Prevalence of Suicidal Ideation among Iraqi Secondary School Students in Babylon Province During the Academic Year 2016-2017

Hasan Alwan Baiee,Zainab Fadhil Kizar,Huda Salman Jasim,Suha Sheehan Jasim
Authors Emails are requested on demand or by logging in
Keywords : Suicidal ideation, Students, secondary school, Iraq.
Medical Journal of Babylon  14:3 , 2018 doi:1812-156X-14-3
Published :08 January 2018


The impact of the importance of suicide in our society should not be neglected or overlooked. It is an important cause of death specially among adolescents . Suicide behavior is increasing in developing countries including Iraq during last decades. This was a cross sectional school based epidemiologic study which was conducted during the period from February to May, 2017. The aim of this study was to identify the prevalence of twenty four months and the correlates of suicidal ideation among the 4th and 5th grades secondary school students. Five secondary schools were selected randomly (one male, one female and three mixed secondary schools), a multi stage sampling technique was used to select 420 students from the 4th and 5th grades after obtaining their verbal consents. A self-filled questionnaire(prepared from the Global School Health Survey) was used to collect data. Results revealed that about half of the participants (49.5%) mentioned that they were having thoughts of engaging in behavior intended to end their lives, females were significantly having higher rate (55%)of suicidal ideations p<0.05. There were a significant relationship between suicidal ideations and low school academic achievement <0.05.There was no significant association between suicidal ideations and low family income > 0.05. In conclusion very high prevalence rate of suicidal ideations in the last 24months was noticed among secondary school students the main associated factors were being female and low school performance. Strategic multisector intervention plan is strongly requested to address this emerging serious public health problem among Iraqi students.


Developing countries account for three fourth suicide deaths worldwide. Suicidal behaviors include the following: suicidal ideation and attempting suicide [1,2]. Suicidal ideation, defined as the wishes to be dead or thoughts of killing oneself, has been introduced by some researchers [3,4]. Suicidal ideation, which involves a hierarchy of feelings from the thought of “Life is not worth living” to more serious articulation of a thought-out plan, is important because most suicides and Para suicides have engaged in suicidal thoughts prior to their acts [5,6]. Suicidal ideations often begins in the transitional period of adolescences and is more prevalent in this age interval, mainly among girls [7]. Among developed countries, the prevalence of ideation among middle and secondary school students was not uncommon [8], meaning that this health problem prospectively may end with suicide [9,10]. Most of youth or students who have suicidal ideations did not attempt to commit suicide [11,12]. Chronic exposure to oppressive environment creates distributed thought among adolescents [13]. Some major potential risks for young people suicidal behaviors include gender (more in female gender), exposure to different types of violence (school violence and domestic violence both physical or verbal or both of them), using some drugs, broken families and bad peer relationships [8,14,15], identifying modifiable risk factors is essential for applying intervention programs for prevention [1]. The Global School-Based Health Survey (GSHS) has been used worldwide to provide comparable data on the prevalence of adolescent suicidal ideations and correlates [16,17]. Researches that address this high priority public health problem in many developing countries including Iraq are scarce, without sound data base and epidemiologic information, successful prevention programs cannot be applied [18]. There were shortage in studies among students suicidal ideations in Iraq and non in Babylon province [19]. This study was conducted to identify the prevalence and correlates of suicidal ideations among a sample of secondary school students in Babylon province-Iraq.

Materials and methods

Study design
   A cross-sectional descriptive study was conducted on secondary school students In 4th& 4th grades both males and females from five randomly selected schools located in rural and urban districts in Babylon province/Iraq during the academic year 2016- 2017, by using a self-completed anonymous questionnaire as a part of GSHS questionnaire. A multistage, probability sampling technique stratified by urban and rural settings, school type and gender, in which schools, classrooms and students were selected randomly. The overall response rate was 99% (N = 420).
Ethical clearances
    Written approvals  were sought  from the research ethical committee in Babylon University- College of Nursing as well as consents from Babil Educational Directorate and  the school management authorities were obtained, verbal consents from all  participants were  taken. Students were briefed about the purpose of the study, encouraged to participate and to express their experiences. The study included all apparently healthy students those with apparent and confirmed  mental diseases or disabilities  were excluded.                                                                                                                             
    Study participants were asked  questions about suicidal ideation adopted from Global School-Based Health Survey [16,17]: During the last two years from the beginning of data collection ;did you ever  consider ideation suicide during the past two years? responses were (yes, no). Data were also collected on, gender, low economic level, and school  achievement. Responses  of economic status of the students family were categorized into three levels. Low, medium and high levels, the economic levels were classified into three similar levels.
Statistical Analysis: Data was analyzed statistically by using SPSS (Statistical Package for Social Sciences) Version 17.0. Chi ?2 were used. P-value <0.05 was considered  of Statistical Significance.


Table (1) shows the distribution of the study group by stage and gender,(56.2) percentage of the study group is females. The total number of the selected sample is 420. Table (2) shows frequency distribution of students according to suicidal ideation by stages of the study, the overall prevalence rate of suicidal ideation during 24 months period among the study group (both stages) is 49.5%. The prevalence among 4th stage students is (43.1%) while the prevalence among fifth stage is (53.8%) this difference is statistically significant, Chi square 4.557 df=1;p=0.0328.


Our findings reveal that the overall prevalence of suicidal ideation among secondary students is very high, about half of the studied group mentioned that they have experienced suicidal ideation during the last twenty four months from the time of this survey, the prevalence of the current study is higher than those reported by other investigators [8,19,20]. Other Brazilian studies [21], showed that prevalence of suicidal ideation was 22.2% in the Northeastern and 36% in the Southern Regions of Brazil, while in United States the prevalence was 23.3% among ages 12–17 [22], in European countries, the prevalence of 12 months ideations among secondary school students aged 15-16 years ranged from 15% in Armenia to 31.5% in Hungary [8] while in Gaza the prevalence of suicidal ideations reported among middle school students was 26.6% [23]. Previous publications from the Eastern Mediterranean Region suggested that suicidal thinking is common among students. A study in Lebanon found that about 16% of students aged 11–16 years reported suicidal ideation [24]. A study in Morocco found that 12.8% of 11- to 14-year-old students had suicidal thinking and 6.5% of them reported suicidal planning [25]. The high prevalence of suicidal ideation in the current study may be related to insecurity situation in Iraq , arm conflict and high rate of terrorist acts, in addition to high rates of different types of domestic and school violence, the violent behavior of people in any society coupled with economic crisis put a high burden on shoulders of Iraqi families, chronic exposure to such oppressive environment may disturb the thought of adolescents [13], this may be attributed to school examinations stress and bullying this type of violence was highly prevalent among secondary school students in Iraq [23,26]. This high prevalence rate of suicidal ideations may also be related to the absence of a real psychosocial support activities provided to secondary school students in our country this unrest situation could increase the psychological morbidity of adolescents. Our finding reveals that female students are at higher risk of suicidal ideations as compared to males, this finding is consistent with the findings of other investigators [27-29] this can be explained by the fact that females were easier influenced by negative economic situation and females may be more vulnerable when they experienced the life-events including being unmarried, depression, uninsured, and having debts, compared with males [30], the less social support of females specially in low and middle income countries played more roles on female suicidal ideations and suicide attempters. Compared with male suicide attempters, female ones are mainly influenced by social factors. A gender-specific approach should be emphasized in suicide prevention [31]. The current study explains that there is no significant association between suicidal ideation and the low family income of the study group, this finding is in contrast with findings of other studies, while Low financial status may exacerbate any ongoing deterioration in psychological well-being, [32,33]. In another previous local study conducted in Iraq by Jabor MA and Kareem SS who reported that the psychosocial causes among a sample of 100 fatal recorded suicidal cases brought for postmortem examination at the Medico-legal institute of Baghdad within four years period from 2011 to 2015 (males 49 and females 51 cases) [18]. This study depicts that there is a strong positive relationship between having suicide ideation and low school achievement this finding is similar to the finding of other local study conducted in Wasit province –Iraq by Ismail et al who found that suicidal ideation was significantly associated with low school performance [19], the causal relationship between suicidality and school performance cannot achieved by cross-sectional studies , but this association can formulate hypothesis to be tested by further analytic large scale studies.


Considerable number of students have suicidal behavior (suicidal ideation) in our study sample. The percentage of suicidal ideation among females is higher than that of males. Low school achievement and low family income are significantly associated with suicidal ideation.


1. McKinnon B,Gariépy G, Sentenaca M Elgara FJ. Epidemiology of adolescent suicidal behaviours in 32 countries. Bull World Health Organ 2016;94:340–350.
2. Preventing global suicide: a global imperative [Internet]. Geneva: World Health Organization; 2014. Available from:
3. Goldstein RB, Black DW, Nasrallah A, Winokur G. The prediction of suicide. Sensitivity, specificity, and predictive value of a multivariate model applied to suicide among 1906 patients with affective disorders. Arch Gen Psychiatry. 1991; 48:418–22.
4. Beck AT, Kovacs M, Weissman A. Assessment of suicidal intention: the scale for suicide ideation. J Consult Clin Psychol. 1979; 47:343–52.
5. Shneidman McAuliffe CM. Suicidal ideation as an articulation of intent: a focus for suicide prevention? Arch Suicide Res. 2002;6:325–38.
6. Shneidman ES. The suicidal mind. New York: Oxford University Press; 1996.
7. Nock MK, Borges G, Bromet EJ, Cha CB, Kessler RC, Lee S. Suicide and suicidal behavior. Epidemiologic reviews. Oxford: Oxford University Press; 2008. pp. 133–54.
8. Kokkevi A, Rotsika V, Arapaki A, Richardson C. Adolescents’ self-reported suicide attempts, self-harm thoughts and their correlates across 17 European countries. J Child Psychol Psychiatry. 2012; 53(4):381–9.
9. Scott LN, Pilkonis PA, Hipwell AE, Keenan K, Stepp SD. Non-suicidal self-injury and suicidal ideation as predictors of suicide attempts in adolescent girls: a multi-wave prospective study. Compr Psychiatry. 2015;58:1–10.
10. Grossman DC. Risk and prevention of youth suicide. Pediatr Ann. 1992; 21(7): 448–9.
11. Hawton K, Van Heeringen K. Suicide. Lancet 2009; 373(9672): 1372-81.
12. Silverman MM, Berman AL, Sanddal ND, O’carroll PW, Joiner TE. Rebuilding the Tower of Babel: a revised nomenclature for the study of suicide and suicidal behaviors. Part 2: suicide-related ideations, communications, and behaviors. Suicide Life Threat Behav 2007; 37(3):264e77.
13. David EJR. Internalized oppression, psychopathology, and cognitive behavioral therapy among historically oppressed groups. J Psychol Prac, 2009; 15:71e103
14. Swahn MH, Bossarte RM. Gender, early alcohol use, and suicide ideation and attempts: findings from the 2005 youth risk behavior survey. J Adolesc Health. 2007; 41(2):175–81.
15. Hawton K, Saunders KE, O’Connor RC. Self-harm and suicide in adolescents. Lancet. 2012; 23;379.
16. Page RM, Saumweber J, Hall PC, Crookston BT, West JH. Multi-country, cross-national comparison of youth suicide ideation: Findings from Global School-based Health Surveys. Sch Psychol Int. 2013; 34(5):540–55.
17. Global School-based Student Health Survey (GSHS) [Internet]. Atlanta: Centers for Disease Control and Prevention; 2016. Available from: [cited 2016 Mar 22].
18. Jabor MA, Kareem SS. Causes, Attempts and Methods of Suicide in Baghdad: An Autopsy Study. Al-Mustansiriyah Journal for Pharmaceutical Sciences; 2016, 16(2): 10-15
19. Hussen AG, Al-Khalidy FF. Suicide Ideas among Hawler Medical College Students Tikrit Med J 2013; 19(1): 170--177.
20. Ismail IS, Abdulsatar K, Baiee HA. Depression and suicide ideation among secondary school adolescents involved in school bullying. BMJ 2010;11(4):349-63.
21. Silva RJ dos S, dos Santos FAL, Soares NMM, Pardono E. Suicidal Ideation and Associated Factors among Adolescents in Northeastern Brazil. Scientific World J. 2014;2014:450943.
22. Choi† SB, Lee† WH, Yoon HJ, Won UJ, Kim DW. Risk factors of suicide attempt among people with suicidal ideation in South Korea: a cross-sectional study. BMC Public health BMC series – open, inclusive and trusted201717:579.
23. Lee J, Choi H, Kim JM, Park GC, Shin SD. Anger as a predictor of suicidal ideation in middle-school students in korea: gender difference in threshold point. Journal of Adolescence health 2009; 44 (174): 433-446.
24. Lindsay A, Taliaferro MS, Barbara A, Rienzo P, David PM R, Morgan JP, HSD, Virginia J, Dodd P. High school youth and suicide risk: exploring protection afforded through physical activity and sport participation. J school health, 2008; 10, Pages 545–553.
25. Almeida OP, Draper B, Snowdon J, Lautenschlager NT, Pirkis J, Byrne G, et al. Factors associated with suicidal thoughts in a large community study of older adults. Br J Psychiatry. 2012; 201(6):466–72.
26. Park SM, Moon SS. Elderly Koreans who consider suicide: role of healthcare use and financial status. Psychiatry Res. 2016; 244:345–504/450943.
27. Waldrop AE, Hanson RF, Resnick HS, Kilpatrick DG, Naugle AE, Saunders BE. Risk factors for suicidal behavior among a national sample of adolescents: J Trauma Stress. 2007 ;20 (5):869–879implications for prevention.
28. Itani T, Jacobsen KH, Kraemer A. Suicidal ideation and planning among Palestinian middle school students living in Gaza Strip, West Bank, and United Nations Relief and Works Agency (UNRWA) camps. Int J Pediat Adolescent Med. 2017.
29. Mahfoud ZR, Afifi RA, Haddad PH, Dejong J. Prevalence and determinants of suicide ideation among Lebanese adolescents: results of the GSHS Lebanon Adolesc J 2005; 34(2): 379–38.
30. Xu H, Zhang W, Wang X, Yuan J, Tang X, Yin Y et al. Prevalence and influence factors of suicidal ideation among females and males in Northwestern urban China: a population-based epidemiological study. BMC Public Health 2015; 15(1):1.
31. Sun L, Zhang J. Gender differences among medically serious suicide attempters aged 15–54 years in rural China. Psychiatry Res., 2017; 252 : 57-62.
32. Zarrouq B, Bendaou B, Elkinany S, Rammouz I, Aalouane R, Lyoussi B, et al. Suicidal behaviors among Moroccan school students: prevalence and association with socio-demographic characteristics and psychoactive substances use: a cross-sectional study. BMC Psychiatry 2015;15: 284.
33. Yahya HM. Hashim MT,Al-Kaseer EA, AL-Diwan JK. Bullying victimization among school- going adolescents in Iraq. J Fac Med Baghdad, 2015;57(3):221-224.

The complete article is available as a PDF File that is freely accessible. The fully formatted HTML version can be viewed as HTML Page.

Medical Journal of Babylon

volume 14 : 3

Share |

Viewing Options

Download Abstract File
( 5 KB )

Related literature

Cited By
Google Blog Search
Other Articles by authors

Related articles/pages

On Google
On Google Scholar
On UOBabylon Rep

User Interaction

4  Users accessed this article in 1 year past
Last Access was at
14/01/2018 13:08:49