Bullying victimization and suicide attempt among adolescents aged 12-15 years from 48 countries

Objective: Adolescent suicide is a global public health problem. Bullying is a risk factor for suicidality in adolescence; however, global data on its association with suicide attempts are lacking, and data from low- and middle-income countries (LMICs) and non-Western settings are scarce. Thus, we assessed the association between bullying victimization and suicide attempts using data from 48 countries (predominantly LMICs) across multiple continents. Method: Data from the Global School-based Student Health Survey were analyzed. Data on past 12-month suicide attempts and past-30 day bullying victimization were collected. Multivariable logistic regression and meta-analysis with random effects were conducted to assess the associations. Results: The final sample consisted of 134,229 adolescents aged 12-15 years. The overall prevalence of suicide attempts and bullying victimization were 10.7% and 30.4%, respectively. After adjustment for sex, age, and socioeconomic status, bullying victimization was significantly associated with higher odds for a suicide attempt in 47 of the 48 countries studied with the pooled OR being 3.06 (95%CI=2.73-3.43). Greater number of days bullied in the past month was dose-dependently associated with higher odds for suicide attempts. The past-year prevalence of suicide attempts ranged from 5.9% for the “no bullying” group up to 32.7% for the “being bullied for 20-30 days/month” group [OR=5.51 (95%CI=4.56-6.65)]. Conclusion: Bullying victimization may be an important risk factor of suicide attempts among adolescents globally. Thus, there is an urgent need to implement effective and evidence-based interventions to address bullying in order to prevent suicides and suicide attempts among adolescents worldwide.