BACKGROUND: Suicide is the fourth leading cause of death among American adolescents. The Youth Risk Behavior Survey (YRBS), which provides state-level estimates of health-related behaviors of high school and middle school students, can help identify Hawaii-specific factors associated with youth suicidal ideation. This information can help guide policies and programs.
METHODS: We analyzed data from 6,089 high school and 6,374 middle school respondents from the 2015 Hawaii YRBS. High school questions asked about experiences in the past 12 months, whereas middle school questions were about lifetime experiences. Respondents were categorized as having suicidal ideation if they seriously considered attempting suicide in the past 12 months (high schoolers) or ever (middle schoolers). We used multivariate logistic regression and calculated adjusted odds ratios (AORs) for associations between suicidal ideation and potential risk factors: sex, being bullied (in school or online), self-reported depressive symptoms, alcohol consumption in the previous 30 days, forced sexual intercourse, sexual orientation (high school only), and protective factors: having an adult at school to talk with about problems, and having an adult outside school to talk to about important things.
RESULTS: Overall, 16.0 % (95%CI=14.2-18.1) of high schoolers reported suicidal ideation in the past 12 months and 24.8% (95% CI=22.1-27.7) of middle schoolers reported ever having suicidal ideation. High schoolers with suicidal ideation were more likely bullied in the past 12 months (AOR=1.7, 95%CI=1.2-2.4), depressed in the past 12 months (AOR=9.0, 95%CI=6.2-13.1), forced to have sex (AOR=1.8, 95% CI=1.3-2.7), recently consumed alcohol (AOR=1.5, 95% CI=1.1-2.1), or identified as gay, lesbian, or unsure (LGBQ) (AOR=2.3, 95%CI=1.5-3.5). Middle schoolers with suicidal ideation were more likely to be female (AOR=1.7, 95% CI=1.4-2.1), bullied (AOR=2.4, 95% CI=1.8-3.2), depressed (AOR=6.1, 95% CI=4.6-8.1), forced to have sex (AOR=2.5, 95% CI=1.5-4.1), and recently consumed alcohol (AOR=2.2, 95% CI=1.7-2.8). Having an adult to talk to outside school was associated with lower risk for high schoolers (AOR=0.7, 95%CI=0.5-1.0) and middle schoolers (AOR=0.6, 95% CI=0.5-0.9). Having an adult at school to talk to was associated with lower risk for middle schoolers (AOR=0.7, 95% CI=0.5-0.8).
CONCLUSIONS: Depression, being bullied, forced sexual intercourse, alcohol consumption, and LGBQ orientation were associated with a higher risk of suicidal ideation among Hawaii students, while having an adult to talk to was associated with a lower risk. Schools and communities can work to prevent and handle bullying, alcohol consumption, and forced sexual intercourse. Students at high risk of suicidal ideation should be identified and provided with appropriate adult support.