In each of the participating countries, the GSHS received ethics approval from the Ministry of Education or a relevant Institutional Ethics Review Committee, or both. Only adolescents and their parents who provided written or verbal consent participated. As the current study used retrospective publicly available secondary data, we did not need ethics approval from any Institutional Ethics Review Committee. Suicidal ideation, suicide planning and suicide attempts among 229 129 adolescents in 59 low-andmiddle-income countries: a population-based study Abstract Background: Suicide is a major global health challenge and a leading cause of death among adolescents. Research related to suicide has concentrated on high-income countries with little evidence from low-and middle-income countries (LMICs). Methods: We used data from the Global School-based Student Health Survey conducted among schoolchildren aged 13-17 years (52% female) between 2003 and 2015 in 59 LMICs across six WorldHealth Organization regions. Using a meta-analysis with random effects, we computed the sex and agebased estimates of regional and overall prevalence of suicidal ideation, suicide planning and suicide attempts. Findings:The overall prevalence of suicidal ideation, suicide planning and suicide attempts in the 12 months preceding survey completion was 16•9% (95% CI: 15•0-18•8), 17•0% (14•8-19•2), and 17•0% (14•7-19•3), respectively. The African region had the highest prevalence of suicidal ideation and suicide planning, and the Western Pacific region had the highest prevalence of suicide attempts. The lowest prevalence of ideation, plan, and attempts was in the South-East Asian region. Females had higher prevalence than males for suicidal ideation [18•5% (16•4-20•6) vs. 15•1% (13•4-16•7)], suicide planning [18•2% (15•8-20•6) vs. 15•6% (13.7-17.6)], and attempts [17•4% (15•0-19•8) vs. 16•3% (14•0-18•6)]. Adolescents aged 15-17 years had higher prevalence than those aged 13-14 years of suicidal ideation [17•8% (15•8-19•8) vs. 15•9% (14•1-17•6)], plan [17•8% (15•7-20•0) vs. 16•3% (14•7-17•9)], and attempts [17•6% (15•2-20•0) vs. 16•2% (13•8-18•5)].Interpretation: Suicidal thoughts and behaviours are prevalent among adolescents in LMICs, in particular in the African and the Western Pacific regions, and among females and those aged 15-17 years. Customised suicide prevention initiatives are needed in LMICs, taking into account the diverse range of cultural and socio-economic backgrounds of the countries.

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Introduction A healthy workforce is pivotal to effective service delivery. Changing work environments during the past decade have seen practitioners faced with heavy workloads, long working hours and, in many environments, having to deal with work 'overflow' outside working hours. Ongoing pressures that impinge on out-of-work recovery time contribute to burnout, with potential consequences for both personal health and service delivery (Hakanen and Schaufeli 2012). As in other professions, occupational therapists with burnout describe high levels of emotional exhaustion and cynicism towards their work (Gupta et al 2012). Emotional exhaustion is symptomatic of high levels of strain and feelings of being depleted, while cynicism is shown by individuals displaying negative, uncaring, or detached attitudes to various aspects of their job (Maslach 1996). The downstream affects for organizations include high absenteeism, low employee commitment, and high turnover in workers (Bothma and Roodt 2012). Researchers in work-related stress have frequently considered engagement as the opposite of burnout in terms of worker wellbeing (Demerouti et al 2010). Employees who are highly engaged with their work feel energized, involved, and vigorous at work, rather than drained and exhausted (Schaufeli and Bakker 2004). High engagement is associated with strong organizational outcomes, including dedication, work loyalty, creativity, and resourcefulness (Bakker and Leiter 2010). Scant attention has been directed towards examining

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