Victimisation, depression and suicidal ideation: understanding interlinkages among youth in North India through structural equation modelling

Background Suicide and violence are major contributors to youth mortality. Effective prevention strategies require understanding of their psychological underpinnings. We therefore aimed to determine the interconnections among victimisation, physical violence, depression and suicidal ideation and attempts, among young adults in a North India city. Methods We used data from a survey of young adults aged 18-22 years, recruited across six colleges by random sampling. Our theory-based structural equation model specified suicidal ideation and attempts as an outcome of victimisation, indicated by dating violence, campus bullying and cyberbullying. We coded "suicidal ideation and attempts" as a single ordinal variable, with five levels from "did not consider suicide" to "had a suicide attempt requiring medical treatment". We used the probit link function and theta parameterisation for categorical endogenous variables. We computed standardised path coefficients, p-values and global fit measures. Results Among 752 survey respondents (median age 19 years, 64.4% women), 16.6% had been involved in a physical fight, 24.2% had had depressive symptoms and 4.5% had seriously considered suicide in the past 12 months. We found indirect associations between victimisation and suicidal ideation and attempts, mediated by physical violence and depressive symptoms. Direct effects of victimisation on suicidal ideation and attempts were negligible. Global model fit was acceptable. Discussion Our findings suggest that youth victimisation predisposes to suicidal behaviour, by increasing physical aggression and depression. Prevention of suicide among youth requires multi-level action, including measures to stop bullying and violence, life skills education, and treatment of underlying depression.