The association between suicidality and HIV/AIDS has been demonstrated for three decades, but little is know about risk factors that can help understand this association and help identify who is most at risk. Few research studies have been conducted in sub-Saharan Africa, a region that accounts for more than 70% of the HIV global burden. This paper describes clinical risk factors for suicidality among individuals with HIV infection and AIDS disease in Mbarara, Uganda. In this study, suicidality includes both suicidal ideation and suicidal attempts. A cross-sectional survey was conducted with 543 HIV-positive individuals aged 15 years and above, recruited from 2 HIV specialised clinics in Mbarara. Using logistic regression analysis, factors significantly associated with suicidality at 95% confidence interval were identified. The rate of suicidality was 10% (n = 54; 95% CI: 5.00–15.00). Risk factors for suicidality were: perception of poor physical health (OR 2.22, 95% CI 1.23–3.99, p = 0.007), physical pain (OR 1.83, 95% CI 1.01–3.30, p = 0.049), reducing work due to illness (OR = 2.22, 95% CI 1.23–3.99, p = 0.004) and recent HIV diagnosis (OR 1.02, 95% CI 1.01–1.03, p = 0.001). These findings suggest that HIV/AIDS in south-western Uganda is associated with a considerable burden of suicidality. HIV is associated with several clinical factors that increase vulnerability to suicidality. There is need for more appropriate interventions targeting these clinical risk factors, systematic suicide risk assessment and management of suicidal ideation and behaviours in HIV care.

Background Depression in adolescents constitutes a global public health concern. However, data on its prevalence and associated factors are limited in low income countries like Uganda. Methods Using a cross-sectional descriptive study design, 519 adolescent students in 4 secondary schools in Mukono district, Uganda, were randomly selected after meeting study criteria. The 4 school types were: boarding mixed (boys and girls) school; day mixed school; girls’ only boarding school; and, boys’ only boarding school. The 519 participants filled out standardized questionnaires regarding their socio-demographic characteristics and health history. They were then screened for depression using the Children Depression Inventory (CDI) and those with a cut-off of 19 were administered the Mini International Neuro-Psychiatric Interview for Children and Adolescents 2.0 (MINI-KID), to ascertain the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition (DSM IV) diagnostic types of depression and any co morbidity. Logistic regression analyses were used to assess factors associated with significant depression symptoms (a score of 19 or more on the CDI). ResultsThere were 301 (58 %) boys and 218 (42 %) girls with age range 14–16 years and a mean age of 16 years (SD 2.18). Of 519 participants screened with the CDI, 109 (21 %) had significant depression symptoms. Of the 109 participants with significant depression symptoms, only 74 were evaluated with the MINI-KID and of these, 8 (11 %) met criteria for major depression and 6 (8 %) met criteria for dysthymia. Therefore, among participants that were assessed with both the CDI and the MINI-KID (n = 484), the prevalence of depressive disorders was 2.9 %. In this sample, 15 (3.1 %) reported current suicidal ideation. In the logistic regression analyses, significant depression symptoms were associated with single-sex schools, loss of parents and alcohol consumption. LimitationsThis is a cross-sectional study therefore, causal relationships are difficult to establish. Limited resources and the lack of collateral information precluded the assessment of a number of potential factors that could be associated with adolescent depression. The MINI-KID was administered to only 74 out of 109 students who scored ≥19 on the CDI since 35 students could not be traced again due to limited resources at the time. Conclusions Significant depression symptoms are prevalent among school-going adolescents and may progress to full-blown depressive disorders. Culturally sensitive psychological interventions to prevent and treat depression among school-going adolescents are urgently needed.

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.

There is paucity of data on the burden of suicidality in HIV/AIDS and associated clinical factors in sub-Saharan Africa. Yet, the region accounts for 70% of the HIV burden. This study aimed to assess the rate and clinical risk factors for suicidality in HIV-positive individuals in semi-urban Uganda. It was a cross-sectional survey of 543 HIV-positive individuals aged 15 years and above recruited from two HIV specialized clinics in Mbarara. Using logistic regression analysis, factors significantly associated with suicidality at 95% confidence interval and p-value of ≤ 0.05 were identified. The rate of suicidality was 10% (n= 54; 95% CI: 5.00-15.00); suicidal ideation 8.8% (n=48; 95% CI: 6.70-11.50) and suicidal attempt 3.1% (17, 95% CI 2.00-5.00). Risk factors for suicidality were: perception of poor physical health (OR 2.22, 95%CI 1.23-3.99, p= 0.007), physical pain (OR 1.83, 95%CI 1.01-3.30, p= .049), reducing on the work due to illness (OR = 2.22, 95%CI 1.23-3.99, p= 0.004) and recent HIV diagnosis (OR 1.02, 95% CI 1.01-1.03, p= 0.001). The findings suggest that HIV/AIDS in south-western Uganda is associated with a considerable burden of suicidality. HIV seems to work secondarily through clinical factors to increase vulnerability to suicidality. Suicide risk assessment and management should be an integral part of HIV care.

There is a paucity of data on the prevalence of suicidality in HIV/AIDS, and associated psychological factors in sub-Saharan Africa, shown to be high in Uganda. Yet, the region accounts for over 70% of the world HIV burden. Our study used a cross-sectional survey of 226 HIV-positive (HIV+) adults and adolescents (aged 15–17 years) in Mbarara, Uganda. The relationship between suicidality and depressed mood, anxiety symptoms, state anger, self-esteem, trait anger and hopelessness was examined; anger was the predominant factor in suicidality, suggesting that anger management could potentially lower the prevalence of suicidality.