R ESEARCH A RTICLE Association of Being Bullied in School With Suicide Ideation and Planning Among Rural Middle School Adolescents MADHAV P. BHATTA, PhD, MPH a SUNITA SHAKYA, MPH b ERIC JEFFERIS, PhD c ABSTRACT BACKGROUND: This study examined the association of ever being bullied in school with suicide ideation (ever thinking about killing oneself) and ever seriously making a plan to kill oneself (suicide planning) among rural middle school adolescents. METHODS: Using the US Centers for Disease Control and Prevention’s Middle School Youth Risk Behavior Survey instrument, 2 cross-sectional surveys were conducted among middle school adolescents (N = 1082) in a rural Appalachian county in Ohio in 2009 and 2012. Multivariable logistic regression models assessed the relationship of ever being bullied in school with suicide ideation and planning. RESULTS: Overall, a total of 468 participants (43.1%) reported ever being bullied in school, and 22.3% and 13.2% of the adolescents surveyed reported suicide ideation and planning, respectively. In the multivariable analyses, ever being bullied in school was significantly associated with both suicide ideation (odds ratio [OR] = 2.4; 95% confidence interval [CI]: 1.7-3.5) and planning (OR = 2.5; 95% CI: 1.6-3.8). CONCLUSIONS: The results show a strong association between being bullied in school and suicide ideation and planning among rural middle school adolescents. Prevention of bullying in school as early as in middle school should be a strategy for reducing suicide ideation and planning among adolescents. Keywords: adolescents; suicide; ideation; planning; bullying. Citation: Bhatta MP, Shakya S, Jefferis E. Association of being bullied in school with suicide ideation and planning among rural middle school adolescents. J Sch Health. 2014; 84: 731-738. Received on June 13, 2013 Accepted on April 13, 2014 S uicide among adolescents and young adults is a serious public health problem in the United States. It is the third leading cause of death in the United States among adolescents aged 10-19 years. In 2010, 267 and 1659 adolescents aged 10-14 and 15-19 years, respectively, died as a result of suicide. 1 Completed suicide is just the tip of the epidemiologic iceberg of suicide and suicidal behaviors among adolescents. For every completed suicide there are about 25 attempted suicides and an even greater number of individuals exhibiting nonfatal suicidal thoughts and behaviors. 2 These nonfatal suicidal thoughts and behaviors are classified into the categories of suicide ideation, suicide plan, and suicide attempt . 3 Suicide ideation is defined as having thoughts of engaging in behavior intended to end one’s life; suicide plan is defined as the formulation a Assistant Professor of Epidemiology, (mbhatta@kent.edu), College of Public Health, Kent State University, PO Box 5190, Kent, OH 44242. b Graduate Assistant, (sshakya2@kent.edu), College of Public Health, Kent State University, PO Box 5190, Kent, OH 44242. c Associate Professor of Social and Behavioral Sciences, (ejefferi@kent.edu), College of Public Health, Kent State University, PO Box 5190, Kent, OH 44242. Address correspondence to: Madhav P. Bhatta, Assistant Professor of Epidemiology, (mbhatta@kent.edu), College of Public Health, Kent State University, PO Box 5190, Kent, OH 44242. of a specific method through which one intends to die; and suicide attempt is defined as engagement in potentially self-injurious behavior in which there is at least some intent to die. 4 According to the national Youth Risk Behavior Survey (YRBS) from 2011, 15.8% and 12.8% of high school-aged adolescents (15-18 year olds) had seriously considered attempting suicide (suicide ideation) or had made a plan about how they would attempt suicide (suicide plan) during the 12 months prior to the survey, respectively. 5 These statistics clearly highlight the extent to which suicidal behaviors are a public health problem among high school-aged US adolescents. Data on suicide and suicidal behaviors among middle school-aged adolescent students (11- 14 year olds), however, are limited. 6,7 Journal of School Health • November 2014, Vol. 84, No. 11 •  2014, American School Health Association • 731