Family violence as a determinant of suicidality and depression among adolescents in India

Abstract

Background Suicide/self-harm is a leading cause of death for adolescent girls and boys globally, and family violence may increase the risk for adolescent suicidality, self-harm and depression. This study assessed whether family violence was associated with suicidality and depressive symptoms among adolescents in India. This study is the first to examine the role of family violence in suicidality and depression among Indian adolescents. Methods We analyzed data from 20,594 adolescents (10-19 years) collected as part of a cross-sectional study in Bihar and Uttar Pradesh, India (2015-2016). Family violence variables included child abuse, witnessing parental marital violence, and personal experiences of marital violence. Suicidal ideation, self-harm and depression (measured using the Patient Health Questionnaire (PHQ-9)) served as outcomes of interest. Multivariate models assessed associations of family violence with outcomes, adjusting for sociodemographic determinants. Analyses were stratified by adolescent gender, age (10-14 and 15-19 year olds) and marital status (for girls 15-19 years). Results Married adolescent girls in India were at highest risk, with 8.2% reporting suicidal ideation and 4.9% reporting self-harm behaviors. Unmarried older adolescent girls were more likely to consider suicide compared to same-age boys (4.4% vs 2.4% respectively) while older boys (4.2% vs 2.9% for older girls) and younger adolescents (boys:5.3%, girls: 6.1%) were more likely to engage in self-harm behaviors. Depressive symptoms were rare except among older married (8%) and unmarried (5%) girls. For unmarried girls, child abuse was associated with suicidality (adjusted odds ratio (AOR)=2.08, 95% confidence interval CI=1.4-3.07) and self-harm behaviors (AOR=2.8, 95% CI=1.83-4.26) and witnessing parental marital violence was associated with moderate-severe depressive symptoms (AOR=1.81, 95% CI=1.30-2.50). For married girls aged 15-19 years, personal experiences of marital violence were associated with suicidality (AOR=3.73, 95% CI=2.0-6.96) and moderate-severe depressive symptoms (AOR=2.93, 95% CI=1.83-4.68). Among unmarried boys 13-19 years, witnessing parental marital violence was associated with suicidality (AOR=3.18, 95% CI=1.79-5.67). Conclusions Adolescent health programs in India need to consider interventions for preventing adolescent suicidality, self-harm and depression that include improving parent-child relationships, reducing early marriage and preventing domestic violence.