title: Sexual abuse and substance abuse increase risk of suicidal behavior in Malaysian youth.
abstract: BACKGROUND
  The aim of this study was to determine the association between sexual abuse, substance abuse and socio-demographic factors with suicidal ideation (SI), plans (SP) and deliberate self-harm (DSH) and propose steps to prevent youth suicidal behavior.
  
  
  METHODS
  This was a cross-sectional study of 6786 adolescents aged 17-18 years, selected randomly from all Malaysian adolescents to undergo compulsory youth camps located in Selangor, Malaysia (2008-2009). Participants were assessed using self-administered questionnaires developed to reflect the local cultural setting. However, only 4581 subjects were analyzed after excluding incomplete data.
  
  
  RESULTS
  The rates of SI, SP and DSH were 7.6%, 3.2% and 6.3%, respectively. The multivariable-adjusted odds ratio showed that sexual abuse was associated with SI 1.99 (95% CI: 1.56-2.55), SP 1.57 (95% CI: 1.09-2.27) and DSH 2.26 (95% CI: 1.75-2.94); illicit drug use was associated with SI 4.05 (95% CI: 2.14-7.67), SP 2.62 (95% CI: 1.05-6.53) and DSH 2.06, (95% CI: 1.05-4.04); for alcohol use DSH was 1.34 (95% CI: 1.00-1.79). Being female was associated with all suicidal behaviors: SI 2.51 (95% CI: 1.91-3.30), SP 2.07 (95% CI: 1.39-3.08) and DSH 1.59 (95% CI: 1.19-2.11).
  
  
  CONCLUSIONS
  Given the well-founded concern of increasing risk of suicidal behavior among youth, preventive efforts should adopt a more comprehensive approach in dealing with sexual abuse and substance abuse, and their sequelae, especially in girls.
authors.affiliation: Department of Psychiatry, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia.
authors.forename: Lai Fong
authors.initials: LF
authors.lastname: Chan
authors.forename: T
authors.initials: T
authors.lastname: Maniam
authors.forename: Suriati Mohamed
authors.initials: SM
authors.lastname: Saini
authors.forename: Shamsul Azhar
authors.initials: SA
authors.lastname: Shah
authors.forename: Sit Fong
authors.initials: SF
authors.lastname: Loh
authors.forename: Aishvarya
authors.initials: A
authors.lastname: Sinniah
authors.forename: Zawaha Haji
authors.initials: ZH
authors.lastname: Idris
authors.forename: Sulaiman
authors.initials: S
authors.lastname: Che Rus
authors.forename: Siti Sa'adiah
authors.initials: SS
authors.lastname: Hassan Nudin
authors.forename: Susan Mooi Koon
authors.initials: SM
authors.lastname: Tan
mesh_terms: D000293:Adolescent; D002650:Child Abuse, Sexual / Q000523:psychology* / Q000706:statistics & numerical data; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008296:Malaysia / Q000453:epidemiology; D008297:Male; D012307:Risk Factors; D016728:Self-Injurious Behavior / Q000453:epidemiology / Q000523:psychology; D019966:Substance-Related Disorders / Q000453:epidemiology / Q000523:psychology*; D059020:Suicidal Ideation; D011795:Surveys and Questionnaires
keywords: adolescent; risks; sexual abuse; substance abuse; suicidal behavior