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Social Determinants of Suicidal Ideation Among Adolescents in Rural Bangladesh

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Social Determinants of Suicidal Ideation Among Adolescents in Rural Bangladesh Social Determinants of Suicidal Ideation among Adolescents in Rural Bangladesh Afroza Begum Main supervisor: Gloria Macassa, Professor Co-supervisors: Joaquim Soares, Professor, AKM Fazlur Rahman, Professor, Eija Viitasara, Associate Professor, Hamid Reza Khankeh Professor Faculty of Human Sciences Thesis for Licentiate degree in Health Sciences Mid Sweden University Sundsvall, 2021-02-26 Akademisk avhandling som med tillstånd av Mittuniversitetet i Sundsvall framläggs till offentlig granskning för avläggande av filosofie licentiatexamen fredagen den 26 februari 2021, klockan 10:00 via Zoom, Mittuniversitetet, Sundsvall. Seminariet kommer att hållas på engelska. Social Determinants of Suicidal Ideation among Adolescents in Rural Bangladesh © Afroza Begum, 2021-02-26 Printed by Mid Sweden University, Sundsvall ISSN: 1652-8948 ISBN: 978-91-88947-90-1 Faculty of Human Sciences Mid Sweden University, SE-851 70 Sundsvall Phone: +46 (0)10 142 80 00 Mid Sweden University Licentiate Thesis Number 177 To my beloved parents To my beloved daughters, Tasneem and Tashfia To my beloved husband And To my beloved brother Acknowledgement I feel deeply indebted to Almighty Allah and a great many people whose inspiration and support enabled me to complete my thesis. In particular, I would like to thank my main supervisor Professor Gloria Macassa, for her invaluable guidance, encouragement, academic inspiration and generous help. From the inception of this thesis to its completion, she has contributed so much to my studies. She was always there for me whenever I needed assistance and suggestions throughout my writing. I gained not only the knowledge, but the rigorous scientific approach and spirit of dedication to the work that needed to be done. Her steady, reliable supervision enabled me to complete this challenging project. Professor Joaquim Soares, my co-supervisor, for giving me practical guidance and encouragement in my study. Professor AKM Fazlur Rahman, my co-supervisor, for his overwhelming support in collecting data on suicidal ideation as well as for sharing his immense knowledge, scientific assistance and comments in my licentiate studies. I will always remember his encouragement to keep writing and moving forward. Associate Professor Eija Viitasara, my co-supervisor, who always had words of encouragement and enthusiastically offered assistance in any way she could throughout the research project. Professor Hamidreza Khankeh, University of Social Welfare and Rehabilitation Science, my co-supervisor, a true personality, his patient support for my study plan encouraged me to continue the studies. Professor Sadiqa Tahera Khanam, former director and professor at MCH, NIPSOM and my MPH supervisor, for her support during different stages of my thesis. She has always been extremely accommodating whenever I had a question about my research or writing. Professor Shamsun Nahar, professor of community medicine, King Khaled University, Abha, Saudi Arabia and Dr. Meera Momtaz Sabeka, consultant neurologist, East Kent Hospital, UK, my best friends and ex-colleagues who inspired me and helped me throughout my PhD studies. Professor Jahanara Begum and Professor Mahmudul Haque, my dear ex-colleagues at NIPSOM, for their tremendous assistance while completing my studies. Dr. Aminur Rahman, director, Dr. Saidur Rahman Mashreky, director, Md. Al-Amin Bhuiyan, deputy team leader and Md. Abu Talab, senior statistician at CIPRB, for all their support during my studies. The data collectors and respondents whose efforts made data collection successful on this sensitive issue. Last but not least, I owe so much to my dear parents, Md. Abul Hossain and Rizia Khanom. Their unwavering love and confidence in me have encouraged me to keep moving forward in my study and career. I express my gratitude to all my beloved family members, my husband H. M. Akhter Khan, daughters Takfi Tasneem, Tashfia Kawakib, my brother Iqbal Hossain and sister-in-law Nupur for their understanding, support and encouragement to finish my studies. Table of Contents Abstract .............................................................................................................. ix List of Papers ..................................................................................................... xi List of Abbreviations ........................................................................................ xii 1. Introduction ..................................................................................................... 1 2. Background ..................................................................................................... 2 2.1 Suicidal Ideation Worldwide ........................................................................ 2 2.2. Suicidal Ideation in Developing Countries and Asia ................................ 3 2.3. Suicidal Ideation in Bangladesh ................................................................ 5 3. Determinants of Suicidal Ideation among Adolescents ............................. 7 3.1 Biological and Psychological Determinants .............................................. 7 Biological Risk Factors .................................................................................. 7 Psychological Risk Factors ........................................................................... 8 3.2. Environmental Determinants ...................................................................... 9 3.3. Socio-Economic Determinants ................................................................ 10 4. Conceptual Model ......................................................................................... 11 5. Rationale ....................................................................................................... 11 6. Objectives ..................................................................................................... 13 6.1 General Objective: ...................................................................................... 13 6.2. Specific Objectives .................................................................................... 13 7. Method ........................................................................................................... 13 7.1. Setting and Participants ........................................................................... 13 7.2. Study Sample and Design ........................................................................ 14 7.3. Sampling Procedure .................................................................................. 14 7.4. Survey Procedure ...................................................................................... 15 7.5. Measurement of Variables ........................................................................ 16 7.5.1. Dependent Variable .......................................................................... 16 7.5.2. Independent Variables ...................................................................... 16 7.6. Statistical Analyses ................................................................................... 16 7.7. Ethical Considerations .............................................................................. 17 8. Results ........................................................................................................... 18 8.1. Study 1 ........................................................................................................ 18 8.2. Study 2 ........................................................................................................ 20 9. Discussion .................................................................................................... 24 9.1 Prevalence of Suicidal Ideation among Adolescents and Young Adults in Rural Bangladesh ......................................................................................... 24 9.2. Parental Socio-Economic Status and Suicidal Ideation among Adolescents in Rural Bangladesh .................................................................. 25 9.3. Strengths and Limitations ........................................................................ 26 9.4. Future Research ........................................................................................ 26 10. Conclusions ................................................................................................ 27 11. References .................................................................................................. 28 Abstract Background and Objective: Suicide is a leading cause of death and a critical public health problem among adolescents worldwide. However, adolescent suicidal behavior is a neglected public health issue, especially in low- and middle-income countries, such as Bangladesh. There is evidence from developed countries showing that suicidal ideation (SI) among adolescents is related to social indicators as well as individual risk factors. Scarce evidence from studies in low- and middle-income countries suggests that social factors may influence adolescent SI. In Bangladesh, only a few studies have focused on the social determinants of suicide, and the present study is the first to examine the prevalence and social determinants of suicidal ideation among adolescents in rural Bangladesh. Therefore, the present thesis assessed the effects of socioeconomic status (SES) on adolescent SI. Methods: The present thesis is based on two studies, which used data from a cross- sectional survey conducted in 2013 among 2,476 adolescents aged 14-19 years selected randomly
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