Suicidal ideation, suicide planning, and suicide attempts among adolescents in 59 low-income and middle-income countries: a population-based study

© 2019 Elsevier Ltd Background: Suicide is a major global health challenge and a leading cause of death among adolescents, but research related to suicide has concentrated on high-income countries. We aimed to estimate the prevalence of suicidal ideation, suicide planning, and suicide attempts in adolescents from 59 low-income and middle-income countries. Methods: In this population-based study, we used data from the Global School-based Student Health Survey of schoolchildren aged 13–17 years between 2003 and 2015, in 59 low-income and middle-income countries across six WHO regions. Using a meta-analysis with random effects, we computed the sex-based and age-based estimates of regional and overall prevalence of suicidal ideation, suicide planning, and suicide attempts. Findings: Our sample consisted of 229 129 adolescents (mean age 14·6 [SD 1·18] years; 111 082 [48%] boys and 118 047 [52%] girls). The overall prevalence of suicidal ideation was 16·9% (95% CI 15·0–18·8), suicide planning was 17·0% (14·8–19·2), and suicide attempts was 17·0% (14·7–19·3) in the 12 months preceding survey completion. The African region had the highest prevalence of suicidal ideation (20·4%, 17·3–23·6) and suicide planning (23·7%, 19·1–28·3), and the western Pacific region had the highest prevalence of suicide attempts (20·5%, 14·3–26·7). Southeast Asia had the lowest prevalence of ideation (8·0%, 4·5–11·5), planning (9·9%, 5·0–14·8), and attempts (9·2%, 5·1–13·3). Girls had higher prevalence than boys for suicidal ideation (18·5%, 16·4–20·6 vs 15·1%, 13·4–16·7), suicide planning (18·2%, 15·8–20·6 vs 15·6%, 13·7–17·6), and suicide attempts (17·4%, 15·0–19·8 vs 16·3%, 14·0–18·6). Adolescents aged 15–17 years had higher prevalence than those aged 13–14 years of suicidal ideation (17·8%, 15·8–19·8 vs 15·9%, 14·1–17·6), suicide planning (17·8%, 15·7–20·0 vs 16·3%, 14·7–17·9), and suicide attempts (17·6%, 15·2–20·0 vs 16·2%, 13·8–18·5). Interpretation: Suicidal thoughts and behaviours are prevalent among adolescents in low-income and middle-income countries, particularly in the African and the western Pacific regions, and particularly among girls and adolescents aged 15–17 years. Targeted suicide prevention initiatives are needed and should take into account the diverse range of cultural and socioeconomic backgrounds of the countries. Funding: None.