Food insecurity (hunger) and suicide attempts among 179,771 adolescents attending school from 9 high-income, 31 middle-income, and 4 low-income countries: A cross-sectional study

Background: Data on food insecurity and suicide attempts in adolescence are scarce. Thus, the aim of the current study was to assess the association between food insecurity (hunger) and suicide attempts in adolescents from 44 countries. Methods: Cross-sectional, school-based data from the Global School-based Student Health Survey were analyzed. Data on past 12-month suicide attempts and past 30-day food insecurity (hunger) were collected. Multivariable logistic regression, meta-analysis, and meta-regression were conducted to assess the associations. Results: The final sample consisted of 179,771 adolescents attending school. The prevalence of moderate (rarely/sometimes hungry) and severe (most of the time/always hungry) food insecurity were 46.7% and 7.0%, respectively. After adjustment for potential confounders, severe food insecurity (vs. no food insecurity, i. e., no hunger) was significantly associated with higher odds for suicide attempts in 31 of the 44 countries studied with the pooled OR (95% CI) being 1.90 (1.77-2.04) (I-2 = 45.2%). The associations were similar across countryincome levels. However, meta-regression analysis by country showed that stronger associations were related with lower population prevalence of severe food insecurity. The pooled OR (95% CI) for moderate food insecurity (vs. no food insecurity) was 1.26 (1.21-1.32) (I-2 = 29.7%). Limitations: Causality cannot be established due to the cross-sectional study design. Conclusions: Food insecurity (hunger) is a global problem and is associated with suicide attempts. The identification of children suffering from food insecurity (hunger) and remedying this condition may be important to improve mental health among adolescents worldwide.