Prevalence of suicidal thoughts and behaviors among individuals with mental disorders in Africa: a systematic review and meta-analysis of the past 25 years

Suicide causes over 800,000 deaths globally each year, with 73% occurring in low- and middle-income countries (LMICs). However, data on suicidal thoughts and behaviors (STBs) among individuals with psychiatric disorders in Africa remain limited. This study aims to assess the prevalence of STBs in this population using both general and clinical samples, addressing key data gaps in the African context. This systematic review and meta-analysis searched PubMed, Web of Science, Scopus, and other databases from January 2000 to January 2025. Study selection followed PRISMA guidelines, with Rayyan and Zotero used for screening and duplicate removal. Data were extracted using a structured framework, and study quality was assessed with Joanna Briggs Institute tools. Statistical analyses, including I² heterogeneity evaluation, were conducted in R using a random-effects model. Eighty-two studies (n= 24,687) were included in the final meta-analysis. Recent suicide attempts (SA) prevalence was at 9% (95% CI: 6–12%, I² = 91%): substance-related disorders (17%), bipolar (15%), depressive disorders (14%), and schizophrenia spectrum disorders (6%). Lifetime SA prevalence was at 24% (95% CI: 21–27%, I² = 95.3%): cluster B personality disorders (33%), substance-related disorders (28%), schizophrenia spectrum disorders (27%), bipolar disorders (25%), and trauma-related disorders (25%). Recent suicidal ideation (SI) was at 31% (95% CI: 25–37%, I² = 97.5%): bipolar (61%), trauma-related disorders (58%), anxiety disorders (44%), depressive disorders (36%), and schizophrenia spectrum disorders (20%). Lifetime SI was 40% (95% CI: 33–46%, I² = 98.4%): patients with schizophrenia (41%), bipolar disorders (40%), and depressive disorders (39%). STBs among African individuals with psychiatric disorders represent a serious public health concern. These findings are essential for guiding targeted mental health policies and refining global STBs estimates.