Bullying Victimization, School Environment, and Suicide Ideation and Plan: Focusing on Youth in Low- and Middle-Income Countries

Abstract

Purpose: This study examines the relationship between bullying victimization, measured at individual and school levels, and suicide intent and plan among youth living in less developed parts of the world. Methods: Multilevel modeling is used to estimate the degree to which school-level bullying has an independent effect on the two suicide measures and how it moderates the impact of individual-level victimization on contemplating and planning suicide. Data are drawn from the Global School-Based Student Health (2000-2012) survey that consists of probability samples of adolescents in low- and middle-income countries. Results: By fitting three-level mixed effects models, we find that adjusting for personal experience of victimization, greater school-level prevalence of bullying has a positive independent relationship with suicide plan, but not ideation. Significant cross-level interaction effects are shown, that is, the bullying-suicide linkage at the individual level is moderated by the school environment. For suicide ideation only, it is weaker in schools where more students are bullied. The association is also less pronounced in the context characterized by higher proportion of physical violence among students and peer hostility on campus. Conclusions: The bulk of prior research narrowly defines the relationship between bullying and suicide at the individual (e.g., student) level. This study shows that school context (e.g., proportion of bullied peers) must be incorporated into the analysis in better understanding the conditions under which youth think about and/or plan on inflicting lethal self-harm. (C) 2019 Society for Adolescent Health and Medicine. All rights reserved.