Child and Adolescent Suicide Attempts, Suicidal Behavior, and Adverse Childhood Experiences in South Africa: A Prospective Study

Abstract Purpose This is the first known prospective study of child suicidal behavior in sub-Saharan Africa. Aims were to determine whether (1) cumulative exposure to adverse childhood experiences (ACEs) predicts later suicidality and (2) heightened risks are mediated by mental health disorder and drug/alcohol misuse. Methods Longitudinal repeated interviews were conducted 1 year apart (97% retention) with 3,515 adolescents aged 10–18 years in South Africa (56% female; 5 ACEs (cumulative odds ratio [OR], 2.46; confidence interval [CI], 1.00–6.05); for suicide planning, from 2.4% to 12.5% (cumulative OR, 4.40; CI, 2.08–9.29); and for suicide ideation, from 4.2% to 15.6% (cumulative OR, 2.99; CI, 1.68–5.53). Conclusions Preventing and mitigating childhood adversities have the potential to reduce suicidality. Among adolescents already exposed to adversities, effective mental health services may buffer against future suicidality.