Effects of Self-Esteem on the Association between Negative Life Events and Suicidal Ideation in Adolescents

Negative life events (NLEs) increase the risk of suicidal ideation (SI) in adolescents. However, it is not known whether the association between NLEs and SI can be moderated by self-esteem and varies with gender. The aim of the current paper was to examine gender differences in the association of SI with NLEs in adolescents, and assess the effects of self-esteem on the association and their gender variations. We conducted a school-based health survey in 15 schools in China between November 2013 and January 2014. A total of 9704 participants aged 11-19 years had sociodemographic data reported and self-esteem (Rosenberg self-esteem scale), NLEs, and SI measured. Multivariate-adjusted logistic regression was used to calculate the odds ratio (OR) of having SI in relation to NLEs. Increased risk of SI was significantly associated with NLEs (adjusted OR 2.19, 95%CI 1.94-2.47), showing no gender differences (in females 2.38, 2.02-2.80, in males 1.96, 1.64-2.36, respectively). The association was stronger in adolescents with high esteem (2.93, 2.34-3.68) than those with low esteem (2.00, 1.65-2.42) (ORs ratio 1.47, p = 0.012). The matched figures in females were 3.66 (2.69-4.99) and 2.08 (1.61-2.70) (1.76, p = 0.006), while in males these figures were 2.27(1.62-3.19) and 1.89 (1.41-2.53) (1.20, p = 0.422), respectively. Self-esteem had moderate effects on the association between NLEs and SI in adolescents, mainly in females. NLEs, self-esteem, and gender need to be incorporated into future intervention programs to prevent SI in adolescents.