Prevalence and Factors Associated With Suicidal Ideation Among Children and Adolescents Attending a Pediatric HIV Clinic in Uganda.

Justine Diana Namuli,Etheldreda Nakimuli-Mpungu,Paul Bangirana,Joyce Sserunjogi Nalugya

doi:10.3389/fsoc.2021.656739

Justine Diana Namuli, Etheldreda Nakimuli-Mpungu + Show 2 more

Open Access

https://doi.org/10.3389/fsoc.2021.656739

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Abstract

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.

Highlights

Suicide is the second leading cause of death for young people ages 10–34 years and accounts for 20% of all deaths annually1
Our main findings were; 1) The prevalence of suicidal ideation among children and adolescents living with HIV/AIDS was 17%; 2) HIV infected children and adolescents with exposure to family or friend’s death, those with higher depression scores, anxiety symptoms and rule breaking behavior scores are more likely to report suicidal ideation; 3) Those with HIV wasting syndrome were less likely to report suicidal ideation
Our study shows that the prevalence of suicidal ideation among children and adolescents living with HIV/AIDS is substantial, which is more or less similar to rates that have been reported in previous studies among youth and adults with HIV/AIDS such as 16% in Nigeria (8), 15.5% in Thailand (Benjamin Lee and Manik Chhabra, 2011) and 14.0% in Canada (5)

Summary

Introduction

Suicide is the second leading cause of death for young people ages 10–34 years and accounts for 20% of all deaths annually. 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). 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).

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