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Gender difference in suicidal expressions and it's determinants among young people in Cambodia, a post-conflict country
Center for Child and Adolescent Mental Health, Chey Chumneas Hospital, Cambodia .
Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
2011 (English)In: BMC Psychiatry, ISSN 1471-244X, Vol. 11, no 1, 47- p.Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Suicide among young people is a global public health problem, but adequate information on determinants of suicidal expression is lacking in middle and low income countries. Young people in transitional economies are vulnerable to psychosocial stressors and suicidal expressions. This study explores the suicidal expressions and their determinants among high school students in Cambodia, with specific focus on gender differences.

METHODS: A sample of 320 young people, consisting of 153 boys and 167 girls between 15-18 years of age, was randomly selected from two high schools in Cambodia. Their self-reported suicidal expressions, mental health problems, life-skills dimensions, and exposure to suicidal behavior in others were measured using the Youth Self-Report (YSR), Life-Skills Development Scale (LSDS)-Adolescent Form, and Attitude Towards Suicide (ATTS) questionnaires.

RESULTS: Suicidal plans were reported more often by teenage boys than teenage girls (M=17.3%, F=5.6%, p=0.001), whereas girls reported more attempts (M=0.6%, F=7.8%, p=0.012). Young men scored significantly higher on rule-breaking behavior than young women (p=0.001), whereas young women scored higher on anxious/depression (p=0.000), withdrawn/depression (p=0.002), somatic complaints (p=0.034), social problems (p=0.006), and internalizing syndrome (p=0.000). Young men exposed to suicide had significantly higher scores for internalizing syndrome compared to those unexposed (p=0.001), while young women exposed to suicide scored significantly higher on both internalizing (p=0.001) and externalizing syndromes (p=0.012). Any type of exposure to suicidal expressions increased the risk for own suicidal expressions in both genders (OR=2.04, 95% CI=1.06-3.91); among young women, however, those exposed to suicide among friends and partners were at greater risk for the serious suicidal expressions (OR=2.79, 95% CI=1.00-7.74). Life skills dimension scores inversely correlated with externalizing syndrome in young men (p=0.026) and internalizing syndrome in young women (p=0.001).

CONCLUSIONS: The significant gender differences in suicidal expressions and their determinants in Cambodian teenagers highlight the importance of culturally appropriate and gender-specific suicide prevention programs. School-based life skills promotion may indirectly influence the determinants for suicidal expressions, particularly among young women with internalizing syndrome in Cambodia.

Place, publisher, year, edition, pages
BioMed Central, 2011. Vol. 11, no 1, 47- p.
Keyword [en]
mental-health; general-population; adolescent suicide; youth; risk; ideation; prevention; nicaragua; behaviors; children
National Category
Psychiatry
Identifiers
URN: urn:nbn:se:umu:diva-41655DOI: 10.1186/1471-244X-11-47ISI: 000289351600001PubMedID: 21418649OAI: oai:DiVA.org:umu-41655DiVA: diva2:407464
Available from: 2011-03-30 Created: 2011-03-30 Last updated: 2014-04-25Bibliographically approved
In thesis
1. ‘Striving to negotiate… dying to escape’: suicidal expressions among young people in Cambodia
Open this publication in new window or tab >>‘Striving to negotiate… dying to escape’: suicidal expressions among young people in Cambodia
2014 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Background Suicide among young people is a global public health problem, but information on determinants and understanding of suicidal expressions are lacking in low and middle income countries (LMIC). Though school-based interventions are common in many parts of the world, evidence for efficacy is less reported, particularly from post-conflict countries.

Aim To explore suicidal expressions and their determinants with psychosocial and gender perspective in Cambodia and Nicaragua and to evaluate a school based intervention to promote mental health and prevent suicidal behavior among young people in Cambodia.

Method School students between the age of 15-19 from Cambodia and Nicaragua responded to Attitude Towards Suicide (ATTS) and Youth Self-Report (YSR) questionnaires. In addition, Life Skill Dimension Scale Adolescent Form (LSDS-AF) was used in schools in Cambodia, one experimental and the other control, to measure the impact of intervention. Six focus group discussions (FGDs), both gender-specific and mixed groups, were held to understand young people’s perception of gender, culture, religion and media and their impact on suicide among them.

Results Paper I. Revealed few gender differences in suicidal expressions, except girls reporting more attempts than boys. Girls exposed to suicide among friends and partners were likely to report own suicidal expressions and girls with internalizing syndrome were at risk for suicidal expressions.   

Paper II. Cambodian teenagers reported more mental health problems but fewer suicidal expressions as compared to Nicaragua. The determinants varied between countries.  

Paper III. Participants of FGDs mentioned “Plue Plun” male and “Kath Klei” female to describe gender difference in suicidal behavior among young people in Cambodia who found it a challenge to negotiate between traditional and modern values.

Paper IV. Suicide ambiguity in Buddhism, stigmatizing culture and double edged media were seen as suicide-provoking by the young people in Cambodia, who recommended peer-focused, school based program.

Paper V. School based Life Skills Intervention overall benefited girls. Boys with high risk behavior had shown improvement on many Life Skills dimensions, as well as in their mental health profile.

Conclusion The gender and cultural differences in suicidal expressions and their determinants among teenagers emphasize the importance of culturally sensitive and gender-specific suicide prevention programs. The influence of religion and media ought to be considered while planning intervention programs. School-based program may be a window of opportunity to promote mental health and prevent suicide among young people in Cambodia.

Place, publisher, year, edition, pages
Umeå: Umeå University, 2014. 49 p.
Series
Umeå University medical dissertations, ISSN 0346-6612 ; 1643
Keyword
Suicidal expressions, Young people, Cambodia
National Category
Psychiatry
Identifiers
urn:nbn:se:umu:diva-88195 (URN)978-91-7601-041-9 (ISBN)
Public defence
2014-05-16, Föreläsningssal A, Psykiatriska kliniken, By 23, Norrlands universitetssjukhus, Umeå, 09:00 (English)
Opponent
Supervisors
Available from: 2014-04-25 Created: 2014-04-25 Last updated: 2014-04-25Bibliographically approved

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