This study examined trends in suicide attempts, suicidal ideation, and self-harm among adolescents before and after the COVID-19 pandemic, and explored their associations with psychopathology, bullying victimization, and perceived school safety.

Two cross-sectional surveys were conducted in 2016 (n = 1,459) and 2023 (n = 1,153) among students in grades 7 to 9 (ages 11–17) across nine schools in South India. Suicidal behaviours were assessed using self-report items on suicide attempts, suicidal ideation, and self-harm. Risk factors included mental health (measured using the Strengths and Difficulties Questionnaire), traditional and cyberbullying victimization, and perceived school safety.

Between 2016 and 2023, the odds of suicide attempts increased from 2.1% to 6.6% (adjusted odds ratio, aOR = 3.45; 2.11–5.64), suicidal ideation from 4.7% to 11.6% (aOR = 2.64; 1.87–3.74), and self-harm from 8.5% to 15.2% (aOR = 1.65; 1.25–2.17). The largest increase in suicide attempts was observed among boys (aOR = 4.25; 2.05–8.80). Higher odds of suicidality were associated with emotional and conduct problems, physical health issues, bullying (traditional and cyber), male gender, urban residence, and non-nuclear family structures. Feeling safe at school and prosocial behaviour were protective factors.

Rates of adolescent suicidality increased after the pandemic. Risk factors identified were bullying, mental and physical health issues, and family structure, while school safety and prosocial behaviour are protective. Interventions targeting these areas are urgently needed to mitigate rising suicide risk among adolescents.