Prevalence and factors associated with Suicidal Behaviour in Eswatini

Abstract
Introduction
The determinants of suicidal behaviour are not well understood for both adolescents and the general adult population in Eswatini. The problem of SB is a lifetime experience that can affect anyone, both young and old. Hence, the research was performed to generate evidence on the factors associated with suicidal behavior in the aforementioned populations. This dissertation contains two studies. The first study employed a mediation approach to evaluate the roles of multiple mediators (anxiety and loneliness) in the relationship of food insecurity (FI) and being bullied (BB) on suicidal behavior (SB) among adolescents in schools. Additionally, it used analysis approaches to assess the combined roles of food insecurity and being bullied on SB, anxiety, and loneliness. The second study addressed whether chronic disease and lifestyle are associated with suicidal ideation (SI) among adults in Eswatini. Moreover, the study examined the potential modification roles of socioeconomic status (SES) on the association of chronic diseases and lifestyle factors with SI.
Methods
Study hypotheses were examined through secondary analysis from the Global School-based Health Survey (GSHS) 2012 and STEPwise Approach to NCD Risk Factor Surveillance Survey (STEPS) 2013 surveys. Both of these surveys were designed to produce nationally representative samples using stratified sampling approaches. For our analysis (study 1), we included 3,264 students aged 13-17 years, who responded to the questions on food insecurity, being bullied, loneliness, anxiety, and SB. Data for the primary survey were collected through self-administered questionnaires, which were executed through regular class periods. We employed bivariate and multivariate regression models to estimate factors associated between FI and BB with SB, anxiety and loneliness. In addition, we used a binary mediation regression model to assess the potential mediation roles of anxiety and loneliness on the association between FI and BB with SB. The second study utilized STEPs and used a complex sampling design, where a total of 216 primary sampling units (PSU) were selected using probability-proportionate-to-size sampling. About 20 households were systematically sampled from the PSU to form secondary sampling units. Our analysis, included 3026 adult men and women aged 18 - 69 years who gave responses to the questions on suicide to ascertain the presence or absence of suicidal thoughts. Bivariate and multivariate logistic regression models were used to estimate the associated factors between chronic disease and lifestyle factors with SI.
Results
Study 1: The results demonstrated that SB, anxiety, and loneliness were more likely for adolescents who had combined food insecurity and being bullied; were being bullied only; were food insecure only; were physically attacked; had a fight; had no friends; were truant; used marijuana and lacked parental support (all p <0.05). In addition, after the covariates were adjusted for, compared with no FI or BB, both FI and BB as well as BB alone were associated with increased SB [adjusted odds ratios (95% confidence intervals) = 3.16 (1.74–5.74) and 1.48 (1.24–1.79), respectively]. Moreover, the relationship between FI and BB with SB was partly (approximately 23.5%) mediated by anxiety and loneliness. Our results highlight the mediating roles of loneliness and anxiety in suicidal adolescents who experience FI and BB. In conclusion, interventions for alleviating SB for high-risk adolescents experiencing FI and BB should also be aimed at ameliorating anxiety and loneliness.
Study 2: Our study showed that the overall prevalence of past-year suicidal ideation (SI) was high (9.9%). %). The burden of chronic disease was high with high blood pressure (HBP) at 25.7% and cardiovascular disease (CVD) at 13.1%. Those who had past-year SI tended to have a positive history of CVD; lifetime alcohol use; be women; currently unemployed; have a positive family history of suicide; and have an experience of adult sexual abuse, threats and childhood sexual abuse (all p < 0.05). Additionally, after controlling for other variables among employed individuals, having high blood pressure (aOR: 3.38, 95% CI: 1.54–7.40), not exercising (aOR: 2.65, 95% CI: 1.09–6.39), drinking alcohol (aOR: 2.40, 95% CI: 1.14–5.05), being aged 18–30 years (aOR: 3.50, 95% CI: 1.01–12.1), and being exposed to threats (aOR: 2.37, 95% CI: 1.01–5.53) were significantly associated with past-year suicidal ideation.
Conclusions
In summary, the study advanced knowledge, in that anxiety and loneliness have a potential mediation role in the association between FI and BB with SB. Our findings are a call consider other mental factors (anxiety and loneliness) in planning preventive interventions for adolescents. In addition, specifically for adults’ population the importance of identifying the high risk group was outlined. The study showed HBP, not engaging in exercise, and lifetime alcohol use among currently employed individuals were associated with increased risk for past-year suicidal ideation.