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)

Figures & data

Table 1. A list of the 37 included countries and their characteristics.

Region	Country	Total, n	Boys, n (%)	Mean age (years)	Boys SuI (%)	Girls SuI (%)	Total SuI (%)	P-value^a	Year of GSHS^b	GII^c, (data year^d)	Log GDP/C^e	SSE (%), (Data year^d)
Africa	Benin	2574	1673 (65)	15.33	21.82	22.09	21.91	0.875	2009	6.21 (2010)	7.480	47.68 (2011)
	Botswana	2092	942 (45)	14.96	21.55	24.17	22.99	0.156	2005	5.23	9.241	78.53
	Ghana	2171	1134 (52)	15.32	17.37	20.73	18.98	0.046	2012	5.49 (2013)	8.216	58.36
	Kenya	3102	1514 (49)	14.44	25.69	27.46	26.6	0.267	2003	6.54 (2005)	7.480	43.14
	Malawi	2146	1006 (47)	13.97	10.44	14.04	12.35	0.011	2009	6.16 (2010)	6.871	31.84
	Mauritania	1842	862 (47)	14.96	19.26	17.24	18.19	0.264	2010	6.56	8.086	20.33
	Morocco	2380	1285 (54)	14.34	14.63	21.1	17.61	0.000	2010	5.63	8.750	62.69
	Swaziland	2533	1100 (43)	15.42	15.18	18.49	17.05	0.028	2013	5.76	9.00	62.99
	Tunisia	2344	1145 (49)	14.19	17.38	24.77	21.16	0.000	2008	3.09 (2010)	9.171	92.51
	Uganda	2938	1516 (52)	15.01	16.89	21.31	19.03	0.002	2003	5.92 (2005)	6.876	19.37
Americas	Argentina	26,430	12,546 (47)	14.57	11.94	24.09	18.32	0.000	2012	3.66	9.882	105.19
	Bahamas	1062	493 (46)	13.74	14.2	23.02	18.93	0.000	2013	3.72	10.059	92.63 (2010)
	Belize	1564	748 (48)	14.47	11.36	20.83	16.3	0.000	2011	4.11	8.969	76.03
	Bolivia	3263	1653 (51)	14.49	13.67	23.79	18.66	0.000	2012	4.92	8.683	82.88
	Costa Rica	2585	1247 (48)	14.28	7.7	14.13	11.03	0.000	2009	3.27 (2010)	9.404	99.65
	El Salvador	1795	977 (54)	14.40	10.03	19.56	14.37	0.000	2013	4.06	8.975	81.30
	Guatemala	5135	2322 (45)	14.42	10.47	20.65	16.05	0.000	2009	5.4 (2010)	8.773	57.33
	Guyana	2273	992 (44)	14.43	15.73	28.49	22.92	0.000	2010	5.22	8.653	88.64
	Honduras	1450	709 (49)	14.27	15.09	23.35	19.31	0.000	2012	4.95	8.346	72.51
	Jamaica	1474	712 (48)	14.65	18.26	25.2	21.85	0.001	2010	4.55	8.966	92.83
	Peru	2780	1351 (49)	14.51	12.07	28.34	20.43	0.000	2010	4.06	9.186	94.70
	Suriname	1567	805 (51)	14.87	9.32	18.11	13.59	0.000	2009	5.14 (2010)	9.489	75.07
	Uruguay	3402	1567 (46)	14.45	7.28	16.4	12.2	0.000	2012	3.2	9.843	107.97
Asia	Indonesia	2924	1401 (48)	13.87	3.93	5.32	4.65	0.074	2007	5.33 (2005)	8.856	70.56
	Jordan	2029	1113 (55)	14.79	16.26	18.89	17.45	0.121	2007	5.57 (2005)	9.099	93.08
	Kuwait	2586	1305 (50)	14.39	17.93	21.16	19.53	0.039	2011	2.34	11.258	93.31
	Lebanon	3890	1812 (47)	14.20	12.47	18	15.42	0.000	2011	3.98	9.661	76.13
	Malaysia	24,817	12,325 (50)	14.91	6.03	8.51	7.28	0.000	2012	3.03	10.044	69.61
	Mongolia	4471	2097 (47)	14.76	17.36	28.14	23.08	0.000	2013	2.92	9.314	91.46 (2015)
	Myanmar	2531	1275 (50)	14.51	0.71	1.04	0.87	0.372	2007	4.59 (2010)	7.892	46.26
	Pakistan	5026	3770 (75)	14.27	7.48	7.01	7.36	0.578	2009	5.7 (2010)	8.335	35.26
	Philippines	4924	2122 (43)	14.61	12.02	20.38	16.77	0.000	2011	4.49 (2010)	8.649	88.39 (2013)
	Sri Lanka	2275	1019 (45)	13.91	10.89	9.39	10.07	0.238	2008	4.09 (2010)	8.918	96.93 (2010)
	Tajikistan	9245	4628 (50)	14.60	13.46	10.05	11.76	0.000	2006	3.45 (2005)	7.403	81.40
	Thailand	2258	1130 (50)	13.92	9.2	7.54	8.37	0.152	2008	3.19 (2010)	9.414	78.22
Oceania	Fiji	1627	686 (42)	14.34	16.33	18.38	17.52	0.281	2010	3.69 (2014)	8.882	90.92 (2011)
	Samoa	1801	690 (38)	14.17	38.41	29.25	32.76	0.000	2011	4.91	8.643	86.37
		Total, n	Boys, n (%)	Mean age (years)	Boys SuI (%)	Girls SuI (%)	Total SuI (%)	P-value^a		Mean of all countries
Total		149,306	73,672 (49)	14.58	12.03	17.92	15.01	0.000		4.60	8.832	74.11

SuI: Suicide Ideation. GII: Gender Inequality Index. SSE: Secondary School Enrolment. GSHS: Global School-based Student Health Survey.

^aChi²- test, p-value of difference in suicide ideation between genders.

^bYear the Global School-based Student Health Survey was conducted in country.

^c Gender Inequality Index. Multiplied by 10 to simplify analyzing.

^dIf different from the year of GSHS the year the data was sampled is stated in parentheses.

^eGDP per capita is measured as PPP (purchasing power parities).

Table 2. The association between national gender inequality and suicide ideation among 13–17 year-olds in 37 countries. Multilevel logistic regression. (Total n = 149,306; mean [range] per country n = 4035 [1062–26,430]; 1,085 strata, mean [range] per stratum n = 138 [18–524]).

	Model 1		Model 2		Model 3		Model 4
	OR (95% CI)	P-value	OR (95% CI)	P-value	OR (95% CI)	P-value	OR (95% CI)	P-value
Fixed effects
GII^a,b	1.14	0.130	1.51	<0.001	1.54	<0.001	1.64	<0.001
	(0.96–1.36)		(1.28–1.78)		(1.27–1.88)		(1.34–2.00)
Age	1.11	<0.001	1.11	<0.001	1.11	<0.001	1.11	<0.001
	(1.10–1.13)		(1.10–1.13)		(1.10–1.13)		(1.10–1.13)
Sex
Boy^c	1.00		1.00		1.00		1.00
Girl	1.58	<0.001	1.60	<0.001	1.60	<0.001	2.45	<0.001
	(1.55–1.65)		(1.55–1.65)		(1.55–1.65)		(2.16–2.77)
Sec. school enrolment rate (%)			1.02	<0.001	1.02	<0.001	1.02	<0.001
			(1.01–1.03)		(1.01–1.03)		(1.01–1.03)
logGDP/Capita^d					1.05	0.674	1.06	0.663
					(0.80–1.35)		(0.83–1.35)
Interactions
GII*girls							0.91	<0.001
							(0.88–0.93)
Random effects
Median Odds Ratios
Country level	1.53		1.36		1.36		1.36
Strata level	1.39		1.39		1.39		1.39
Log likelihood	−59,943.7		−59,933.2		−59,933.1		−59,908.9
Likelihood ratio test^e	<0.001		<0.001		0.674		<0.001

Gender Inequality Index, potential range 0–10, actual range 2.34–6.56. Higher value means less equal.

All models controlled for the year the Global School-based Health Survey was made, categorical variable (range: 2003–2013), coefficients not in table.

^cBoys: n = 73,672 (49.34%).

^dlog GDP per capita is measured as PPP (purchasing power parities).

^ethe likelihood ratio test compares each nested model to the previous model to see if it is a significantly better fit. The first model is compared to a single-level regression.

Table 3. The association between national gender inequality and suicide ideation among 13–17 year-olds in 37 countries, stratified by gender.

		Model 1		Model 2		Model 3
		OR	P-value	OR	P-value	OR	P-value
Only girls (Total n = 75,634; mean [range] per country = 2044 [569–13,884]; 1071 strata, mean [range] per stratum n = 71 [1–279])
Fixed effects
GII^a,b		1.07 (0.90–1.28)	0.458	1.46 (1.23–1.72)	<0.001	1.46 (1.20–1.77)	<0.001
Age		1.14 (0.12–1.16)	<0.001	1.14 (1.12–1.16)	<0.001	1.14 (1.12–1.16)	<0.001
Sec. school enrolment rate (%)				1.02 (1.02–1.03)	<0.001	1.02 (1.02–1.13)	<0.001
logGDP/Capita^c						1.00 (0.78–1.28)	1.000
Random effects
Median Odds Ratio
Country level		1.54		1.35		1.35
Stratum level		1.41		1.41		1.41
Log likelihood		−33,790.8		−33,778.3		−33,778.2
Likelihood ratio test^d		<0.001		<0.001		<0.001
Only boys (Total n = 73,672; mean [range] per country = 1991.1 [493–12,546]; 1,079 strata, mean [range] per stratum n = 68.3 [1–336])
Fixed effects
GII^a,b		1.25 (1.05–1.49)	0.013	1.56 (1.29–1.90)	<0.001	1.61 (1.28–2.03)	<0.001
Age		1.07 (1.05–1.10)	<0.001	1.07 (1.05–1.10)	<0.001	1.07 (1.05–1.10)	<0.001
Sec. school enrolment rate (%)				1.02 (1.01–1.03)	<0.001	1.02 (1.01–1.03)	0.001
logGDP/Capita^c						1.07 (0.8–1.43)	0.638
Random effects
Median Odds Ratio
Country level		1.52		1.43		1.42
Stratum level		1.42		1.43		1.42
Log likelihood		−25,945.6		−25,939.6		−25,939.5
Likelihood ratio test^d		<0.001		0.001		0.6378

^aGender Inequality Index, potential range 0–10, actual range 2.34–6.56. Higher value means less equal.

^bAll models controlled for the year the Global School-based Health Survey was made, categorical variable (range: 2003–2013), coefficients not in table.

^clog GDP per capita is measured as PPP (purchasing power parities).

^dthe likelihood ratio test compares each nested model to the previous model to see if it is a significantly better fit. The first model is compared to a single-level regression.

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.