The overall response rate of the selected participants was 89% with 3262 usable data records. One hundred and sixteen (n=388) either did not give consent to be included in the study or was absent from school on the day of the data collection.
Characteristics of participants
Most of the students who responded belonged to the 13-15 age group (66.5%). The study group consisted of an equal proportion of males (48.9%) and females (51.1%) (table 1). Further analyses were performed on the 3173 participants who were within the 13 to 17 years (i.e. excluding the 88 participants who were studying between grades 8-12 but being outside these age limits).
Table 1: Description of study participants of the 2016 Sri Lankan Global School-Based Survey (N=3261)
Characteristic
|
Frequency
|
(%)
|
Age
|
|
|
12 years or younger
|
66
|
(2.1)
|
13-15 years
|
2196
|
(66.5)
|
16-17 years
|
977
|
(30.7)
|
18 and older
|
22
|
(0.7)
|
Sex (Missing – 19)
|
|
|
Male
|
1437
|
(48.9)
|
Female
|
1805
|
(51.1)
|
Selected outcomes related to psycho-social well-being psycho-social well-being
The table 2 shows the percentage of participants who experienced three selected outcomes in relation to psycho-social well-being, namely being subjected to bullying, feeling loneliness and feeling anxious.
Table 2: Distribution of the study participants of age 13-17 by the frequency of been subjected to bullying during the last 30 days, felt loneliness during last 12 months and felt anxious during last 12 months by sex and age categories
Variable
|
Subjected to bullying in last 30 days
|
Loneliness (felt most of the time or always) during past 12 months
|
Feeing anxious
(most of the time or always) in last 12 months
|
Percentage (95% CI)
|
Percentage (95% CI)
|
Percentage (95% CI)
|
Total
|
37.7 (36.1- 39.5)
|
9.0 (8.0- 10.0)
|
4.7 (3.9- 5.4)
|
Sex
|
|
|
|
Males
|
48.6 (45.8- 51.2)
|
8.2 (6.8-9.7)
|
4.1 (3.2-5.2)
|
Females
|
28.9 (26.7-30.9)
|
9.5 (8.1-10.8)
|
4.8 (3.8-5.8)
|
Age
|
|
|
|
13-15 years
|
37.7 (35.7-39.8)
|
7.6 (6.5-8.7)
|
3.7 (2.9-4.5)
|
16-17 years
|
36.8 (33.7-39.8)
|
12.0 (9.9-14.0)
|
6.3 (4.8-7.9)
|
More than one third of the participants (37.7%) had experienced bullying 30 days prior to the study, with a significantly higher male (48.6%, 95% CI 45.8- 51.2) preponderance compared to females (28.9%, 95% CI 26.7-30.9). ‘Loneliness’ and ‘feeling anxious’ had been experienced equally by both sexes. The prevalence of experiences in bullying was similar between the two age categories (age 13-15 years and 16-17 years). In contrast, ‘loneliness’ was significantly higher in the older age group (12.0%, 95% CI 9.9-14.0) compared to the 13-15 category (7.6%, 95% CI 6.5-8.7). Significantly more students in the elderly group (i.e. age group 16-17 years) (6.3%, 95% CI 4.8-7.9) had experienced anxiousness compared to their younger counterparts (3.7%, 95% CI 2.9-4.5).
Table 3 depicts three outcomes in relation to psycho-social well-being, related to suicides: ideation, planning and attempting. Nearly one tenth of the participants have seriously considered attempting suicide. The prevalence of planning an attempt of suicide was 6.3%, while 6.6% had at least once attempted suicide. None of these outcomes showed significant difference between different sex and age groups.
Table 3: Distribution of the study participants of age 13-17 by the frequency of the consideration of attempting suicide, planned suicide, attempted suicide by sex and age categories
|
Seriously considered attempting suicide
|
Planned attempting suicide
|
At least once attempted suicide
|
Percentage (95% CI)
|
Percentage (95% CI)
|
Percentage (95% CI)
|
Total
|
9.3 (8.2-10.2)
|
6.3 (5.4-7.1)
|
6.6 (5.7-7.5)
|
Sex
|
|
|
|
Males
|
9.6 (8.1-11.1)
|
6.1 (4.8-7.4)
|
6.6 (5.3-7.9)
|
Females
|
8.9 (7.6-10.2)
|
6.5 (5.3-7.6)
|
6.5 (5.3-7.7)
|
Age
|
|
|
|
13-15 years
|
9.0 (7.8-10.2)
|
6.4 (5.3-7.4)
|
6.6 (5.7-7.7)
|
16-17 years
|
9.5 (7.7-11.3)
|
6.1 (4.5-7.5)
|
6.4 (4.8-7.9)
|
Associations of psycho-social wellbeing
Table 4 shows unadjusted associations of eleven selected characteristics in relation to four selected outcomes of the psycho-social wellbeing: being bullied, loneliness, feeling anxious and considering attempting suicide.
Table 4: Factors associated mental health illness (Unadjusted Odds Ratios with 95% CI) - from total study population
Characteristic
|
Total
|
Subjected to bullying 30 days
|
Loneliness- felt most of the time or always
|
Feeling anxious - last 12 months
|
Considered attempting suicide
|
Age
|
13-15
|
2196
|
1
|
1
|
1
|
1
|
|
16-17
|
977
|
0.9 (0.8-1.1)
|
1.6 (1.2-2.1)*
|
1.8 (1.3-2.5)*
|
1.0 (0.8-1.4)
|
Sex
|
Male
|
1437
|
2.3 (2.0-2.7)*
|
0.9 (0.7-1.1)
|
0.8 (0.6-1.2)
|
1.1 (0.9-1.4)
|
Female
|
1805
|
1
|
1
|
|
1
|
Ever smoking
|
Yes
|
189
|
3.4(2.5- 4.7)*
|
1.8 (1.2-2.8)*
|
3.1 (1.8-5.0)*
|
2.7 (1.8-4.1)*
|
No
|
2906
|
1
|
1
|
1
|
1
|
Ever drinking alcohol
|
Yes
|
219
|
2.3(1.7-3.1)*
|
2.0 (1.4-3.0)*
|
2.5 (1.5-4.0)*
|
2.3 (1.5-3.3)*
|
No
|
2929
|
1
|
1
|
|
1
|
Had close friends
|
No
|
180
|
1.4* (1.1-1.9)
|
2.3 (1.6-3.5)*
|
2.6 (1.5-4.2)*
|
2.5 (1.6-3.6)*
|
Yes
|
3082
|
1
|
1
|
|
1
|
Students in their school were kind and helpful
|
No
|
1564
|
1.5* (1.3-1.8)
|
1.2 (0.9-1.6) *
|
1.7 (1.2-2.4)*
|
1.7 (1.3-2.2)*
|
Yes
|
1666
|
1
|
1
|
1
|
1
|
Played one or more sports
|
No
|
532
|
0.7* (0.6-0.9)
|
1.6 (1.2-2.1)*
|
1.4 (0.9-2.0)
|
1.6 (1.2-2.1)*
|
Yes
|
2730
|
1
|
1
|
1
|
1
|
Lacked parental support
|
Yes
|
1214
|
2.0* (1.7-2.8)
|
2.5 (1.9-3.2)*
|
2.6 (1.8-3.7)*
|
2.7 (2.1-3.5)*
|
No
|
2013
|
1
|
1
|
|
1
|
Lacked parental supervision
|
Yes
|
987
|
2.5* (2.2-3.0)
|
2.1 (1.6-2.6)*
|
2.3 (1.7-3.2)*
|
2.6 (2.0-3.3)*
|
No
|
2246
|
1
|
1
|
|
1
|
Was physically attacked
|
Yes
|
1119
|
4.9* (4.2-5.8)
|
2.0 (1.6-2.6)*
|
2.4 (1.7-3.3)*
|
2.0 (1.5-2.5)*
|
No
|
2120
|
1
|
1
|
|
1
|
Was in a fight
|
Yes
|
1420
|
3.9* (3.3-4.5)
|
1.5 (1.2-1.9)*
|
2.4 (1.7-3.4)*
|
2.1 (1.7-2.7)*
|
No
|
1838
|
1
|
1
|
1
|
1
|
*Significant at p=0.05 level
It is observed that except for the age, other characteristics are statistically significantly associated with being bullied at 5% significant level (Table 4). The highest effect measure was observed for ‘being physically attacked’. A participant who has been physically attacked is 4.9 times likely to be subjected to bullying compared to one without. Except for the sex of the participant, other characteristics were significantly associated with loneliness. The highest effect measure was observed for ‘lacking parental support’ (OR=2.5, 95% CI= 1.9- 3.2). Ten characteristics had been associated with considering attempting suicide, with age and sex being the only exceptions. ‘Lacked parental support’ and ‘having ever smoked’ were associated with 2.7 times likelihood of considering attempting suicide compared to absence of those factors.
Table 5 shows the adjusted effect measures of these associations. Adjustments have been done for the other 10 characteristics in this table as well as for the presence of these outcomes (as mentioned in table 6). Out of the characteristics mentioned in Table 5, five were independently associated with being bullied: male sex (OR=1.7, 95% CI=1.4 to 2.1), lacking parental support (OR=1.3, 95% CI=1.1 to 1.5), lacking parental supervision (OR=1.6, 95% CI=1.2 to 1.9), being physically attacked (OR=3.0, 95% CI=2.5 to 3.7) and being in a fight (OR=2.1, 95%CI=1.7 to 2.5). Older age (OR=1.7, 95% CI=1.2 to 2.3) and lack of parental support (OR=1.8, 95% CI=1.3 to 2.5) were independently associated with loneliness while male sex was observed to be a protective factor (OR=0.6, 95% CI=0.4 to 0.8). Five factors were associated significantly with considering attempting to suicide. Those were: not having close friends (OR=1.6, 95% CI=1.01 to 2.7), not engaging in sports (OR=1.5, 95% CI=1.1 to 2.1), lacking parental support (OR=1.7, 95% CI=1.2 to 2.3), lacking parental supervision (OR=1.5, 95% CI=1.1 to 2.1) and being in a fight (OR=1.5, 95% CI=1.1 to 2.1).
Mutual correlations of these four outcomes with each other are mentioned in table 6. Being bullied was significantly associated with loneliness (OR=2.4, 95% CI=1.8 to 3.3) and feeling anxious (OR=2.8, 95% CI= 1.7 to 4.5). In addition, experiencing loneliness was independently associated “considering an attempt of suicide” (OR=2.9, 95% CI=2.0 to 4.3). Feeling anxious was also associated with considering attempting suicide (OR=3.4, 95% CI= 2.1 to 5.4).