The main thrust of the study was to assess the association between in-school students’ drug use and suicidal behaviour in Bolivia. The major finding was that students who ever used drugs were associated with suicidal behaviour in both the unadjusted and adjusted models. The results are consistent with findings by Breet and co-authors who noted a significant association between high-risk behaviours such as drug use and suicidal behaviour among students in high-income countries [18]. It is not surprising that drug use was found to have the strongest associations with suicidal behaviour in this current study, as these variables have been found to have the strongest relationships with suicidal behaviours in longitudinal samples [22, 23]. The plausible pathway linking drug use to suicidal behaviour is that drug users, especially adolescents addicted to marijuana suffer from depression [24–26] which then influence and impair their thoughts and emotions. Drug use, in addition to smoking marijuana and alcoholism, has been observed to have the combined effects of complicating the course of depression and impairing the judgement of a person experiencing depression, and at the same time resulting in high impulsivity which leads to acute life-threatening behaviour such as suicide [25]. Globally, evidence suggests that those who abuse drugs are at higher risk and that is an important variable in the aetiology of suicidal behaviour [27].
Alcoholism was associated with suicidal behaviour in the present study. A recent review reported that in Southern America, alcohol, drugs and other unconventional substances are commonly misused by young people in bad political and socioeconomic circumstances in countries, including Bolivia [24]. The increase in impulsivity and aggression as a result of alcohol use is one of the most frequently suggested links in the literature [28, 29]. Consistent evidence supports that young people in South America still face multiple challenges that expose them to risky health behaviours [30, 24, 29]. For example, whereas underage use of marijuana and alcohol is illegal in South American Countries, the enforcement of such laws remains a critical challenge, with retailers selling out alcohol to in-school children [24–26]. Literature on the health effects of marijuana use indicates that marijuana acute intoxication harms memory learning, memory, attention, concentration and abstract reasoning [15]. These effects persist even when the individual is no more using the substance [15].
Findings by sociodemographic variables such as age, sex and parental care reflected relatively similar patterns to earlier studies with the age group 10–24 having the highest odds of suicidal behaviours [24, 29]. Depending on the age and sex of individuals, they may decide to indulge in behavioural patterns which may directly or indirectly reflect their interactions with peers. A study by Xiao and Lindsey in the USA also noted that females were more likely to engage in suicidal behaviour than males [31]. What might have accounted for the inequalities in suicidal behaviours across age, sex, and difference in socioeconomic status cannot be explained due to our study design adopted (i.e. cross-sectional study). As such, further studies that could employ, at least, a qualitative approach to the phenomenon will be desired to understand these observations.
Students with sleeping difficulties were inclined to suicidal behaviour. This has been corroborated by Norman and colleagues who noted a clear relationship between a range of subjective sleep problems (e.g., insomnia, hypersomnia, sleep duration, nightmares) and the continuum of suicidality in adolescents and adults in the USA [32]. The finding that parental monitoring and supervision, having many close friends parental understanding of ward concerns are associated with decreased odds of suicidal planning is intuitive and less surprising. This is consistent with existing Western life-course models that suggest that larger social networks, parental monitoring and supervision are strong predictors of positive health and behavioural outcomes among school-age adolescents across cultures [29, 30, 7]. Although, similar evidence has been reported among in-school students in the United States [24], the Bolivian situation is not different; as the data suggest that in school students who had friends, never felt lonely had a decreased odd with suicidal behaviour.
In agreement with previous evidence from high-income countries [15], this study found an increased odd of suicidal behaviours among those ever bullied and previously physically attacked in school. Consistent evidence has also established an association between these risky behaviours and suicidal attempts [28, 24]. Conceivably, any form of violence experienced could trigger suicidal thoughts and the effect is suicidal behaviour [33].
Strength and weakness
It must be acknowledged that the study has some limitations. Firstly, since the dataset was derived from a cross-sectional study design, causality cannot be established. Also, the study could be affected by recall and social desirability biases since drug use and suicidal behaviour is a sensitive issues. Also, the study design limited the effort to unravel the reasons behind some of the observations. However, the study relied on samples drawn using a probabilistic method, as such, findings and conclusions shall reflect the views of in-school students aged 13–17 in Bolivia. Also, a strict methodological approach was followed to analyse the variables of the study which improved the methodological rigour and robustness of the results.