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

Sexual violence has immediate and long-term adverse health outcomes on survivors, such as reduced mental well-being, suicidal thoughts, self-harm behaviours, and substance abuse. However, empirical evidence detailing the association between sexual violence, suicide ideation and self-harm among young people (18–24 years) in sub-Saharan Africa remains limited. This study investigated the prevalence of sexual violence, suicide ideation and self-harm among young people aged 18 to 24 years in Ivory Coast, Kenya, Lesotho, and Namibia, as well as the influence of sexual violence experience on suicide ideation and self-harm. This study is a secondary analysis of nationally representative Violence Against Children Survey (VACS) data for the Ivory Coast (2018), Kenya (2018), Lesotho (2019) and Namibia (2019). In total, the study involved 9,826 young people aged 18 to 24 years across the four countries. Descriptive statistics were used to describe the characteristics of respondents, while binary logistic regression was used to examine the influence of sexual violence on suicide ideation and self-harm. The results were adjusted for sex, school attendance, orphanhood status, working experience, talk to friends and justification for physical violence. The prevalence of sexual violence was more than 20% in all study countries, with Ivory Coast having the highest prevalence (38.7%; 95% CI = 34.2–43.5), followed by Kenya (28.8%; 95% CI = 24.7–33.2), then Namibia (23.7%; 95% CI = 20.0-27.7), and Lesotho having the least (20.5%; 95% CI = 18.0-23.3). Suicide ideation is highest among respondents from Kenya (13.2%; 95% CI = 10.9–15.8), but lowest among those from Ivory Coast (6.1%; 95% CI = 4.6–8.2). Self-harm was observed to be more prevalent in Ivory Coast (13.5%; 95% CI = 9.6–18.6), but lowest in Lesotho (2.8%; 95% CI = 1.9–4.1).The adjusted results show that across all study countries, respondents who had ever experienced sexual violence were more likely to experience suicide ideation: Ivory Coast (OR = 2.86; 95% CI = 1.83–4.47); Kenya (OR = 3.06; 95% CI = 2.12–4.41); Lesotho (OR = 3.30; 95% CI = 2.69–4.05) and Namibia (OR = 2.51; 95% CI = 2.04–3.09). Similarly, respondents who had ever experienced sexual violence in all countries were more likely to experience self-harm: Ivory Coast (OR = 1.77; 95% CI = 1.27–2.46); Kenya (OR = 2.59; 95% CI = 1.61–4.16); Lesotho (OR = 4.75; 95% CI = 3.13–7.21) and Namibia (OR = 2.81; 95% CI = 2.16–3.66). Sexual violence, suicide ideation and self-harm remain relatively high among young people. The findings call for prioritizing sexual-violence prevention and survivor-centred response through integrating routine screening for sexual violence among young people into youth mental health or sexual and reproductive health services and primary care.