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. 2019 Mar 29:47:22.
doi: 10.1186/s41182-019-0149-6. eCollection 2019.

Suicidal ideation, suicidal behaviors, and attitudes towards suicide of adolescents enrolled in the Alternative Learning System in Manila, Philippines-a mixed methods study

Crystal Amiel M Estrada  1 , Daisuke Nonaka  1 , Ernesto R Gregorio Jr  1   2   3 , Cynthia R Leynes  4 , Ronald T Del Castillo  2   5 , Paul Michael R Hernandez  6   2 , Tatsuro Hayakawa  7 , Jun Kobayashi  1
Affiliations

Suicidal ideation, suicidal behaviors, and attitudes towards suicide of adolescents enrolled in the Alternative Learning System in Manila, Philippines-a mixed methods study

Crystal Amiel M Estrada et al. Trop Med Health. .

Abstract

Background: Globally, suicide is a significant cause of death among adolescents. Previous studies conducted in high-income countries suggest that students in alternative schools are more likely to engage in suicidal behaviors than those in formal schools. This study aimed to document suicidal ideation and behaviors among adolescent learners enrolled in the Alternative Learning System (ALS) in Manila, Philippines.

Methods: A mixed methods study was conducted in 24 ALS centers in the city of Manila. ALS centers were stratified according to congressional district and selected using probability proportionate sampling. A cross-sectional survey to determine attitudes towards suicide and prevalence of suicidal ideation and behaviors was administered to 171 learners aged 13 to 17 years old. In-depth interviews with 18 teachers and 12 learners were conducted to explore the school psychosocial environment's role on learners' suicidal ideation and behaviors. Exploratory factor analysis was used to extract attitude factors. Fisher's exact test and Student's t-test were used to identify differences in sociodemographic characteristics and attitudes towards suicide between learners with or without suicidal ideation or behaviors. Qualitative data were analyzed using thematic analysis.

Results: Non-specific active thoughts were the most common type of lifetime suicidal ideation (40.9%) while passive ideation was the most common in the past month (13.5%). Aborted suicide attempt was the most frequent behavior in both lifetime (16.4%) and in the past month (4.7%). Non-fatal suicide attempt in the past month was 2.3%, reaching 12.9% for the entire lifetime. Age, sex, education, and attitudes towards suicide were significantly associated with suicidal ideation or behavior. Thematic analysis showed five themes: (1) fostering belongingness, (2) securing learners' safety, (3) teaching philosophy, (4) teacher and learner beliefs towards suicidal behavior, and (5) availability of school-offered and community-based services.

Conclusion: Suicidal ideation and behaviors are prevalent among adolescent ALS learners. This study also showed a significant difference in attitudes towards suicide and sociodemographic characteristics between learners with and without suicidal ideation behaviors. It also suggests that the school psychosocial environment, through social norms and learner-teacher interactions, can potentially prevent progression of suicidal ideation to behavior, influence help-seeking, and promote mental health among learners.

Keywords: (Alternative) education; Adolescent; Attitude; Philippines; Suicidal ideation; Suicide.

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Conflict of interest statement

Permission to conduct the study was granted by the Department of Education, Division of City Schools-Manila and the respective school principals. Ethical approval of the study was granted by the Ethical Committee for Medical and Health Research Involving Humans, University of the Ryukyus, Japan (Protocol Identification Number 1247) and the National Children’s Hospital – Institutional Review Board, Philippines (NCH – IRB 2017-24-NCT-01). Written assent and consent from the participants and their guardians were obtained prior to conducting the study. Participants’ information was kept confidential.Not applicableThe authors declare that they have no competing interests.Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Flow of participant inclusion in the study
See this image and copyright information in PMC

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