We found that suicide expression here (16%) was lower than reported rates elsewhere in the SSA region (20–36%) using a comparable period of recall [10
], but similar to those in HIC settings [21
]. Higher average living standards and greater stability in the Seychelles, as compared with countries in the region, may partially explain these differences [22
]. A favorable social context may potentially mitigate suicidal expression among adolescents, including social cohesion linked to the Creole culture, comprehensive education and health care services which are available free of cost, high community involvement due to the small size of the country, and low unemployment.
Suicidality is reported in the literature as being a non-specific marker for a broad range of psychosocial distresses such as political unrest and poor life quality [23
]. These have been previously shown to negatively impact mental health at the individual level, potentially to the extent of self-harm [24
]. While SI in the present sample was less prevalent among older adolescents, no significant association between age and SISP was found when other covariates were added to the model. This is in contrast to previous research which suggests that suicidality among those at risk increases after age 14 years. This may be due to increasing social pressures and expectations about pending adulthood [26
]. In the Seychelles however, several government sponsored efforts exist to allow, for example, to pursue post secondary education and to find employment for school leavers, which can ease the transition between adolescence and adulthood.
Females were more likely to have reported planning a suicide attempt. This was consistent with findings elsewhere in the region [18
] and internationally [27
]. Other gender sensitive research on suicide suggests that while females may be more likely to think about suicide, males were more likely to successfully complete a suicide attempt [29
]. Signs of depression and loneliness were both associated with SI and SISP, a finding which was congruent with other research highlighting mental ill-health as one important factor in suicidality [30
Unlike prior research which informed that food deprivation was associated with higher rates of SI [5
], we were not able to replicate this finding in the present sample. One hypothesis might be that although some participants reported not having enough food in the home, they may have had access to food while in school. Additionally, in the tropical climate of the Seychelles, fruits and vegetables are widely accessible throughout the year. It is also plausible that other factors such as family or sibling support offer protective mechanisms which confound associations between suicidality and food deprivation [31
Consistent with prior research, tobacco use was elevated among adolescents with suicidal ideation [32
]. We found that tobacco was use significantly associated with higher rates of self-reported SI and SISP. This may be related to evidence which supports tobacco use being used as a coping mechanism for negative life events, anger and stress [34
], or other stressful situations such as physical transformation, sexuality, independence and social pressures [4
Our finding that not having close friends was associated with an increase in suicidal expression, was congruent with the literature [30
]. Adolescence is a period during which the formation of peer groups and friendships is an important aspect of their psychosocial development. Not having friends or being excluded from desirable peer groups, can have negative consequences for individual well-being and mental health [36
]. Parent influence on the social behavior of children decreases during adolescence, with increased influence from peers [37
]. However, our results demonstrate that parents may too play an important supportive role in the socialization process. Having understanding parents in our sample was associated with lower rates of SISP. This potentially suggests that adolescents who have open communication with their parents may be more likely to address their concerns.
After adjusting for covariates, we found no association between suicidal expression and parent knowledge about their child’s free time activities. Other research presented mixed results upon examining the link between parent supervision and adolescent suicidal expression. For example, among 2,598 pre/early adolescents in the United States, it was found that parent supervision played a significant role in reducing suicidal expression, but mainly among girls [38
]. Other research has suggested that low parental monitoring, was independently associated with increased suicide expression [39
]. Another longitudinal study provided even more inconclusive information - that parental vigilance was associated with increased rates of suicidality [40
We found that reported rates of suicidal expression did not increase among those who reported being bullied, a finding not consistent with the literature [41
]. Prior research from the Seychelles using similar measures and a similar period of recall, found that mental well-being declined in the presence of bullying [17
]. However, this decline in mental health, may not have been sufficiently severe as to demonstrate higher levels of suicidal expression. It is also plausible that bullying rates among those who were victimized were underreported, thus obscuring the association with suicidal expression.
Despite research highlighting increased substance and alcohol use among those with suicidal expression [42
], we were unable to replicate previous research findings using the current sample. One hypothesis concerning alcohol, may be the fact that other research considers alcohol use and not alcohol misuse as a correlate as was done in the present study. Thus there still exists the discrete possibility that alcohol use may be correlated with suicidal expression in the current sample, but misuse was not. The lack of an association with substance use may be explained by limitations in the data. Roughly 14% of all respondents reported some form of substance use during their lifetimes. It is likely that most of the substance use was due to experimentation, rather than as a coping mechanism in the presence of mental ill health. Furthermore, it is difficult to assess alcohol intake by use of a questionnaire, and imprecision in assessment of alcohol intake tends to drive an association to the null [44