This study examined suicide attempts and revealed that 6.9% of Malaysian adolescents attempted suicide. The survey result was higher compared to China (2.9%) (19), Indonesia, Brunei, and Laos where the suicidal attempt was at 3.9%, 5.2%, and 5.9% respectively (20). However, the result was lower than a survey reported in Thailand whereby 13.3% of Thailand adolescents aged 13–17 years old attempted suicide. Our result was also lower compared to Myanmar (8.8%) and Timur leste (9.5%) (21). In addition, a population-based study done by Uddin et al. (2019)(22) in 59 low and middle countries involving 29, 129 adolescents showed a higher rate of suicidal attempts compared to our result at 17%. A study by Maniam et al. (2014) (18) revealed that younger people aged 16–24 in Malaysia are at a 2.6 times higher risk of suicidal behaviour. According to Wu et al. (2012), compared to other Asian regions, the prevalence of suicidal behaviours among school-going adolescents in Malaysia is comparatively low; non-reporting and underreporting of suicide cases in Malaysia are most probably the reason for the low rate of suicide cases due to cultural, religious as well as legal factors (23). Additionally, according to the Malaysian Penal Code, section 309, suicide is an offence that can be fined, imprisoned, or both, which further prevents reporting such cases (24). Suicide is culturally taboo; thus, reporting is avoided to spare families from embarrassment and stigma (23).
The survey result showed adolescents aged 13–14 years reported higher odds of suicide attempts compared with other aged groups. The result is not consistent with a past study (25) in which adolescents aged 17 and 18 reported the highest rates at 40.40% and 28.40% respectively.
Results showed gender factors are not significantly related to suicide attempts. This finding is comparable to research done by Campisi et al. (2020) which analysed data from 90 countries of the global school-based student health survey among adolescents (26). Their result showed no difference in suicide attempt rates for both genders. Our study result is in line with past studies which showed no statistically significant difference between male and female adolescent suicide attempts (27). However, Miranda et al. (2019)(28) conducted a meta-analysis of 24 studies and reported that females presented with a two-fold higher risk of suicide attempts than males. A School health survey participated by adolescents aged 11–17 years in China reported 8.0% of the respondents attempted suicide, and girls showed a higher rate (9.3%) than boys (6.6%) (29). More girls (5.34%) reported suicide attempts than boys (2.14) in a study involving adolescents aged 13–19 years done in Eastern Poland (25). Maniam et al. (2014)(30) reported that 16% of Malaysian adolescent girls have a higher risk of suicidal behaviour. The discrepancy between male and female suicidal behaviour rates may be associated with cultural acceptability, psychosocial differences between the two gender, and the suicide method used (31, 32).
The prevalence of suicide attempts differs among ethnicities, where Indians and Chinese were at higher risk of having suicide attempts compared to other ethnicities. Among all ethnicities, Indians were significantly higher in suicide attempts (38%). Other studies in Malaysia have consistently reported higher rates of suicidality among Indians (30, 33–35). Malaysia is a multiracial society with a diverse population of religious and cultural values. Therefore the variations in suicide rates among ethnicities are likely influenced by religious and cultural factors.
There were 16.2% of respondents reported that they were bullied. This result was lower compared to other South East Asia Countries, whereby the rate of bullying among school adolescents reported by the Philippines (51.5%), Thailand (32.7%), Timor-Leste (31.3%), Brunei (23%), Cambodia (22.2%), and Indonesia (21%), but higher compared with Laos (13.2%) (20). Our result is also higher compared with Korea where 14% of their school adolescents were victims of bullying (36). The Global School-based Student Health Survey (2009–2015) from 48 countries reported that the prevalence of bullying victimisation among adolescents aged 12 to 15 was 30.4% (20). Similarly, the result was shown in a meta-analysis of 80 studies by Modecki et al. (2014) that reported a prevalence of bullying victimisation of 36% (37).
Being bullied can be a significant traumatic event associated with many negative effects (38, 39). The current study has determined a relationship between suicide attempts and bullying, showing that 17% of adolescents who experienced bullying have attempted suicide. This is in line with other works of literature. The GSHS between 2009–2015 found that among adolescents from 48 countries, being bullied at least once in the past 30 days was associated with 3-fold higher odds for an overall suicide attempt (20). A study done in Malawi found that 13.4% of the school-going adolescent had attempted one or more suicide attempts after being bullied (27).
Romo et al. reported that in Latin America, adolescents who experienced bullying in the past 30 days were three times the odds of suicide attempts (40). A school health survey in Tanzania found out adolescents who were bullied were about 4 times odds higher for suicide attempts than those not experiencing bullying (41). This study’s findings are consistent with other studies that reported adolescents being bullied were significantly more likely to have suicide attempts (15, 42–46).
This’s study result showed adolescents whose parents live apart showed a higher risk for suicide attempts compared with adolescents residing with both parents (aOR: 1.412). A study done by Garnefski and Diekstra(47) revealed that adolescents from intact families had the lowest likelihood of suicide attempts. According to a child health study in Ontario, adolescents whose parents lived apart or without biological parents had higher rates of suicide attempts (48). Adolescents who were being raised in an incomplete family structure reported a higher risk for suicide attempts (27.71%, X2 66.73) (25).
Strength and limitations
The strength of this study is the analysis used in this study, which was based on a substantial, nationally representative sample, enabled a trustworthy extrapolation to Malaysian adolescents in a related age range. In addition, an anonymous version of the GSHS was employed in this study, which is favourable for cross-national comparison. This poll employed a validated bilingual (English and Bahasa Malaysia) questionnaire that is common with students. However, some limitations of the current study including could not identifying the causal relationship between bullying and suicidal attempt but only demonstrating the associations. Second, since it was self-reporting, there might be bias in recalling the bullying experience and answering the questionnaire influenced by respondents’ cultural factors.