Suicide behavior and associated psychosocial factors among adolescents in Campeche, Mexico
Introduction
Suicide is a preventable public health problem worldwide, only second to road traffic injuries as leading cause of death among people 15–29 years old, claiming > 800,000 lives in 2012 (World Health Organization, 2014, World Health Organization, 2016). Data show that 8% of high-school students in the U.S. attempted suicide in 2011 and 9% did in 2015 (Eaton et al., 2012, Kann et al., 2016). Suicidal behavior also causes considerable economic burden on health systems: for example, consider the $33 billion caused by self-inflicted injuries in 2000 (Corso et al., 2007).
A history of suicide attempt is one of the strongest predictors for suicide (World Health Organization, 2014) but other risk factors are also important and inter-related. Drug use, violence victimization, poor family support, hopelessness, depressive symptoms, low self-esteem and impulsivity add-up to trigger suicide behavior among high school students (Lewinsohn et al., 1994, Borowsky et al., 2001, Gould et al., 2003, Hallfors et al., 2006, Nock et al., 2008).
In the face of the worldwide suicide epidemic, local and regional studies may provide insights to better understand the causes and alternatives to the problem. Mexico's suicide rates have doubled in the past 24 years, from 2.39 per 100,000 people in 1990 to 5.64 per 100,000 people in 2014 (INEGI (Instituto Nacional de Estadística y Geografía), 2016a, INEGI (Instituto Nacional de Estadística y Geografía), 2016b). However, some regions were affected by higher increases; in the Mexican State of Campeche, the suicide rate rose from 7.54 per 100,000 people in 2010 to 11.19 per 100,000 in 2014, nearly double the national rate (INEGI, 2016a). This unfortunate trend has had an already measurable impact in state statistics of years of life lost and productivity because the highest incidence occurred among working-age men (Dávila-Cervantes et al., 2015, Instituto de Servicios Descentralizados de Salud Pública del Estado de Campeche (INDESALUD), 2009). Although suicide and suicide behaviors are growing problems in Mexico and particularly in Campeche, there is little research that could shed light on how better to address these issues.
One of the limitations of current knowledge is that studies fail to realize the convergent and synergistic relationships between risk factors and suicide behavior. For example, a youth with suicidal ideation may be more prone to engage in life-threatening behaviors, including attempting suicide, given cognitive impairment by alcohol binge drinking (Cherpitel et al., 2004, Bagge et al., 2015, Borges et al., 2016). Traditional statistical approaches cannot accommodate the complexities created by the highly correlated nature of these behaviors and factors (Jiang et al., 2010). Yet, public health implications transcend mere statistical discussions: for example, it is likely that population sub-groups are formed depending on specific risk-factor/risk behavior constellations. Moreover, the number, type, and specific array of risk factors altogether may create subgroups in the population that cannot be identified by simply counting the number of factors. Identifying these sub-population risk groups may help dictate the specific interventions needed to address their needs (Jiang et al., 2010).
The aim of this study is to identify the scope and psychosocial risk and protective factors among middle school students in Campeche, Mexico, using data of a statewide probability survey about recent drug use, binge alcohol use, depression, suicide ideation and attempts, as well as self-inflicted injuries. In addition, to overcome limitations of prior research based on single-indicator models, we used latent class analysis to identify groups in the population accounting for individuals' recent drug use, binge alcohol use, depression, suicide ideation and attempts, as well as self-inflicted injuries. In other words, we ask if people's behaviors can be used to identify existing groups in the population that are not directly observable (i.e., latent classes), which may be relevant when designing preventive interventions. The second step in the analyses included multinomial logistic regression models to study associations between membership in each of the latent classes and selected covariates. The information sheds light into the scope of the problem and potential public health alternatives.
Section snippets
Methods
The present study is one of the outcomes of a partnership between a national health research institute and the state and local government health and education agencies of Campeche in 2012–2013. An earlier publication in Spanish describes the study design and the association between suicidal ideation, drug use, and depression (González-Forteza et al., 2015).
Results
The sample included 2383 randomly selected middle-school students from the State of Campeche, Mexico, (mean age = 13.30 years, standard deviation = 1.02, range was 11–16 years). An estimated 49.43% were females, and evenly distributed in each of the three middle-school grades, as shown in Table 1.
The best fit to the data was achieved with a four-latent class model based upon the AIC, BIC, Sample-size Adjusted BIC, and Model Entropy, as well as interpretability criteria with statistical summaries of
Discussion
We launched this investigation to assess the scope of suicidal behaviors in Campeche and to study factors that may be associated with increased or reduced risk with focused interest on psychosocial factors highlighted in the literature (González-Forteza et al., 2003, Larsson and Sund, 2008, Tang et al., 2009). An estimated 8% of the middle school population in Campeche, aged 12–16 years, had three or more psychosocial problems in the past month including drug use; severe or sub-threshold
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Acknowledgments
The present study received support from the Fondo Mixto de Fomento a la Investigación Científica y Tecnológica CONACYT-Gobierno del Estado de Campeche (grant FOMIX M03-2011-04-177446). An earlier version of this manuscript was presented at the XVI World Congress of Psychiatry (Madrid, Spain, September 2014). The authors report no conflict of interest, otherwise.
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