Suicidal behavior and subjective mental well-being among conflict-affected high school students in the North Wollo Zone, Ethiopia: a multilevel analysis

Adolescents living in conflict-affected areas have higher rates of suicidal behaviors and lower subjective mental well-being than adolescents living outside war-affected areas. However, the extent of the problem might be much greater than we can imagine in northern Ethiopia due to severe impacts of the war among high school students. This study aimed to examine the predictors of suicidal behavior and subjective mental well-being among high school students in conflict-affected areas in the North Wollo Zone, Ethiopia. A school-based cross-sectional survey was carried out among 3400 high school students in the North Wollo Zone, Ethiopia. Multistage stratified random sampling was used to recruit study participants. The analysis focused on two binary outcome variables: suicidal behavior and subjective mental well-being. Multilevel logistic regression analysis was used to identify factors influencing students’ suicidal behaviors and poor mental well-being. In the final model, all significance tests with a p-value < 0.05 were considered significant factors associated with suicidal behaviors and poor mental well-being. The prevalence of suicidal behaviors was 6.9%, and nearly one-third (33.5%) of high school students struggled with poor subjective mental well-being. The final analysis revealed significant associations: female sex, family residence, post-traumatic stress disorder, and generalized anxiety disorder were associated with both suicidal behavior and poor subjective mental well-being. Suicidal behavior was associated with poor sleep and poor subjective mental well-being, whereas low academic performance, large class size and suicidal behavior were associated with poor mental well-being. High school students living in conflict-affected areas reported high levels of suicidal behavior and poor subjective mental well-being. This highlights the urgent need to prioritize mental and psychosocial support, and ensuring access to services is a critical and urgent component.