Prevalence and factors associated with suicidal ideation among young youth 15-24 years in community setting of Hunza, Pakistan
Date of Award
Master of Science in Epidemiology & Biostatistics (MSc Epidemiology & Biostats)
Community Health Sciences
Suicide among youth is considered to be the leading causes of death worldwide and has emerged as a huge public health concern in many developing countries. Suicidal Ideation being important predictors for suicide completion, offer critical stage for intervention if identified early. The term suicidal behavior includes suicidal ideation, attempt and completion. There are very few community based studies found in the context of Pakistan conducted on factor associated with suicidal ideation. A significantly high rate of suicidal Ideation has also been found by different studies conducted in Pakistan. Considering the fact that suicidal ideation leads to further suicidal attempts and completion therefore identifying the extent and associated factors at this stage will help to respond early to this population and avert more risky behaviors. Objective: This study aims to estimate the prevalence and identify factors associated with suicidal ideation and also explore the perception of youth regarding suicidal thoughts in district Hunza, Pakistan. Method: The research design of this study was cross-sectional using mixed method approach. Sample size was calculated for the quantitative part which included 385 youths (15-24 years) from rural communities in Hunza, Pakistan. Suicidal ideation and its associated factors were assessed using a structured questionnaire. Based on the survey result those participants who had higher suicidal ideation were purposefully selected for semi-structured interviews. The outcome of the study i.e. suicidal ideation score was measured by Beck scale for suicidal ideation. Data Analysis included descriptive statistics of all the variables included in this study. Prevalence of suicidal ideation was estimated by taking the suicidal ideation score as a categorical variable based on the screening questions of the scale. We used multiple linear regression to assess the association of socio demographic, interpersonal relation, and violence related factors with suicidal ideation. We conducted thematic analysis for the qualitative data. Results: A total of 385 participants were recruited from four selected villages. The mean suicidal ideation score is 5.4 (SD 6.02). Overall 80 i.e., 20.78 % (95% CI 16.71, 24.85) of the youth reported suicidal ideation. The final model shows that among participants who were sometimes bullied, the mean suicidal ideation score is 2.988 (95% CI: 1.212, 4.762) higher than those who were never bullied and among participants who are always bullied, the mean suicidal ideation score is 1.889 (95% CI: 0.655, 3.122) higher than those who are never bullied. The estimated mean suicidal ideation score increases by 2.859 (1.012, 4.779) among participants who sometimes feel comfortable in talking to parents about studies as compared to those who always feel comfortable in talking to parents about studies. Among participants who does not feel comfortable in talking to parents about studies, the mean suicidal ideation score is 5.598 (95% CI: 3.756, 7.439) times higher than those who always feel comfortable in talking to parents about studies. Among participants who had any experience of sexual abuse, the estimated mean suicidal ideation score is 1.315 (95% Cl: 0.132, 2.499) higher as compared to those who have not experienced sexual abuse. The estimated mean suicidal ideation score increases by 3.621 (95% CI: 1.412, 5.831) among participants who had satisfactory performance in last major exam as compared to those who had excellent performance. The estimated mean suicidal ideation score increases by 2.033 (95% Cl: 0.928, 3.137) among females as compared to males. The estimated mean suicidal ideation score is 2.148 (95% CI: 0.345, 3.950) higher among participants who never discuss issues with parents as compared to those who always discuss issues with parents. Five major problems emerged from the qualitative data; individual, relationship, school/education, social and media related problems, with parental relationship being the most frequently reported including lack of parental support/ negligence, dominancy of parents in career choice, parents blaming and comparison, non-friendly behavior of parents, conflict between parents and domestic violence. Study Implication: The study shows that gender, interpersonal relation particularly unfriendly relationship with parents, bullying and any experience of sexual abuse are associated with increased suicidal ideation. Youth who are facing financial issues, unemployment and low performance in exam are found to be at increased risk for suicidal ideation. Prevention programs for youth suicide should focus on counseling sessions for students and their parents covering the above mentioned factors. The knowledge generated from this study should be used by policy makers and practitioners working with youth who have the potential to commit suicide to reduce the suicidal rates. By recognizing and treating suicidal ideation and by focusing on the identified factors associated with suicidal ideation, the progression towards other suicidal behavior might be averted.
Karim, S. (2018). Prevalence and factors associated with suicidal ideation among young youth 15-24 years in community setting of Hunza, Pakistan (Unpublished doctoral thesis). Aga Khan University, Karachi, Pakistan.