Prevalence of suicidal behavior and ideation among young people
Our study showed a very high prevalence of suicidal behavior and ideation among young people in the Anywaa area. This study shows higher rates than studies in Dangla, Ethiopia, where suicidal thoughts and attempts are reported at 22.5 and 16.2 percent, respectively.  or Butajira, Ethiopia, where the cumulative risk of suicide attempt was 26.3% for major depression, 23.8% for bipolar I disorder . Comparatively, Thailand reported suicidal ideation in the past 12 months as 8.8%  and in Japan, the overall 12-month rate of suicidal thoughts, plans, and attempts was 7.9, 6.8, and 8.9 percent where 10.3% of students had had suicidal thoughts in the previous weeks . In low- and middle-income countries, the 12-month prevalence of attempted suicide was 17.4% among adolescents, which is higher than the prevalence reported in most studies from developed countries. .
The higher prevalence in the current study could be due to the high risk factors or drivers of suicide-related ideation and behavior that contribute to an increased likelihood of dying by suicide. . It could also be attributed due to the influence of the expression of humor and depressive emotion of students and parents, which causes young people to have poor abstract thinking. poor social support, school truancy, substance abuse and mental illness often associated with youth suicide [31, 33, 37].
In this study, the majority of youth were acutely aware of not being observed by others as having signs of suicide planning, such as getting a gun or writing a suicide note. They hide their behaviors so as not to be recognized by others as having suicidal behaviors and thoughts. Shreds of evidence indicated that people with suicidal thoughts and behaviors were likely to die soon by suicide. Among several studies, more than half of people with suicidal ideation (56.4%) went from suicidal ideation to suicide attempt due to a high depression score . Meanwhile, suicide attempt is one of the most crucial predictors of completed suicide . Previous research suggests that for many patients, the formation of a suicide plan precedes a suicidal act, usually within a year of the onset of suicidal ideation. [36, 38]. The more detailed and specific the suicide plan, the higher the level of risk will be . A study in Dares Salaam, Tanzania, of school-going adolescents showed that 7% of participants had thought about suicide and 6.3% had created a plan to try to make an attempt. and in Ethiopia, the overall 12-month prevalence of non-fatal suicidal behaviors, consisting of suicidal ideation, plans and attempts, was 7.9%. .
In this study, suicidal ideation and behavior was higher among people aged 15 to 34, consistent with previous research indicating that suicide ideation and behavior were more common among older age groups. younger than later in life. [40, 41]. However, in Butajira, younger age was significantly associated with increased non-fatal suicidal behaviors In low- and middle-income countries, suicide attempts are a common problem among adolescents aged 12 to 18  however, Yip found that older people had the highest suicide rate, followed by women between the ages of 20 and 29. .
Our study further revealed that the majority of participants who attempted suicide or who died by suicide were female. This is consistent with similar studies done in Dangila, Ethiopia, and similar to findings from 40 low-income countries where the majority of people who died by suicide were women. [31, 36]. At the same time, our results contrast with the results found in Butajira and Thailand . A study in Butajira, Ethiopia found that male gender was significantly associated with a suicide attempt that resulted in a fatal outcome, 16.2%, compared to 2.4% among females. .
The model or method used by young people who have attempted suicide
Focus group participants were asked about the suicide patterns/methods most used by young people or who died by suicide. Respondents indicated that hanging and drug overdose or poisoning were the methods used for those who had attempted or died by suicide. Hanging was the most common method used by people who died by suicide. This finding is consistent with previous studies from South Africa where hanging was the most commonly used method, followed by poisoning and firearms, . In Ethiopia, hanging and strangulation were the most commonly used methods of suicide (70%), especially in urban Ethiopia among both sexes. . In African countries, poisoning has been reported as the most common means used by people to end their lives in rural areas .
Relatives/families in this study reported similar results as expressed by these relatives: “Without seeing any sign of suicide on his part, he went into the forest and hung himself by a rope.” (Interview 7); “The means were hanging! She hanged herself in her own house where nobody knows” (Interview 8). Once young people decide to commit suicide, they research and use different methods or patterns of suicide. As quotes from all groups indicated above, hanging and drug overdose or poisoning were observed as the two main patterns of death by suicide and attempted suicide among youth in the area. ‘Anywaa. Of the six young people who attempted suicide, 66.7% resorted to hanging while the rest resorted to overdoses or poisoning. Data obtained from interviews and focus group discussions simply show that hanging was the most common pattern for both sexes and drug overdose or poisoning was the most common among women.
Through many lively discussions, FGD participants came to a common understanding that men had fewer suicide attempts than women. “Young women are the most vulnerable to both suicide and attempted suicide. However, young men will die by suicide when they intended to kill themselves.
Contrary to the current study, firearms were found to be the most commonly used method of suicide, followed by hanging or suffocation and poison in America, [22, 23]injury and poisoning [20, 21, 27] in Ethiopia, in other African countries, poisoning was the most common way to end one’s life in rural areas . Reducing suicide requires risk assessment and standard precautions, Age-specific, gender-specific approaches [44, 45]development and evaluation of empirical protocols for the prevention and treatment of suicide  among these target age groups, with cooperation, effective policies and program implementations.
Strength and limitations of the study
This study attempted to address some very interesting issues among young people from understudied backgrounds in Ethiopia. Additionally, this study used a mixed-methods approach to unearth the root causes currently affecting youth associated with traditional and community issues. Despite the above strength, this study has the following drawbacks. The cross-sectional nature of the study design has constraints on the causal relationship of the independent variables and the results.