Abstract
Studies conducted in sub-Saharan Africa suggest a high prevalence of depression and suicidality among adolescents living with HIV (ALWH). This is an important public health issue because depression is known to compromise HIV treatment adherence. However, the drivers of depression and suicidality in this population are unclear. We conducted a cross-sectional study to estimate the associations between internalized stigma, bullying, major depressive disorder, and suicidality. We conducted a cross-sectional survey between November 2016 and March 2017, enrolling a consecutive sample of 224 ALWH aged 13-17 years. We collected information on demographic characteristics, internalized HIV-related stigma (using the six-item Internalized AIDS-Related Stigma Scale), bullying victimization (using the nine-item Social and Health Assessment Peer Victimization Scale), major depressive disorder [using the Mini International Neuropsychiatric Interview for Children and Adolescents (MINI-KID)], and suicidality (also using the MINI-KID). We fitted multivariable logistic regression models to estimate the associations between stigma, bullying, major depressive disorder, and suicidality. Thirty-seven participants (16%) had major depressive disorder, 30 (13%) had suicidality, and nine (4%) had high-risk suicidality. Ninety-one participants (41%) had high levels of internalized stigma, while 97 (43%) reported two or more bullying events in the past year. In multivariable logistic regression models, major depressive disorder had a statistically significant association with bullying (AOR = 1.09; 95% CI 1.00-1.20; p = 0.04); while suicidality (low, moderate, high risk) had statistically significant associations with both bullying (AOR = 1.09; 95% CI 1.01-1.17; p = 0.02) and stigma (AOR = 1.30; 95% CI 1.03-1.30; p = 0.02). Among ALWH in rural Uganda, stigma and bullying are strongly associated with major depressive disorder and suicidality. There is a need to incorporate psychological interventions in the mainstream HIV care to address these challenges for optimal management of HIV among ALWH.
Highlights
In 2015, approximately 1.8 million adolescents between the ages of 10 and 19 years were living with HIV global mental health worldwide (UNAIDS, 2014; Bekker et al 2015), and the number of adolescents living with HIV (ALWH) continues to rise due to increasing availability of HIV antiretroviral medications, which have enabled the survival of perinatally infected children (Brady et al 2010)
In multivariable logistic regression models, major depressive disorder had a statistically significant association with bullying (AOR = 1.09; 95% CI 1.00–1.20; p = 0.04); while suicidality had statistically significant associations with both bullying (AOR = 1.09; 95% CI 1.01–1.17; p = 0.02) and stigma (AOR = 1.30; 95% CI 1.03–1.30; p = 0.02)
Among ALWH in rural Uganda, stigma and bullying are strongly associated with major depressive disorder and suicidality
Summary
In 2015, approximately 1.8 million adolescents between the ages of 10 and 19 years were living with HIV global mental health worldwide (UNAIDS, 2014; Bekker et al 2015), and the number of adolescents living with HIV (ALWH) continues to rise due to increasing availability of HIV antiretroviral medications, which have enabled the survival of perinatally infected children (Brady et al 2010). Numerous studies have documented a high prevalence of depressive symptoms and suicidality among adults living with HIV throughout sub-Saharan Africa (SSA) (Antelman et al 2007; Simbayi et al 2007; Tsai et al 2012; Zunner et al 2015; Ashaba et al 2017; Kinyanda et al 2017). Studies conducted in sub-Saharan Africa suggest a high prevalence of depression and suicidality among adolescents living with HIV (ALWH). This is an important public health issue because depression is known to compromise HIV treatment adherence. We conducted a cross-sectional study to estimate the associations between internalized stigma, bullying, major depressive disorder, and suicidality
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