Mental Health Determinants Of Suicidal Ideation Among Adolescent Females in Gorontalo, Indonesia: Evidence from a Lower-Middle-Income Country

Mental Health Determinants Of Suicidal Ideation Among Adolescent Females in Gorontalo, Indonesia: Evidence from a Lower-Middle-Income Country | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Mental Health Determinants Of Suicidal Ideation Among Adolescent Females in Gorontalo, Indonesia: Evidence from a Lower-Middle-Income Country Yeyen Afriyanty Amma, Yeyen Afriyanty Amma, Andi Zulkifli Abdullah, and 5 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8113944/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background Mental health disorders significantly contribute to the global disease burden, with suicide being a major preventable cause of mortality, particularly among youth. Adolescents experience a critical developmental stage that increases their vulnerability to common mental disorders and suicidal ideation, with females exhibiting higher rates of nonfatal suicidal behavior than males. In low- and middle-income countries, this vulnerability is further exacerbated by structural gender inequality and limited access to mental health services. In Indonesia, millions of adolescents face mental health challenges; however, the factors influencing suicidal ideation among young women are poorly understood. Provincial data indicate alarming trends, with Gorontalo reporting some of the highest national rates of suicide attempts and a recent increase in suicide cases, prompting national-level investigations. Despite this, there is a paucity of empirical data on the personal and environmental factors influencing suicidal ideation among adolescent girls in this context. Objective This study aimed to examine the association between common mental disorders and suicidal ideation among adolescent females in Gorontalo, Indonesia, to inform early intervention strategies in public health services. Methods A cross-sectional study was conducted among 408 adolescent females aged 18–24 years. Data were collected using the Self-Reporting Questionnaire for mental health screening and the Adolescent Mental Resilience Instrument for suicidal ideation (SI). Results The prevalence of common mental disorders was 28.2%, psychotic symptoms 21.1%, post-traumatic stress disorder (PTSD) 39.5%, and suicidal ideation 6.1%. Bivariate analysis indicated significant associations between common mental disorders and suicidal ideation ( p < 0.05). Conclusions Mental health problems remain a critical issue among adolescent females in Gorontalo, with suicidal ideation being strongly associated with psychosocial factors. Strengthening family support, promoting mental health awareness in schools, and implementing early screening programs in community health centers are essential for suicide prevention and enhancing adolescent mental health. Mental Health Suicide Suicidal Ideation Adolescent Females Figures Figure 1 Figure 2 Introduction Mental health disorders are among the leading contributors to the global burden of disease and disability, with one in four individuals aged 20–29 years experiencing mental health problems each year. According to the World Health Organization (WHO), the global burden of disease attributable to mental disorders was 2,463.29 per 100,000 population, while suicide accounted for 3.4 per 100,000 population in 2017 ( 1 ) .​ The determinants of mental health are multifactorial, encompassing individual attributes, such as the ability to regulate thoughts, emotions, and behavior, as well as broader social, cultural, economic, and political contexts, including national policies, social protection, living conditions, work environment, and community support ( 2 , 3 ). Mental disorders are closely linked to other chronic conditions, such as cardiovascular diseases, cancer, and HIV/AIDS. For instance, depression increases vulnerability to myocardial infarction and diabetes, which in turn raises the likelihood of developing depression. Globally, depression accounts for 4.3% of the total disease burden and is among the leading causes of disability( 3 , 4 ). Suicide, often a consequence of untreated mental disorders, remains a pressing global health issue. Each year, over 703,000 individuals die by suicide, representing more than one in every 100 deaths in 2019. The age-standardized suicide mortality rate was 9 per 100,000 in 2019, with wide variation across countries, ranging from fewer than 2 to more than 80 per 100,000( 3 ). Suicide reduction has been prioritized as a global target by the WHO and is included as an indicator of the Sustainable Development Goals (SDGs). Adolescents are particularly vulnerable to mental health problems during the transition from childhood to adulthood, with an increased risk of suicidal ideation and attempts, especially among socially marginalized groups. Risk factors include depression, substance use, mental disorders, antisocial behavior, sexual and physical abuse, poor peer relationships, exposure to suicidal behavior by peers or family, family conflict, lack of parental support, and parental separation. Approximately 60% of adolescent and young adult suicides are influenced by adverse social environments, with deliberate self-harm being more common among females( 5 ). In Southeast Asia, adolescents comprise 18.8% of the population, with approximately 362 million individuals aged 10–19 years. Mental health problems, including anxiety, depression, behavioral disorders, PTSD, and hyperactivity, affect Mental health problems, including anxiety, depression, behavioral disorders, PTSD, and hyperactivity, affect approximately 15.5 million adolescents in Indonesia ( 6 , 7 ). Notably, females demonstrate a sharper rise in suicidal ideation and are three times more likely to attempt suicide than males. Mental health problems, including anxiety, depression, behavioral disorders, PTSD, and hyperactivity, affect approximately 15.5 million adolescents in Indonesia (Kaligis et al., 2023; University of Queensland & Johns Hopkins Bloomberg, 2022).the contributing factors remain poorly understood( 8 ).​ A systematic review in South Asia revealed that suicidal ideation was more prevalent among adult women, while suicide attempts were more common among adolescent girls, highlighting the significant psychosocial and epidemiological burdens that require multisectoral responses ( 9 ). In low- and middle-income countries (LMICs), suicide among women is a critical public health concern exacerbated by structural inequalities and institutional discrimination, including limited access to financial resources, justice, citizenship rights, gender equity in household responsibilities, divorce, and inheritance ( 10 ). In India, women aged 15–39 years account for 71.2% of all suicide deaths, with rates that are twice the global average ( 11 ). In Indonesia, the prevalence of suicide varies by province. Central Java, Yogyakarta, North Maluku, and Riau Islands report the highest suicide mortality rates, while West Sulawesi, Gorontalo, Bengkulu, and North Sulawesi recorded the highest rates of suicide attempts( 12 ). Specifically, Gorontalo Province has experienced a dramatic rise in suicide cases, with 31 incidents reported by October 2023. This alarming increase prompted the Ministry of Health, through the National Mental Health Center (PKJN) of Marzoeki Mahdi Hospital, to conduct field investigations into the methods and determinants of suicide in Gorontalo ( 13 , 14 ). Methods and material Study setting, and design This study employed a quantitative cross-sectional design to examine the association between mental health disorders and suicidal ideation among adolescent females in Gorontalo, Indonesia. Participants The study population comprised adolescent females aged 18–24 years, consistent with the World Health Organization (WHO), which defines 'Adolescents' as individuals in the 10–19 years age group and 'Youth' as the 15–24 year age group. While 'Young People' covers the age range 10–24 years and the Indonesian National Population and Family Planning Board (BKKBN) classifies adolescents as the age range 10–24 year ( 15 , 16 ). These age groups are usually combined under the broader term “young people,” which largely corresponds to adolescence (Sawyer and Patton, 2011). Sampling size and sampling procedure A multistage random sampling technique was used. In the first stage, cluster sampling randomly selected community health centers ( Puskesmas ) as study sites. In the second stage, purposive sampling was used to recruit eligible participants: adolescent females aged 18–24 years, registered as residents in the selected districts, and willing to participate. The required sample size for a two-tailed test was determined using the formula by Lemeshow (1997) to account for potential participant dropouts ( 18 ). A total of 377 samples were collected, and an additional 10 % (7 samples) were included, resulting in 414 respondents for this study. Data collection procedures Data were collected using structured self-administered questionnaires facilitated by trained mental health staff at the selected community health centers. Two standardized instruments were employed. Self-Reporting Questionnaire (SRQ-29) – a validated screening tool developed by the WHO and adapted by the Indonesian Ministry of Health (2021) to assess common mental disorders among adults. Adolescent Mental Resilience Instrument ( Instrumen Ketahanan Jiwa Remaja , IKJR) – used for early detection of risk factors related to suicidal ideation, also adapted by the Indonesian Ministry of Health (2021). ( 19 ) Data Analysis Data were analyzed using the SPSS software. The analysis process consisted of the following steps: Univariate analysis was used to describe the participants’ sociodemographic characteristics and the prevalence of mental health disorders and suicidal ideation. Bivariate analysis using the chi-square test was used to examine the association between independent variables ( sociodemographic factors, family support, academic pressure, bullying, and social media use) and the dependent variables (mental health disorders and suicidal ideation). Statistical significance was set at P < 0.05 . Result Characteristics of the study population Figure 1 shows the respondent selection process, indicating that the initial screening phase identified 414 participants.. After screening, 10 respondents were excluded due to duplicate data and 2 respondents were excluded due to incomplete data, resulting in a final sample of 408 respondents. The study achieved a response rate of 98.6%, with 408 valid responses obtained from the targeted sample of 414 participants. Six responses were excluded because of duplication and incomplete data. This high response rate indicates strong participant engagement and effective data collection. Participants were recruited from five Community Health Centers (Puskesmas) in Gorontalo City: Dumbo Raya (n = 81), Kota Selatan (n = 74), Kota Tengah (n = 83), Kota Timur (n = 81), and Sipatana (n = 89). Table 1 presents the descriptive characteristics of the 408 adolescent girls. By region, the largest proportion came from Sipatana (21.8%), followed by Kota Tengah (20.3%), Kota Timur (19.9%), Dumbo Raya (19.9%), and the lowest from Kota Selatan (18.1%). Regarding education, most respondents were attending or had completed Senior High School (46.3%) an d college/university (45.8% ) , while a small proportion had only completed Primary School (1.2%) or Junior High School (6.6%). Regarding marital status, most respondents were single (64.7%), 14.7% were married, and 20.6% were in a relationship. Regarding occupational status, the majority had never worked (76.5%), 13.2% were currently working, 6.9% had worked but not within the last 12 months, and 3.4% were not currently working but had worked within the last 12 months. Overall, these findings indicate that the study population was predominantly high school or college-aged, mostly unmarried, and had limited work experience. Table 1 Descriptive Characteristics of Adolescent Female Respondents Variables Sub Groups n % Region Dumbo Raya 81 19.9 Kota Selatan 74 18.1 Kota Tengah 83 20.3 Kota Timur 81 19.9 Sipatana 89 21.8 Education Primary School 5 1.2 Junior High School 27 6.6 Senior High School 189 46.3 College/University 187 45.8 Marital Status Single 264 64.7 Married 60 14.7 In a Relationship 84 20.6 Occupation Ever Worked (not in last 12 months) 28 6.9 Currently Working 54 13.2 Not Working (worked in last 12 months) 14 3.4 Never Worked 312 76.5 Total 408 100.0 Prevalence and distribution of the severity of mental health conditions. Table 2 Mental Health Characteristics of Adolescent Female Respondents Mental Health Variables n Yes No Emotional Mental Disorder 115 (28.2) 293 (71.8) Addiction 0 (0.0) 408 (100.0) Psychotic 86 (21.1) 322 (78.9) PTSD 161 (39.5) 247 (60.5) Suicidal Ideation 25 (6.1) 383 (93.9) Table 2 presents the mental health characteristics of the 408 adolescent female participants. The findings indicate that 28.2% of the respondents experienced emotional or mental disorders, while 71.8% did not. None of the participants reported addiction problems (0.0%). Psychotic symptoms were identified in 21.1% of the participants, whereas 78.9% did not exhibit such conditions. Regarding post-traumatic stress disorder (PTSD), 39.5% screened positive and 60.5% screened negative. Suicidal ideation was reported by 2.7% of the respondents, compared to 97.3% who did not report such thoughts. Overall, the results highlighted that emotional mental disorders, psychotic symptoms, and PTSD were relatively common, whereas suicidal ideation was observed in only a small proportion of participants. Figure 2 : The line graph illustrates the distribution of mental health disorders and suicidal ideation among adolescent females across different health centers. Emotional mental disorders were most prevalent in Kota Selatan (44.6%) and Kota Tengah (41.0%) and lowest in Dumbo Raya (13.6%) and Kota Timur (16.0%). No respondents reported addiction in any of the health centers (0.0%). For psychotic symptoms, the highest rate was recorded in Kota Selatan (37.8%) and Kota Tengah (33.7%), while the lowest was recorded in Kota Timur (4.9%). Regarding PTSD, prevalence was highest in Kota Tengah (69.9%), followed by Kota Selatan (59.5%) and Sipatana (41.6%), and lowest in Kota Timur (4.9%). Finally, suicidal ideation was reported by 2.7% to 4.8% of respondents across most health centers, with the highest proportion in Kota Tengah (4.8%) and none in Kota Timur. Overall, the distribution indicates significant regional variations in emotional disorders, psychotic symptoms, and PTSD, while suicidal ideation, although relatively low, was still present among adolescents. Bivariate Analysis of factors associated with mental health condition and suicidal ideation Table 3 Distribution of Mental Health Disorders and Suicidal Ideation among Adolescent Females by Health Center Variables Dumbo Raya Kota Selatan Kota Tengah Kota Timur Sipatana Total p-value Emotional Mental Disorder 11 (13.6%) 33 (44.6%) 34 (41.0%) 13 (16.0%) 24 (27.0%) 115 (28.2%) 0.000 Addiction 0 (0.0%) 0 (0.0%) 0 (0.0%) 0 (0.0%) 0 (0.0%) 0 (0.0%) - Psychotic Symptoms 11 (13.6%) 28 (37.8%) 28 (33.7%) 4 (4.9%) 15 (16.9%) 86 (21.1%) 0.000 PTSD 18 (22.2%) 44 (59.5%) 58 (69.9%) 4 (4.9%) 37 (41.6%) 161 (39.5%) 0.000 Suicidal Ideation 1 (1.2%) 8 (10.8%) 8 (9.6%) 2 (2.5%) 6 (6.7%) 25 (6.1%) 0.042 Table 3 presents the distribution of mental health disorders and suicidal ideation among adolescent females across the different health centers. Emotional mental disorders were most prevalent in Kota Selatan (44.6%) and Kota Tengah (41.0%) and lowest in Dumbo Raya (13.6%) and Kota Timur (16.0%) ( p = 0.000). No respondents reported addiction in any of the health centers (0.0%). For psychotic symptoms, the highest rate was recorded in Kota Selatan (37.8%) and Kota Tengah (33.7%), while Kota Timur (4.9%) had the lowest prevalence ( p = 0.000). Regarding PTSD, prevalence was highest in Kota Tengah (69.9%), followed by Kota Selatan (59.5%) and Sipatana (41.6%), and lowest in Kota Timur (4.9%) ( p = 0.000). Finally, suicidal ideation was reported by 1.2% to 6.1% of respondents across most health centers, with the highest proportions in Kota Selatan (10.8%) and Kota Tengah (9,6%). The prevalence of suicidal ideation among adolescent females showed a statistically significant difference across health centers ( P = 0.042). This indicates that suicidal ideation rates vary meaningfully by location, suggesting the influence of contextual and regional psychosocial factors. Overall, the distribution indicates significant regional variations in emotional mental disorders, psychotic symptoms, PTSD, and suicidal ideation among adolescents. Table 4 Association Between Mental Health Disorders and Suicidal Ideation Among Adolescent Females Variables Suicidal Ideation Total p-value Yes No Emotional Mental Disorder Yes 11 (9.6%) 104 (90.4%) 115 0.000 No 0 (0.0%) 293 (100.0%) 293 Addiction No 11 (2.7%) 397 (97.3%) 408 - Psychotic Yes 10 (11.6%) 76 (88.4%) 86 0.000 No 1 (0.3%) 321 (99.7%) 322 PTSD Yes 11 (6.8%) 150 (93.2%) 161 0.000 No 0 (0.0%) 247 (100.0%) 247 Total 11 (2.7%) 397 (97.3%) 408 Table 4 presents the association between mental health disorders and suicidal ideation among adolescent girls. Emotional mental disorders were significantly associated with suicidal ideation, with 9.6% of affected respondents reporting suicidal ideation (p = 0.000). Psychotic symptoms were also strongly associated with suicidal ideation, as 11.6% of adolescents with psychotic symptoms reported suicidal ideation compared to 0.3% without (p = 0.000). Similarly, PTSD was significantly associated with suicidal ideation, with 6.8% of the respondents reporting suicidal thoughts (p = 0.000). Meanwhile, addiction was not reported among the respondents and showed no association. Overall, suicidal ideation was observed in 2.7% of participants (n = 11). Discussion This study found significant associations between emotional mental disorders, psychotic symptoms, PTSD, and suicidal ideation among adolescent females. These findings align with the growing evidence highlighting the role of psychiatric symptoms in influencing suicide risk among youth. Emotional mental disorders Adolescents with emotional mental disorders had a higher prevalence of suicidal ideation (9.6%) than those without such disorders. This aligns with Tonaydin et al. (2025), who reported a score of 90.84 ± 5.5. The mean score of participants who attempted suicide on the suppression subscale of the ERQ was higher than that of those who did not attempt suicide. ( 20 ) Zhai et al. analyzed data from 5,313 US medical students (2018–2023) to examine trends in anxiety, depression, suicidal ideation, and counselling use. The results showed significant increases in anxiety (21.6% to 33.9%), depression (14.0% to 27.1%), and counselling utilization (6.7% to 23.9%), whereas suicidal ideation remained stable. Despite the rise in service use, a treatment gap persists, underscoring the need for stronger mental health support for medical students.( 21 ) Psychotic symptoms Psychotic symptoms were also strongly associated with suicidal ideation (11.6%). A recent review demonstrated that The findings indicated a significantly positive correlation between psychotic-like experiences (PLEs) and suicidal ideation (SI), which was sequentially mediated by insomnia symptoms and resilience. Furthermore, insomnia symptoms and resilience played a chain-mediation role between PLEs and adolescent SI. This indicates that adolescents who frequently experience PLEs can be considered a high-risk group for SI and require early intervention. When intervening, the effects of insomnia symptoms and resilience on adolescents’ SI should be comprehensively considered.( 22 ) A study conducted in New South Wales prisons, Australia, examined self-harm among inmates with psychosis compared to matched controls. The results showed that prisoners with psychosis (15.0%) were far more likely to engage in self-harm than controls (3.6%), with the highest risk among those with schizophrenia and related disorders. Aboriginal heritage was associated with an increased risk, whereas male sex and older age were protective factors. Notably, all 17 suicides recorded during the study period occurred among prisoners with psychosis, highlighting the urgent need for targeted interventions in this population ( 23 ). Post-traumatic stress disorder (PTSD) In this study, post-traumatic stress disorder (PTSD) was identified as a strong predictor of suicidal ideation, with 6.8% of affected adolescents reporting such thoughts. Similarly, Bora et al. demonstrated that among firefighters, witnessing a colleague’s line-of-duty death or suicide has a profound psychological impact, heightening vulnerability to PTSD and suicide risk. In a large survey involving 58,299 South Korean firefighters (92.6% response rate), assessments included posttraumatic symptoms, suicide risk, alcohol-related problems, emotional damage from emotional labor, and perceived peer support. The findings indicated that both emotional damage from emotional labor and alcohol-related problems significantly mediated the relationship between exposure to colleagues’ deaths and subsequent PTSD or suicide risk ( 24 ). Evidence from clinical settings further reinforces the link between suicide and PTSD. A descriptive survey conducted in 2023 at Razi Hospital among patients with one or more suicide attempts found that 80% experienced moderate-to-severe depressive episodes at the time of their attempt. The most common methods were medication ingestion (60%), followed by phlebotomy (16%), jumping from a height (8%), hanging (8%), and ingestion of toxins (8%). Over half (56%) required hospitalization in a medical unit, and 36% subsequently developed post-traumatic stress disorder (PTSD) as defined by the DSM-5 criteria. These findings indicate that a substantial proportion of suicide-attempt survivors are at risk of PTSD related to their attempts. Recognizing PTSD as a potential consequence of suicide attempts underscores the importance of systematic assessment and timely therapeutic interventions to the improve quality of life and reduce the risk of reattempts ( 25 ). Addiction Although no cases of substance-related addiction were reported in this study, limiting the possibility of a direct association with suicidal ideation, growing evidence highlights the broader role of addictions, including behavioral and substance-related forms, in suicide risk. Alcohol and drugs are strongly implicated in suicide through several mechanisms: they may serve as a direct means of self-harm, either alone or in combination with other substances to increase lethality, and they may also reduce fear and inhibitions prior to an attempt.( 26 ) Population-level data further emphasize this relationship between obesity and depression. An analysis of deaths in Colorado between 2009 and 2020 found that 6.4% of veteran deaths (n = 6,948) were attributable to suicide, alcohol, or drugs. Compared with the general adult population, veterans had substantially higher mortality rates from these causes (2.1-fold higher for suicide, 1.8-fold for alcohol-related deaths, and 1.3-fold for drug-related deaths). These findings underscore the disproportionate burden of substance-related mortality among veterans and the urgent need for upstream prevention strategies, including community-based interventions targeting alcohol use and socioeconomic distress ( 27 ). At the individual level, bereavement studies have revealed a complex interplay between suicide and substance use. A thematic analysis of free-text responses from 346 adults in Britain (aged 18–40 years) identified three key themes shaping alcohol and drug use after losing a family member or close friend to suicide: control over substance use, perceived purpose of consumption, and attribution of misuse to external factors. These themes were consistently underpinned by issues of self-control and awareness of potential harm. Importantly, increased substance use is often described as a coping strategy following suicide bereavement, highlighting the need for sensitive assessments when determining whether and when an intervention is appropriate ( 28 ). Prevalence and global comparison The overall prevalence of suicidal ideation in this study (6,1%) was lower than the global estimates; however, Gorontalo emerged as one of the provinces with the highest rates of suicide attempts. A systematic review of 30 studies reported that 17% of participants experienced suicidal ideation and 5% attempted suicide, with ideation more common among adult women and attempts more frequently among adolescent girls, highlighting the significant epidemiological and psychosocial burden on females in South Asia ( 9 ). Suicide among women represents a serious public health problem in low-and middle-income countries, where institutional discrimination, limited access to productive assets, unequal rights in citizenship, divorce, and inheritance contribute to vulnerability ( 10 ). In India, 71.2% of suicide deaths among women occurred in those aged 15–39 years, with mortality rates documented as twice the global female average, a pattern that persisted from 2016 to 2019 ( 11 ). In Japan, youth suicide remains alarming, with 513 school-aged deaths reported in 2023. Contributing factors include academic pressure, bullying (especially cyberbullying), family problems, Internet addiction, and subcultural influences such as anime, manga, and gaming, all of which were further compounded by the COVID-19 pandemic, emphasizing the urgent need for comprehensive school- and community-based interventions to strengthen youth mental health( 29 ). A pooled analysis of 118 surveys from 90 countries (2003–2017) involving 397,299 adolescents found higher suicidal ideation among girls, while suicide attempts showed no sex or age differences. Bullying, serious injury, and lack of close friends were key correlates of ideation and attempts, which varied by age and sex. Strengthening peer relationships and preventing bullying and injuries are critical components of adolescent suicide prevention, particularly in low- and middle-income countries (30). Conclusion This study elucidates that common mental disorders, particularly emotional mental disorders, psychotic symptoms, and post-traumatic stress disorder (PTSD), are significantly correlated with suicidal ideation among adolescent girls in Gorontalo, Indonesia. Although the overall prevalence of suicidal ideation was relatively low at 6.1%, individuals exhibiting psychiatric symptoms were at substantially elevated risk. The prevalence of suicidal ideation in this study, while lower than several global estimates, still represents approximately one in 16 adolescent girls, highlighting a significant public health concern. Contextual factors, such as family support, social environment, and exposure to bullying, may also play critical roles. These findings emphasize the urgent need for early screening and intervention programs in schools and community health centers, focusing on enhancing family support, trauma-informed care, and psychoeducation. Preventive strategies should also consider the impact of digital media, which is increasingly important for adolescent mental health. Declarations Funding Funding this research was funded by Center Of Higher Education Funding And Assessment (PPAT) Ministry Of Higher Education, Science And Technology Of Republic Indonesia through the Indonesia Endowment Fund (LPDP) with Indonesian Educational Scholarship (BPI) (Grant Number 202209090498) Ethics Approvals Ethical approval for the project was obtained from the Research Ethics Committee of the Faculty of Public Health, Hasanuddin University (approval number: 1608/UN4.14.1/TP.01.02/2024) and adhered to the principles outlined in the Declaration of Helsinki. After a thorough explanation of the study objectives, written informed consent was obtained from each participant. Consent for publication Not applicable. Competing interests The authors declare no conflicts of interest. Author Contribution Conceptualization: YAA., AZA., SN., and DAP.; methodology: YAA., AZA., SN.; validation: AZA., SN. DAP.: Formal analysis, YAA.; investigation, AR., IFI. and SS.; data curation, YAA., AZA., and SN.; writing the original draft preparation, YAA.; supervision, AZA., SN., DAP., AR., IFI., and SS. All authors have read and agreed to the published version of the manuscript. Acknowledgment All authors of this manuscript have disclosed any potential financial or personal conflicts of interest with organizations or individuals that may have influenced their work. The authors have also disclosed any financial support received for the preparation of this review. The authors explicitly declare that there are no relevant conflicts of interest that could affect the objectivity of this study. Data Availability The datasets generated and/or analysed during the current study are not publicly available due to the sensitive nature of mental health and suicidal ideation data among adolescent females . Only aggregated results are presented in this article. De-identified individual level data and the study codebook may be available from the corresponding author on reasonable request and subject to approval by the relevant institutional ethics committee and a data sharing agreement. References Subu MA, Wati DF, Al-Yateem N, Netrida N, Priscilla V, Maria Dias J, et al. Family stigma’ among family members of people with mental illness in Indonesia: A grounded theory approach. Int J Ment Health. 2023;52(2):102–23. O’Neill E, Cole HVS, García-Lamarca M, Anguelovski I, Gullón P, Triguero-Mas M. The right to an unhealthy deprived city: An exploration of the impacts of state-led redevelopment projects on the determinants of mental health. Soc Sci Med. 2023;318. 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Eng J, Drabwell L, Stevenson F, King M, Osborn D, Pitman A. Use of alcohol and unprescribed drugs after suicide bereavement: Qualitative study. Int J Environ Res Public Health. 2019;16(21). Imataka G, Shiraishi H. Youth Suicide in Japan: Exploring the Role of Subcultures, Internet Addiction, and Societal Pressures [Internet]. 2024. Available from: https://www.preprints.org/manuscript/202412.0452/v1 Campisi SC, Carducci B, Akseer N, Zasowski C, Szatmari P, Bhutta ZA. Suicidal behaviours among adolescents from 90 countries: A pooled analysis of the global school-based student health survey. Volume 20. BMC Public Health. BioMed Central; 2020. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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1","display":"","copyAsset":false,"role":"figure","size":248111,"visible":true,"origin":"","legend":"\u003cp\u003eRespondent selection process in the study analysis.\u003c/p\u003e","description":"","filename":"floatimage2.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-8113944/v1/7be19e92d6c0c2f3b22058f7.jpeg"},{"id":96249639,"identity":"34a4a572-9bb0-4e99-a9a9-f292ecdb44c7","added_by":"auto","created_at":"2025-11-19 07:35:48","extension":"jpeg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":325005,"visible":true,"origin":"","legend":"\u003cp\u003eDistribution of Mental Health Disorders and Suicidal Ideation among Adolescent Females by Health Center.\u003c/p\u003e","description":"","filename":"floatimage3.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-8113944/v1/e9e25e2338d77fbb36cbf059.jpeg"},{"id":102746421,"identity":"41fb3a0b-8cbc-421e-926a-7b2ce163ede4","added_by":"auto","created_at":"2026-02-16 08:57:37","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1434662,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8113944/v1/475f860a-7fd8-4b55-9df7-78bb070a07ed.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Mental Health Determinants Of Suicidal Ideation Among Adolescent Females in Gorontalo, Indonesia: Evidence from a Lower-Middle-Income Country","fulltext":[{"header":"Introduction","content":"\u003cp\u003eMental health disorders are among the leading contributors to the global burden of disease and disability, with one in four individuals aged 20\u0026ndash;29 years experiencing mental health problems each year. According to the World Health Organization (WHO), the global burden of disease attributable to mental disorders was 2,463.29 per 100,000 population, while suicide accounted for 3.4 per 100,000 population in 2017 (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e) .​ The determinants of mental health are multifactorial, encompassing individual attributes, such as the ability to regulate thoughts, emotions, and behavior, as well as broader social, cultural, economic, and political contexts, including national policies, social protection, living conditions, work environment, and community support (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eMental disorders are closely linked to other chronic conditions, such as cardiovascular diseases, cancer, and HIV/AIDS. For instance, depression increases vulnerability to myocardial infarction and diabetes, which in turn raises the likelihood of developing depression. Globally, depression accounts for 4.3% of the total disease burden and is among the leading causes of disability(\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e). Suicide, often a consequence of untreated mental disorders, remains a pressing global health issue. Each year, over 703,000 individuals die by suicide, representing more than one in every 100 deaths in 2019. The age-standardized suicide mortality rate was 9 per 100,000 in 2019, with wide variation across countries, ranging from fewer than 2 to more than 80 per 100,000(\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e). Suicide reduction has been prioritized as a global target by the WHO and is included as an indicator of the Sustainable Development Goals (SDGs).\u003c/p\u003e\u003cp\u003eAdolescents are particularly vulnerable to mental health problems during the transition from childhood to adulthood, with an increased risk of suicidal ideation and attempts, especially among socially marginalized groups. Risk factors include depression, substance use, mental disorders, antisocial behavior, sexual and physical abuse, poor peer relationships, exposure to suicidal behavior by peers or family, family conflict, lack of parental support, and parental separation. Approximately 60% of adolescent and young adult suicides are influenced by adverse social environments, with deliberate self-harm being more common among females(\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eIn Southeast Asia, adolescents comprise 18.8% of the population, with approximately 362\u0026nbsp;million individuals aged 10\u0026ndash;19 years. Mental health problems, including anxiety, depression, behavioral disorders, PTSD, and hyperactivity, affect Mental health problems, including anxiety, depression, behavioral disorders, PTSD, and hyperactivity, affect approximately 15.5\u0026nbsp;million adolescents in Indonesia (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e). Notably, females demonstrate a sharper rise in suicidal ideation and are three times more likely to attempt suicide than males. Mental health problems, including anxiety, depression, behavioral disorders, PTSD, and hyperactivity, affect approximately 15.5\u0026nbsp;million adolescents in Indonesia (Kaligis et al., 2023; University of Queensland \u0026amp; Johns Hopkins Bloomberg, 2022).the contributing factors remain poorly understood(\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e).​ A systematic review in South Asia revealed that suicidal ideation was more prevalent among adult women, while suicide attempts were more common among adolescent girls, highlighting the significant psychosocial and epidemiological burdens that require multisectoral responses (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eIn low- and middle-income countries (LMICs), suicide among women is a critical public health concern exacerbated by structural inequalities and institutional discrimination, including limited access to financial resources, justice, citizenship rights, gender equity in household responsibilities, divorce, and inheritance (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e). In India, women aged 15\u0026ndash;39 years account for 71.2% of all suicide deaths, with rates that are twice the global average (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e). In Indonesia, the prevalence of suicide varies by province. Central Java, Yogyakarta, North Maluku, and Riau Islands report the highest suicide mortality rates, while West Sulawesi, Gorontalo, Bengkulu, and North Sulawesi recorded the highest rates of suicide attempts(\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e). Specifically, Gorontalo Province has experienced a dramatic rise in suicide cases, with 31 incidents reported by October 2023. This alarming increase prompted the Ministry of Health, through the National Mental Health Center (PKJN) of Marzoeki Mahdi Hospital, to conduct field investigations into the methods and determinants of suicide in Gorontalo (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e).\u003c/p\u003e"},{"header":"Methods and material","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003eStudy setting, and design\u003c/h2\u003e\u003cp\u003eThis study employed a quantitative cross-sectional design to examine the association between mental health disorders and suicidal ideation among adolescent females in Gorontalo, Indonesia.\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eParticipants\u003c/h3\u003e\n\u003cp\u003eThe study population comprised adolescent females aged 18–24 years, consistent with the World Health Organization (WHO), which defines 'Adolescents' as individuals in the 10–19 years age group and 'Youth' as the 15–24 year age group. While 'Young People' covers the age range 10–24 years and the Indonesian National Population and Family Planning Board (BKKBN) classifies adolescents as the age range 10–24 year (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e). These age groups are usually combined under the broader term “young people,” which largely corresponds to adolescence (Sawyer and Patton, 2011).\u003c/p\u003e\n\u003ch3\u003eSampling size and sampling procedure\u003c/h3\u003e\n\u003cp\u003eA multistage random sampling technique was used. In the first stage, cluster sampling randomly selected community health centers (\u003cem\u003ePuskesmas\u003c/em\u003e) as study sites. In the second stage, purposive sampling was used to recruit eligible participants: adolescent females aged 18–24 years, registered as residents in the selected districts, and willing to participate. The required sample size for a two-tailed test was determined using the formula by Lemeshow (1997) to account for potential participant dropouts (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e). A total of 377 samples were collected, and an additional 10 % (7 samples) were included, resulting in 414 respondents for this study.\u003c/p\u003e\u003cp\u003e\u003cimg src=\"https://myfiles.space/user_files/127393_c7e80a1c9bb65875/127393_custom_files/img1763376627.png\" style=\"width: 385px;\"\u003e\u003c/p\u003e\n\u003ch3\u003eData collection procedures\u003c/h3\u003e\n\u003cp\u003eData were collected using structured self-administered questionnaires facilitated by trained mental health staff at the selected community health centers. Two standardized instruments were employed.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003col\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003eSelf-Reporting Questionnaire (SRQ-29) – a validated screening tool developed by the WHO and adapted by the Indonesian Ministry of Health (2021) to assess common mental disorders among adults.\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003eAdolescent Mental Resilience Instrument \u003cb\u003e(\u003c/b\u003e\u003cem\u003eInstrumen Ketahanan Jiwa Remaja\u003c/em\u003e, IKJR) – used for early detection of risk factors related to suicidal ideation, also adapted by the Indonesian Ministry of Health (2021). (\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e)\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003c/ol\u003e\u003cp\u003e\u003c/p\u003e\u003cdiv id=\"Sec7\" class=\"Section2\"\u003e\u003ch2\u003eData Analysis\u003c/h2\u003e\u003cp\u003eData were analyzed using the SPSS software. The analysis process consisted of the following steps: Univariate analysis was used to describe the participants’ sociodemographic characteristics and the prevalence of mental health disorders and suicidal ideation. Bivariate analysis using the chi-square test was used to examine the association between independent variables ( sociodemographic factors, family support, academic pressure, bullying, and social media use) and the dependent variables (mental health disorders and suicidal ideation). Statistical significance was set at \u003cem\u003eP \u0026lt; 0.05\u003c/em\u003e.\u003c/p\u003e\u003c/div\u003e"},{"header":"Result","content":"\u003ch2\u003eCharacteristics of the study population\u003c/h2\u003e\u003cp\u003eFigure \u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e shows the respondent selection process, indicating that the initial screening phase identified 414 participants.. After screening, 10 respondents were excluded due to duplicate data and 2 respondents were excluded due to incomplete data, resulting in a final sample of 408 respondents. The study achieved a response rate of 98.6%, with 408 valid responses obtained from the targeted sample of 414 participants. Six responses were excluded because of duplication and incomplete data. This high response rate indicates strong participant engagement and effective data collection. Participants were recruited from five Community Health Centers (Puskesmas) in Gorontalo City: Dumbo Raya (n = 81), Kota Selatan (n = 74), Kota Tengah (n = 83), Kota Timur (n = 81), and Sipatana (n = 89).\u003c/p\u003e\u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e presents the descriptive characteristics of the 408 adolescent girls. By region, the largest proportion came from Sipatana (21.8%), followed by Kota Tengah (20.3%), Kota Timur (19.9%), Dumbo Raya (19.9%), and the lowest from Kota Selatan (18.1%). Regarding education, most respondents were attending or had completed Senior High School (46.3%) an\u003cb\u003ed\u003c/b\u003e college/university (45.8%\u003cb\u003e)\u003c/b\u003e, while a small proportion had only completed Primary School (1.2%) or Junior High School (6.6%). Regarding marital status, most respondents were single (64.7%), 14.7% were married, and 20.6% were in a relationship. Regarding occupational status, the majority had never worked (76.5%), 13.2% were currently working, 6.9% had worked but not within the last 12 months, and 3.4% were not currently working but had worked within the last 12 months. Overall, these findings indicate that the study population was predominantly high school or college-aged, mostly unmarried, and had limited work experience.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cdiv class=\"gridtable\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eDescriptive Characteristics of Adolescent Female Respondents\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"4\"\u003e\u003c/colgroup\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVariables\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSub Groups\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003en\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003e%\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eRegion\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eDumbo Raya\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e81\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e19.9\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eKota Selatan\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e74\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e18.1\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eKota Tengah\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e83\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e20.3\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eKota Timur\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e81\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e19.9\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSipatana\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e89\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e21.8\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eEducation\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePrimary School\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e1.2\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eJunior High School\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e27\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e6.6\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSenior High School\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e189\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e46.3\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCollege/University\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e187\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e45.8\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMarital Status\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSingle\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e264\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e64.7\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMarried\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e60\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e14.7\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eIn a Relationship\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e84\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e20.6\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOccupation\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eEver Worked (not in last 12 months)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e28\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e6.9\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCurrently Working\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e54\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e13.2\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNot Working (worked in last 12 months)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e14\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e3.4\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNever Worked\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e312\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e76.5\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTotal\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e408\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e100.0\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/table\u003e\u003c/div\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003ePrevalence and distribution of the severity of mental health conditions.\u003c/b\u003e\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cdiv class=\"gridtable\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eMental Health Characteristics of Adolescent Female Respondents\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"3\"\u003e\u003c/colgroup\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eMental Health Variables\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003en\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003eYes\u003c/b\u003e\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003eNo\u003c/b\u003e\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eEmotional Mental Disorder\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e115 (28.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e293 (71.8)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAddiction\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e0 (0.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e408 (100.0)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePsychotic\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e86 (21.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e322 (78.9)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePTSD\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e161 (39.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e247 (60.5)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSuicidal Ideation\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e25 (6.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e383 (93.9)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/table\u003e\u003c/div\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e presents the mental health characteristics of the 408 adolescent female participants. The findings indicate that 28.2% of the respondents experienced emotional or mental disorders, while 71.8% did not. None of the participants reported addiction problems (0.0%). Psychotic symptoms were identified in 21.1% of the participants, whereas 78.9% did not exhibit such conditions. Regarding post-traumatic stress disorder (PTSD), 39.5% screened positive and 60.5% screened negative. Suicidal ideation was reported by 2.7% of the respondents, compared to 97.3% who did not report such thoughts. Overall, the results highlighted that emotional mental disorders, psychotic symptoms, and PTSD were relatively common, whereas suicidal ideation was observed in only a small proportion of participants.\u003c/p\u003e\u003cp\u003eFigure \u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e: The line graph illustrates the distribution of mental health disorders and suicidal ideation among adolescent females across different health centers. Emotional mental disorders were most prevalent in Kota Selatan (44.6%) and Kota Tengah (41.0%) and lowest in Dumbo Raya (13.6%) and Kota Timur (16.0%). No respondents reported addiction in any of the health centers (0.0%). For psychotic symptoms, the highest rate was recorded in Kota Selatan (37.8%) and Kota Tengah (33.7%), while the lowest was recorded in Kota Timur (4.9%). Regarding PTSD, prevalence was highest in Kota Tengah (69.9%), followed by Kota Selatan (59.5%) and Sipatana (41.6%), and lowest in Kota Timur (4.9%). Finally, suicidal ideation was reported by 2.7% to 4.8% of respondents across most health centers, with the highest proportion in Kota Tengah (4.8%) and none in Kota Timur. Overall, the distribution indicates significant regional variations in emotional disorders, psychotic symptoms, and PTSD, while suicidal ideation, although relatively low, was still present among adolescents.\u003c/p\u003e\u003ch3\u003eBivariate Analysis of factors associated with mental health condition and suicidal ideation\u003c/h3\u003e\u003cdiv class=\"gridtable\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eDistribution of Mental Health Disorders and Suicidal Ideation among Adolescent Females by Health Center\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"8\"\u003e\u003c/colgroup\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVariables\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eDumbo Raya\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eKota Selatan\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eKota Tengah\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eKota Timur\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003eSipatana\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e\u003cp\u003eTotal\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c8\"\u003e\u003cp\u003ep-value\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eEmotional Mental Disorder\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e11 (13.6%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e33 (44.6%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e34 (41.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e13 (16.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e24 (27.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e115 (28.2%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.000\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAddiction\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e0 (0.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0 (0.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0 (0.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0 (0.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0 (0.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e0 (0.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePsychotic Symptoms\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e11 (13.6%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e28 (37.8%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e28 (33.7%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e4 (4.9%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e15 (16.9%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e86 (21.1%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.000\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePTSD\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e18 (22.2%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e44 (59.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e58 (69.9%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e4 (4.9%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e37 (41.6%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e161 (39.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.000\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSuicidal Ideation\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e1 (1.2%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e8 (10.8%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e8 (9.6%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e2 (2.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e6 (6.7%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e25 (6.1%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.042\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/table\u003e\u003c/div\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e presents the distribution of mental health disorders and suicidal ideation among adolescent females across the different health centers. Emotional mental disorders were most prevalent in Kota Selatan (44.6%) and Kota Tengah (41.0%) and lowest in Dumbo Raya (13.6%) and Kota Timur (16.0%) (\u003cem\u003ep\u003c/em\u003e = 0.000). No respondents reported addiction in any of the health centers (0.0%). For psychotic symptoms, the highest rate was recorded in Kota Selatan (37.8%) and Kota Tengah (33.7%), while Kota Timur (4.9%) had the lowest prevalence (\u003cem\u003ep\u003c/em\u003e = 0.000).\u003c/p\u003e\u003cp\u003eRegarding PTSD, prevalence was highest in Kota Tengah (69.9%), followed by Kota Selatan (59.5%) and Sipatana (41.6%), and lowest in Kota Timur (4.9%) (\u003cem\u003ep\u003c/em\u003e = 0.000). Finally, suicidal ideation was reported by 1.2% to 6.1% of respondents across most health centers, with the highest proportions in Kota Selatan (10.8%) and Kota Tengah (9,6%). The prevalence of suicidal ideation among adolescent females showed a statistically significant difference across health centers (\u003cem\u003eP\u003c/em\u003e = 0.042). This indicates that suicidal ideation rates vary meaningfully by location, suggesting the influence of contextual and regional psychosocial factors. Overall, the distribution indicates significant regional variations in emotional mental disorders, psychotic symptoms, PTSD, and suicidal ideation among adolescents.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cdiv class=\"gridtable\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eAssociation Between Mental Health Disorders and Suicidal Ideation Among Adolescent Females\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"6\"\u003e\u003c/colgroup\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eVariables\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u003cp\u003eSuicidal Ideation\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eTotal\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003ep-value\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003eYes\u003c/b\u003e\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003eNo\u003c/b\u003e\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eEmotional Mental Disorder\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e11 (9.6%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e104 (90.4%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e115\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e0.000\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0 (0.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e293 (100.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e293\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAddiction\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e11 (2.7%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e397 (97.3%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e408\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003ePsychotic\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e10 (11.6%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e76 (88.4%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e86\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e0.000\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e1 (0.3%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e321 (99.7%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e322\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003ePTSD\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e11 (6.8%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e150 (93.2%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e161\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e0.000\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0 (0.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e247 (100.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e247\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTotal\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e11 (2.7%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e397 (97.3%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e408\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/table\u003e\u003c/div\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e presents the association between mental health disorders and suicidal ideation among adolescent girls. Emotional mental disorders were significantly associated with suicidal ideation, with 9.6% of affected respondents reporting suicidal ideation (p = 0.000). Psychotic symptoms were also strongly associated with suicidal ideation, as 11.6% of adolescents with psychotic symptoms reported suicidal ideation compared to 0.3% without (p = 0.000). Similarly, PTSD was significantly associated with suicidal ideation, with 6.8% of the respondents reporting suicidal thoughts (p = 0.000). Meanwhile, addiction was not reported among the respondents and showed no association. Overall, suicidal ideation was observed in 2.7% of participants (n = 11).\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study found significant associations between emotional mental disorders, psychotic symptoms, PTSD, and suicidal ideation among adolescent females. These findings align with the growing evidence highlighting the role of psychiatric symptoms in influencing suicide risk among youth.\u003c/p\u003e\u003cdiv id=\"Sec12\" class=\"Section2\"\u003e\u003ch2\u003eEmotional mental disorders\u003c/h2\u003e\u003cp\u003eAdolescents with emotional mental disorders had a higher prevalence of suicidal ideation (9.6%) than those without such disorders. This aligns with Tonaydin et al. (2025), who reported a score of 90.84\u0026thinsp;\u0026plusmn;\u0026thinsp;5.5. The mean score of participants who attempted suicide on the suppression subscale of the ERQ was higher than that of those who did not attempt suicide. (\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e)\u003c/p\u003e\u003cp\u003eZhai et al. analyzed data from 5,313 US medical students (2018\u0026ndash;2023) to examine trends in anxiety, depression, suicidal ideation, and counselling use. The results showed significant increases in anxiety (21.6% to 33.9%), depression (14.0% to 27.1%), and counselling utilization (6.7% to 23.9%), whereas suicidal ideation remained stable. Despite the rise in service use, a treatment gap persists, underscoring the need for stronger mental health support for medical students.(\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e)\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec13\" class=\"Section2\"\u003e\u003ch2\u003ePsychotic symptoms\u003c/h2\u003e\u003cp\u003ePsychotic symptoms were also strongly associated with suicidal ideation (11.6%). A recent review demonstrated that The findings indicated a significantly positive correlation between psychotic-like experiences (PLEs) and suicidal ideation (SI), which was sequentially mediated by insomnia symptoms and resilience. Furthermore, insomnia symptoms and resilience played a chain-mediation role between PLEs and adolescent SI. This indicates that adolescents who frequently experience PLEs can be considered a high-risk group for SI and require early intervention. When intervening, the effects of insomnia symptoms and resilience on adolescents\u0026rsquo; SI should be comprehensively considered.(\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e)\u003c/p\u003e\u003cp\u003eA study conducted in New South Wales prisons, Australia, examined self-harm among inmates with psychosis compared to matched controls. The results showed that prisoners with psychosis (15.0%) were far more likely to engage in self-harm than controls (3.6%), with the highest risk among those with schizophrenia and related disorders. Aboriginal heritage was associated with an increased risk, whereas male sex and older age were protective factors. Notably, all 17 suicides recorded during the study period occurred among prisoners with psychosis, highlighting the urgent need for targeted interventions in this population (\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e).\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec14\" class=\"Section2\"\u003e\u003ch2\u003ePost-traumatic stress disorder (PTSD)\u003c/h2\u003e\u003cp\u003eIn this study, post-traumatic stress disorder (PTSD) was identified as a strong predictor of suicidal ideation, with 6.8% of affected adolescents reporting such thoughts. Similarly, Bora et al. demonstrated that among firefighters, witnessing a colleague\u0026rsquo;s line-of-duty death or suicide has a profound psychological impact, heightening vulnerability to PTSD and suicide risk. In a large survey involving 58,299 South Korean firefighters (92.6% response rate), assessments included posttraumatic symptoms, suicide risk, alcohol-related problems, emotional damage from emotional labor, and perceived peer support. The findings indicated that both emotional damage from emotional labor and alcohol-related problems significantly mediated the relationship between exposure to colleagues\u0026rsquo; deaths and subsequent PTSD or suicide risk (\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eEvidence from clinical settings further reinforces the link between suicide and PTSD. A descriptive survey conducted in 2023 at Razi Hospital among patients with one or more suicide attempts found that 80% experienced moderate-to-severe depressive episodes at the time of their attempt. The most common methods were medication ingestion (60%), followed by phlebotomy (16%), jumping from a height (8%), hanging (8%), and ingestion of toxins (8%). Over half (56%) required hospitalization in a medical unit, and 36% subsequently developed post-traumatic stress disorder (PTSD) as defined by the DSM-5 criteria. These findings indicate that a substantial proportion of suicide-attempt survivors are at risk of PTSD related to their attempts. Recognizing PTSD as a potential consequence of suicide attempts underscores the importance of systematic assessment and timely therapeutic interventions to the improve quality of life and reduce the risk of reattempts (\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e).\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec15\" class=\"Section2\"\u003e\u003ch2\u003eAddiction\u003c/h2\u003e\u003cp\u003eAlthough no cases of substance-related addiction were reported in this study, limiting the possibility of a direct association with suicidal ideation, growing evidence highlights the broader role of addictions, including behavioral and substance-related forms, in suicide risk. Alcohol and drugs are strongly implicated in suicide through several mechanisms: they may serve as a direct means of self-harm, either alone or in combination with other substances to increase lethality, and they may also reduce fear and inhibitions prior to an attempt.(\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e)\u003c/p\u003e\u003cp\u003ePopulation-level data further emphasize this relationship between obesity and depression. An analysis of deaths in Colorado between 2009 and 2020 found that 6.4% of veteran deaths (n\u0026thinsp;=\u0026thinsp;6,948) were attributable to suicide, alcohol, or drugs. Compared with the general adult population, veterans had substantially higher mortality rates from these causes (2.1-fold higher for suicide, 1.8-fold for alcohol-related deaths, and 1.3-fold for drug-related deaths). These findings underscore the disproportionate burden of substance-related mortality among veterans and the urgent need for upstream prevention strategies, including community-based interventions targeting alcohol use and socioeconomic distress (\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eAt the individual level, bereavement studies have revealed a complex interplay between suicide and substance use. A thematic analysis of free-text responses from 346 adults in Britain (aged 18\u0026ndash;40 years) identified three key themes shaping alcohol and drug use after losing a family member or close friend to suicide: control over substance use, perceived purpose of consumption, and attribution of misuse to external factors. These themes were consistently underpinned by issues of self-control and awareness of potential harm. Importantly, increased substance use is often described as a coping strategy following suicide bereavement, highlighting the need for sensitive assessments when determining whether and when an intervention is appropriate (\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e).\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec16\" class=\"Section2\"\u003e\u003ch2\u003ePrevalence and global comparison\u003c/h2\u003e\u003cp\u003eThe overall prevalence of suicidal ideation in this study (6,1%) was lower than the global estimates; however, Gorontalo emerged as one of the provinces with the highest rates of suicide attempts. A systematic review of 30 studies reported that 17% of participants experienced suicidal ideation and 5% attempted suicide, with ideation more common among adult women and attempts more frequently among adolescent girls, highlighting the significant epidemiological and psychosocial burden on females in South Asia (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e). Suicide among women represents a serious public health problem in low-and middle-income countries, where institutional discrimination, limited access to productive assets, unequal rights in citizenship, divorce, and inheritance contribute to vulnerability (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eIn India, 71.2% of suicide deaths among women occurred in those aged 15\u0026ndash;39 years, with mortality rates documented as twice the global female average, a pattern that persisted from 2016 to 2019 (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e). In Japan, youth suicide remains alarming, with 513 school-aged deaths reported in 2023. Contributing factors include academic pressure, bullying (especially cyberbullying), family problems, Internet addiction, and subcultural influences such as anime, manga, and gaming, all of which were further compounded by the COVID-19 pandemic, emphasizing the urgent need for comprehensive school- and community-based interventions to strengthen youth mental health(\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e). A pooled analysis of 118 surveys from 90 countries (2003\u0026ndash;2017) involving 397,299 adolescents found higher suicidal ideation among girls, while suicide attempts showed no sex or age differences. Bullying, serious injury, and lack of close friends were key correlates of ideation and attempts, which varied by age and sex. Strengthening peer relationships and preventing bullying and injuries are critical components of adolescent suicide prevention, particularly in low- and middle-income countries (30).\u003c/p\u003e\u003c/div\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThis study elucidates that common mental disorders, particularly emotional mental disorders, psychotic symptoms, and post-traumatic stress disorder (PTSD), are significantly correlated with suicidal ideation among adolescent girls in Gorontalo, Indonesia. Although the overall prevalence of suicidal ideation was relatively low at 6.1%, individuals exhibiting psychiatric symptoms were at substantially elevated risk. The prevalence of suicidal ideation in this study, while lower than several global estimates, still represents approximately one in 16 adolescent girls, highlighting a significant public health concern. Contextual factors, such as family support, social environment, and exposure to bullying, may also play critical roles. These findings emphasize the urgent need for early screening and intervention programs in schools and community health centers, focusing on enhancing family support, trauma-informed care, and psychoeducation. Preventive strategies should also consider the impact of digital media, which is increasingly important for adolescent mental health.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003ch2\u003eFunding\u003c/h2\u003e\u003cp\u003eFunding this research was funded by Center Of Higher Education Funding And Assessment (PPAT) Ministry Of Higher Education, Science And Technology Of Republic Indonesia through the Indonesia Endowment Fund (LPDP) with Indonesian Educational Scholarship (BPI) (Grant Number 202209090498)\u003c/p\u003e\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eEthics Approvals\u003c/strong\u003e\u003cp\u003e Ethical approval for the project was obtained from the Research Ethics Committee of the Faculty of Public Health, Hasanuddin University (approval number: 1608/UN4.14.1/TP.01.02/2024) and adhered to the principles outlined in the Declaration of Helsinki. After a thorough explanation of the study objectives, written informed consent was obtained from each participant.\u003c/p\u003e\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003cp\u003eNot applicable.\u003c/p\u003e\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003cp\u003eThe authors declare no conflicts of interest.\u003c/p\u003e\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eConceptualization: YAA., AZA., SN., and DAP.; methodology: YAA., AZA., SN.; validation: AZA., SN. DAP.: Formal analysis, YAA.; investigation, AR., IFI. and SS.; data curation, YAA., AZA., and SN.; writing the original draft preparation, YAA.; supervision, AZA., SN., DAP., AR., IFI., and SS. All authors have read and agreed to the published version of the manuscript.\u003c/p\u003e\u003ch2\u003eAcknowledgment\u003c/h2\u003e\u003cp\u003eAll authors of this manuscript have disclosed any potential financial or personal conflicts of interest with organizations or individuals that may have influenced their work. The authors have also disclosed any financial support received for the preparation of this review. The authors explicitly declare that there are no relevant conflicts of interest that could affect the objectivity of this study.\u003c/p\u003e\u003ch2\u003eData Availability\u003c/h2\u003e\u003cp\u003eThe datasets generated and/or analysed during the current study are not publicly available due to the sensitive nature of mental health and suicidal ideation data among adolescent females . Only aggregated results are presented in this article. De-identified individual level data and the study codebook may be available from the corresponding author on reasonable request and subject to approval by the relevant institutional ethics committee and a data sharing agreement.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eSubu MA, Wati DF, Al-Yateem N, Netrida N, Priscilla V, Maria Dias J, et al. Family stigma\u0026rsquo; among family members of people with mental illness in Indonesia: A grounded theory approach. Int J Ment Health. 2023;52(2):102\u0026ndash;23.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eO\u0026rsquo;Neill E, Cole HVS, Garc\u0026iacute;a-Lamarca M, Anguelovski I, Gull\u0026oacute;n P, Triguero-Mas M. The right to an unhealthy deprived city: An exploration of the impacts of state-led redevelopment projects on the determinants of mental health. 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Geography, rurality, and community distress: deaths due to suicide, alcohol-use, and drug-use among Colorado Veterans. Inj Epidemiol. 2023;10(1).\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eEng J, Drabwell L, Stevenson F, King M, Osborn D, Pitman A. Use of alcohol and unprescribed drugs after suicide bereavement: Qualitative study. Int J Environ Res Public Health. 2019;16(21).\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eImataka G, Shiraishi H. Youth Suicide in Japan: Exploring the Role of Subcultures, Internet Addiction, and Societal Pressures [Internet]. 2024. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.preprints.org/manuscript/202412.0452/v1\u003c/span\u003e\u003cspan address=\"https://www.preprints.org/manuscript/202412.0452/v1\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eCampisi SC, Carducci B, Akseer N, Zasowski C, Szatmari P, Bhutta ZA. Suicidal behaviours among adolescents from 90 countries: A pooled analysis of the global school-based student health survey. Volume 20. BMC Public Health. BioMed Central; 2020.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":false,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Mental Health, Suicide, Suicidal Ideation, Adolescent Females","lastPublishedDoi":"10.21203/rs.3.rs-8113944/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8113944/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e\u003cp\u003eMental health disorders significantly contribute to the global disease burden, with suicide being a major preventable cause of mortality, particularly among youth. Adolescents experience a critical developmental stage that increases their vulnerability to common mental disorders and suicidal ideation, with females exhibiting higher rates of nonfatal suicidal behavior than males. In low- and middle-income countries, this vulnerability is further exacerbated by structural gender inequality and limited access to mental health services. In Indonesia, millions of adolescents face mental health challenges; however, the factors influencing suicidal ideation among young women are poorly understood. Provincial data indicate alarming trends, with Gorontalo reporting some of the highest national rates of suicide attempts and a recent increase in suicide cases, prompting national-level investigations. Despite this, there is a paucity of empirical data on the personal and environmental factors influencing suicidal ideation among adolescent girls in this context.\u003c/p\u003e\u003ch2\u003eObjective\u003c/h2\u003e\u003cp\u003eThis study aimed to examine the association between common mental disorders and suicidal ideation among adolescent females in Gorontalo, Indonesia, to inform early intervention strategies in public health services.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e\u003cp\u003eA cross-sectional study was conducted among 408 adolescent females aged 18\u0026ndash;24 years. Data were collected using the Self-Reporting Questionnaire for mental health screening and the Adolescent Mental Resilience Instrument for suicidal ideation (SI).\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003eThe prevalence of common mental disorders was 28.2%, psychotic symptoms 21.1%, post-traumatic stress disorder (PTSD) 39.5%, and suicidal ideation 6.1%. Bivariate analysis indicated significant associations between common mental disorders and suicidal ideation (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05).\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e\u003cp\u003eMental health problems remain a critical issue among adolescent females in Gorontalo, with suicidal ideation being strongly associated with psychosocial factors. Strengthening family support, promoting mental health awareness in schools, and implementing early screening programs in community health centers are essential for suicide prevention and enhancing adolescent mental health.\u003c/p\u003e","manuscriptTitle":"Mental Health Determinants Of Suicidal Ideation Among Adolescent Females in Gorontalo, Indonesia: Evidence from a Lower-Middle-Income Country","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-11-18 08:50:13","doi":"10.21203/rs.3.rs-8113944/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"c817d698-6cf9-41b5-a97a-235ca0d3d9c5","owner":[],"postedDate":"November 18th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2026-02-12T03:25:21+00:00","versionOfRecord":[],"versionCreatedAt":"2025-11-18 08:50:13","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8113944","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8113944","identity":"rs-8113944","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}