Determinants of suicidal ideation and attempts among Thai adolescents: A mixed-effects modeling approach

Introduction

Thailand faces mental health challenges, with adolescent suicide rates being a public health concern. Various factors influence suicide ideation and attempts, highlighting the need for targeted prevention.

Methods

We analyzed data from the 2021 Thailand Global School-based Student Health Survey to identify factors associated with suicidal ideation and suicide attempts. Initially, mixed-effects logistic regression models were fitted separately for each independent variable to estimate odds ratios. Using significant variables and interaction terms, we developed several comprehensive models and evaluated their improvement with the Likelihood Ratio Test. The best-fitting model was selected based on the Akaike Information Criterion (AIC), Bayesian Information Criterion (BIC), McFadden’s R², and deviance. Final adjusted odds ratios were estimated from this model. All analyses were performed using R programming.

Results

Gender differences showed that males had lower odds of suicide-related behaviors than females. Adolescents aged 15 and older had lower odds of these behaviors than their younger peers. Mental health issues, including cyberbullying, sadness, and anxiety, were strongly associated with increased suicide ideation and attempts, emphasizing the need for targeted interventions for adolescents facing mental distress. Parental attachment acted as a protective factor, suggesting that strong family bonds may reduce the risk of suicide-related behaviors. Certain behaviors, such as a sedentary lifestyle, alcohol consumption, and tobacco use, were linked to higher odds of ideation and attempts, pointing to the importance of addressing these habits in prevention efforts. Interaction effects revealed complex relationships, such as gender and tobacco use, and the influence of sadness and lack of close friends.

Conclusion

Suicide-related behaviors among adolescents reflect the influence of gender, age, mental health, and lifestyle factors. Strengthening mental health support, family bonds, and addressing risky behaviors are key to preventing adolescent suicide.