Sexual Violence Tied to Suicidal Thoughts and Self-Harm in Young People Across Four African Nations

A sweeping analysis of nationally representative survey data from four sub-Saharan African countries has found that young people who have experienced sexual violence face roughly two-and-a-half to nearly five times higher odds of suicidal thoughts and deliberate self-harm compared with their peers who have not. The study, published in Discover Psychology, draws on the Violence Against Children Surveys conducted in Ivory Coast, Kenya, Lesotho and Namibia, and offers some of the most robust evidence to date that sexual violence is a powerful statistical predictor of suicide risk among people aged 18 to 24 in the region. With more than one in five young respondents in every country reporting sexual violence, the findings point to a public health burden that researchers say has remained largely invisible in national mental health planning.

The research team, led by Peter Kisaakye of Makerere University in Uganda and including collaborators from institutions in Ghana and Uganda, performed a secondary analysis of data collected in 2018 and 2019. Their sample comprised 9,826 young people between the ages of 18 and 24, all drawn from surveys designed by the US Centers for Disease Control and Prevention in partnership with national governments to measure violence against children and youth. Because these surveys use household sampling frames and standardized questionnaires, they allow researchers to estimate prevalence with confidence intervals and to generalize findings to entire national populations of young adults, something that small clinic-based studies cannot do.

The headline numbers are stark. Sexual violence prevalence exceeded 20 percent in all four countries, with Ivory Coast recording the highest rate at 38.7 percent, followed by Kenya at 28.8 percent, Namibia at 23.7 percent and Lesotho at 20.5 percent. Suicide ideation, meaning serious thoughts of ending one’s own life, was highest in Kenya at 13.2 percent and lowest in Ivory Coast at 6.1 percent. Self-harm showed a different geographic pattern: it was most prevalent in Ivory Coast at 13.5 percent and least common in Lesotho at 2.8 percent. The fact that the country with the highest violence prevalence did not have the highest suicide ideation rate underscores that the relationship between victimization and suicidality is shaped by broader social and economic contexts, not by exposure alone.

Methodologically, the study relied on binary logistic regression, a statistical technique suited to modeling outcomes with two possible values, such as whether a respondent reported suicidal thoughts or not. The researchers estimated odds ratios, which express how much more likely an outcome is in one group relative to another, together with 95 percent confidence intervals that indicate the range within which the true population value likely falls. Crucially, the models were adjusted for several potential confounders, including sex, school attendance, orphanhood status, work experience, whether respondents could talk to friends, and whether they believed physical violence was justifiable. This adjustment matters because factors such as losing a parent or lacking social support are themselves linked to both violence exposure and mental health outcomes, and failing to account for them could exaggerate or distort the apparent effect of sexual violence.

After adjustment, the association between sexual violence and suicide ideation held in every country. Young people who had ever experienced sexual violence had 2.86 times higher odds of suicidal thoughts in Ivory Coast, 3.06 times higher odds in Kenya, 3.30 times higher odds in Lesotho and 2.51 times higher odds in Namibia, with confidence intervals that excluded the null value of one in all cases. The consistency of this effect across four distinct national settings is one of the study’s most significant contributions. It suggests that the psychological toll of sexual victimization is not an artifact of any single country’s data quality or cultural reporting norms, but a robust pattern that transcends borders within the region.

The link with self-harm was even stronger in some settings. Adjusted odds ratios for self-harm among survivors of sexual violence were 1.77 in Ivory Coast, 2.59 in Kenya, 2.81 in Namibia and a striking 4.75 in Lesotho, where survivors had nearly five times the odds of engaging in deliberate self-injury compared with non-survivors. Self-harm, which includes behaviors such as intentional cutting or burning, is recognized in the clinical literature as both a marker of acute psychological distress and one of the strongest predictors of future suicide attempts. The Lesotho finding, in particular, implies that in some contexts sexual violence may be intertwined with coping mechanisms that carry immediate physical danger, amplifying the case for early identification of survivors before self-directed harm begins.

Why does sexual violence exert such a profound effect on the mental health of young adults? The authors frame sexual violence as having both immediate and long-term adverse consequences, including reduced mental well-being, substance abuse and suicidality. Developmental science offers several converging explanations. The late teens and early twenties are a period of heightened vulnerability, in which identity formation, educational attainment and intimate relationships are all in flux, and the brain’s emotion-regulation circuitry is still maturing. Trauma experienced during this window can disrupt attachment, erode self-worth and instill a sense of shame that discourages disclosure. In many communities across sub-Saharan Africa, stigma surrounding sexual victimization remains intense, and survivors, particularly young men, may fear social rejection if they come forward. Silence, in turn, prevents access to the social support that the survey data themselves suggest is protective.

The study also carries implications for how mental health services are organized in low- and middle-income countries. The authors call for prioritizing sexual violence prevention and survivor-centered response, and specifically recommend integrating routine screening for sexual violence into youth mental health services, sexual and reproductive health services and primary care. This is a practical proposal with a strong evidence logic: young people are far more likely to encounter a clinic for contraception, HIV testing or a routine illness than to seek out a specialist mental health provider, and a brief, confidential screening question about violence exposure could route survivors toward counseling and crisis support they would otherwise never receive. Screening programs of this kind have shown promise elsewhere, though they require training, referral pathways and safeguards for confidentiality to avoid re-traumatizing patients.

The reliance on the Violence Against Children Surveys gives the study unusual methodological strength, but it also imposes limits that the authors acknowledge implicitly through their design. The surveys are cross-sectional, capturing a snapshot in time, which means they can establish association but not definitive causation; it remains possible that some unmeasured factor, such as family instability or prior childhood adversity, contributes to both violence exposure and suicidality. Self-reported data on sexual violence are also sensitive to disclosure bias, and stigma may lead some survivors to remain silent, which would tend to make the observed associations conservative rather than inflated. The authors tested for multicollinearity among predictors, reported in an appendix, to ensure that the adjusted estimates were not distorted by overlapping variables, a standard but important robustness check.

For policymakers across the region, the message is difficult to ignore. Suicide is among the leading causes of death for young people worldwide, and the new evidence indicates that a substantial and preventable share of the risk in these four countries is tied to sexual violence that often occurs years before the suicidal thoughts emerge. Prevention programs that address gender norms, strengthen child protection systems and engage communities have demonstrated reductions in violence exposure in trials supported by the same CDC survey infrastructure. What the present study adds is a clear quantitative bridge between that prevention agenda and mental health outcomes: every case of sexual violence averted is not only an end to a human rights violation but potentially an intervention against a lifetime of psychological suffering. As the authors conclude, sexual violence, suicide ideation and self-harm remain relatively high among young people, and treating them as separate policy problems, rather than as connected outcomes of the same trauma, risks missing the point at which help can change a life.

Subject of Research: The association between sexual violence experience and suicide ideation and self-harm among young people aged 18 to 24 in four sub-Saharan African countries

Article Title: Experience of sexual violence is associated with suicide ideation and self-harm among young people (18–24 years): evidence from a violence against children survey in four countries

Article References: Kisaakye, P., Kyei-Arthur, F., Kyei-Gyamfi, S., Afrifa-Anane, G. F., Boadu, E. S., Miezah, D., & Bukuluki, P. (2026). Experience of sexual violence is associated with suicide ideation and self-harm among young people (18–24 years): evidence from a violence against children survey in four countries. Discover Psychology. https://doi.org/10.1007/s44202-026-00892-4

Image Credits: AI Generated

DOI: 10.1007/s44202-026-00892-4

Keywords: sexual violence, suicide ideation, self-harm, young people, sub-Saharan Africa, Violence Against Children Surveys, mental health, Ivory Coast, Kenya, Lesotho, Namibia, logistic regression