Abstract

Background: Suicidal ideation among adolescents is a critical public health issue, influenced by various psychosocial factors such as bullying. Specific Background: The prevalence of bullying and its relationship to suicidal ideation remains underexplored in the context of secondary school students in Dhi Qar Governorate, Iraq. Knowledge Gap: While existing studies have addressed bullying and suicide, the specific impact in this region and its demographic characteristics remain unclear. Aims: This study aimed to evaluate the prevalence of suicidal ideation among secondary school students and its correlation with bullying experiences. Methods: An observational cross-sectional descriptive study was conducted using a demographic questionnaire and the Suicidal Ideation Questionnaire, with 380 secondary school students from Dhi Qar Governorate. Results: The findings indicated a low prevalence of bullying but a significant correlation between bullying and suicidal ideation. Although most participants did not experience suicidal thoughts, those subjected to bullying were more likely to report such thoughts. Novelty: This study provides new insights into the psychological health of secondary school students in Iraq, particularly regarding bullying and suicidal ideation. Implications: The results highlight the need for psychological support programs in schools to mitigate bullying’s impact on mental health, with further research recommended to expand the sample size and regional scope.

HIghlights:

1. Correlation: Bullying linked to increased suicidal ideation among secondary school students.

2. Prevalence: Over 50% experienced some degree of bullying.

3. Recommendations: Psychological support programs needed in schools.

Keywords: Suicidal ideation, bullying, secondary school, Iraq, psychological support

Introduction

Suicide is the fourth largest cause of mortality for those aged 15 to 29, behind road accidents, tuberculosis, and interpersonal violence ,Bullying is classified as planned, damaging, hostile behavior in which a person or group persistently attacks a person who possesses physical or mental power(1). Suicidal ideation is a critical habit to monitor, as it serves as a significant indicator for early detection of suicidal thoughts and prevention of suicide(2). Depending on how the problem is defined and how it is monitored, figures on youth who experience suicidal thoughts vary substantially(3). Suicide is a significant global public health issue, leading to more than 800,000 fatalities each year. In 2019, China recorded 116.3 thousand suicide-related fatalities, accounting for around 16.5% of global suicide deaths(4). When it comes to teenagers, there is a limited amount of research that suggests a specific type of bullying victimization is associated with suicidal ideation or attempts. Within the Chinese middle school and high school student population, these relationships were investigated in this study(5). The association between bullying involvement (as a victim, perpetrator, or bully-victim) and suicide thoughts and behaviors has gotten greater attention throughout the past 10 years(6). To quantify the association between participation in bullying and suicide thoughts and behaviors, we ran a meta-analysis(7).

psychology research, establishing a definition of bullying is likely the most challenging undertaking, given the literature presents multiple divergent meanings(8). But many of them have one thing in common Bullying is seen as a type of aggressiveness(9). Parental online monitoring may be enacted as a preventive strategy against their children's engagement in cyberbullying and cyber victimization, or it may be a practice adopted by parents irrespective of its potential as a protective element(10). Regarding the role of parents online and the distinction between cyberbullying and cyber victimization, the research and ideas are neither clear nor consistent(11). Extensive study has been conducted on the risk variables associated with bullying, although there is a paucity of empirical investigation on sibling hostility(12). Unfortunately, there is less consensus among scholars over the concept or operationalization of sibling hostility, as opposed to bullying(13). Previous study has characterized sibling aggressiveness through many terminology, including abuse, bullying, violence, and rivalry(13). A new study presents evidence on parental reactions to persistent offline bullying episodes, emphasizing the influence of environmental and relational family dynamics on offline bullying and victimization. Nonetheless, empirical data about the efficacy of these reactions is insufficient(14). Previous research indicate that suicidal thoughts is prevalent among medical students(15). This high occurrence is a result of variables linked to medical school atmosphere and admissions procedures(16). Suicidal ideation has numerous effects, including attempted and actualized suicide, This article examines the latest studies on suicidal ideation among medical students(17).

Methods

An observational cross sectional descriptive study was done on students at secondary level in Dhi Qar Governorate secondary schools in Iraq Region, students were asked to fill a questionnaire about assessing the victims of bullying and Suicidal Ideation using Scale of victims of bullying and Suicidal Ideation Scale.

Design

A quantitative cross-sectional study was conducted to evaluate the parenting styles and their effects on social phobia in students. One noticeable advantage of this study is its capacity to make simultaneous comparisons of several parameters among the participating students.

Study Instrument

TWO tools were used for data collection in this study:

1) A demographic data questionnaire created for this study by researchers obtained information about the elderly sociodemographic characteristics.

2) The Suicidal Ideation Questionnaire

.Data Collection

The researcher conducted interviews with the participants (students), provided them with instructions, addressed their inquiries, encouraged them to participate, and expressed gratitude for their assistance. Interview procedures were conducted on an individual basis, and each interview lasted 15–20 minutes following the completion of the necessary steps for the study design.

Statistical Analysis

All subsequent analyses were implemented with IBM SPSS 20.0. The variables were classified using whole numbers and percentages (No. and %), while the mean and standard deviation were used to define the continuous variables (mean and SD). Correlational analysis was implemented to determine the relationship between the numerous variables. A two-tailed p.05 threshold was employed to ascertain statistical significance.

Result and Discussion

Results

Resp.= response, f=frequency,%= percent

Table (1) illustrates the descriptive analysis of suicidal ideation scale items in terms of frequency and percentage. The descriptive analysis of suicidal ideation reveals considerable differences in the frequency of suicidal thoughts across various items. The results reported that Items 9 (86.1%), 7 (83.4%), and 3 (79.2%) had the highest percentage of respondents reporting 'Never,' indicating that the vast majority of individuals did not experience suicidal ideation for these items. Similarly, items 2 (76.1%) and 4 (78.9%) also had high levels of 'Never' responses, suggesting that suicidal ideation was low for these aspects.

In contrast, items 5 (33.4% 'Never', 36.3% 'Sometimes', 30.3% 'Always'), 6 (55.8% 'Never', 25.5% 'Sometimes', 18.7% 'Always'), and 10 (53.2% 'Never', 27.1% 'Sometimes', 19.7% 'Always') showed a higher frequency of 'Sometimes' or 'Always' responses, reflecting more frequent suicidal thoughts. Item 5, in particular, had a high percentage of respondents reporting 'Sometimes' and 'Always,' indicating more frequent suicidal ideation. Items 8 (68.7% 'Never', 18.2% 'Sometimes', 13.2% 'Always') and 11 (67.6% 'Never', 17.9% 'Sometimes', 14.5% 'Always') displayed low levels of 'Sometimes' and 'Always' responses, with the vast majority selecting 'Never.' However, there was still a notable portion of respondents who reported occasional or frequent suicidal thoughts. Items 12 (72.9% 'Never', 14.5% 'Sometimes', 12.6% 'Always'), 13 (72.6% 'Never', 18.9% 'Sometimes', 8.4% 'Always'), and 14 (67.6% 'Never', 19.7% 'Sometimes', 12.6% 'Always') also had high 'Never' responses, yet a smaller group reported 'Sometimes' or 'Always,' reflecting occasional or frequent suicidal ideation for these items.

Lastly, items 16 (65.0% 'Never', 15.8% 'Sometimes', 19.2% 'Always') and 15 (66.8% 'Never', 20.8% 'Sometimes', 12.4% 'Always') had a higher percentage of respondents indicating 'Sometimes' or 'Always,' which suggests a higher frequency of suicidal ideation for these items compared to others. Overall, the findings show that 68.0% of respondents reported 'Never' experiencing suicidal ideation, 19.0% reported 'Sometimes,' and 13.0% reported 'Always.'

F. = frequency, %= percentage, Level of suicide ideation: 0-5 =very low, 6-13=low, 14-21= moderate, 22-32= severe

Table (2): presents the descriptive analysis of the severity of suicide ideation among the studied sample, including frequency and percentages. The findings found that 218 participants (57.4%) had very low suicide ideation, while 87 (22.9%) experienced low levels. Additionally, 47 participants (12.4%) reported moderate suicide ideation, whereas 28 (7.4%) had severe levels.

Discussion

The table (1) illustrates the descriptive analysis of suicidal ideation scale items in terms of frequency and percentage. The descriptive analysis of suicidal ideation reveals considerable differences in the frequency of suicidal thoughts across various items. The results reported that Items 9 (86.1%), 7 (83.4%), and 3 (79.2%) had the highest percentage of respondents reporting 'Never,' indicating that the vast majority of individuals did not experience suicidal ideation for these items. Similarly, items 2 (76.1%) and 4 (78.9%) also had high levels of 'Never' responses, suggesting that suicidal ideation was low for these aspects. and this finding agree with study mad by Mohammed Fadhil Ali (2024) Based on the statistical cutoff point of 0.66, the study's findings show that the participants had low levels of suicidal ideation at (M.S=1.62)

In contrast, items 5 (33.4% 'Never', 36.3% 'Sometimes', 30.3% 'Always'), 6 (55.8% 'Never', 25.5% 'Sometimes', 18.7% 'Always'), and 10 (53.2% 'Never', 27.1% 'Sometimes', 19.7% 'Always') showed a higher frequency of 'Sometimes' or 'Always' responses, reflecting more frequent suicidal thoughts. Item 5, in particular, had a high percentage of respondents reporting 'Sometimes' and 'Always,' indicating more frequent suicidal ideation. Items 8 (68.7% 'Never', 18.2% 'Sometimes', 13.2% 'Always') and 11 (67.6% 'Never', 17.9% 'Sometimes', 14.5% 'Always') displayed low levels of 'Sometimes' and 'Always' responses, with the vast majority selecting 'Never.' However, there was still a notable portion of respondents who reported occasional or frequent suicidal thoughts. Items 12 (72.9% 'Never', 14.5% 'Sometimes', 12.6% 'Always'), 13 (72.6% 'Never', 18.9% 'Sometimes', 8.4% 'Always'), and 14 (67.6% 'Never', 19.7% 'Sometimes', 12.6% 'Always') also had high 'Never' responses, yet a smaller group reported 'Sometimes' or 'Always,' reflecting occasional or frequent suicidal ideation for these items.

Lastly, items 16 (65.0% 'Never', 15.8% 'Sometimes', 19.2% 'Always') and 15 (66.8% 'Never', 20.8% 'Sometimes', 12.4% 'Always') had a higher percentage of respondents indicating 'Sometimes' or 'Always,' which suggests a higher frequency of suicidal ideation for these items compared to others. Overall, the findings show that 68.0% of respondents reported 'Never' experiencing suicidal ideation, 19.0% reported 'Sometimes,' and 13.0% reported 'Always.' (18).

Table (2) presents the descriptive analysis of the severity of suicide ideation among the studied sample, including frequency and percentages. The findings found that 218 participants (57.4%) had very low suicide ideation, while 87 (22.9%) experienced low levels. Additionally, 47 participants (12.4%) reported moderate suicide ideation, whereas 28 (7.4%) had severe levels(18).

Conclusion

While the circumstances surrounding every suicide are different, the data presented throughout this section can be used as a guide to help identify and target programming towards the populations with the highest need for prevention of suicide and self-harm injury. Understanding how the different risk and protective factors interact, overlap, and impact different populations could help increase the effectiveness of suicide prevention efforts and warrants further investigation. For effective programming, prevention strategies should also address individual, relationship, and community levels of risk factors for greatest impact. In Part 3 of this report, specific strategies and recommendations for effective suicide prevention will be presented.

References

1. A. M. Mousa, H. M. Majeed, and A. F. Hassan, "Students' Knowledge and Attitude Concerning Organ Donation at Iraqi Nursing Colleges," J. Educ. Health Promot., vol. 13, no. 1, p. 60, 2024.
2. M. B. Al‐Jubouri, S. A. Jaafar, M. K. Abbas, I. N. Gazi, M. A. Shawwat, K. F. Karmoud, et al., "Using Cryotherapy, EMLA (Eutectic Lidocaine/Prilocaine) Cream, or Lidocaine Spray to Reduce Pain During Arteriovenous Fistula Puncture: A Randomized Controlled Trial," Hemodial. Int., vol. 28, no. 3, pp. 270–277, 2024.
3. E. D. Klonsky, A. M. May, and B. Y. Saffer, "Suicide, Suicide Attempts, and Suicidal Ideation," Annu. Rev. Clin. Psychol., vol. 12, no. 1, pp. 307–330, 2016.
4. Q. Q. Mohammed and K. R. Sajit, "Stress and Its Associated Factors Among Students of the College of Nursing University of Baghdad," Iraqi Natl. J. Nurs. Spec., vol. 29, no. 2, 2016.
5. K. Szanto, A. Gildengers, B. H. Mulsant, G. Brown, G. S. Alexopoulos, and C. F. Reynolds, "Identification of Suicidal Ideation and Prevention of Suicidal Behaviour in the Elderly," Drugs Aging, vol. 19, pp. 11–24, 2002.
6. I. H. Alwan, H. A. Hussein, and A. K. M. Noori, "Psychological Distress of Home Quarantine During COVID-19," Egypt. J. Hosp. Med., vol. 95, pp. 2230–2232, Apr. 2024.
7. Q. Q. Mohammed and H. S. Ali, "Influence of Emotional Intelligence on Academic Achievement Among Students at Secondary Schools in Babylon City," Indian J. Med. Forensic Med. Toxicol., vol. 14, no. 1, 2020.
8. T. A. Radhi and H. H. Atiyah, "Iraqi National Journal of Nursing Specialties," Iraqi Natl. J. Nurs. Spec., 2023.
9. D. A. Jobes and T. E. Joiner, "Reflections on Suicidal Ideation," 2019.
10. A. T. Beck, M. Kovacs, and A. Weissman, "Assessment of Suicidal Intention: The Scale for Suicide Ideation," J. Consult. Clin. Psychol., vol. 47, no. 2, pp. 343–349, 1979.
11. A. F. Sadeq, A. J. Nashwan, G. F. D. Valdez, H. Al-Najjar, H. Elamir, M. Barakat, et al., "Stigma Towards Health Care Providers Taking Care of COVID-19 Patients: A Multi-Country Study," Heliyon, vol. 8, no. 4, 2022.
12. H. A. A. T. Alhamad and H. B. Hassan, "Iraqi National Journal of Nursing Specialties," Iraqi Natl. J. Nurs. Spec..
13. N. Hallensleben, L. Spangenberg, T. Forkmann, D. Rath, U. Hegerl, A. Kersting, et al., "Investigating the Dynamics of Suicidal Ideation," Crisis, 2017.
14. J. A. Nasser and S. Hassoun, "Effectiveness of Health Educational Program on Nurses' Practices Toward Chemotherapy-Induced Peripheral Neuropathy for Children at Hematology Center in Baghdad City," Iraqi Natl. J. Nurs. Spec., vol. 33, no. 2, pp. 1–12, 2020.
15. K. R. Sajit and S. S. Ahmed, "Prevalence and Distribution of Occupational Stress Among Emergency Nurses in Mosul City Hospitals," Prevalence, vol. 45, no. 01, 2022.
16. Q. Rajih, "Effectiveness of an Education Program on Nursing Staffs' Knowledge About Infection Control Measures at Intensive Care Unit in Al-Diwaniya Teaching Hospital," Iraqi Natl. J. Nurs. Spec., vol. 33, no. 1, pp. 85–92, 2020.
17. P. Ghasemi, A. Shaghaghi, and H. Allahverdipour, "Measurement Scales of Suicidal Ideation and Attitudes: A Systematic Review Article," Heal. Promot. Perspect., vol. 5, no. 3, pp. 156–167, 2015.
18. M. Fadhil and A. A. Abud, "Impact of Pupils' Self-Esteem Upon Bullying at Primary Schools in Al Nassirrya City Centre," Int. J. Pharm. Res., vol. 11, no. 1, 2019.