Risk Factors for Suicide Attempt among Rural Appalachian Middle School Adolescents

Introduction: Suicide is the third-leading cause of death among adolescents in the United States. However, only a limited number of studies have examined risk factors for suicide attempt among middle school adolescents, particularly those from rural areas.

Methods: In 2009, we conducted a cross-sectional study among 490 middle school (6th-8th grades) adolescents from an Appalachian county using an abridged Youth Risk Behavior Survey (YRBS). YRBS is a confidential, voluntary, and self-administered instrument; the modified version included 50 questions on demographics and several categories of health-risk behaviors.

Results: Of 490 participants, 236 (48.2%) were female and 396 (86.4%) were white. Forty-seven percent reported ever being bullied on school property; 22.3% reported ever seriously thinking about killing themselves; 13.6% reported ever making a plan about killing themselves; and 8.3% reported having ever tried killing themselves. In a multivariable logistic regression analysis, factors significantly associated with “having tried killing oneself” included: being a “female” (odds ratio [OR]=3.4; 95% confidence interval [CI]: 1.5-7.8 ); “having ever been bullied on school property” (OR=3.4; 95% CI: 1.5-8.0); “having ever had sex” (OR=4.2; 95% CI: 1.9-9.2); and “having ever sniffed glue, or breathed the contents of spray cans, or inhaled paints or sprays to get high” (OR=5.0; 95% CI: 2.1-11.9).

Conclusion: Being a female, experiencing bullying in school, glue sniffing to get high, and ever having had sex are strongly associated with suicide attempt in this adolescent population. Early identification of at-risk individuals and intervention programs should begin in middle school to reduce the risk of suicide in adolescents.