Publications & Reports

The global and regional burden of sexual behaviours and food insecurity and their combined association on the magnitude of suicidal behaviours among 121,248 adolescent girls: An international observational study in 67 low- and middle-income and high-income countries.

Mahumud RA, Rahman MA, Gow J, Kamara JK, Koly KN, Shahjalal M, Law CK, Hossain MG, Renzaho AMN


BACKGROUND: Food insecurity and sexual victimisation increase the risk of suicidal behaviour, however their combined association on social behaviours receive little attention. Therefore, this study estimated the magnitude of adolescent global suicidal burden and assessed the combined association of food insecurity and sexual behaviours on the burden of suicidal behaviours among school-going adolescent girls aged between 11-17 years. METHODS: The study design is multicounty and pooled cross-sectional in nature. Data for 67 countries from the Global School-based Student Health Survey (GSHS) were used. A random-effects meta-analysis was used to generate national and overall pooled estimates of suicidal behaviours. Multinomial logistic regression analyses were employed to investigate the combined associations of sexual behaviours and food insecurity on adolescent suicidal behaviours in the context of global, regional, and country income groups and adjusted by a set of explanatory factors. RESULTS: The study included 121,248 girls aged 11-17 years. The population-weighted prevalence of high-level suicidal behaviours was 40.65% among school-going girls who experienced sexual intercourse and 7.41% among those who reported severe food insecurity. However, the burden of suicidal behaviours varied according to type of sexual behaviours and the age. The burden of suicidal behaviour among girls who were sexually victimised by 1-2 persons, 3-4 persons, or >4 people was 11.49%, 13.28%, or 18.43%, respectively. The high-level suicidal behaviour was double (23.08%) among adolescent girls who were sexually victimised aged 11-13 years old compared to adolescent girls aged 14-17 years (11.49%). The burden of suicidal behaviours (for at least one suicidal behaviour, for two suicidal behaviours, or for three suicidal behaviours) were significantly associated with adolescent girls who experienced sexually victimised (relative risk ratios, RRR= 2.04, 95% confidence interval, CI:1.83-2.28; RRR=2.24, 1.99-2.52; RRR=1.86, 1.59-2.18), sexually victimised with four or more persons (RRR=1.44, 1.15-1.79; RRR=1.65, 1.33-2.06; RRR=2.47, 1.94-3.16), first sexual intercourse aged 11-13 years (RRR=1.22, 1.02-1.46; RRR=1.51, 1.26-1.82; for three suicidal behaviours, RRR=2.26, 1.81-2.83) were significantly associated with higher suicidal burden compared to adolescents who had no experience of suicidal behaviours. The burden of three suicidal behaviours was significantly higher among those reporting experiencing both food insecurity and sexual intercourse (RRR=1.54, 1.26-1.88) and experiencing food insecurity only but not sexual intercourse (RRR=1.62, 1.36-1.92) compared to adolescent girls who did neither experience food insecurity nor sexual intercourse. This association was extended amongst adolescents in the context of regional and country income groups. CONCLUSION: The high burden of suicide occurrences among adolescents calls for an urgent need for gender and culturally sensitive policy interventions to address food insecurity and sexual victimisation among young people to prevent premature deaths, promote mental health and well-being, and to accentuate the roadmap to achieving SDG3.4.2.

Link to publisher’s web site


  • Journal: Journal of Affective Disorders
  • Published: 01/01/2022
  • Volume: 298
  • Pagination: 481-491