Cross-national comparisons of adolescent mental health and suicidality in the Middle East: a cross-sectional secondary analysis of the global school-based student health survey

Atika Khalaf, Basma Al Yazeedi, Anas Alsharawneh

Background Adolescent mental health and suicidality represent growing global public health concerns, yet comparative evidence from the Middle East remains limited. This study examined the prevalence and correlates of psychological distress and suicidal behaviors among adolescents across Middle Eastern countries using the Global School-based Student Health Survey (GSHS). Methods A cross-sectional analysis of nationally representative GSHS datasets from 12 Middle Eastern countries collected between 2004 and 2017. The pooled sample included 90,573 school-attending adolescents aged 11–18 years. Multivariable logistic regression models assessed associations between psychosocial factors and suicidal behaviors while adjusting for age, sex, and country. Results Substantial cross-country variation in mental health indicators and suicidality was observed. Loneliness ranged from 11.5% in Bahrain to over 50.0% among female adolescents in Tunisia and Morocco. Suicidal ideation affected 16.3% of adolescents overall, while suicide planning was reported by 13.4%. Suicide attempts were reported by 9.1% of adolescents at least once. Female adolescents consistently reported higher levels of loneliness and anxiety, whereas males showed slightly higher adjusted odds of suicidal ideation and attempts (OR = 1.2). Lack of parental support, low school connectedness, and fewer friendships were significantly associated with higher odds of suicidal ideation, planning, and attempts. Emotional symptoms such as loneliness (OR = 1.7) and anxiety (OR = 1.8) were also strongly associated with suicide attempts. Conclusions Psychological distress and suicidality are prevalent among adolescents across the Middle East, with notable gender and cross-country differences. Strengthening family support, peer relationships, and school connectedness should be central to regional adolescent mental health and suicide prevention strategies.