The global and regional burden of sexual behaviors and food insecurity and their combined association on the magnitude of suicidal behaviors among 121,248 adolescent girls: An international observational study in 67 low- and middle-income and high-income countries
Category:- Journal; Year:- 2021
Discipline:- Development Studies Discipline
School:- Social Science School
Abstract
Food insecurity and early sexual behaviors increase the risk
of suicidal behavior, however their combined association on social behaviors
receive little attention. Therefore, this study estimated the magnitude of
adolescent global suicidal burden, it correlates with food insecurity and
sexual behaviors, and assessed the combined association of food insecurity and
sexual behaviors on the burden of suicidal behaviors (SBs) among school-going
adolescent girls aged between 11 and 17 years. Methods The study design is
multi-county, 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 behaviors. Multinomial logistic regression analyses were
employed to estimate the adjusted effect of independent factors and the
combined associations of sexual behaviors and food insecurity on adolescent SBs
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 (SBs) 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 SBs varied according to
type of sexual behaviors and the age. The burden of SB among girls who had
sexual intercourse with 1–2 sex partners, 3–4 sex partners, or >4 sex
partners was 11.49%, 13.28%, or 18.43%, respectively. The high-level SB was
double (23.08%) among adolescent girls who had first sexual intercourse aged
11–13 years old compared to adolescent girls aged 14–17 years (11.49%). The
burden of SBs (for at least one SB, for two SBs, or for three SBs) were
significantly associated with adolescent girls who experienced sexual
intercourse (relative risk ratio, 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), sexual intercourse
with four or more sex partners (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; RRR = 2.26, 1.81–2.83), compared to
adolescents who had no experience of SBs. Compared to adolescent girls who did
neither experience food insecurity nor sexual intercourse, the overall burden
of SBs (for at least one SB, for two SBs or for three SBs) were significantly
higher among girls reporting to have experienced both food insecurity and
sexual intercourse (RRR = 1.55, 1.29–1.86; RRR = 1.70, 1.42–2.04; RRR = 1.54,
1.26–1.88); and those reporting having experienced food insecurity but have
never had sexual intercourse (RRR = 1.66, 1.48–1.87; RRR = 1.45, 1.26–1.67; RRR
= 1.62, 1.36–1.92). However, it was significantly lower among girls reporting
to have had sexual intercourse but never experienced food insecurity. This
association was extended among adolescents in the context of regional and
country income groups. Conclusion The high burden of suicidal behaviors among
adolescents calls for an urgent policy interventions to address food insecurity
as a means to keep adolescents in school. The interventions should also aim to
integrate safeguards that dissuade youngsters from early sex and protect them
from sexual victimisation, and the associated adverse outcomes that that
hamstring the attainment of SDG 3.4.2.