonstrating that SA and gender are associated, with most studies suggesting the males are more likely to attempt suicide and self-harm [18, 46]. However, a few authors have reported the opposite [16, 47, 48]. Early sexual debut did not play a role in SA in the three Islands under consideration, although it showed a high correlation in Brunei and Malawi [16, 31]. These differences highlight the probable effect of context in moderating the factors that underlie SA. An in-depth understanding of adolescents’ characteristics and socioeconomic circumstances should precede policy-making, strategy formulation, and program implementation concerning SA.

Conclusion

Despite population and socioeconomic differences between the studied countries, SA is common with similar rates in each country. Adolescents in the three Islands had a disproportionate distribution negative attributes potentially influenced by differences in living standards in each country. These differences highlight the need to investigate the effect of wider social, environmental and economic contexts outside of school environments.

Limitations

The cross-sectional nature of these data are not amenable to causal interpretations. Secondly, as these are self-reported responses, they are subject to social desirability bias. Lastly, the lack of responses from adolescents who were absent from school on the day of the survey.

Availability of data and materials

The datasets supporting this analysis are publicly available at http://www.cdc.gov/gshs/.

Abbreviations

LMIC:

Low- and middle-income countries

SA:

Suicide attempts

CI:

Confidence intervals

nGDP:

Gross Nominal Domestic Product per capita

USD:

United States Dollars

3ST:

Three-step theory

IPTS:

Interpersonal theory of suicide

PPE:

Painful and provocative events

References

  1. Page RM, Saumweber J, Hall PC, Crookston BT, West JH. Multi-country, cross-national comparison of youth suicide ideation: findings from global school-based health surveys. Sch Psychol Int. 2013;34(5):540–55. https://doi.org/10.1177/0143034312469152.

    Article  Google Scholar 

  2. WHO. Suicide. Geneva: World Health Organization; 2019.

    Google Scholar 

  3. Xu Y, Wang C, Shi M. Identifying Chinese adolescents with a high suicide attempt risk. Psychiatry Res. 2018;269:474–80. https://doi.org/10.1016/j.psychres.2018.08.085.

    Article  PubMed  Google Scholar 

  4. Lee HJ, Lee G. Suicidal behaviors of culturally diverse adolescents with sexual experience: using date from the \(10\sim\) 12th Korean youth risk behavior web-based survey. J Korean Acad Psychiatr Ment Health Nurs. 2019;28(3):205–15.

    Article  Google Scholar 

  5. O’Brien KHM, Becker SJ, Spirito A, Simon V, Prinstein MJ. Differentiating adolescent suicide attempters from ideators: examining the interaction between depression severity and alcohol use. Suicide Life Threat Behav. 2013;44(1):23–33. https://doi.org/10.1111/sltb.12050.

    Article  Google Scholar 

  6. Brière FN, Rohde P, Seeley JR, Klein D, Lewinsohn PM. Adolescent suicide attempts and adult adjustment. Depress Anxiety. 2014;32(4):270–6. https://doi.org/10.1002/da.22296.

    Article  PubMed  PubMed Central  Google Scholar 

  7. Yildiz M, Demirhan E, Gurbuz S. Contextual socioeconomic disadvantage and adolescent suicide attempts: a multilevel investigation. J Youth Adolesc. 2018;48(4):802–14. https://doi.org/10.1007/s10964-018-0961-z.

    Article  PubMed  Google Scholar 

  8. Liu Z-Z, Wang Z-Y, Bo Q-G, Qi Z-B, Xu R-J, Jia C-X, Liu X. Suicidal behaviours among Chinese adolescents exposed to suicide attempt or death. Epidemiol Psychiatr Sci. 2018. https://doi.org/10.1017/s2045796018000756.

    Article  PubMed  PubMed Central  Google Scholar 

  9. United Nations Department of Economic and Social Affairs. World population prospects 2019: highlights. New York: United Nations Department for Economic and Social Affairs; 2019.

    Google Scholar 

  10. Australia-Oceania Cook Islands—The World Factbook—Central Intelligence Agency. 2020. https://www.cia.gov/library/publications/the-world-factbook/geos/cw.html. Accessed 25 June 2020.

  11. Central America Curacao—The World Factbook—Central Intelligence Agency. 2020. https://www.cia.gov/library/publications/the-world-factbook/geos/uc.html. Accessed 25 June 2020.

  12. East Asia/Southeast Asia Timor-Leste—The World Factbook—Central Intelligence Agency. 2020. https://www.cia.gov/library/publications/the-world-factbook/geos/tt.html. Accessed 25 June 2020.

  13. Pengpid S, Peltzer K. Associations of number of victimizations with mental health indicators and health-risk behaviours among a nationally representative sample of in-school adolescents in Curaçao. Child Abuse Negl. 2021;111:104831. https://doi.org/10.1016/j.chiabu.2020.104831.

    Article  PubMed  Google Scholar 

  14. Pengpid S, Peltzer K. High prevalence of unintentional injuries and socio-psychological correlates among school-going adolescents in Timor-Leste. Int J Adolesc Med Health. 2020;33(3):253–9. https://doi.org/10.1515/ijamh-2019-0069.

    Article  PubMed  Google Scholar 

  15. Pirkis J, Amadeo S, Beautrais A, Phillips M, Yip PSF. Suicide prevention in the Western Pacific Region. Crisis. 2020;41(Suppl):1.

    Article  Google Scholar 

  16. Shaikh MA, Lloyd J, Acquah E, Celedonia KL, Wilson ML. Suicide attempts and behavioral correlates among a nationally representative sample of school-attending adolescents in the Republic of Malawi. BMC Public Health. 2016;16(1):1–8. https://doi.org/10.1186/s12889-016-3509-8.

    Article  Google Scholar 

  17. Randall JR, Doku D, Wilson ML, Peltzer K. Suicidal behaviour and related risk factors among school-aged youth in the Republic of Benin. PLoS ONE. 2014;9(2):88233.

    Article  Google Scholar 

  18. Wilson ML, Dunlavy AC, Viswanathan B, Bovet P. Suicidal expression among school-attending adolescents in a middle-income sub-Saharan country. Int J Environ Res Public Health. 2012;9(11):4122–34.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Fund IM. Suicide. Geneva: World Health Organization; 2019.

  20. The World Bank. Excel file of historical classifications by income 2019. Washington, D.C: The World Bank; 2019.

    Google Scholar 

  21. The World Bank. How are the income group thresholds determined? World Bank Data. 2020.

  22. United Nations. UN Data. United Nations: WHO. 2019. http://data.un.org/en/iso/ck.html.

  23. Koyanagi A, Stubbs B, Oh H, Veronese N, Smith L, Haro JM, Vancampfort D. Food insecurity (hunger) and suicide attempts among 179,771 adolescents attending school from 9 high-income, 31 middle-income, and 4 low-income countries: a cross-sectional study. J Affect Disord. 2019;248:91–8.

    Article  PubMed  Google Scholar 

  24. McKinnon B, Gariépy G, Sentenac M, Elgar FJ. Adolescent suicidal behaviours in 32 low-and middle-income countries. Bull World Health Organ. 2016;94(5):340.

    Article  PubMed  PubMed Central  Google Scholar 

  25. Uddin R, Burton NW, Maple M, Khan SR, Khan A. Suicidal ideation, suicide planning, and suicide attempts among adolescents in 59 low-income and middle-income countries: a population-based study. Lancet Child Adolesc Health. 2019;3(4):223–33.

    Article  PubMed  Google Scholar 

  26. Wang L, Mamudu HM, Collins C, Wang Y. High prevalence of tobacco use and exposure to secondhand tobacco smoke among adolescents in low-and middle-income countries. Ann Transl Med. 2017;5(Suppl 1):S4.

    Article  PubMed  PubMed Central  Google Scholar 

  27. Xi B, Liang Y, Liu Y, Yan Y, Zhao M, Ma C, Bovet P. Tobacco use and second-hand smoke exposure in young adolescents aged 12–15 years: data from 68 low-income and middle-income countries. Lancet Glob Health. 2016;4(11):795–805.

    Article  Google Scholar 

  28. Levinson D, Haklai Z, Stein N, Polakiewicz J, Levav I. Suicide ideation, planning and attempts: results from the Israel national health survey. Israel J Psychiatry Relat Sci. 2007;44(2):136.

    Google Scholar 

  29. Mars B, Heron J, Klonsky ED, Moran P, O’Connor RC, Tilling K, Wilkinson P, Gunnell D. Predictors of future suicide attempt among adolescents with suicidal thoughts or non-suicidal self-harm: a population-based birth cohort study. Lancet Psychiatry. 2019;6(4):327–37.

    Article  PubMed  PubMed Central  Google Scholar 

  30. Scherrer JF, Grant JD, Agrawal A, Madden PA, Fu Q, Jacob T, Bucholz KK, Xian H. Suicidal behavior, smoking, and familial vulnerability. Nicotine Tob Res. 2011;14(4):415–24.

    Article  PubMed  PubMed Central  Google Scholar 

  31. Shahedifar N, Shaikh MA, Oporia F, Wilson ML. Bruneian suicidal behaviors among school attending adolescents: a nationwide cross sectional study. J Injury Violence Res. 2019;11(4 Suppl 2).

  32. ten Have M, de Graaf R, van Dorsselaer S, Verdurmen J, van’Land H, Vollebergh W, Beekman A. Incidence and course of suicidal ideation and suicide attempts in the general population. Can J Psychiatry. 2009;54(12):824–33. https://doi.org/10.1177/070674370905401205.

    Article  PubMed  Google Scholar 

  33. Nock MK, Borges G, Bromet EJ, Alonso J, Angermeyer M, Beautrais A, Bruffaerts R, Chiu WT, de Girolamo G, Gluzman S, de Graaf R, Gureje O, Haro JM, Huang Y, Karam E, Kessler RC, Lepine JP, Levinson D, Medina-Mora ME, Ono Y, Posada-Villa J, Williams D. Cross-national prevalence and risk factors for suicidal ideation, plans and attempts. Br J Psychiatry. 2008;192(2):98–105. https://doi.org/10.1192/bjp.bp.107.040113.

    Article  PubMed  PubMed Central  Google Scholar 

  34. Miranda-Mendizabal A, Castellví P, Parés-Badell O, Alayo I, Almenara J, Alonso I, Blasco MJ, Cebrià A, Gabilondo A, Gili M, Lagares C, Piqueras JA, Rodríguez-Jiménez T, Rodríguez-Marín J, Roca M, Soto-Sanz V, Vilagut G, Alonso J. Gender differences in suicidal behavior in adolescents and young adults: systematic review and meta-analysis of longitudinal studies. Int J Public Health. 2019;64(2):265–83. https://doi.org/10.1007/s00038-018-1196-1.

    Article  PubMed  Google Scholar 

  35. Bolton JM, Robinson J. Population-attributable fractions of axis i and axis ii mental disorders for suicide attempts: findings from a representative sample of the adult, noninstitutionalized us population. Am J Public Health. 2010;100(12):2473–80.

    Article  PubMed  PubMed Central  Google Scholar 

  36. Hepburn L, Azrael D, Molnar B, Miller M. Bullying and suicidal behaviors among urban high school youth. J Adolesc Health. 2012;51(1):93–5.

    Article  PubMed  Google Scholar 

  37. Kodish T, Herres J, Shearer A, Atte T, Fein J, Diamond G. Bullying, depression, and suicide risk in a pediatric primary care sample. Crisis. 2016;37(3):241–6. https://doi.org/10.1027/0227-5910/a000378.

    Article  PubMed  Google Scholar 

  38. Klomek AB, Marrocco F, Kleinman M, Schonfeld IS, Gould MS. Bullying, depression, and suicidality in adolescents. J Am Acad Child Adolesc Psychiatry. 2007;46(1):40–9. https://doi.org/10.1097/01.chi.0000242237.84925.18.

    Article  Google Scholar 

  39. Copeland WE, Wolke D, Angold A, Costello EJ. Adult psychiatric outcomes of bullying and being bullied by peers in childhood and adolescence. JAMA Psychiatry. 2013;70(4):419. https://doi.org/10.1001/jamapsychiatry.2013.504.

    Article  PubMed  PubMed Central  Google Scholar 

  40. Klomek AB, Sourander A, Gould M. The association of suicide and bullying in childhood to young adulthood: a review of cross-sectional and longitudinal research findings. Can J Psychiatry. 2010;55(5):282–8. https://doi.org/10.1177/070674371005500503.

    Article  Google Scholar 

  41. Koyanagi A, Oh H, Carvalho AF, Smith L, Haro JM, Vancampfort D, Stubbs B, DeVylder JE. Bullying victimization and suicide attempt among adolescents aged 12–15 years from 48 countries. J Am Acad Child Adolesc Psychiatry. 2019;58(9):907–9184. https://doi.org/10.1016/j.jaac.2018.10.018.

    Article  PubMed  Google Scholar 

  42. Wunderlich U, Bronisch T, Wittchen H-U. Comorbidity patterns in adolescents and young adults with suicide attempts. Eur Arch Psychiatry Clin Neurosci. 1998;248(2):87–95. https://doi.org/10.1007/s004060050023.

    CAS  Article  PubMed  Google Scholar 

  43. Lipschitz JM, Yen S, Weinstock LM, Spirito A. Adolescent and caregiver perception of family functioning: relation to suicide ideation and attempts. Psychiatry Res. 2012;200(2–3):400–3. https://doi.org/10.1016/j.psychres.2012.07.051.

    Article  PubMed  PubMed Central  Google Scholar 

  44. Stickley A, Koyanagi A, Roberts B, Richardson E, Abbott P, Tumanov S, McKee M. Loneliness: its correlates and association with health behaviours and outcomes in nine countries of the former soviet union. PLoS ONE. 2013;8(7):67978. https://doi.org/10.1371/journal.pone.0067978.

    CAS  Article  Google Scholar 

  45. Poorolajal J, Darvishi N. Smoking and suicide: a meta-analysis. PLoS ONE. 2016;11(7):0156348. https://doi.org/10.1371/journal.pone.0156348.

    CAS  Article  Google Scholar 

  46. Cash SJ, Bridge JA. Epidemiology of youth suicide and suicidal behavior. Curr Opin Pediatr. 2009;21(5):613.

    Article  PubMed  PubMed Central  Google Scholar 

  47. Rudatsikira E, Muula AS, Siziya S. Prevalence and associated factors of suicidal ideation among school-going adolescents in Guyana: results from a cross sectional study. Clin Pract Epidemiol Ment Health. 2007;3(1):1–5.

    Article  Google Scholar 

  48. Rutz EM, Wasserman D. Trends in adolescent suicide mortality in the WHO European Region. Eur Child Adolesc Psychiatry. 2004;13(5):321–31.

    Article  PubMed  Google Scholar 

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Acknowledgements

The survey participants and organizers are greatly appreciated for their contributions to the data collection.

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Conceptualization: MAS; methodology: MAS and MLW; validation: AO, MLW and JF; formal analysis: MAS; writing—original draft preparation: all; writing—review and editing: all. All authors read and approved the final manuscript.

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Correspondence to Michael Lowery Wilson.

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Supplementary information

Additional file 1:

Table S1: Independent variable derivation from GSHS survey data (Cook Islands, Curacao, East Timor) 2015.

Additional file 2:

Table S2: Cumulative proportion of factors in school-attending adolescents in Cook Islands, Curacao, and East Timor, GSHS 2015.

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Fu, J., Abiodun, O., Lowery Wilson, M. et al. Adolescent suicide attempts in three diverse island nations: patterns, contextual differences and demographic associations. BMC Res Notes 14, 464 (2021). https://doi.org/10.1186/s13104-021-05804-4

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Keywords

  • Adolescent health
  • Epidemiology
  • Self-harm
  • Global health
  • Mental health
  • School health