Sex Differences in the Integrated Associations of Lifestyle Behaviors and Family–Peer Contexts with Suicidal Ideation and Suicide Planning Among Adolescents: A Nationwide Study

Abstract

Background: Suicidal ideation and suicide planning during adolescence are major public health concerns and are likely influenced by multiple behavioral and interpersonal factors. However, lifestyle, dietary, and family and peer correlates are often examined separately rather than within an integrated analytic framework. Objectives: To investigate the integrated associations of lifestyle behaviors, dietary factors, and family and peer relationship factors with suicidal ideation and/or suicide planning among adolescents in Taiwan, and to further examine sex-related differences. Methods: This study was a cross-sectional secondary analysis of 18,081 junior high school students who participated in the Taiwan Youth Health Survey in 2012, 2014, and 2016. Hierarchical multivariable logistic regression models were used to estimate odds ratios (ORs) and 95% confidence intervals (CIs) for associations between explanatory variables and suicidal ideation and/or suicide planning. Sex-stratified analyses were also performed. Results: Adolescents who reported suicidal ideation and/or suicide planning tended to have less favorable lifestyle and dietary patterns and less supportive family and peer environments. In the fully adjusted model, female sex was associated with higher odds of the outcome (OR 1.602, 95% CI 1.483 - 1.730). Regular breakfast consumption, greater parental understanding, stronger parental monitoring, and higher peer support at school were associated with lower odds, whereas frequent fast-food consumption and parental intrusion into adolescents’ belongings were associated with higher odds. Sex-stratified analyses suggested that some associations differed between boys and girls. Conclusions: Suicidal ideation and/or suicide planning among adolescents were associated with a combination of behavioral, dietary, and relational factors. These findings underscore the value of considering multiple domains concurrently when examining adolescents’ vulnerability to suicide-related outcomes and may inform future research and prevention-oriented strategies.