Burden of Suicidal Ideation and Attempt among Persons Living with HIV and AIDS in Semiurban Uganda
Abstract
Although the impact of HIV/AIDS has changed globally, it still causes considerable morbidity and mortality, including suicidality, in countries like Uganda. This paper describes the burden and risk factors for suicidal ideation and attempt among 543 HIV-positive attending two HIV specialized clinics in Mbarara municipality, Uganda. The rate of suicidal ideation was 8.8% (
n
=
48
; 95% CI: 6.70–11.50) and suicidal attempt was 3.1% (17, 95% CI 2.00–5.00). The factors associated with increased risk for suicidal ideation and attempts were state anger (OR = 1.06, 95% CI: 1.03–1.09;
p
=
0.001
); trait anger (OR 1.10, 95% CI 1.04–1.16,
p
=
0.002
); depression (OR 1.13, 95% CI 1.07–1.20,
p
=
0.001
); hopelessness (OR 1.12, 95% CI 1.02–1.23,
p
=
0.024
); anxiety (OR 1.06, 95% CI 1.03–1.09); low social support (OR 0.19, 95% CI 0.07–0.47,
p
=
0.001
); inability to provide for others (OR 0.19, 95% CI 0.07–0.47,
p
=
0.001
); and stigma (OR 2.48, 95% CI 1.11–5.54,
p
=
0.027
). At multivariate analysis, only state anger remained statistically significant. HIV/AIDS is associated with several clinical, psychological, and social factors which increase vulnerability to suicidal ideation and attempts. Making suicide risk assessment and management an integral part of HIV care is warranted.
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Research Article
Burden of Suicidal Ideation and Attempt among Persons Living
with HIV and AIDS in Semiurban Uganda
Godfrey Zari Rukundo,1Brian Leslie Mishara,2and Eugene Kinyanda3
1Department of Psychiatry, Mbarara University of Science and Technology, Mbarara, Uganda
2Centre for Research and Intervention on Suicide and Euthanasia and Psychology Department,
Universit´
eduQu
´
ebec `
aMontr
´
eal, Montr´
eal,QC,CanadaH3C3P8
3Uganda Medical Research Council, Entebbe and Department of Psychiatry, Makerere College of Health Sciences,
Kampala, Uganda
Correspondence should be addressed to Godfrey Zari Rukundo; gzrukundo@gmail.com
Received November ; Revised February ; Accepted February
Academic Editor: Patrice K. Nicholas
Copyright © Godfrey Zari Rukundo et al. is is an open access article distributed under the Creative Commons Attribution
License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly
cited.
Although the impact of HIV/AIDS has changed globally, it still causes considerable morbidity and mortality, including suicidality,
in countries like Uganda. is paper describes the burden and risk factors for suicidal ideation and attempt among HIV-positive
attending two HIV specialized clinics in Mbarara municipality, Uganda. e rate of suicidal ideation was .% (𝑛=48;%CI:
.–.) and suicidal attempt was .% (, % CI .–.). e factors associated with increased risk for suicidal ideation and
attempts were state anger (OR = ., % CI: .–.; 𝑝 = 0.001); trait anger (OR ., % CI .–., 𝑝 = 0.002); depression
(OR ., % CI .–., 𝑝 = 0.001); hopelessness (OR ., % CI .–., 𝑝 = 0.024); anxiety (OR ., % CI .–.);
low social support (OR ., % CI .–., 𝑝 = 0.001); inability to provide for others (OR ., % CI .–., 𝑝 = 0.001);
and stigma (OR ., % CI .–., 𝑝 = 0.027). At multivariate analysis, only state anger remained statistically signicant.
HIV/AIDS is associated with several clinical, psychological, and social factors which increase vulnerability to suicidal ideation and
attempts. Making suicide risk assessment and management an integral part of HIV care is warranted.
1. Introduction
Suicide remains an underreported phenomenon in the
developing world despite its possible high prevalence [].
Studies have reported dierent suicide prevalence rates in
several countries and settings [–]. Physical illness, mental
disorders, and social-environmental factors are associated
with increased suicide risk []. e relationship between
HIV/AIDS and suicidal ideation and attempts has been
discussed for almost three decades but ndings have been
inconsistent []. Whereas some studies have reported high
rates of suicide among persons with HIV/AIDS, other studies
have reported no signicant increased suicide risk [–].
Furthermore, there is paucity of information about this topic
in Sub-Saharan Africa [] despite the fact that Sub-Saharan
Africa accounts for more than two-thirds of the HIV global
disease burden [, ]. ere is need for a local body
of research to inform policy development and programme
implementation concerning suicidal ideation and attempts
in persons with HIV/AIDS in Sub-Saharan Africa []. is
study investigated the burden of suicide and risk factors
associated with suicidal ideation and attempts among African
individuals living with HIV/AIDS in semiurban Uganda.
2. Materials and Methods
We conducted a cross-sectional survey at the Immune
Suppression Syndrome Clinic of Mbarara Regional Referral
Hospital (MRRH) and e AIDS Support Organization
(TASO) Mbarara branch clinic. Both clinics are located in
Mbarara municipality, South Western Uganda, and provide
care to HIV-positive patients. e study participants were
years or older, HIV seropositive, receiving care at either the
TASO or ISS clinic, and each participant provided informed
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AIDS Research and Treatment
Volume 2016, Article ID 3015468, 9 pages
http://dx.doi.org/10.1155/2016/3015468
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consent. e exclusion criteria consisted of attending the
clinic for the rst time and not yet being enrolled for care,
beingphysicallyveryill,andrefusaltoparticipateinthestudy.
e participants were not given any monetary incentive.
Of the clients who were contacted to participate in
the study, % (𝑛=30) of the patients refused to participate.
e most common reasons for nonparticipation was coming
from too far, their employers having given limited time for the
clinic visit, and associating participation in the study with the
stigma of mental illness.
Sincesomeoftheparticipantscouldnotreadand
write, the questionnaires were interviewer administered for
consistency. All questionnaires were translated into the
locally spoken language (Runyankore-Rukiga) by an expert
translator, and they were later back translated by another
expert in translation. e quality of the translation and
back translation was checked by two people, a psychiatric
nurseandasocialworker,whobothspokebothEnglishand
Runyankore uently.
Screening for suicidal ideation and attempts was con-
ducted using ve questions about death, suicidal ideation,
andattempts,fourofwhichwereusedinthestudyonSuicide
Attempts in the Epidemiologic Catchment Area Study by
Moscicki and colleagues in the United States []: () Have
you thought a lot about death in the past? () Have you
felt like you wanted to die in the past? () Have you felt
so low and thought about committing suicide in the past
year?()Didyouattemptsuicideinthepastyear?()Have
you ever attempted suicide at some other time in life? A
participant who answered yes to any of the questions ()–
() was considered to have suicidal ideation and an attempt.
Becauseofthestateofillnessoftheparticipants,inorder
to minimize respondent fatigue due to lengthy interviews,
we randomly assigned some of the respondents to either the
psychological or the social assessment modules of this study.
2.1. Study Instruments. e WHO clinical staging and CD
counts were used to determine the stage of HIV infection at
thetimeofthestudy,baseduponthepatients’clinicalrecords,
classifying patients according to four stages of infection, I, II,
III, and IV.
e Beck Hopelessness Scale [] was used to assess
the extent of hopelessness in the participants who answered
the questionnaire on psychological factors (substudy I). is
-item questionnaire assesses negative expectations and
pessimism about one’s future. Each statement is scored one
point. e total of responses to the true-false questions result
in scores which are rated follows: – minimal hopelessness,
– mild, – moderate, and – severe hopelessness.
e CAGE questionnaire [], consisting of four “yes-no”
questions, was used to screen for alcohol abuse and depen-
dence. It was administered to all participants in the study.
e person is asked if he/she has considered cutting down the
amount of alcohol consumed, if she/he gets annoyed when
people comment on the drinking habit, if the person feels
guilty about the amount drunk and the habit, and if she/he
takes an early morning alcoholic drink as an eye opener. In
thecurrentstudy,weusedacut-ooftwooutofthefour
questions to indicate alcohol abuse and dependence.
e relationship between suicidality and the way partic-
ipants solved their problems was assessed with the -item
Problem Solving Styles Questionnaire [] that describes
styles of reacting to problems to reduce, remove, or tolerate
stress. e items in the questionnaire have been categorized
according to four main ways in which people respond to
problems: sensing, intuitiveness, feeling, and thinking. It is
believed that in solving problems, it matters rst how we
perceive information. is is usually through the process of
sensing (through the ve senses) and through intuition (the
abilitytoknowthingswithouttheuseofrationalthinking
processes). is questionnaire uses a ve-point Likert scale
where = strongly disagree; = slightly disagree; = not
sure; = slightly agree; and = strongly agree. e lowest
scoreisandthehighestscoreis.ehigherthescore
on each subscale is, the more likely the person uses that way
of coping. e Cronbach alpha for this questionnaire in the
current study was ..
e -item Ways of Coping Questionnaire [] was
administered to assess the ways of participants cope with
problems. Each item is scored on a four-point scale: , does
not apply or not used; , used somewhat; , used quite a bit; ,
used a great deal. Fiy items of the questionnaire have been
used and found to consistently identify eight subscales: con-
frontive coping, distancing, self-controlling, seeking social
support, accepting responsibility, escape avoidance, planful
problem solving, and positive reappraisal. e lowest overall
score is zero while the highest is , with higher scores
indicatingmoreuseofthatwayofcoping.eCronbach
alpha for this tool in the current study was ..
e Beck depression inventory [] was used to assess
depression symptoms. e nal assessment was undertaken
by the rst author, who is a psychiatrist. Each item is rated
on a four-point scale ( to ) and total scores are between
and . e total scores measure the severity of self-reported
depression with – minimal, – mild, – moderate,
and – severe.
e Beck Anxiety Inventory [] was used to assess
anxiety symptoms. is -item self-report inventory has
items rated on a four-point scale ( to ), with the total score
being between and , indicating the severity of anxiety:
– minimal anxiety, – mild, – moderate, and –
severe anxiety.
Self-esteem was assessed using the -item Rosenberg’s
Self-Esteem Scale []. Each of the items is scored on a
-point scale: = strongly agree; = agree; = disagree;
= strongly disagree. e self-esteem score is calculated
aer reversing the positively worded items with higher scores
indicative of higher self-esteem. e lowest score is and
the highest score is , a score below indicating low self-
esteem. Cronbach’s alpha for this instrument was ..
e -item State-Trait Anger Scale developed by Spiel-
berger [] was administered to assess the predisposition to
experience angry feelings as a personality trait (trait anger)
and the intensity of anger as an emotional state (state anger)
at the time of assessment. It assesses the intensity of anger at
a particular moment and the frequency of anger experience,
expression, and control []. Trait anger is scored on a four-
point scale with being the least (almost never) and
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being the most common feeling. e state anger scale is also
measured on a four-point scale with (not at all) being the
least intense and being the most intense (very much). is
questionnaire was administered to participants in substudy I.
e questionnaire had a Cronbach alpha of . and .
for trait and state anger, respectively.
e -item Perceived Social Support Questionnaire
(PSSQ) was designed by the rst author using items outlined
in the questionnaire developed by Sarason and colleagues
[, ]. It assesses four aspects of social support: whether the
participant needed support from family and friends, received
support, was needed for support by other people, and felt they
were able to provide support to others. e social support
considered was both practical (physical/material/nancial)
and moral support. e questionnaire had a Cronbach alpha
of ..
e HIV Stigma Scale Questionnaire (HSSQ), a -
item questionnaire, was designed by the rst author using
items outlined by Berger and collegues []. irty-ve of
the items required answers of “yes” and “no” whereas two
of them required explanation. e questionnaire examines,
from the patient’s perspective, feelings (felt stigma) about
being HIV-positive. Questions focus on HIV testing as well
as on the feelings and attitudes about HIV-positive status. e
questionnaire had a Cronbach alpha of ..
Participants’ medical records, carried by the patients,
were reviewed to note if there was any additional important
information, especially the duration of the HIV diagnosis,
physical diagnosis, medications, CD cell counts, and the
clinical staging of the HIV infection. is was done with
permission and consent from the individual participants.
Data analysis was guided by the modied stress-diathesis
model in which HIV/AIDS is considered to cause consid-
erable stress that acts on the various vulnerability factors to
cause several complications/eects []. e stress-diathesis
model suggests that an individual’s biological vulnerabilities
to certain mental disorders can be triggered by stress. is
means that if an individual has a high level of vulnerability,
it would take lower levels of stress for symptoms of the
disorder to develop. In our study population, HIV was a
key vulnerability factor whereas suicidal ideation/attempts
were the key complications/eects. Results were considered
statisticallysignicantifthe𝑝value was ≤. at %
condence interval. Cross tabulations and logistic regression
analysis were used to assess the relationship between each of
thecorrelateswithsuicidalideationandattempts.
e study was approved by the Institutional Research and
Ethics Committee (MUST-REC) of Mbarara University of
Science and Technology and the leadership at the two study
centres. Written informed consent was obtained from each
adult participant. Participants below years were contacted
to give assent and then the primary caregivers provided
written informed consent.
All participants found to have moderate-severe psychi-
atric illness or increased risk of suicidality were referred to
thementalhealthunitofMbararahospitalforappropriate
treatment. e psychiatric illness and risk for suicidality were
determined by high scores on the screening instruments. e
referral was done in collaboration with the case managers at
the two clinics. e total number of participants that required
referral for further assessment and treatment was eight.
3. Results
A total of HIV-positive individuals were interviewed.
Forty-four percent (𝑛 = 239) of the participants attended
the TASO clinic while % (𝑛 = 304) attended the ISS clinic.
Among the participants, % (𝑛 = 131) were males and %
(𝑛 = 412) were females. e participant ages ranged from
to years with a median of . years and a mean age of .
years (SD = .). e mean age of the males was signicantly
higher than that of the females (mean age of males = .
years, SD = .; mean age of females = . years, SD = .;
𝑡-test = ., and 𝑝 = 0.001).
More females (%) than males (%) had no formal
education or only a primary level education (OR .; %
CI: .–.; 𝑝 = 0.001). ere was a statistically signicant
dierence between males and females on employment status
(OR = ., % CI .–. and 𝑝 = 0.003), with the
majority (%) of the females being in the categories of
peasants or the unemployed.
3.1. Prevalence of Suicide Ideation and Suicide Attempt in
HIV/AIDS. Suicidal ideation in the preceding year was
reported by .% (𝑛=48; % CI: .–.) while
attempted suicide in the same period was .% (, % CI
.–.). In addition, % (𝑛=16) had attempted suicide
at some other time in their life. In total, % of the study
participants (𝑛=54;%CI:.–.)metcriteriafor
suicidality dened as suicidal ideation in the preceding year
or attempted suicide in one’s life time.
3.2. Psychological Factors Associated with Suicidal Ideation
and Attempts in HIV/AIDS. e psychological factors signi-
cantly associated with suicidal ideation and attempts (Table )
were state anger, trait anger, depression hopelessness, anxiety,
and low self-esteem. Only state anger remained signicantly
associated with suicidal ideation and attempts in this study
(Table ) in the multiple regression analysis.
3.3. Problem Solving Styles in HIV/AIDS. As shown in
Table , the sensing style of information acquisition and
analysis was associated with a decrease in the odds for suicidal
ideation and attempt (suicidal group mean score = . (SD
= .), nonsuicidal group mean score = . (SD = .), OR
= ., % CI .–., and 𝑝 = 0.024). e feeling style was
also associated with a decrease in the odds of suicidal ideation
and attempt (suicidal group, mean score = . (SD = .),
nonsuicidal group, mean score = . (SD = .), OR = .,
% CI .–., and 𝑝 = 0.034).
3.4. Ways of Coping in HIV/AIDS. Table shows t h e co p i n g
processes that were assessed. e coping styles found to be
adaptive against suicidal ideation and attempts in this study
were seeking social support (suicidal group, mean score =
. (SD = .), nonsuicidal group, mean score = . (SD
= .), OR = ., % CI .–., and 𝑝 = 0.006),
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T : Demographic characteristics of participants (𝑁 = 543).
Frequency (𝑛) Percent (%)
District
Mbarara .
Isingiro .
Bushenyi .
Ntungamo .
Other .
Study site
ISS clinic .
TASO clinic .
Sex of participant
Male .
Female .
Trib e
Munyankore .
Mukiga .
Muganda .
Other .
Religion
Anglican .
Catholic .
Saved .
Moslem .
Other .
Marital status
Never married .
Married/cohabiting .
Widowed, separated, or divorced .
Level of education
No formal education .
Primary .
O’ level .
A’ l e v e l .
Vocational education .
Tertiary/university .
Employment status
Formal employment or full-time business .
Peasant farmer .
Unemployed, homemaker, or retired .
Student and any other .
escape avoidance (suicidal group, mean score = . (SD =
.), nonsuicidal group, mean score = . (SD = .), OR
., % CI .–., and 𝑝 = 0.027), planful problem
solving (suicidal group, mean score = . (SD = .), OR
., % CI .–., and 𝑝 = 0.036), positive reappraisal
(suicidalgroup,meanscore=.(SD=.),nonsuicidal
group, mean score = . (SD = .), OR ., % CI .–
., and 𝑝 = 0.009), and distancing (suicidal group, mean
score = . (SD = .), OR ., % CI .–., and
𝑝 = 0.026). Aer adjusting for signicant clinical factors,
none of the investigated ways of coping style factors remained
signicantly associated with suicidal ideation and attempts.
3.5. Social Factors Associated with Suicidal Ideation and
Attempt in HIV/AIDS
3.5.1. Social Support in HIV/AIDS. Participants who reported
that they needed support from friends and family had lower
odds for suicidal ideation and attempt (OR ., % CI .–
., and 𝑝 = 0.030) than individuals who felt they did
AIDS Research and Treatment
T : Psychological correlates of suicidal ideation and attempt in HIV infected patients in HIV clinics in Mbarara (𝑁 = 226).
Independent variable Suicidal (𝑛=25)-
mean (SD)
Nonsuicidal (𝑛 = 201)-
mean (SD) cOR (% CI) 𝑝value aOR (% CI) 𝑝value
Emotional factors
Anxiety (BAI) score . (.) . (.) . (.–.) .∗. (.–.) .
Depression (BDI) score . (.) . (.) . (.–.) .∗. (.–.) .
Hopelessness (BHS) score . (.) . (.) . (.–.) .∗. (.–.) .
Tra i t ang e r s cor e . (.) . (.) . (.–.) .∗. (.–.) .
State anger score . (.) . (.) . (.–.) .∗. (.–.) .∗
Problem solving styles
Sensing style score . (.) . (.) . (.–.) .∗. (.–.) .
Intuitive style score . (.) . (.) . (.–.) .
Feeling style score . (.) . (.) . (.–.) .∗. (.–.) .
inking style score . (.) . (.) . (.–.) .
cOR: crude odds ratios; aOR: adjusted odds ratios.
∗𝑝<0.05.
T : Relationship between ways of coping and suicidal ideation and attempts among HIV infected patients in HIV clinics in Mbarara,
July–October (𝑁 = 317).
Variable Mean score (SD), suicidal Mean score (SD) nonsuicidal cOR (% CI) 𝑝value aOR (% CI) 𝑝value
Seeking social support . (.) . (.) . (.–.) .∗. (.–.) .
Accepting responsibility . (.) . (.) . (.–.) .
Escape-avoidance . (.) . (.) . (.–.) .∗. (.–.) .
Planful problem solving . (.) . (.) . (.–.) .∗. (.–.) .
Positive reappraisal . (.) . (.) . (.–.) .∗. (.–.) .
Confrontive coping . (.) . (.) . (.–.) .
Distancing . (.) . (.) . (.–.) .∗. (.–.) .
Self-controlling . (.) . (.) . (.–.) .
∗𝑝<0.05.
not need support from other people (see Table ). Similarly,
individuals who felt that they were able to provide for their
families and friends had lower odds for suicidal ideation and
attempt (OR ., % CI .–., and 𝑝 = 0.001)than
those who felt that they had failed in that responsibility.
3.5.2. Stigma in HIV/AIDS. Among the investigated stigma
factors, isolating self from friends and family (OR ., .–
., and 𝑝 = 0.004), feeling ashamed of the HIV-positive
status (OR ., % CI .–., and 𝑝 = 0.027), and being
assaulted by a spouse (OR ., % CI .–., and 𝑝=
0.027) were associated with higher odds for suicidal ideation
and attempts, as shown in Table .
3.5.3. Clinical Factors and Suicidality in HIV/AIDS. Most
(%, 𝑛 = 413) of the participants had experienced excellent
or good physical health in the past three months and %
(𝑛=45) had to cut down on activities because of physical
illness. Most of the participants (%, 𝑛 = 452)wereinStages
IandIIwhile%(𝑛=70) were in Stage III and % (𝑛=21)
in Stage IV of the disease. On most recent CD cell counts,
% (𝑛=89) had – cells/𝜇L, % (𝑛 = 244)had–
cells/𝜇L, and % (𝑛 = 127)had≥ cells/𝜇L, while
% (𝑛=83) had never had their CD counts done. Seventy
percent (𝑛 = 382) were on ARVs while % (𝑛 = 161)were
ARV na¨
ıve. e following clinical factors were signicantly
associated with suicidality: perception of poor physical health
(OR ., % CI .–., and 𝑝 = 0.007), physical pain
(OR ., % CI .–., and 𝑝 = 0.049), reducing the
workduetoillness(OR=.,%CI.–.,and𝑝=
0.004), and duration of HIV infection (those newly infected
having higher proportions with suicidality than those who
had lived longer with the infection) (OR ., % CI .–
., and 𝑝 = 0.001). All clinical factors that were signicantly
associated with suicidality in bivariate analysis were included
in the model for the subsequent analyses.
3.6. Negative Life Events and Suicidal Ideation and Attempt
in HIV/AIDS. Negative life events at dierent stages in life
were assessed and scores were generated for each section of
negative life events. Only negative life events experienced
later in life in relation to children, for example, problems in
bringing up your children, were signicantly associated with
suicidal ideation and attempts (suicidal group, mean score =
. (SD = .), nonsuicidal group, mean score = . (SD =
.), OR ., % CI .–., and 𝑝 = 0.006).
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T : Association between suicidal ideation and attempt and aspects of social support in HIV infected patients in HIV clinics in Mbarara,
July–October (𝑁 = 317).
Variable Suicidal 𝑛(%) (𝑛=29)cOR(%CI)𝑝value aOR (% CI) 𝑝value
Needs support
Yes (.) . (.–.) .∗. (.–.) .
No (.)
Receives support
Yes (.) . (.–.) .
No (.)
Needed by others
Yes (.) . (.–.) .∗. (.–.) .
No (.)
Gives needed support
Yes (.) . (.–.) .∗. (.–.) .
No (.)
Isolating self
Yes (.) . (.–.) .∗. (.–.) .
No (.)
Ashamed of HIV
Yes (.) . (.–.) .∗. (.–.) .
No (.)
Guilt of HIV positivity
Yes (.) . (.–.) .
No (.)
Blaming self for HIV
Yes (.) . (.–.) .
No (.)
Physically assaulted
Yes (.) . (.–.) .∗. (.–.) .∗
No (.)
∗𝑝<0.05.
4. Discussion
e objective of this study was to determine prevalence of
suicidality and to explore associated factors among HIV-
positive patients in Mbarara municipality. e prevalence of
suicidality was %. Perceived poor physical health, physical
pain, trait/state anger, anxiety, depression, hopelessness, lack
of social support, poor problem solving skills, and ways of
coping were risk factors associated with increased suicidality.
We also demonstrated that poor problem solving skills and
lack of social support seem to be a vulnerability factor rather
than a precipitant for suicidal ideation and attempt.
4.1. Prevalence of Suicidal Ideation in HIV/AIDS. In the
current study, the rate of suicidal ideation and attempts
was % (/) with a rate of suicidal ideation of .%
intheprecedingyear.erateofsuicidalideationand
attempts obtained in this study is similar that of .% reported
by Kinyanda and colleagues [] in Entebbe Uganda in
similar settings. However, when the rates of suicidal ideation
reported in this study are compared to those reported
elsewhere, they are much lower. For instance, the following
rates have been reported in the west: % in the USA [, ];
%inAustralia[];%intheUK[];and%inNew
York, USA []. Dierences between the rates obtained in
this study with those from the west could be attributed to
two factors: the rst being methodological dierences in the
assessment of suicidal ideation and attempts in this study
compared to the other studies undertaken in the west. Despite
the methodological dierences, the large dierence between
the rates reported in Uganda and western studies, about %
in the west compared to about % in Uganda, this suggests a
generally lower rate of suicidal ideation in Uganda.
4.2. Prevalence of Suicidal Attempt in HIV/AIDS. Although
theoveralltherateofsuicidalideationandattemptswas
% (/), suicide attempts in the preceding year were
reported as only .%. is rate is very similar to the life time
attempted suicide rate of .% that was reported by [] in
semiurban Entebbe, Uganda. Other studies mainly from the
west have reported higher rates such as O’Dowd et al. []
in the United States who reported a rate of attempted suicide
of .%. Apart from the fact that the study participants in
O’Dowd et al.’s [] study were self-referred for psychiatric
problems, they were mainly derived from subpopulations
who are already at high risk for psychopathology [].
AIDS Research and Treatment
e explanation for the dierence between the rates of
attempted suicide in the west with those in the Sub-Saharan
African setting of Uganda cannot be explained alone by
thedierencesinpsychopathologyofthebasepopulations.
Schlebusch and Vawda [] who did their study among a
predominantly heterosexual population in Kwazulu-Natal,
South Africa, reported a rate of attempted suicide of .%
among general hospital HIV in-patients []. ese rates
aresimilartothoseseeninthewest.eseresultsfromrural
South Africa indicate that the prevalence of attempted suicide
and possibly suicidal ideation in HIV/AIDS are determined
by the complex interactions of factors, including the base
psychopathology of the parent population.
4.3. Sociodemographic Correlates of Suicidal Ideation and
Attempts. e sociodemographic characteristics found in
the study were representative of the general population in
south western Uganda. In this study there was a slight
preponderance of females to males just as in the general
population of Uganda, where females account for % and
males %. Although slightly more females (.%) than
males (.%) were suicidal, the dierence was not statistically
signicant. Sociodemographic factors were not associated
with suicidal ideation and attempts. Previous studies among
HIV-positive persons found the following sociodemographic
factors to be signicantly associated with suicidal ideation
and attempts: female gender [–]; male gender [, , ];
age [, ]; marital status []; and occupation [].
Studies elsewhere have also reported the following
sociodemographic factors to be associated with suicidal
ideation and attempt in HIV/AIDS: lack of religious ali-
ation []; low levels of education [, ]; high levels of
education []; unemployment [–]; widowhood [];
andamongthedivorced[].Ecologicalfactorsrepresented
by district in this study were not signicantly associated with
suicidal ideation and attempts.
4.4. Psychological Factors Associated with Suicidal Ideation
and Attempt in HIV/AIDS. In this study the following
psychological factors were signicantly associated with sui-
cidal ideation and attempts: depression, anxiety disorder,
hopelessness, state/trait anger, and feeling style and sensing
styleofsolvingproblems.Similartothisstudy,aprevious
study among HIV-positive persons in Uganda reported the
following psychological factors to be associated with suicidal
ideation and attempts: negative coping style, the psychi-
atric diagnoses of PTSD, generalized anxiety disorder, and
major depressive disorder []. Other studies elsewhere have
reported the following psychological factors to be associ-
ated with suicidal ideation and attempts: major depressive
disorder, drug dependence and depressive personality, and
dependent personality. e ndings from this and previous
studies emphasize the importance of negative psychological
factors in the development of suicidal ideation and attempt
in HIV/AIDS.
Participants who predominantly used the sensing style
to perceive information and issues or who used the feeling
styletomakedecisionsandconclusionsweremorelikelyto
be suicidal than those who used the intuitive style or made
decisions using the thinking style. Kinyanda and colleagues
[], in semiurban Entebbe, reported that participants with
higher negative coping style scores had higher rates of suicidal
ideationandattemptsthanthosewithlowerrates.Inthewest,
Kalichmanetal.[]andKellyetal.[]reportedthatescape
avoidance as a means of problem solving was associated with
increased risk of suicidal ideation and attempts [, ].
4.5. Social Factors Associated with Suicide Ideation and
Attempt in HIV/AIDS. In this study the following social
factors were signicantly associated with suicidal ideation
and attempts: lack of social support, HIV stigma, being
assaulted due to HIV and negative life events associated with
children, and low perceived need for moral and practical
social support. Previous studies among HIV-positive persons
reportedthefollowingsocialfactorstobeassociatedwith
suicidal ideation and attempts: food insecurity; increasing
number of negative life events and increasing stress scores
[]; physical and sexual abuse []; socioeconomic pressures
and relational problems []; HIV stigma [–]; negative
life events [, –]. Kinyanda and colleagues [] among
a general hospital population which was not assessed for HIV
statusinurbanKampalareportedthefollowingadditional
socialfactorstobeassociatedwithattemptedsuicide:living
in overcrowded tenements (Mizigos), negative life events in
childhood, negative life events in later in life, and negative life
events in the previous year []. Social factors were found to
be signicant contributors to suicidal ideation and attempt in
this study just like in many other studies of HIV populations.
Although social factors were associated with suicidal ideation
and attempt individually, in combination with other factors
these relationships did not remain signicant.
5. Conclusions
ere is a considerable burden of suicidal ideation and
attempts among individuals living with HIV/AIDS in south
western Uganda. While the prevalence of suicidal ideation
and suicide attempts in this study is similar to what has been
reported in another study in Uganda, it is much lower than
rates reported in western settings. is may reect dierences
in the rate of psychopathology in the base populations.
Additional Points
isstudywasfacilitybasedandthendingsmaynotbe
generalizable to the general population. In addition, the study
was cross-sectional in nature. erefore, causality could not
be determined.
Competing Interests
e authors declare that they have no competing interests.
Acknowledgments
e authors acknowledge the contribution of Dr. Adriana
Carvalhal and Dr. Eric Wobudeya during the design of the
study. is work was nancially supported by the Faculty
of Medicine, Mbarara University of Science and Technology,
AIDS Research and Treatment
fordatacollection,aswelltheCentreforResearchand
Intervention on Suicide and Euthanasia (CRISE) at the
Universit´
eduQu
´
ebec `
aMontr
´
eal for data analysis.
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... The literature highlights a number of factors responsible for suicide ideation and attempt among adolescents. Suicide ideation or attempt among adolescents may be triggered by factors such as being homeless, poor, or suffering from a particular disease, psychological stress among others (Kessler et al., 2003;Rukundo et al., 2016;Ssebunnya et al., 2019;Nyundo et al., 2020). As Swahn et al. (2012) observe, psychological stress may be caused by death of a loved one, history of disease, discrimination, and being lonely, among others (Asiki et al., 2011;Carr, 2012;Mugisha et al., 2016). ...
... Psychological stress may result from losing a parent or someone to HIV/AIDS, stigma, discrimination, isolation, or not having social support (Swahn et al., 2012). Previous research has shown that adolescents living on streets or in slums in urban areas experience financial difficulties and are likely to use alcohol and/or drugs, lack enough food, have poor quality of life, are lonely, or have a history of mental illness (Rudatsikira et al., 2007;Kinyanda et al., 2012;Swahn et al., 2012Swahn et al., , 2014Mugisha et al., 2016;Rukundo et al., 2016). These factors facilitate the occurrence of suicidal ideation or attempt. ...
... These factors facilitate the occurrence of suicidal ideation or attempt. Other plausible reasons for suicidal ideation or attempt from previous research are depression, hopelessness, lack of social support, and failure to provide for the family (Rukundo et al., 2016). ...
There is an increasing recognition that suicidal ideation is a major public health concern in sub-Saharan Africa. We employed a case study design, taking a case study of adolescents currently under the care of Uganda Youth Development Link (UYDEL). The data analyzed were collected from 219 female and male adolescents (13–19 years) recruited through UYDEL in Kampala, Uganda. A Poisson regression model with robust variance was used to assess the risk factors associated with suicidality. The prevalence of suicidal ideation in the past 4 weeks and attempt within the past 6 months among adolescents was 30.6% (95% CI: 24.8, 38.0%) and 24.2% (95% CI: 18.7, 30.4%), respectively. The most stressful precursors of suicidal ideation or attempt included financial difficulties (59.5%), family breakdown or conflicts (37.4%), and trauma (23.1%). Suicidal ideation in the past 1 week preceding the survey was as high as 13.3% (95% CI: 9.0, 18.6%), of which 75.0% (95% CI: 55.1%, 89.3%) had a suicide plan. Prevalence of suicidal ideation in the past 4 weeks was significantly higher among respondents with moderate psychological distress [Prevalence Ratio (PRR) = 2.74; 95% CI: 0.96, 7.84] and severe psychological distress (PRR = 4.75; 95% CI: 1.72, 13.08) but lower among adolescents who knew where to obtain professional psychological care (PRR = 0.51; 95% CI: 0.30, 0.87). Similarly, suicidal attempt was significantly higher among respondents with moderate psychological distress (PRR = 4.72; 95% CI: 1.01, 12.03) and severe psychological distress (PRR = 11.8; 95% CI: 4.66, 32.37), and who abuse drugs or substances (PRR = 2.13; 95% CI: 1.13, 4.01). Therefore, suicidal ideation is a major public health issue among adolescents living in poor urban settlements in Kampala, Uganda. Psychological distress due to financial difficulties, unemployment, and family breakdown are major facilitators of suicidality among adolescents in urban poor settlements in Kampala. Interventions aimed at preventing suicide among vulnerable adolescents in urban settlements in Kampala, Uganda should incorporate this unique risk factor profile.
... In Uganda, the few studies on suicidal behavior in persons living with HIV/AIDS have reported the following prevalence rates: 17.1% for the 12-month prevalence of attempted suicide rate among HIV positive adolescent ages 10-18 years (Musisi and Kinyanda, 2009), 7.8% for moderate to high risk suicidality and 3.9% of life-time attempted suicide among HIV adult patients(13). Further, rates of suicidal ideation of 8.8 and 3.1% for suicide attempts among patients 15 years and above were reported by Rukundo et al. (2016). All these Ugandan studies were conducted among majorly adult population, and a few in adolescents, however children below 10 years were not included in the studies. ...
... All these Ugandan studies were conducted among majorly adult population, and a few in adolescents, however children below 10 years were not included in the studies. The factors that have been reported to be associated with suicide ideation and attempts among adults and youth living with HIV/AIDS have been gender, negative life events, depression (Kinyanda et al., 2012;Arseniou et al., 2014;Wonde et al., 2018), the clinical stage of HIV/AIDS (Wonde et al., 2018), perception of poor physical health, physical pain (Rukundo et al., 2016), poor social support and HIV related stigma (Martinez et al., 2012;Mutumba et al., 2015;Bitew et al., 2016;Wang et al., 2018;Wonde et al., 2018). ...
... The rate of suicidal ideation obtained in this study is higher and almost twice the rate of suicidal ideation of 8.8% reported by Rukundo and colleagues 2016 in Mbarara, Western Uganda in similar settings (Rukundo et al., 2016). This difference might be due to variations in the study populations. ...
Background: Suicidal behavior and HIV/AIDS are vital public health challenges especially in low and middle-income countries. As suicide in adults is perturbing for those closest to them, this sentiment is much more intense and generalized in the case of a child or adolescent. Knowledge of factors associated with suicidal ideation in HIV infected children and adolescents may inform suicide prevention strategies needed to improve their quality of life. This study aimed to assess the prevalence and factors associated with suicidal ideation among HIV infected children and adolescents attending a pediatric HIV clinic in Uganda.
Methods: Data from a sample of 271 children and adolescents aged 6–18 years living with HIV/AIDS attending a pediatric HIV clinic was analyzed. Child characteristics and clinical variables were assessed using a socio-demographic questionnaire and medical records respectively. Suicidal ideation and depression were assessed using the Child Depression Inventory. The types of behavioral problems and the parent–child relationship were assessed using Child Behavioral Check List (6–18 years) and the Parent Child Relationship Scale respectively. Child exposure to different stressful life events was assessed with a series of standardized questions. Logistic regression models were used to explore factors independently associated with suicidal ideation.
Results: The prevalence of suicidal ideation was 17%. In the multivariate analysis; Child exposure to family or friend’s death (prevalence rate ratio (PRR = 2.02; 95% CI, 1.01–4.03), p = 0.046), HIV wasting syndrome (PRR = 0.39; 95% CI, 0.21–0.75, p = 0.04), Depression (PRR = 1.08; 95% CI, 1.03–1.12, p = 0.001), Anxiety symptoms (PRR = 1.10; 95% CI, 1.01–1.20, p = 0.024) and Rule breaking behavior (PRR = 1.06; 95% CI, 0.99–1.13, p = 0.051) were independently associated with suicidal ideations.
Conclusion: The prevalence of suicidal ideation among children and adolescents living with HIV/AIDS is substantial. Children and adolescents with exposure to family or friend’s death, those with higher depression scores, anxiety symptoms and rule breaking behavior are more likely to report suicidal ideation. Those with HIV wasting syndrome were less likely to report suicidal ideation. There is urgent need for HIV care providers to screen for suicide and link to mental health services.
... Studies have shown that HIV-related stress was associated with worse mental health and even suicidal ideation [18,19]. Depression and anxiety are two common types of emotional distress that have also been shown to be risk factors for suicidal ideation among HIV-positive SMM [20,21]. In addition, social support has been widely recognized as a moderator that can buffer the negative effects of HIV diagnosis among SMM, including suicidal ideation [22]. ...
This study aimed to explore whether there were differences in suicidal ideation at different time points among sexual minority men (SMM) within five years of HIV diagnosis, and to investigate the influence of time and psychosocial variables on suicidal ideation. This was a five-year follow-up study focusing on the suicidal ideation among HIV-positive SMM who were recruited when they were newly diagnosed with HIV. Suicidal ideation and psychosocial characteristics including depression, anxiety, HIV-related stress, and social support were assessed within one month, the first year, and the fifth year after HIV diagnosis. A total of 197 SMM newly diagnosed with HIV completed three-time point surveys in this study. The prevalence of suicidal ideation was 27.4%, 15.7%, and 23.9% at one month, the first year, and the fifth year after HIV diagnosis, respectively. The risk of suicidal ideation was lower in the first year than baseline, but there was no significant difference between the fifth year and baseline. Emotional stress and objective support independently predicted suicidal ideation and they had interactions with time. The suicidal ideation of SMM newly diagnosed with HIV decreased in the first year and then increased in the fifth year, not showing a sustained decline trend in a longer trajectory of HIV diagnosis. Stress management, especially long-term stress assessment and management with a focus on emotional stress should be incorporated into HIV health care in an appropriate manner. In addition, social support should also be continuously provided to this vulnerable population.
... In recent decades, global suicide rates have risen significantly so that every 40 s a person takes their own life (World Health Organization, 2014)). Suicide has become a serious social and public health problem and is a leading cause of death in both high and low, income countries (Machado, Rasella, & dos Santos, 2015;Rukundo, Mishara, & Kinyanda, 2016). Although Brazil does not have a high suicide mortality rates as other countries in the world, its rates has been increasing over the last few years (Alicandro et al., 2019;Ministry of Health -Brazil, 2017). ...
Global suicide rates have increased in recent decades becoming a serious social and public health problem. In Brazil, rates have been increasing annually. We aimed to analyze the correlation between suicide mortality rates and global economic and political crisis periods of 2008 and 2014 in Brazil. The analysis of suicide mortality in Brazil was done using a time-series segmented linear regression model that estimated the trend of rates over time. To obtain the model, changes in the trend of both abrupt and gradual suicide rates were investigated. The results indicate statistically significant changes showing an upward trend of suicide rates during the world economic crisis (2008-2013) and during the economic and political crisis in Brazil (2014-2017) compared to previous periods, especially at the extremes of schooling (3 < years and > 8 years). Among white and parda, there were significant trend rates increases in both periods and in different regions. In the Northeast and South regions, we observed a significant increase in the trend rate for males after the Brazilian economic and political crisis (2014 to 2017). We can conclude that the national suicide rates were influenced by the economic and political instability that our country has been going through since 2008, affecting each region differently. Further studies are needed to explore the reasons for interregional differences and the relation of suicide with unemployment rates and possible economic predictors.
... In addition to the psychosocial factors, individuals with HIV also experience challenges with clinical symptoms that subjects them to additional difficulties [15]. The greatest HIV/AIDS burden is born by sub-Saharan Africa (SSA), a region with the youngest populations [16,17]. Suicidality is often comorbid with many physical and psychological conditions that are commonly not assessed or attended to. ...
Background
Research from high income countries indicates that suicide is a major mental health care concern and a leading cause of preventable deaths among children and adolescents. Proper assessment and management of youth suicidality is crucial in suicide prevention, but little is known about its prevalence and associated risk factors in Sub-Saharan Africa. In low income countries there is an increased risk of suicide among persons with HIV/AIDS even in the presence of the highly active antiretroviral therapy.
Objective
To determine the prevalence of and risk factors for youth suicidality among perinatally infected youth living with HIV/AIDS in Uganda.
Methods
We studied 392 HIV positive children (5–11 years) and adolescents (12–17 years) and their caregivers in Kampala and Masaka districts. Caregivers were administered the suicide assessment section of the MINI International Psychiatric Interview. Socio-demographic characteristics, psychiatric diagnoses, and psychosocial and clinical factors were assessed and suicidality (suicidal ideation and or suicidal attempt) was the outcome variable. Logistic regression was used to calculate odds ratios adjusting for study site and sex at 95% confidence intervals.
Results
Caregivers reported a suicidality rate of 10.7% (CI 8–14.1) in the past one month with higher rates among urban female (12.4%, CI 8.6–17.7) than male (8.7%, CI 5.4–13.8) youth. Lifetime prevalence of attempted suicide was 2.3% (n = 9, CI 1.2–4.4) with the highest rates among urban female youth. Among children, caregivers reported a lifetime prevalence of attempted suicide of 1.5%. The self-reported rate of attempted suicide in the past month was 1.8% (n = 7, CI 0.8–3.7) with lifetime prevalence of 2.8% (n = 11, CI 1.6–5.0). The most common methods used during suicide attempts were cutting, taking overdose of HIV medications, use of organophosphates, hanging, stabbing and self-starvation. Clinical correlates of suicidality were low socioeconomic status (OR = 2.27, CI 1.06–4.87, p = 0.04), HIV felt stigma (OR = 2.10, CI 1.04–3.00, p = 0.02), and major depressive disorder (OR = 1.80, CI 0.48–2.10, p = 0.04). Attention-deficit/hyperactivity disorder was protective against suicidality (OR = 0.41, CI 0.18–0.92, p = 0.04).
Conclusion
The one-month prevalence of suicidality among CA-HIV was 10.7%.
... Similar to other literature on this topic, women who endorsed HIV-related shame and self-stigma were significantly more likely to endorse suicidal ideation [13,48]. Further, stigma has been shown to impede HIV care engagement and quality of life, which can negatively impact the physical and psychological well being of people living with HIV [49]. ...
Objective:
Pregnant and postpartum women living with HIV face disproportionate risk of depression and suicide, particularly in low- and middle-income countries. This study examined patterns and predictors of suicidal ideation among women living with HIV in antenatal care in Kilimanjaro, Tanzania.
Design:
We conducted a longitudinal cohort study of 200 pregnant women living with HIV, with surveys conducted during pregnancy and six months postpartum.
Methods:
Pregnant women were recruited during HIV and antenatal care visits at nine clinics. A structured questionnaire was verbally administered in Kiswahili by a trained study nurse. We used simple frequencies and t-tests to measure patterns of suicidal ideation and logistic regression to assess factors associated with suicidal ideation.
Results:
Suicidal ideation was endorsed by 12.8% of women during pregnancy and decreased significantly to 3.9% by 6 months postpartum. Ideation was not significantly greater among participants newly diagnosed with HIV. In univariable analyses, suicidal ideation was associated with depression, anxiety, HIV stigma, single relationship status, unknown HIV status of the father of the baby, negative attitudes about antiretroviral medication, and low social support. In the multivariable model, women experiencing anxiety and HIV stigma were significantly more likely to endorse suicidal ideation during pregnancy.
Conclusions:
Suicidal ideation and associated feelings of hopelessness are a critical challenge in antenatal care among women living with HIV, with important implications for quality of life, care engagement, and survival. To better support patients, targeted approaches to address anxiety, depression, stigma, and hopelessness must be prioritized, including crisis support for suicide prevention.
To develop and externally validate a model to predict individualized risk of internalizing symptoms among AIDS-affected youths in low-resource settings in sub-Saharan Africa.
Longitudinal data from 558 Ugandan adolescents orphaned by AIDS was used to develop our predictive model. Least Absolute Shrinkage and Selection Operator logistic regression was used to select the best subset of predictors using 10-fold cross-validation. External validation of the final model was conducted in a sample of 372 adolescents living with HIV in Uganda.
Best predictors for internalizing symptoms were gender, family cohesion, social support, asset ownership, recent sexually transmitted infection (STI) diagnosis, physical health self-rating, and previous poor mental health; area under the curve (AUC) =72.2; 95% CI =67.9-76.5. For adolescents without history of internalizing symptoms, the AUC=69.0, 95% CI=63.4-74.6, and was best predicted by gender, drug use, social support, asset ownership, recent STI diagnosis, and physical health self-rating. Both models were well calibrated. External validation in adolescents living with HIV sample was similar, AUC=69.7; 95% CI=64.1-75.2.
The model predicted internalizing symptoms among African AIDS-affected youth reasonably well and showed good generalizability. The model offers opportunities for the design of public health interventions addressing poor mental health among youth affected by HIV/AIDS.
Introduction
To assess the burden of depression, anxiety and suicidality; and to determine the impact of integrated mental health and HIV services on treatment outcomes among Thai adolescents and young adults living with HIV (AYHIV).
Methods
A multicentre prospective cohort study was conducted among AYHIV (15 to 25 years), and age‐ and sex‐matched HIV‐uninfected adolescents and young adults (HUAY). The Patient Health Questionnaire 9‐item (PHQ‐9) and Generalized Anxiety Disorder 7‐item scales (GAD‐7) were used as screening tools for depressive and anxiety symptoms respectively. History of lifetime and recent suicidal ideations/attempts were ascertained. Elevated mental health screening scores were defined as having either significant depressive symptoms (PHQ‐9 ≥9), significant anxiety symptoms (GAD‐7 ≥10) or suicidality (lifetime; and recent [within two weeks]). Participants meeting these criteria were referred to psychiatrists for confirmatory diagnosis and mental health services. Follow‐up assessment with PHQ‐9 and GAD‐7 was performed one year after psychiatric referral.
Results
From February to April 2018, 150 AYHIV and 150 HUAY were enrolled, median age was 19.0 (IQR:16.8 to 21.8) years and 56% lived in urban areas. Among AYHIV, 73% had HIV RNA <50 copies/mL, and median CD4 count was 580 (IQR:376 to 744) cells/mm³. At enrolment, 31 AYHIV (21%; 95%CI:14% to 28%) had elevated mental health screening scores; 17 (11%) significant depressive symptoms, 11 (7%) significant anxiety symptoms and 21 (14%) suicidality. Seven AYHIV (5%) had all three co‐existing conditions. These prevalences were not substantially different from HUAY. Urban living increased risk, whereas older age decreased risk of elevated mental health screening scores (p < 0.05). All AYHIV with elevated mental health screening scores were referred to study psychiatrists, and 19 (13%; 95%CI: 8% to 19%) had psychiatrist‐confirmed mental health disorders (MHDs), including adjustment disorder (n = 5), major depression (n = 4), anxiety disorders (n = 2), post‐traumatic stress disorder (n = 1) and mixed MHDs (n = 4). One year after psychiatric referral, 42% of AYHIV who received mental health services demonstrated an absence of significant mental health symptoms from the reassessments, and 26% had an improved score.
Conclusions
With the significant burden of MHDs among AYHIV, an integration of mental health services, including mental health screenings, and psychiatric consultation and referral, is critically needed and should be scaled up in HIV healthcare facilities.
Background:
Suicidal behavior is a prevalent psychiatric emergency in HIV-infected adults. Detection of suicidal ideation is important in planning early psychiatric intervention and optimizing HIV/AIDS management. Characterization of suicidal ideation among HIV-infected adults is crucial; however, practically there is no data in Indonesia, the country with the second largest burden of HIV/AIDS epidemic in Asia. This study aims to identify suicidal ideation and analyze the associated psychopathology and determining factors among HIV-infected adults in Indonesia.
Methods:
An observational cross-sectional study was conducted among HIV-infected adults aged 18-65 years old receiving antiretroviral therapy (ART). Measurement using Symptom Checklist-90 (SCL-90) was performed to assess the existing psychopathology. Firth's penalized logistic regression analysis was performed to identify factors associated with suicidal ideation.
Results:
A total of 86 subjects were recruited. Most subjects were male (65.1%), median age was 35 years, and median latest CD4 count was 463 cells/μl. Lifetime suicidal ideation was identified in 20 subjects (23.3%). Mean SCL-90 T-score for depressive and anxiety symptoms were both significantly higher among subjects with suicidal ideation (M = 60.75, SD = 12.0, p = 0.000 and M = 57.9, SD = 2.8, p = 0.001, respectively) compared to those without. Bivariate analyses showed that lifetime suicidal ideation was associated with depressive and anxiety symptoms, non-marital status, CD4 count < 500 cells/μl, and efavirenz use. Multivariate analysis identified that a single-point increase in SCL-90 depression symptoms score (AOR 1.16, 95% CI 4.5-123.6, p = 0.000) and efavirenz use (AOR 5.00, 95% CI 1.02-24.6, p = 0.048) were significant independent factors related to suicidal ideation.
Conclusion:
Suicidal ideation is commonly found among Indonesian HIV-infected adults on ART. Depressive symptoms and efavirenz use are independent factors related to the presence of suicidal ideation. Thus, early screening of psychopathology as well as substitution of efavirenz with other ART regiment are recommended to prevent suicide and improve HIV/AIDS management outcome.
Globally, suicide and HIV/AIDS remain two of the greatest healthcare issues, particularly in low- and middle-income countries. Several studies have observed a relationship between suicidal behaviour and HIV/AIDS.
Materials and Methods
. The main objective of this research was to determine the prevalence of elevated risk of suicidal ideation in HIV-positive persons immediately following voluntary HIV counselling and testing (VCT). The study sample consisted of adult volunteers attending the VCT clinic at a university-affiliated, general state hospital. Participants completed a sociodemographic questionnaire, Beck’s Hopeless Scale, and Beck’s Depression Inventory.
Results
. A significantly elevated risk of suicidal ideation was found in 83.1% of the patients who tested seropositive. Despite a wide age range in the cohort studied, the majority of patients with suicidal ideation were males in the younger age group (age < 30 years), consistent with the age-related spread of the disease and an increase in suicidal behaviour in younger people. Relevant associated variables are discussed.
Conclusion
. The results serve as important markers that could alert healthcare professionals to underlying suicide risks in HIV-positive patients. It is recommended that screening for elevated risk of suicidal ideation and prevention of suicidal behaviour should form a routine aspect of comprehensive patient care at VCT clinics.
Background
Suicide is a major cause of premature mortality worldwide, but data on its epidemiology in Africa, the world’s second most populous continent, are limited.
Methods
We systematically reviewed published literature on suicidal behaviour in African countries. We searched PubMed, Web of Knowledge, PsycINFO, African Index Medicus, Eastern Mediterranean Index Medicus and African Journals OnLine and carried out citation searches of key articles. We crudely estimated the incidence of suicide and suicide attempts in Africa based on country-specific data and compared these with published estimates. We also describe common features of suicide and suicide attempts across the studies, including information related to age, sex, methods used and risk factors.
Results
Regional or national suicide incidence data were available for less than one third (16/53) of African countries containing approximately 60% of Africa’s population; suicide attempt data were available for <20% of countries (7/53). Crude estimates suggest there are over 34,000 (inter-quartile range 13,141 to 63,757) suicides per year in Africa, with an overall incidence rate of 3.2 per 100,000 population. The recent Global Burden of Disease (GBD) estimate of 49,558 deaths is somewhat higher, but falls within the inter-quartile range of our estimate. Suicide rates in men are typically at least three times higher than in women. The most frequently used methods of suicide are hanging and pesticide poisoning. Reported risk factors are similar for suicide and suicide attempts and include interpersonal difficulties, mental and physical health problems, socioeconomic problems and drug and alcohol use/abuse. Qualitative studies are needed to identify additional culturally relevant risk factors and to understand how risk factors may be connected to suicidal behaviour in different socio-cultural contexts.
Conclusions
Our estimate is somewhat lower than GBD, but still clearly indicates suicidal behaviour is an important public health problem in Africa. More regional studies, in both urban and rural areas, are needed to more accurately estimate the burden of suicidal behaviour across the continent. Qualitative studies are required in addition to quantitative studies.
Objective: This study compared suicide rates, clinical symptoms, and perceived preventability of suicide among persons in four ethnic groups who completed suicide within 12 months of contact with mental health services. Methods: The rates and standardized mortality ratios (SMRs) of suicide following contact with mental health services were calculated by using national suicide data from 1996 to 2001 for the four largest ethnic groups in England and Wales: black Caribbean, black African, South Asian (Indian, Pakistani, and Bangladeshi), and white. The study also investigated whether clinical indices of risk show ethnic variations. Results: A total of 8,029 suicides in the four ethnic groups were investigated. Overall, compared with the SMRs for their white counterparts, low SMRs were found for South-Asian men and women (SMR=.5, 95% confidence interval [CI]=.4-.6 for South-Asian men and SMR=.7, CI=.5-.9 for South-Asian women). High SMRs were found for black Caribbean and black African men aged 13-24 (SMR=2.9, CI=1.4-5.3 for black Caribbean men and SMR=2.5, CI=1.1-4.8 for black African men). High SMRs were found for young women aged 25-39 of South-Asian origin (SMR=2.8, CI= 1.9-3.9), black Caribbean origin (SMR=2.7, CI=1.3-4.8), and black African origin (SMR=3.2, CI=1.6-5.7). Some widely accepted suicide risk indicators were less common in the ethnic minority groups than in the white group. There were more symptoms of active psychosis for people from ethnic minority groups who later committed suicide, and perceived preventability was highest among black Caribbean people. Conclusions: Rates and SMRs varied across ethnic groups. Specific preventive actions must take account of the ethnic variations of clinical indices of risk and include more effective treatment of psychosis.
Background:
In contrast to the previous studies reporting that most suicides occur among people with mental disorders, recent studies have reported various rates of mental disorders in suicide in different geographical regions. We aimed to comprehensively investigate the factors influencing the variation in the prevalence of mental disorders reported among suicide victims.
Method:
The authors searched Embase, Medline, Web of Science, and the Cochrane Library to identify psychological autopsy studies reporting the prevalence of any mental disorders among suicide victims. A meta-regression analysis was conducted to identify the potential effects of geographical regions, the year of publication, measurements of personality disorder, measurements of comorbidity, and the ratio of females on the prevalence of mental disorders in addition to examining the heterogeneity across studies.
Results:
From 4475 potentially relevant studies, 48 studies met eligibility criteria, with 6626 suicide victims. The studies from East Asia had a significantly lower mean prevalence (69.6% [95% CI=56.8 to 80.0]) than those in North America (88.2% [95% CI=79.7-93.5]) and South Asia (90.4% [95% CI=71.8-97.2]). The prevalence of any mental disorder decreased according to the year of publication (coefficients=-0.0715, p<0.001).
Limitations:
Substantial heterogeneities were identified within all subgroup analyses.
Conclusions:
The prevalence of mental disorders among suicide cases seemed relatively low in the East Asia region, and recently published studies tended to report a lower prevalence of mental disorders. The link between the risk factors and suicide in the absence of a mental disorder should be examined in different geographical and sociocultural contexts.
nature of anxiety and anger as emotional states and the procedures employed in their measurement are reviewed briefly / the measures of state and trait anxiety are discussed, and the development of the State-Trait Anxiety Inventory (STAI) is described in some detail / examine conceptual ambiguities in the constructs of anger, hostility, and aggression, briefly evaluate a number of instruments developed to assess anger and hostility, and describe the construction and validation of the State-Trait Anger Scale (STAS) / expression and control of anger are considered, and the development of the Anger Expression (AX) Scale and the State-Trait Anger Expression Inventory (STAXI) are described / concludes with a discussion of the utilization of anxiety and anger measures in treatment planning and evaluation
The difficulties inherent in obtaining consistent and adequate diagnoses for the purposes of research and therapy have been pointed out by a number of authors. Pasamanick12 in a recent article viewed the low interclinician agreement on diagnosis as an indictment of the present state of psychiatry and called for "the development of objective, measurable and verifiable criteria of classification based not on personal or parochial considerations, but on behavioral and other objectively measurable manifestations."Attempts by other investigators to subject clinical observations and judgments to objective measurement have resulted in a wide variety of psychiatric rating scales.4,15 These have been well summarized in a review article by Lorr11 on "Rating Scales and Check Lists for the Evaluation of Psychopathology." In the area of psychological testing, a variety of paper-and-pencil tests have been devised for the purpose of measuring specific
The rate of suicide has been reported to be higher in persons with chronic and life-threatening illnesses (eg, cancer, Huntington's disease, and renal failure). We studied the rate of suicide in 1985 in New York City residents diagnosed with the acquired immunodeficiency syndrome (AIDS). There were 668 suicides in New York City residents in 1985, yielding a rate of 9.29 per 100000 personyears. In men aged 20 to 59 years without a known diagnosis of AIDS, the rate was 18.75 per 100000 person-years. There were 3828 individuals who lived with the diagnosis of AIDS for some part, or all, of 1985. There were 12 suicides in men aged 20 to 59 years from this group who lived 1763.25 person-years with a diagnosis of AIDS. This yields a suicide rate of 680.56 per 100000 person-years. Thus, the relative risk of suicide in men with AIDS aged 20 to 59 years was 36.30 times (95% confidence limits, 20.45 to 64.42) that of men aged 20 to 59 years without this diagnosis, and 66.15 times (95% confidence limits, 37.38 to 117.06) that of the general population. We conclude that AIDS represents a significant risk factor for suicide.
(JAMA 1988;259:1333-1337)
A cross-sectional study was developed to evaluate suicide risk and associated factors in HIV/AIDS patients at a regional reference center for the treatment of HIV/AIDS in southern Brazil. We assessed 211 patients in regard to suicide risk, clinical and sociodemographic characteristics, drug use, depression, and anxiety. Suicide risk was assessed with Mini International Neuropsychiatric Interview, Module C. Multivariate analysis was performed using Poisson regression. Of the total sample, 34.1% were at risk of suicide. In the multivariate analysis, the following variables were independently associated with suicide risk: female gender; age up to 47 years; unemployment; indicative of anxiety; indicative of depression; and abuse or addiction on psychoactive substances. Suicide risk is high in this population. Psychosocial factors should be included in the physical and clinical evaluation, given their strong association with suicide risk.
As one of the leading causes of death around the world, suicide is a global public health threat. Due to the paucity of systematic studies, there exist vast variations in suicide ideation, attempts and suicide rates between various regions of Chinese aging communities.
Our systematic study aims to (1) identify studies describing the epidemiology of suicidal ideation, suicide attempts and behaviors among global Chinese communities; (2) conduct systematic review of suicide prevalence; (3) provide cross-cultural insights on this public health issue in the diverse Chinese elderly in China, Hong Kong, Taiwan, Asian societies and Western countries. Data sources: Using the PRISMA statement, we performed systematic review including studies describing suicidal ideation, attempts, and behavior among Chinese older adults in different communities. Literature searches were conducted by using both medical and social science data bases in English and Chinese.
Forty-nine studies met inclusion criteria. Whereas suicide in Chinese aging population is a multifaceted issue, culturally appropriate and inter-disciplinary approach to improve the quality of life for the Chinese older adults is critical.
Future research is needed to explore the risk and protective factors associated with suicidal thoughts, attempts and behaviors in representative Chinese aging populations.