الفهرس 
SuicideOnly 14 pages are availabe for public view
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Abstract
Suicide is a leading cause of death among adolescent; however, many more adolescents are at risk for suicide because of experiencing suicidal ideation, making suicide plans, and attempting suicide, making a focus on nonfatal suicidal behaviour a crucial public health priority. During 2009–2019, trends in suicide attempts among adolescents increased overall and among many demographic groups. Factors at the individual, relationship, community, and societal levels likely contribute to the differences in suicide attempts among adolescent and the differences observed by sex and grade. More research is needed to better understand the risk and protective factors to determine which suicide prevention strategies might best serve each group. The findings in this report underscore the importance of a comprehensive approach to suicide prevention, which would provide necessary support to those at risk, decrease suicidal ideation and behaviours, and ultimately prevent suicide among youths and save lives.
In a survey of over 15,000 adolescent students, 13 % reported having ever seriously considered attempting suicide and 8% reported attempting suicide at least once. Rates of suicidal ideation, plans, and attempts are far higher among this age group than older adults. Fewer studies have examined whether students thinking about suicide tell others about these thoughts, though one study found that almost half (46%) of adolescent students who seriously considered attempting suicide in the past year did not tell anyone else about their thoughts.
Adolescent students’ suicides were thought to be mediated by a wide range of factors including excessive academic stress, relationship problems, family problems, hopelessness, financial stress, feelings of social isolation, work problems, exposure to trauma, alcohol and drug use, and other mental health problems. Furthermore, adolescent student suicide rates were reportedly higher than those of the general population, and in some cases, it rises to 3-5 times higher than that of the public.
The goal of this study is to determine frequency of suicidal ideation and behaviour and to determine risk factors associated with suicidal ideation and behaviours in adolescent high school students in Cairo.
The study was carried out from September 2021 till June 2022, it was cross-sectional study using Epi Info 7 program for sample size calculation and assuming 10% prevalence of suicidal ideation and behaviour, with margin of error = 2.5 and at 95% confidence level, sample size of 553 persons needed, 184 from each school divided between male and female students (92 each), A probabilistic sample by clusters of 100 students, in various stages, was estimated for an expected prevalence of 10% for suicide ideation, a margin of error of 2%, a confidence level of 95%, and replacement for losses of 25%.
The inclusion criteria were both males and females’ Egyptian students, aged 14 to17 after taking informed written consent from guardian and assent from adolescents themselves, on the other hand, the exclusion criteria were students with chronic medical illness, or students who refuse to give informed consent.
The students were assessed by using the following tools: Suicide Probability Scale (SPS) to estimate the risk of suicide including hopelessness, suicidal ideation, Negative self-evaluation, and Hostility, the second tool was GHQ-28 to estimate the probability of psychiatric illnesses.
Socio-demographic data of the results were as the following, 11.03 %, Suicidal attempts were more common in females 12.9 %, than male 8.2%, the whole students were 553, 39.7%of them were males, regarding residence 78.8% were urban from the start, the rest were rural then become urban now. 12% of the studied subjects were smokers. 97.5% of Students were Single, 2.5% are engaged but not married and all of them were female, regarding home atmosphere 75.8% were Harmonious. Regarding financial status 73.2% were adequate. 13.7% had positive family history of psychiatric illness and 0.7% had positive family history of suicide. But according to GHQ_28, 17.54% had moderate or severe risk for psychiatric illness, and regarding to positive history of Nonsuicidal self-injury (NSSI) 100 students represent 18% of whole population, 21.3% female versus 13.2% male.
Using SPS, suicide probability of 31.2% of our sample were severe with mean probability score of 44±68. It was maintained that the mean scores of the hopelessness were high, whereas the mean scores were comparatively lower for the hostility, suicidal ideation, and negative self-evaluation. Our study shows a significant statistically difference between 1st and 3rd year students with first-year students’ scores higher than third-year students regarding hopelessness, suicidal ideation, negative self-evaluation, SPS TW score and total probability score. It showed significant difference between 1st and 3rd year students regarding clinical classification of suicide probability as severe cases were the highest among 1st year students (39.2%), while subclinical cases were the highest among 3rd year students (37.6%).
Regarding suicide probability scale, mean hopelessness was 27.2 ± 7.84, mean suicidal ideation was 19.32 ± 6.51, mean negative self-evaluation was 16.55 ± 5.78, and mean hostility was 14.82± 5.23, while mean SPS score was 73.4 ± 21.36, and mean probability score was 53.62 ± 13.13. Suicide probability scores of 492 (89%) of the students were subclinical, 29 (5.2%) were mild, 19 (3.4%) were moderate, and 13 (2.4%) were severe
Regarding GHQ-28, mean of no risk group was 3.2 ± 2.67, mean of moderate risk group was 9.1 ± 2.73 and mean of severe risk group was 17.8 ± 4.9, probability scores of 456 (82.5%) of the students were no risk, 61 (11%) were moderate, 36 (6.5%) were severe.
There was significant statistical difference among different grades of secondary school according to different sociodemographic variable, which were gender, residence, marital status, love affair, home atmosphere, financial status, smoking, family history, probability of psychiatric illness, suicidal history and nonsuicidal self-injury (NSSI).
The difference between different grades of secondary school, were as the following, students of first and second-year students are higher than third-year students regarding hopelessness, suicidal ideation, negative self-evaluation, SPS TW score, probability score, on the other hand, moderate and severe risk of psychiatric illness is higher in the 1st year than 2nd and 3rd years.
Regarding clinical severity, there was a high statistically significant difference between different grads, where severe cases were the highest among 3rd year students (2.8%), while subclinical cases were the highest among 2nd year students (91.5%).
from the start there were clear relation between SPS and GHQ, where there was positive relationship between subclinical group of SPS and no risk group of GHQ-28, and between severe group of SPS and Severe risk group of GHQ-28, but there was negative relationship between subclinical group of SPS and severe risk group of GHQ-28, and severe group of SPS versus no risk of GHQ-28.
When we compared different group of GHQ-28 we found that the No risk group represented most of the students of all grades then the moderate group then the severe group was the least, and there was significant statistical difference between different sociodemographic variables like age, residence, marital status, love affairs, home atmosphere, financial status smoking and psychiatric illnesses.
There was also significant statistical difference between 1st ,2nd and 3rd year students regarding GHQ-28 findings where moderate and severe risk groups are higher in the 1st year than second and third years.
There was a high statistically significant difference between different grads of secondary school students regarding clinical classification. It showed that severe cases were the highest among 3rd year students (2.8%), while subclinical cases were the highest among 2nd year students (91.5%).
In the 1st year students, the mean age in severe group was significantly higher compared to subclinical and mild groups. Regarding sex, there was significant female predominance in all groups. There was statistically significant difference between four groups regarding residence and living in urban areas and other parameters. the relationship between probability of mental health problems as measured by the GHQ-28 and suicide probability is positive relationship.
In the 2nd year students, the mean age in subclinical group was significantly higher compared to severe group. But regarding sex, there was significant female predominance in all groups. and there was significant difference in another parameter.
In 3rd year students there was a significant statical difference between clinical classes of regarding age, gender, residence, marital status, love affairs, home atmosphere, financial status, smoking and positive family history of psychiatric illness and psychiatric illness in the adolescents themselves.
There was significant difference between different variable regarding different group of GHQ-28 in 1st, 2nd and 3rd year students, and there was significant relation between GHQ-28 and SPS of all grades.
Regarding 1st year students, there was a significant positive correlation between suicide probability score with age and total GHQ-28 score. Regarding 2nd year students, there was no statistically significant correlation between suicide probability score with age but still there was statistically significant correlation between suicide probability score with total GHQ-28 score. Regarding 3rd year students, there was statistically significant correlation between suicide probability score with age and total GHQ-28 score.
On the other hand, regarding 1st, 2nd and 3rd years students, there was a significant positive correlation between total GHQ-28 score and different variables of SPS score.
Recording 1st year students, multiple regression analysis showed that +ve personal history of suicidal attempts, psychiatric illnesses of adolescents themselves (high score of GHQ_28 more than 12), +ve family history of psychiatric, +ve personal history of suicidal thoughts and Nonsuicidal self-injury (NSSI) were significantly associated with higher suicidal score.
Regarding 2nd year students, multiple regression analysis showed that +ve personal history of suicidal attempts, +ve family history of psychiatric illnesses, +ve personal history of suicidal thoughts, Nonsuicidal self-injury (NSSI), +ve family history of suicide, were significantly associated with higher suicidal score.
Regarding 3rd year students, multiple regression analysis showed that +ve personal history of suicidal attempts, +ve family history of psychiatric illnesses, +ve personal history of suicidal thoughts, psychiatric illnesses of adolescents themselves (high score of GHQ_28 more than 12) were significantly associated with higher suicidal.
These findings can contribute to the understanding of suicidal behaviours among school adolescents. With this, it offers a basis for the design of actions in different contexts, culturally adapted, for the reduction of suicide risk amidst school adolescents.