Prevalence of Suicidal Ideation and its Association with Depression and Self-Esteem Among Bangladeshi Youth: A Web-based Cross-Sectional Study

Aim of the study

The study aims to:

1. Assess the prevalence of SI among Bangladeshi youth using a web-based cross-sectional survey.

2. Examine the association between SI and depression, identifying how depressive symptoms increase suicide risk.

3. Explore the relationship between SI and SE, particularly focusing on the impact of low self-worth.

4. Provide data-driven evidence to inform culturally responsive mental health interventions tailored to the specific needs of Bangladeshi youth.

By addressing these objectives, this study contributes to the growing body of literature on youth mental health in LMICs and supports the development of preventive strategies that are both contextually relevant and digitally adaptive—an urgent need in Bangladesh’s rapidly evolving socio-technological landscape.

Study design and setting

This study used a web-based cross-sectional design to assess the prevalence of SI and its association with depression and SE among youths, covering all regions of Bangladesh from 5 January, 2025 to 25 March, 2025.

Study population, sampling technique, and sample size estimation

The target population comprised Bangladeshi youth aged 18 to 30 years. A total of 514 participants were recruited using a purposive convenience sampling technique to ensure diverse representation from various regions of the country. Inclusion criteria included: (i) Bangladeshi residency, (ii) regular internet access, (iii) age between 18 and 30 years, and (iv) ability to provide informed consent. Participants were excluded if they had a self-reported diagnosis of severe psychiatric disorders, were unable to complete the online survey, or submitted incomplete responses. Of approximately 1,200 individuals who accessed the survey, 640 began the survey, 560 met eligibility, and 514 completed the questionnaire. This reflects a completion rate of approximately 42.8%.

The required sample size was estimated using the single population proportion formula, based on a previously reported prevalence of SI of 13.8% among Bangladeshi individuals.^[18] Assuming a 95% confidence level, 5% margin of error, and a design effect of 1.0, the minimum sample size was calculated as:

To accommodate potential incomplete responses and increase statistical power for subgroup analyses, the final sample was expanded to 514 respondents.

Data collection tools

The Personal Information Form was developed to collect key demographic data, including age, gender, educational background (EB), and socioeconomic status. Age was recorded to examine its association with SI, while gender was categorized as male, female, or other, enabling an exploration of gender-based differences in mental health outcomes.

The Bengali Version of the Patient Health Questionnaire-9 (PHQ-9) was implemented to assess levels of depression among participants, ensuring cultural and linguistic relevance.^[19,20] The nine-item self-administered tool aligns with the DSM-IV criteria for major depressive disorder and evaluates the frequency of depressive symptoms over the past two weeks.^[19] Each item is scored on a scale of 0–3, with total scores ranging from 0 to 27. Depression severity was categorized as none, mild, moderate, moderately severe, or severe based on these scores.^[21]

The Bengali Version of the Rosenberg Self Esteem Scale (RSES) was employed to measure SE. This ten-item scale evaluates both positive and negative aspects of SE using a four-point Likert scale, with responses ranging from “strongly agree” to “strongly disagree”.^[22] Higher scores indicate greater levels of SE. The Bengali version of the RSES has been validated in prior research and demonstrates strong psychometric properties for use in Bangladeshi populations.^[23-25]

The Bangla Beck Scale for Suicide Ideation (BSSI) was the primary tool for assessing SI. This 19-item scale evaluates the frequency and intensity of SI, ranging from “no thoughts of suicide” to “strong suicide intent”.^[26] The Bangla version has been adapted and validated to maintain its psychometric reliability in Bangladeshi contexts.^[27,28] No cut- point was used to categorize the scores.^[29] So, SI was categorized based on percentiles, with the first 25% (scores ranging from 0 to 18) classified as low, the middle 50% (scores between 19 and 26) as moderate, and the top 25% (scores of 27 or higher) as high.

Data collection procedure

Data were collected through an online survey that included the BSSI, the PHQ-9 to assess depression, and the RSES to measure SE. The survey was distributed via social media platforms, university networks, and online forums to ensure broad participation from the target population. Participants were selected based on inclusion criteria, such as being between 18 and 30 years of age and residing in Bangladesh. The sample size was determined through statistical analysis or reference to similar previous studies to ensure precision. Prior to participation, all respondents were asked to provide informed consent, with assurance of confidentiality and data protection. The survey was created using Google Forms and remained open for a specified period. Any incomplete responses were excluded from the final dataset.

Data analysis

All statistical analyses were conducted using IBM SPSS Statistics (Version 27.0). The normality of the data was assessed using the Kolmogorov-Smirnov test, which indicated that the data were non-normally distributed (p < 0.05). Descriptive statistics, including frequencies and percentages, were used to summarize socio-demographic characteristics and key study variables. To examine the association between socio-demographic factors and SI, chi-square (χ²) tests of independence were performed. Effect sizes were reported using Cramer’s V to determine the strength of associations. A clustered bar chart was used to visually represent the distribution of SI across gender, residential area (RA), depression levels, and SE categories. Initially, logistic regression analysis was considered to assess independent predictors of SI. However, due to non-significant associations in preliminary analyses, regression was not pursued. Instead, chi-square tests were used to explore group differences. Statistical significance was set at p < 0.05 for all analyses.

Ethical considerations

This study received ethical approval from the Institutional Review Board (IRB) of the Bangladesh Institute of Innovative Health Research on 20 December 2024 (IRB Protocol No.: BIIHR-2024-018). Participants provided informed consent after being briefed about the study's purpose, confidentiality, and voluntary nature. No personally identifiable information was collected. All data were encrypted, securely stored, and accessed only by authorized personnel. Supportive language was used throughout the survey to ensure participants’ emotional safety. All procedures in this study were performed according to the Declaration of Helsinki in treating all participants ethically.^[30]

Characteristics of the study participants

Table 1 presents the socio-demographic characteristics of the study participants. A total of 514 individuals participated in the study, with the majority (63.2%) aged between 21 and 25 years. More than half of the participants were female (58.6%). In terms of educational qualification, 62.1% had completed graduation, while only 0.6% were illiterate. The majority of the participants were unmarried (80.4%), and most resided in urban areas (77.2%). Regarding monthly income, 65.0% of participants earned less than 10,000 BDT per month. The predominant occupation was students (76.8%), followed by employees/businessmen (12.3%). Mental health-related variables revealed that 56.0% of participants had low SE, and none reported high SE. Depression levels varied, with 30.2% experiencing mild depression, while 9.9% had severe depression. SI was classified as low in 30.5% of participants, moderate in 50.4%, and high in 19.1%.

Prevalence of SI

Figure 1 illustrates the prevalence of SI among the study participants. The majority of individuals (50.4%) reported moderate SI, whereas 19.1% experienced high SI.

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Figure 1:

Prevalence of suicidal ideation among study participants

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Association between socio-demographic factors and SI

Table 2 presents the associations between socio-demographic variables and SI. The results revealed that age significantly influenced SI (χ² = 10.873, p = 0.028), with participants aged 18–20 years showing a higher proportion of low SI. Similarly, RA was significantly associated with SI (χ² = 9.086, p = 0.011), with a greater percentage of rural residents reporting low SI compared to urban residents. EB also showed a significant association with SI (χ² = 36.433, p < 0.001). Participants with higher education levels exhibited more variation in SI levels, with those having a graduate degree showing the highest percentage of high SI. Monthly income was another significant factor (χ² = 12.911, p = 0.044), with participants earning more than 50,000 BDT showing the highest proportion of moderate SI. A strong association was found between depression and SI (χ² = 42.349, p < 0.001), where participants experiencing severe depression were more likely to have high SI. However, SE did not show a significant association with SI (χ² = 1.386, p = 0.50).

Comparison of SI by key variables

Figure 2 (a-d) presents a clustered bar chart illustrating SI distribution across gender, RA, depression, and SE. The results indicate that males exhibited slightly higher rates of high SI compared to females. Similarly, urban residents had higher proportions of moderate and high SI compared to rural residents. Depression levels showed a clear gradient, with higher severity associated with an increased prevalence of high SI. In contrast, SE did not display a clear pattern in relation to SI levels.

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Figure 2:

Clustered bar chart of suicidal ideation by (a) gender, (b) residential area, (c) depression, and (d) self-esteem

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Strengths and limitations

One of the key strengths of this study is its large sample size (N = 514), which enhances the statistical reliability of the findings. The web-based survey method enabled wide geographical coverage and may have reduced stigma-related underreporting by providing anonymity. Additionally, the use of validated psychometric instruments such as the PHQ-9, RSES, and BSSI contributed to the accuracy and consistency of measurement. Nonetheless, the study has several limitations. The reliance on self-reported data introduces the potential for social desirability bias or under-/ over-reporting of mental health symptoms, especially across urban and rural participants with differing levels of mental health awareness.^[38,39] To mitigate this, future studies should consider using clinical diagnostic interviews, which provide more objective and comprehensive assessments.^[40] Moreover, the cross-sectional design limits causal inferences and does not allow the tracking of changes in SI or mental health over time. Future studies should adopt longitudinal designs to monitor the evolution of depression, SE, and SI, offering richer insights into causality and temporal patterns.^[41]

Future directions

The findings of this study underscore the critical need for mental health interventions tailored to the socio-cultural context of Bangladesh. While depression emerged as a significant predictor of SI, it is important to recognize that mental health issues in Bangladesh are often influenced by unique cultural, familial, and societal factors. In the Bangladeshi context, where collectivist values and strong family structures play a prominent role, interventions must consider these social dynamics in order to be effective. Culturally responsive interventions should focus on reducing the stigma associated with mental health, which remains a significant barrier to seeking care in Bangladesh. Public health campaigns and educational programs aimed at increasing awareness about mental health and suicide prevention should be designed to resonate with local cultural values. These initiatives can emphasize the importance of family involvement in mental health care and promote open discussions about emotional well-being within the family and community settings. Moreover, mental health programs should consider the digital engagement of youth, given the increasing use of online platforms among this demographic. Leveraging technology, such as online counseling and mental health support apps, can help reach youth in both urban and rural areas, offering a more accessible means of seeking help. Integrating culturally relevant content, such as peer support groups and community-based counseling services, into these digital platforms can further enhance their effectiveness. Additionally, intervention programs should incorporate coping strategies and resilience-building techniques that align with the cultural and religious beliefs of the youth. CBT and mindfulness-based approaches, adapted to the local context, could be valuable in strengthening emotional regulation and SE. Schools and universities should be at the forefront of these efforts, integrating mental health programs into their curricula to foster early identification of at-risk youth and provide ongoing support. Further research is necessary to deepen our understanding of the complex relationship between mental health and SI in Bangladeshi youth. Longitudinal studies could elucidate causal pathways and early risk indicators, while qualitative research involving interviews and focus groups would offer contextualized insights into the cultural, familial, and societal factors shaping mental health. Additionally, the effectiveness of specific interventions such as digital CBT, mental health education, and peer-led initiatives should be rigorously tested. By focusing on these areas, future research can contribute to the development of evidence-based policies and contextualized intervention strategies to reduce the burden of SI among youth in Bangladesh.