Title : Predictors of suicidal ideation and suicide attempts in sub-Saharan Africa: A multi-country analysis of WHO STEPS survey data (2014-2019)
Abstract:
Background: Suicide remains a major public health concern, accounting for an estimated 800,000 deaths annually, with a disproportionate burden in low- and middle-income countries. In Sub-Saharan Africa, the epidemiology of suicidal behavior is poorly characterized due to stigma, weak mental health infrastructure, and limited population-level data. This study examined the prevalence and determinants of suicidal ideation and suicide attempts across multiple African countries to inform context-specific prevention strategies.
Methods: A cross-sectional analysis was conducted using secondary data from the WHO STEPwise approach to Surveillance (STEPS) surveys (2014-2019) across 12 African countries. The study applied a multistage cluster sampling design and standardized WHO STEPS instruments to assess suicidal behavior among adults aged 15 years and above. A total of 14,374 participants were assessed for suicidal ideation and 16,041 for suicide attempts. Multivariable logistic regression and spatial mapping techniques were used to identify risk factors and geographic patterns of suicidal behavior.
Results: The pooled prevalence of suicidal ideation was 6.34%, and suicide attempts stood at 5.69%, with notably higher rates among females and young adults aged 15-34 years. Male sex was significantly associated with lower odds of suicidal ideation and attempts compared with female sex (Adjusted Odds Ratio = 0.61; 95% Confidence Interval: 0.52-0.72; p < 0.001). Country of residence (particularly Eswatini, Malawi, and Zambia), hypertension, high dietary salt intake, and alcohol consumption emerged as significant predictors, with alcohol use associated with approximately a two-fold increase in both outcomes. Education, marital status, and urban residence showed minimal influence after adjustment for other covariates.
Conclusion: These findings highlight an urgent need to integrate mental health screening and services into primary healthcare systems across Sub-Saharan Africa, strengthen public awareness campaigns, and address stigma surrounding suicide. Targeted interventions addressing alcohol use, hypertension management, and gender- and age-specific vulnerabilities are critical to reducing the burden of suicidal behavior in the region.
Keywords: Suicidal Ideation; Suicide Attempts; Mental Health; Sub-Saharan Africa; WHO STEPS Survey
