Association between perceived unsafe environment, being bullied, and suicidal ideation in a representative sample of Puerto Rican adolescents

Suicidal behavior among adolescents has been associated with their social and environmental contextual influences, particularly their school and neighborhood environments.  However, this relationship has seldom been explored among Puerto Rican teens. Our objective was to explore if suicidal ideation was associated with adolescent’s perception of being unsafe in their schools, communities, or homes, and being bullied.  A representative sample of all 7th-12th grade students in PR was selected  using a multi-stage stratified cluster sampling design. Approximately 3,982 students participated in the cross-sectional survey answering a pre-coded self-administered questionnaire.  Proportions were compared using chi-square tests.  Multiple logistic regression models were fitted to estimate the odds ratios and their 95% confidence intervals.  Prevalence of suicidal ideation in the last year was estimated in 8%. Seriously thinking about suicide was highest among females, those age 15, those who reported being bullied, and among those who reported not feeling safe in their schools, communities, homes, or in the places where they spent time with friends.  Among females, bullying (OR=2.82, 95% CI=2.70-2.95) was more strongly associated with suicidal ideation than feeling unsafe in the different environments after adjusting for age, depression, and unsafe environments. However, for males, feeling unsafe in their homes had a higher odds of ideation (OR=2.90, 95% CI=2.63-3.18) than bullying and feeling unsafe in other environments.  This study highlights the influence that environments have is the teen’s mental health and well-being.  Suicide prevention programs should target these external factors in order to be more effective.