Gender inequality and adolescent suicide ideation across Africa, Asia, the South Pacific and Latin America – a cross-sectional study based on the Global School Health Survey (GSHS)

ABSTRACT

Background: Suicide ideation is a health issue affecting adolescents worldwide. There are significant variations in suicide ideation between countries and genders, which have not been fully explained. Research is especially lacking in countries outside Europe and North America. Gender equality has been shown to matter in other aspects of adolescent mental health, such as life satisfaction, but has not been researched in relation to suicide ideation at national level.

Objective: To investigate how national gender inequality is related to self-reported suicide ideation among adolescents, and whether this association differs between boys and girls.

Methods: This is a cross-national, cross-sectional study using individual survey data from the Global School-based Student Health Survey, a survey in Africa, Asia, Latin America and the South Pacific, developed and supported by among others the WHO and the CDC; connecting this to national data: the gender inequality index from the UNDP; controlling for GDP per capita and secondary school enrolment. The data was analysed using a multilevel logistic regression method and included 149,306 students from 37 countries.

Results: Higher national gender inequality, as measured by the gender inequality index, was significantly associated with a higher likelihood of suicide ideation in both girls and boys (odds ratio: 1.38 p-value: 0.015), but for girls and both sexes this was only after adjusting for selection bias due to secondary school enrolment (as well as GDP/capita). Interaction models showed that this association was stronger in boys than in girls.

Conclusions: National gender inequality seems to be associated with higher levels of suicide ideation among adolescents in mainly low- and middle-income countries, especially among boys.

SPECIAL ISSUE:

• Gender and Health Inequality

KEYWORDS:

• Gender equality
• adolescents
• suicide ideation
• global health
• mental health
• child
• inequality
• low income populations
• gender
• suicide

Responsible Editor Peter Byass, Umeå University, Sweden

Responsible Editor Peter Byass, Umeå University, Sweden

Acknowledgments

The GSHS was coordinated and supported by the WHO and CDC in collaboration with UNICEF, UNESCO, and UNAIDS. We thank all the country coordinators for their hard work, as well as the school principals and students involved in the survey.

We would also like to acknowledge the funding by the Swedish Research Council for Health, Working Life and Welfare (Forte 2015-00048), and the work done by Wolfgang Lohr at Umeå University for compiling the data files from the different countries into one working file.

Disclosure statement

The authors report no conflicts of interest.

Data availability statement

All data used in this study is publicly available. The GSHS is available for download at CDC’s website [https://www.cdc.gov/GSHS/], all other data sources can be found in the reference list.

Ethics and consent

This study used data that were publicly available online, and therefore, it was not relevant to apply for ethical approval.

Paper context

Gender equality has been found to affect the mental health of adolescents in high-income countries, but research in low- and middle-income countries is lacking. We found an association between higher levels of national gender equality with lower rates of suicide ideation among boys and girls, in mainly low- and middle-income countries. The association seems to be stronger for boys than girls. This can support policy makers in advocating for increased gender equality.

Additional information

Funding

The analyses of these secondary data sets for this article were funded by Swedish Research Council for Health, Working Life and Welfare, FORTE, Dnr 2015-00048. The funding agency had no role or influence in study design; in the collection, analysis and interpretation of the data; in the writing of the report; or in the decision to submit the paper for publication.

Notes on contributors

Rebecka Assarsson

RKA conceived of the research question, performed analyses and wrote the manuscript. SP, BH and MS participated in early discussions, read and commented on drafts, and read the final draft. KJ supervised the process, conceived of the research question, helped with analyses, performed sensitivity analyses, and commented on all drafts of the manuscript as well as the last version.