Uddin et al. has reported a 17% prevalence of suicidal ideation and attempts among in-school adolescents aged 13 to 17 across 59 low- and middle-income countries, with the World Health Organisation Africa region showing the highest prevalence, at 20% for suicidal ideation. Aboagye et al. reported a 15% prevalence of suicidal ideation among in-school adolescents aged 10 to 19 in eight countries in sub-Saharan Africa. This rising prevalence necessitates, among other aspects, the exploration of protective factors – family, friendship and community relationships – and the development of interventions that can effectively prevent suicidal ideation and attempts among young people in Africa.

This study will ask the following questions:

1. How do youth in sub-Saharan Africa understand and experience suicidality?
2. What are the main contextual and relational risk factors contributing to youth suicidality in this region?
3. What social or peer support structures and persons help prevent perceived social stress and isolation among youth, and how do they relate to youth suicidality?
4. Is there a collective suicidality or “reasons to live” concept in the Global South, and how is it characterised?
5. Is it possible to contextually adapt and validate a standardised questionnaire to assess the risk of social isolation and suicidality among youth in Africa, considering cultural and social understanding of “reasons to live”?
6. How can the toolkit mentioned in question 5 be integrated into existing youth support systems to improve detection and support for at-risk individuals?

Methods employed will include focus group and interview responses on youth perspectives on relational wellbeing (RWB) and suicidality.

RWB data collected will focus on an eight-item measure of relational wellbeing scores, measuring social connections and close relationships with peers, family, community and institutions (religious, educational, health and employment).

Mental health metrics will look at “reasons for living inventory for African youth” scores, as well as ASAP-20 scores on historical, clinical, contextual and protective factors. Spatial-temporal data collection will include historical climate data (rainfall, temperature, vegetation indices), land use data and environmental conditions over the past decade.

The overall goal of this research project is to generate evidence on suicidality and the main “reasons to live” among youth living in peri-urban areas of South Africa, Tanzania and Ghana and develop tools for surveillance, case identification and support. Furthermore, the research intends to use system thinking and participatory research methodologies to map different forms of relationships, “reasons to live” and risk factors for suicidality among youth in peri-urban areas of the three countries.

By applying these tenets, this project will fulfill three aims. Firstly, the researchers will use systems thinking and participatory research methodologies to map and analyse different forms of relationships and their role in either protecting students from or contributing to their vulnerability to suicidal ideation and attempts. They will also explore the personal, societal and environmental contexts that shape these relationships and their impact on protecting or exposing students to suicidal ideation and attempts. Additionally, the study will map and analyse the reasons to live, which serve as protective factors.

Secondly, using the data collected in aim 1, we will develop and explore the validity of a newly adapted comprehensive suicidal risk assessment for youth living in three different African settings.

Finally, a toolkit will be developed for assessing protective factors and risk of suicidal ideation and attempts, along with guidelines for implementing these tools in non-clinical settings.

Using system thinking methodologies, the study will quantitatively and qualitatively explore the main forces that support health and positive wellbeing among youth (including different forms of relationships), as well as negative mental health dynamics that lead to suicidality. Following the RWB approach, we will not only explore young people’s individual and collective perspectives but also evaluate how institutions, communities and peers contribute to improved wellbeing and reduced suicidality.

The research will generate a multiregion map highlighting the heterogeneity and commonalities in forms of relationships, reasons to live and risk factors for suicidality among youth. We will consider their goals, peer dynamics, family dynamics and surrounding institutions (religion, education, health and employment systems) across various African settings. The study will then develop an implementation toolkit including training materials, dissemination, integration protocols and a referral pathway adapted to each context.

Our monitoring, evaluation and learning (MEL) framework is designed to systematically track, evaluate and document the progress and impact of our project throughout its entire three-year cycle. Given the focus on relational wellbeing and youth mental health in peri-urban areas of Tanzania, Ghana and South Africa, our MEL plan emphasises both traditional evaluation metrics and innovative approaches to assess relational thinking, community engagement and overall youth wellbeing. This approach ensures that the project not only meets its objectives but also fosters a deeper understanding of the interconnections between youth, their communities and the systems surrounding them.