Suicidality and Self-Harm Behavior of Adolescents During the Early Phase of the War in Ukraine

Objective
War profoundly impacts people's lives, causing death, displacement and psychological trauma but limited research has investigated adolescents’ suicidality in this context. We compared suicidality or self-harm behavior among adolescents in regions that were, and were not, affected by Russia’s initial invasion of Ukraine in 2014.

Method
This cross-sectional study comprised 2,752 school students aged 11-17 years from war-affected Donetsk region and non-war Kirovograd region. Data collection occurred from 2016-17 using self-report tools to assess suicidality or self-harm behavior, psychopathology including post-traumatic stress disorder (PTSD), depression and anxiety, and war trauma exposure.

Results
Adolescent girls in war-affected region reported more suicide attempts (9.5% vs 5.1%, adjusted odds ratio [aOR] 1.8, 95% confidence interval [CI] 1.2-2.8), suicidal ideation (39.3% vs 19.6%, aOR 2.6, 95% CI 2.01-3.3) or self-harm behavior (19.6% vs 13.1%, aOR 1.6, 95% CI 1.2-2.1) and boys reported more suicidal ideation (17.0% vs 9.8%, aOR 1.7, 95% CI 1.2-2.4). Boys and girls with PTSD, depression or anxiety showed increased risks for any suicidality or self-harm. A dose-effect relationship was observed in the relationship between war trauma exposure and suicidality or self-harm. The association was strongest for those who had been exposed to 5 or more different war trauma exposures (aOR 3.2, 95% CI 2.2-4.8).

Conclusion
War trauma exposure and psychopathology were strongly associated with suicidality or self-harm behavior, with a greater impact in girls than boys. The high prevalence of suicidality found in this study emphasizes the need for intervention at large scale for adolescents living in war situations. Keywords: suicide attempts, suicidal ideation, self-harm, war, adolescents