Subjects: This study explored the association between active school travel (AST) and suicide attempts among adolescents in low- and middle-income countries. Methods: We used the data from the Global School-based Health Survey, including 127, 097 adolescents aged 13-17 years from 34 LMICs. A self-reported survey was used to collect data on AST and suicide attempts as well as some key control variables. Multivariable logistic regression was performed to assess the association between AST and suicide attempts. A meta-analysis with random effects was undertaken to identify the difference in the association between AST and suicide attempts. Results: Across all the adolescents, the prevalence of AST was 37.0% (at least five times a week) and the prevalence of suicide attempts was 11.6% (at least once in the past 12 months). Adolescents who engaged in AST were less likely to have suicide attempts (OR = 0.82, 95%CI: 0.75-0.90) irrespective of gender (boys: OR = 0.76, 95%CI: 0.64-0.90; girls: OR = 0.87, 0.78-0.98). The country-wise analysis indicated a large inconsistency in the association between AST and suicide attempt across the countries (I2 = 63%, p < 0.01). Conclusions: AST would appear to be a protective factor for reducing suicide attempts among adolescents in LMICs. However, the association between AST and suicide attempts varied greatly across the countries. Future studies should confirm or negate the association between AST and suicide attempts. When designing interventions aimed at preventing suicide attempts for adolescents, country-specific factors should be taken into consideration.
Active school travel is associated with fewer suicide attempts among adolescents from low-and middle-income countries
