What's driving suicide attempts among Ghana's pregnant adolescents?

Globally, suicide is the third leading cause of death among girls aged 15-19 years. However, research on suicidal behavior among pregnant adolescents—particularly in low- and middle-income countries like Ghana—has been notably lacking. In Ghana, where approximately one in seven adolescents experiences unwanted pregnancy, the intersection of pregnancy and mental health in this vulnerable population remains poorly understood.

Researchers from University of Ghana conducted a cross-sectional study between August 2022 and December 2023, surveying 449 pregnant adolescent girls aged 14-19 years from across Ghana's three geographical zones. Using structured anonymous questionnaires, they assessed suicidal ideation, suicide attempts, and various sociodemographic and psychosocial factors.

The study utilized the Suicide Behaviors Questionnaire-Revised (SBQ-R) to evaluate suicidal thoughts and behaviors and included questions about food insecurity, intimate partner violence, depression, pregnancy-related anxiety, and other relevant factors. The results, published in General Psychiatry, showed that 28.5% of participants reported suicidal ideation, 18% reported a history of attempted suicide during the current pregnancy, 11.8% had a history of suicide attempts before their current pregnancy.

For those who attempted suicide, the reasons were predominantly interpersonal rather than intrapersonal. Many pregnant girls reported the intention 'to die' as a minor reason, but they did so as a communicative act, 'a cry for help', in anticipation for help and rescue.

"This suggests that many of these attempts may be cries for help rather than purely suicidal intentions," noted the corresponding author Dr. Quarshie. "The girls are often trying to express their desperation or seeking support in the face of overwhelming circumstances." Compared with non-pregnant adolescent girls, pregnant adolescent girls may face many challenges that predispose them to thoughts of suicide, especially in the (sub-Saharan) African cultural system that being pregnant before marriage is considered immoral, a dishonor and even a taboo.

The study underscores the urgent need for comprehensive mental health screening during antenatal care in Ghana and other sub-Saharan African countries. It serves as a crucial first step in addressing a previously overlooked public health issue in Ghana. By bringing attention to the high rates of suicidal behavior among pregnant adolescents, it is paving the way for targeted interventions that could save lives and improve maternal mental health outcomes across the region.