Objectives: To determine if there is an association between psychosocial distress, health-risk behaviors and 12-month suicidal ideation among sub-Saharan African adolescents. Methods: Subjects included a cross-national sample of adolescents (N25,568) representing 7 African countries who completed the Global School-based Student Health Survey (GSHS). Results: Students with 3-4 psychosocial distress indicators were 4-5 times more likely to report suicide ideation or having made a suicide plan, and those with 4-5 risky health behaviors were 2.5-3.5 times more likely. Conclusions: Interventions designed to identify African adolescents with cumulative psychosocial distress indicators and risky health behaviors have potential as effective suicide prevention strategies.