Objective To estimate prevalence of suicidal ideation and suicidal ideation with a plan in each surveyed country and to examine crossnational
differences in associated risk factors.
Methods We analysed data of students aged 13–17 years who participated in the 2003–2012 Global School-based Health Surveys in
32 countries, of which 29 are low- and middle-income. We used random effects meta-analysis to generate regional and overall pooled
estimates. Multivariable logistic regression was used to estimate risk ratios for the associated risk factors. Population attributable fractions
were estimated based on adjusted risk ratios and the prevalence of the determinants within each exposure level.
Findings Across all countries, the pooled 12-month prevalence of suicide ideation were 16.2% (95% confidence interval, CI: 15.6 to 16.7)
among females and 12.2% (95% CI: 11.7 to 12.7) among males and ideation with a plan were 8.3% (95% CI: 7.9 to 8.7) among females and
5.8% (95% CI: 5.5 to 6.1) among males. Suicide ideation in the WHO Region of the Americas was higher in females than males, with an
estimated prevalence ratio of 1.70 (95% CI: 1.60 to 1.81), while this ratio was 1.04 (95% CI: 0.98 to 1.10) in the WHO African Region. Factors
associated with suicidal ideation in most countries included experiences of bullying and physical violence, loneliness, limited parental
support and alcohol and tobacco use.
Conclusion The prevalence of adolescent suicidal behaviours varies across countries, yet a consistent set of risk factors of suicidal behaviours
emerged across all regions and most countries.