Gender differences in suicidal expressions and their determinants among young people in Cambodia, a post-conflict country*

BACKGROUND Suicide among young people is a global public health problem, but adequate information on determinants of suicidal expression is lacking in middle and low income countries. Young people in transitional economies are vulnerable to psychosocial stressors and suicidal expressions. This study explores the suicidal expressions and their determinants among high school students in Cambodia, with specific focus on gender differences. METHODS A sample of 320 young people, consisting of 153 boys and 167 girls between 15-18 years of age, was randomly selected from two high schools in Cambodia. Their self-reported suicidal expressions, mental health problems, life-skills dimensions, and exposure to suicidal behavior in others were measured using the Youth Self-Report (YSR), Life-Skills Development Scale (LSDS)-Adolescent Form, and Attitude Towards Suicide (ATTS) questionnaires. RESULTS Suicidal plans were reported more often by teenage boys than teenage girls (M=17.3%, F=5.6%, p=0.001), whereas girls reported more attempts (M=0.6%, F=7.8%, p=0.012). Young men scored significantly higher on rule-breaking behavior than young women (p=0.001), whereas young women scored higher on anxious/depression (p=0.000), withdrawn/depression (p=0.002), somatic complaints (p=0.034), social problems (p=0.006), and internalizing syndrome (p=0.000). Young men exposed to suicide had significantly higher scores for internalizing syndrome compared to those unexposed (p=0.001), while young women exposed to suicide scored significantly higher on both internalizing (p=0.001) and externalizing syndromes (p=0.012). Any type of exposure to suicidal expressions increased the risk for own suicidal expressions in both genders (OR=2.04, 95% CI=1.06-3.91); among young women, however, those exposed to suicide among friends and partners were at greater risk for the serious suicidal expressions (OR=2.79, 95% CI=1.00-7.74). Life skills dimension scores inversely correlated with externalizing syndrome in young men (p=0.026) and internalizing syndrome in young women (p=0.001). CONCLUSIONS The significant gender differences in suicidal expressions and their determinants in Cambodian teenagers highlight the importance of culturally appropriate and gender-specific suicide prevention programs. School-based life skills promotion may indirectly influence the determinants for suicidal expressions, particularly among young women with internalizing syndrome in Cambodia.