High prevalence and multilevel correlates of suicidal ideation Among Bahamian adolescents: findings from a national study

Introduction: Suicide is among the leading causes of death among adolescents in the Caribbean, yet suicidal ideation among Bahamian adolescents remains understudied. Few studies have assessed the association between online risk behaviors, environmental factors, and suicidal ideation. This study investigated the prevalence of suicidal ideation among Bahamian adolescents and examined its multilevel correlates, including offline and online risk behaviors and environmental factors. Methods: Grade 9 students attending public schools participating in a nationwide implementation trial in The Bahamas completed a survey during 2023-2024. A total of 2,357 students participated. Data were analyzed using generalized linear mixed-effects models. Results: Approximately 46% of students reported lifetime suicidal ideation, and among those, 33% reported self-harm thoughts nearly every day in the past two weeks. Female gender, engagement in cyberbullying, sexting and certain offline risk behaviors, and depressive symptoms were associated with increased suicidal ideation, whereas parental monitoring was protective. Neighborhood risk was not associated with suicidal ideation. Conclusion: These findings underscore the urgent need for multilevel suicide prevention strategies that address online and offline risk behaviors and strengthen targeted mental health support for adolescents in The Bahamas.