Influence of stressors and possible pathways of onset of seventh graders' suicidal ideation in urban and rural areas in Taiwan

Background: Suicide is the second leading cause of death among young people in Taiwan. However, few studies have investigated children's suicidal ideation, and longitudinal studies are particularly rare. The purposes of this study were: (1) to describe the proportion of students with suicidal ideation in one month and incidence of suicidal ideation in the 7th graders (the first year of junior high school) living in urban and rural areas; (2) to realize the influence of perceived stressors on the onset of 7th graders' suicidal ideation; and (3) to explore possible pathways through which trigger factors and perceived stressors lead to suicidal ideation. Methods. A total of 1,589 students were followed from grade 4 to grade 7. Logistic regression was then used to investigate the influence of perceived stressors on the onset of suicidal ideation in grade 7. Structural equation modeling was used to analyze possible pathways through which trigger factors led to increased pressure from certain stressors which in turn resulted in suicidal ideation. Results: The proportion of students with suicidal ideation in one month was 2 to 3 times higher in both areas compared to that in elementary school. However, the incidence in the rural area showed a large increase from 10.2% and 9.5% in grades 5 and 6 to 15.5% in grade 7. Urban-rural difference was observed. Important stressors and pathways of suicidal ideation differ between urban and rural areas. Conclusions: This study showed that the influential stressors in urban and rural areas might be different. Thus, interventions focused on coping skills for regional specific stressors and trigger factors could be beneficial in the transition time.