Spatial distribution of suicidal ideation and suicide attempts among adolescent students, Puerto Rico, 2002-04

Suicidal behavior among teens has been increasingly identified as an important public health problem. Little is known about the magnitude of the problem in Puerto Rico. The objective of this study was to determine if there are spatial clusters in the prevalence of suicidal ideation and attempts among students, and to evaluate which municipality-level characteristics are associated with these clusters. This study is a secondary analysis of the "Consulta Juvenil VI" survey, an island-wide cross-sectional survey among adolescents. The sample (n=55,227) was selected using a multi-stage stratified cluster sampling design, and is representative of all 7th-12th grade public school students. Moran's I Spatial Autocorrelation Statistic was used to detect spatial clustering in the prevalences of each suicidal behavior by municipality. Multiple linear regression models adjusted for spatial dependence were evaluated to determine which municipality-level characteristics were associated with the prevalences. There was significant spatial clustering of the prevalences of both suicidal behaviors; the highest prevalences were present in the southeastern and eastern municipalities. Presence of depressive symptoms was the only characteristic in the teen's environment associated with the spatial clustering of both behaviors. Attempts were also associated with the number of MD visits, and ideation was associated with alcohol use. Finding geographic clusters suggests that we should look for suicidal behavior determinants in the teens' environment. Effective suicide prevention strategies should target these high-risk geographic areas identified. Funded by the Puerto Rico Mental Health Services and Drug Addiction Administration (ASSMCA), and the Puerto Rico Office of Drug Control.