The Role of Absence of Close Friends in Suicidal Planning Among Thai Adolescents: Analysis of Nationwide Global School-based Health Survey Data

Riska Ratnawati; Shaharuddin Mohd Sham

doi:10.53770/medica.v8i4.899

Authors

Riska Ratnawati Department of Public Health, STIKES Bhakti Husada Mulia, Madiun, East Java, Indonesia
Shaharuddin Mohd Sham Department of Environmental and Occupational Health, Universiti Putra Malaysia, Serdang, Selangor, Malaysia

DOI:

https://doi.org/10.53770/medica.v8i4.899

Keywords:

Adolescents, Close Friends, Suicidal Planning, Peer Support, Thailand

Abstract

Phenomena of suicide among adolescents in Thailand remains a pressing public health concern. Suicide is the third leading cause of death among adolescents aged 15–19 in Thailand. While previous studies have highlighted psychiatric, familial, and psychosocial risk factors, limited evidence exists on the specific role of peer relationships, particularly the absence of close friends, in suicidal planning. This study objective examined the association between adolescents without close friends and suicidal planning using nationally representative data from the 2021 Global School-based Student Health Survey (GSHS). A cross-sectional design using a secondary data approach was employed, analyzing responses from 4,659 students aged 13–17 years after excluding incomplete cases. The independent variable was the absence of close friends, and the dependent variable was suicidal planning within the past 12 months. Binary logistic regression was conducted, adjusting for confounders including age, sex, loneliness, bullying, parental understanding, and peer kindness. Results indicated that adolescents without close friends had a significantly higher likelihood of reporting suicidal plans (OR = 1.042, 95% CI: 1.026–1.058, p < 0.001). Emotional distress factors such as loneliness and worry-induced sleeplessness, along with experiences of bullying, further amplified risk. These findings align with the Interpersonal Theory of Suicide, which emphasizes thwarted belongingness as a driver of suicidal ideation. The study underscores the protective role of peer relationships in adolescent mental health and highlights the need for interventions that strengthen peer support systems and inclusive school environments. Limitations include reliance on self-reported data and the cross-sectional design, which cannot explains causal inference. Future longitudinal research is recommended to explore temporal ambiguity of peer relationships and suicidality.

References

Banstola, I., Banstola, R. S., Paudel, K. S., & Bhandari, S. (2023). Interpersonal Psychological Theory of Suicide in Understanding Suicidal Behavior Among Adolescents in Nepal. Janapriya Journal of Interdisciplinary Studies, 12(1), 188–197. https://doi.org/10.3126/jjis.v12i1.62256

Cabezas-Klinger, H., Daza, F. F. F., & Mina-Paz, Y. (2025). Associations Between Social Media Use and Mental Disorders in Adolescents and Young Adults: A Systematic Review and Meta-Analysis of Recent Evidence. Behavioral Sciences, 15(11), 1450. https://doi.org/10.3390/bs15111450

Chaniang, S., Klongdee, K., & Jompaeng, Y. (2022). Suicide Prevention: A Qualitative Study With Thai Secondary School Students. Belitung Nursing Journal, 8(1), 60–66. https://doi.org/10.33546/bnj.1746

Chiu, H., & Vargo, E. J. (2022). Bullying and other risk factors related to adolescent suicidal behaviours in the Philippines: a look into the 2011 GSHS Survey. BMC psychiatry, 22(1), 445. https://doi.org/10.1186/s12888-022-04085-w

Fuseekul, N., Orchard, F., & Reynolds, S. (2021). Psychometric properties of the Thai Mood and Feelings Questionnaire (MFQ) for adolescent depression. Child and adolescent psychiatry and mental health, 15(1), 17. https://doi.org/10.1186/s13034-021-00372-8

Gesese, A. A., & Ochan, O. O. (2022). Suicidal behavior, suicidal ideation and patterns among youths in Anywaa zone, Gambella, Southwest Ethiopia: a mixed-methods study. BMC Psychiatry, 22(1), 389. https://doi.org/10.1186/s12888-022-03971-7

Kim, K. (2022a). Poor youth mental health is costing Thailand. Bangkok: UNICEF Thailand. Retrieved from https://www.unicef.org/thailand/blog/poor-youth-mental-health-costing-thailand

Kim, C. (2022b). Understanding Asian American College Students’ Suicidal Behavior: Qualitative Study. International Journal of Social Science and Humanity, 213–219. https://doi.org/10.18178/ijssh.2022.v12.1094

Li, M., Bergren, S., Simon, M., & Dong, X. (2022). Cultural attributes of suicidal ideation among older immigrants: a qualitative study. BMC geriatrics, 22(Suppl 1), 678. https://doi.org/10.1186/s12877-021-02628-6

Louthrenoo, O. (2019). Cyberbullying and Emotional-Behavioral Functioning Among Northern Thai Adolescents. Biomedical Journal of Scientific & Technical Research, 17(3), 12877-12881. https://doi.org/10.26717/bjstr.2019.17.003011

Ma, J., Batterham, P. J., Calear, A. L., & Han, J. (2016). A Systematic Review of the Predictions of the Interpersonal–Psychological Theory of Suicidal Behavior. Clinical Psychology Review, 46, 34–45. https://doi.org/10.1016/j.cpr.2016.04.008

McClelland, H., Evans, J. J., Nowland, R., Ferguson, E., & O’Connor, R. C. (2020). Loneliness as a Predictor of Suicidal Ideation and Behaviour: A Systematic Review and Meta-Analysis of Prospective Studies. Journal of Affective Disorders, 274, 880–896. https://doi.org/10.1016/j.jad.2020.05.004

Motillon-Toudic, C., Walter, M., Séguin, M., Carrier, J., Berrouiguet, S., & Lemey, C. (2022). Social Isolation and Suicide Risk: Literature Review and Perspectives. European Psychiatry, 65(1), e65. https://doi.org/10.1192/j.eurpsy.2022.2320

Olson, M. A., McNulty, J. K., March, D. S., Joiner, T. E., Rogers, M. L., & Hicks, L. L. (2022). Automatic and Controlled Antecedents of Suicidal Ideation and Action: A Dual-Process Conceptualization of Suicidality. Psychological Review, 129(2), 388–414. https://doi.org/10.1037/rev0000286

Pandey, A. R., Bista, B., Dhungana, R. R., Aryal, K. K., Chalise, B., & Dhimal, M. (2019). Factors Associated With Suicidal Ideation and Suicidal Attempts Among Adolescent Students in Nepal: Findings From Global School-Based Students Health Survey. Plos One, 14(4), e0210383. https://doi.org/10.1371/journal.pone.0210383

Patanavanich, R., Vityananan, P., Neelapaichit, N., Chariyalertsak, S., Kessomboon, P., Assanangkornchai, S., Taneepanichskul, S., & Aekplakorn, W. (2022). Association Between Electronic Cigarette Use and Depression Among Thai Adolescents: The Thailand National Health Examination Survey 2019–2020. Tobacco Induced Diseases, 20(November), 1–8. https://doi.org/10.18332/tid/155333

Pengpid, S., & Peltzer, K. (2020). Suicide Attempt and Associated Factors Among Adolescents in Five Southeast Asian Countries in 2015. Crisis, 41(4), 296–303. https://doi.org/10.1027/0227-5910/a000642

Pengpid, S., & Peltzer, K. (2024). Adolescent Health-Risk Behaviours in Thailand: Patterns From National Cross-Sectional School Surveys Conducted in 2008, 2015, and 2021. Research Square, 1-25. https://doi.org/10.21203/rs.3.rs-3895717/v1

Prawira, B., Liem, A., Yulianto, J. E., & Han, J. (2023). The Associated Factors of Self-Harm and Suicide Ideation Among Chinese Indonesians During the COVID-19 Pandemic. International Perspectives in Psychology, 12(2), 85–95. https://doi.org/10.1027/2157-3891/a000070

Shawon, M. S. R., Jahan, E., Rouf, R. R., & Hossain, F. B. (2022). Psychological Distress and Unhealthy Dietary Behaviours Among Adolescents Aged 12–15 Years in Nine South-East Asian Countries: A Secondary Analysis of the Global School-Based Health Survey Data. British Journal of Nutrition, 129(7), 1242–1251. https://doi.org/10.1017/s0007114522002306

Sudjaritruk, T., Aurpibul, L., Songtaweesin, W. N., Narkpongphun, A., Thisayakorn, P., Chotecharoentanan, T., ... & Mental Health Study Group. (2021). Integration of mental health services into HIV healthcare facilities among Thai adolescents and young adults living with HIV. Journal of the International AIDS Society, 24(2), e25668. https://doi.org/10.1002/jia2.25668

Wellappuli, N. T., Gunawardena, N., Mahesh, P. K. B., Gunawardena, S., Wickramasinghe, C., Lokubalasooriya, A., Peiris, R., Liyanage, C., Hathurusinghe, L., Mahagamage, K., & Senanayake, S. (2021). Psycho-Social Wellbeing Among in-School Adolescents of Sri Lanka; Prevalence of Selected Attributes and Associated Factors. Research Square, 1-17. https://doi.org/10.21203/rs.3.rs-33489/v2

Wichaidit, W., Mattawanon, N., Somboonmark, W., Prodtongsom, N., Chongsuvivatwong, V., & Assanangkornchai, S. (2023). Behavioral Health and Experience of Violence Among Cisgender Heterosexual and Lesbian, Gay, Bisexual, Transgender, Queer and Questioning, and Asexual (LGBTQA+) Adolescents in Thailand. Plos One, 18(6), e0287130. https://doi.org/10.1371/journal.pone.0287130

Wongpakaran, N., Oon‐arom, A., Karawekpanyawong, N., Lohanan, T., Leesawat, T., & Wongpakaran, T. (2021). Borderline Personality Symptoms: What Not to Be Overlooked When Approaching Suicidal Ideation Among University Students. Healthcare, 9(10), 1399. https://doi.org/10.3390/healthcare9101399