The lifetime prevalence and associated factors of suicidal ideation and suicide attempts among high school adolescents in Ethiopia: a systematic review and meta-analysis.

Introduction: Suicide is a major public health problem and one of the top causes of death among adolescents worldwide. The Ethiopian government works to ensure healthy lives and promote well-being in adolescents through the National Adolescent and Youth Mental Health Strategy. Despite these efforts, suicide in adolescents remains pressing in Ethiopia; however, study findings regarding suicidal ideation and suicide attempts and their associated factors in high school adolescents have been inconsistent and non-conclusive. Therefore, this review aimed to assess the pooled national prevalence and risk factors of suicidal ideation and suicide attempts among high school adolescents in Ethiopia.

Methods: The Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA) guideline was followed for this systematic review. We searched PubMed, Embase, ScienceDirect, and Google Scholar databases. We included all observational studies that report the prevalence and associated factors of suicidal ideation and suicide attempts among high school adolescents in Ethiopia. Using a standard data extraction format, two authors separately extracted all required data. The meta-analysis was conducted using Stata version 17 statistical software. The Cochrane Q test and I² statistics were employed to evaluate the heterogeneity among the included studies. Pooled prevalence estimates, along with their 95% confidence intervals, were calculated using a random-effects model. Potential sources of heterogeneity across studies were further explored through subgroup analyses, sensitivity analysis, and meta-regression analysis.

Result: The review comprised ten studies with 8,620 participants. Out of 1,451 studies identified, 10 studies were included in the analysis. As the random effect model indicated that the pooled prevalence of suicide ideation and suicide attempt among high school adolescents in Ethiopia was 16% (95% CI: 12%, 19%) and 10% (95% CI: 6%, 13%), respectively. The highest prevalence of suicidal ideation was observed after the country's implementation of HSTP II [18 (95% CI: 15-22), I²=83.94, P-value < 0.001], while the lowest prevalence was depicted in adolescents aged 10-19 years [11% (95% CI 10, 13), I²=93.3, P-value < 0.001]. Similarly, the highest pooled prevalence of suicide attempt was observed after the country's implementation of HSTP II [12% (95% CI: 10-13), I²=67.77, P-value < 0.03], while the lowest prevalence was depicted in adolescents aged 10-19 years [5% (95% CI 1, 9), I²=94.43, P-value < 0.001]. The sensitivity analysis indicated that none of the point estimates were outside of the overall 95% confidence interval. No publication bias was seen in suicide ideation. But evidence of publication bias for suicide attempts was identified through the left trim and fill analysis. Gender, disappointment with school results, family history, alcohol use, the presence or absence of family or social support, history of abuse, living arrangement of adolescent, anxiety, and depression were significantly associated with suicide ideation and suicide attempts among high school adolescents in Ethiopia.

Conclusion: This review revealed that a significant proportion of high school adolescents had suicidal ideation and suicide attempts in Ethiopia. Therefore, the government and all stakeholders should track the outcome of the suicide prevention project under HSTP II and other initiatives. In addition, emphasis should be given to disadvantaged adolescents, including females, orphans, alcohol users, and mentally challenged adolescents. Furthermore, school-based interventions like social support and suicide prevention initiatives shall be promoted.