According to the World Health Organization (WHO), more than 700,000 people die by suicide each year. Among young people, suicide is one of the leading causes of death. WHO data from 2019 showed that suicide ranked as the third leading cause of death among girls aged 15–19 and fourth among boys in the same age group.

One of the strongest predictors of suicide is suicidal ideation. In her master's thesis in the public health program at the University of Tartu's Faculty of Medicine, graduate student Hanna Moor studied the prevalence of suicidal thoughts among 15-year-old schoolchildren in Estonia from 2006 to 2022.

One reason she chose the topic was the increasing public conversation about mental health issues among children and adolescents. "If you look at the overall occurrence of mental health problems, you can see they are becoming more common among young people. Suicidal thoughts serve as an indicator that reflects the mental health status of children and adolescents," Moor explained.

Although data on schoolchildren has been collected since 2006, trends in suicidal ideation had not previously been analyzed in Estonia. By using data from the regularly conducted international Health Behavior in School-aged Children (HBSC) study, it was possible to evaluate long-term trends in suicidal ideation and their associations with various factors.

While the number of suicides in Estonia has generally declined in the 21st century, the decrease has slowed somewhat over the past decade. At the same time, the number of suicide attempts has risen. Around 200 people die by suicide in Estonia each year and the suicide rate remains higher than the European Union average.

Moor's thesis found that from 2006 to 2022, the prevalence of suicidal thoughts increased significantly among both 15-year-old boys and girls. In 2006, 10.9 percent of boys and 16.8 percent of girls reported having suicidal thoughts in the past 12 months. By 2022, those figures had risen to 16.1 percent and 33.6 percent, respectively. "One in three girls had thought about suicide in the past year. That is a sobering number," Moor noted.

Suicidal thoughts are more common among girls than boys, and girls also attempt suicide more frequently in Estonia. However, the number of completed suicides does not differ significantly between the two groups. According to Moor, one possible explanation is that girls are more likely to acknowledge or recognize problems earlier.

Young people who experience other mental health issues — such as depressive episodes — are significantly more likely to have suicidal thoughts. In 2022, 60.2 percent of girls and 29.2 percent of boys who responded to the survey reported having experienced such episodes. These episodes were defined as a period of at least two weeks during which the respondent felt unable to do anything and derived no joy or interest from everyday activities.

"It's important to keep in mind that all this data is self-reported, meaning the young people themselves assessed and interpreted the presence of various mental health issues. There are likely some differences in interpretation, but even so, we see that such episodes are increasingly common among girls. Recognizing the problem is already a step toward seeking help. That may also help explain why girls report mental health issues more frequently," Moor said.

Previous scientific literature has also found that girls are more often willing to acknowledge struggles related to mental health.

Getting enough sleep leads to a happier life

In her thesis, Hanna Moor analyzed the relationship between suicidal thoughts and various factors primarily related to mental health, school and family. She also examined aspects of lifestyle, such as sleep duration and social media use. One key finding was the significant link between suicidal ideation and sleep: getting fewer than six hours of sleep was identified as a major risk factor. "It's therefore important to monitor how much children and adolescents are sleeping. Parents play a major role here, but it's also crucial for young people to recognize the importance of adequate rest themselves," Moor said.

Moor also found a somewhat unexpected connection between suicidal thoughts and the language spoken at home. Her study showed that students whose home language was not Estonian were less likely to report suicidal thoughts compared to those who spoke Estonian at home.

She suggested that this difference could be influenced by cultural background. For example, Estonian and non-Estonian communities may differ in terms of social support, religious background, awareness of mental health issues and willingness to acknowledge them. "Mental health problems and suicidal thoughts often carry stigma, and in some cases, cultural or national characteristics might play a role. But that relationship is difficult to assess," she explained.

Several of the study's findings were surprising to Moor herself. One was the strong link between frequent feelings of loneliness and suicidal ideation. "This is especially surprising in the context of today's social media era, where young people have so many ways to stay connected. But the results showed that many young people still feel lonely," she said.

The thesis also revealed that suicidal thoughts were significantly more common among students who found schoolwork highly stressful. "This outcome highlights the need to better support young people in coping with academic pressure — especially considering that 15-year-olds are typically finishing basic school and the transition to the next level of education is often particularly stressful," Moor noted.

Given that girls report more suicidal thoughts, should preventive efforts focus more on them? Moor said the issue is not so clear-cut. "Yes, girls report more suicidal ideation, but when you look further, the gender differences tend to level out. So gender may not be as significant a risk factor as other elements affecting health and well-being. Ultimately, we need to identify all young people at risk and provide them with help, regardless of gender," she said.

Hanna Moor defended her master's thesis, titled "The Prevalence of Suicidal Ideation and Associated Factors Among 15-Year-Old Schoolchildren in Estonia, 2006–2022", in the public health program at the University of Tartu's Faculty of Medicine. The thesis was supervised by Kersti Pärna, Sigrid Vorobjov, and Liina Veskimäe.

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