Suicide is a major global health challenge and a leading cause of death among adolescents, but research related to suicide has concentrated on high-income countries. We aimed to estimate the prevalence of suicidal ideation, suicide planning, and suicide attempts in adolescents from 59 low-income and middle-income countries. In this population-based study, we used data from the Global School-based Student Health Survey of schoolchildren aged 13-17 years between 2003 and 2015, in 59 low-income and middle-income countries across six WHO regions. Using a meta-analysis with random effects, we computed the sex-based and age-based estimates of regional and overall prevalence of suicidal ideation, suicide planning, and suicide attempts. Our sample consisted of 229 129 adolescents (mean age 14·6 [SD 1·18] years; 111 082 [48%] boys and 118 047 [52%] girls). The overall prevalence of suicidal ideation was 16·9% (95% CI 15·0-18·8), suicide planning was 17·0% (14·8-19·2), and suicide attempts was 17·0% (14·7-19·3) in the 12 months preceding survey completion. The African region had the highest prevalence of suicidal ideation (20·4%, 17·3-23·6) and suicide planning (23·7%, 19·1-28·3), and the western Pacific region had the highest prevalence of suicide attempts (20·5%, 14·3-26·7). Southeast Asia had the lowest prevalence of ideation (8·0%, 4·5-11·5), planning (9·9%, 5·0-14·8), and attempts (9·2%, 5·1-13·3). Girls had higher prevalence than boys for suicidal ideation (18·5%, 16·4-20·6 vs 15·1%, 13·4-16·7), suicide planning (18·2%, 15·8-20·6 vs 15·6%, 13·7-17·6), and suicide attempts (17·4%, 15·0-19·8 vs 16·3%, 14·0-18·6). Adolescents aged 15-17 years had higher prevalence than those aged 13-14 years of suicidal ideation (17·8%, 15·8-19·8 vs 15·9%, 14·1-17·6), suicide planning (17·8%, 15·7-20·0 vs 16·3%, 14·7-17·9), and suicide attempts (17·6%, 15·2-20·0 vs 16·2%, 13·8-18·5). Suicidal thoughts and behaviours are prevalent among adolescents in low-income and middle-income countries, particularly in the African and the western Pacific regions, and particularly among girls and adolescents aged 15-17 years. Targeted suicide prevention initiatives are needed and should take into account the diverse range of cultural and socioeconomic backgrounds of the countries. None.

Suicide has been identified as a major public health issue. Exposure to suicide (i.e., knowing someone who died by suicide) is far more pervasive than previously considered and might be associated with significant adverse outcomes. As suicide becomes more commonly discussed in the public arena, a compelling need exists to determine who is exposed to suicide and how this exposure affects those left behind. This study estimated the proportion of the population exposed to suicide and delineated factors that predict significant psychiatric and psychosocial morbidity following that exposure. A dual-frame random-digit-dial survey was conducted on a sample of 1,736 U.S. adults in the Commonwealth of Kentucky. Depression and anxiety were compared in suicide-exposed and suicide-unexposed individuals. Relationships were examined between psychiatric outcomes and perceptions of closeness to the decedent. Forty-eight percent of weighted participants (n=816/1,687) reported lifetime exposure to suicide. Current depression and anxiety symptoms were higher in suicide-exposed than in suicide-unexposed individuals. Suicide-exposed individuals were twice as likely as suicide-unexposed individuals to have diagnosable depression and almost twice as likely to have diagnosable anxiety. Suicide-exposed individuals were more likely than suicide-unexposed individuals to report suicide ideation (9% vs. 5%). Closeness to the decedent increased the odds of depression and anxiety and almost quadrupled the odds of posttraumatic stress disorder. Exposure to suicide is pervasive and occurs beyond family; as such, it is imperative to identify those with perceived closeness to the decedent. This hidden cohort of suicide-exposed people is at elevated risk for psychopathology and suicidal ideation.

Co-creation of new knowledge has the potential to speed up the discovery and application of new knowledge into practice. However, the progress of co-creation is hindered by a lack of definitional clarity and inconsistent use of terminology. The aim of this paper is to propose a new standardised definition of co-creation of new knowledge for health interventions based on the existing co-creation literature. The authors completed a systematic search of electronic databases and Google Scholar using 10 of the most frequently used co-creation-related keywords to identify relevant studies. Qualitative content analysis was performed, and two reviewers independently tested the categorisation of papers. Of the 6571 papers retrieved, 42 papers met the inclusion criteria. Examination of the current literature on co-creation demonstrated how the variability of co-creation-related terms can be reduced to four collaborative processes: co-ideation, co-design, co-implementation and co-evaluation. Based on these four processes, a new definition of co-creation of new knowledge for health interventions is proposed. The analysis revealed the need to address the conceptual ambiguity of the definition of “co-creation of new knowledge”. The proposed new definition may help to resolve the current definitional issues relating to co-creation, allowing researchers and policymakers to progress the development of co-creation of new knowledge in research and practice.