Background
Methods
Participants and procedures
Measures
Suicidality
Socio economic status
HIV stigma
Assessment of psychiatric disorders
Procedure
Statistical analyses
Results
Prevalence of suicidality
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Past month: Among the 392 youths in the study, 10.7% (n = 42, CI 8 – 14.1) had moderate to severe risk of suicidality in the past one month with higher rates among urban female youths (12.4%, CI the youths themselves, the reported life time prevalence of attempted suicide was 2.8% (n = 11, CI 1.6–5.0 (see Table 1). 8.6–17.7) than males (8.7%, CI 5.4 –13.8).Table 1Prevalence of suicidality, frequency and methods used among adolescents with HIV in Uganda (CHAKA study)Total (N = 392)GenderLocalityMaleFemaleUrbanRuralCaregiver reportedModerate to severe risk of suicidalitya42(10.7%)(CI 8–14.1)16(8.7%)(CI 5.4–13.8)26(12.4%)(CI 8.6 –17.7)25(12.9%)(CI 8.9–18.5)17(8.5%)(CI 5.4–13.3)Attempted suicide lifetimeb9 (2.30%)(CI 1.2–4.4)2(1.2%)(CI 0.3–4.5)7(3.4%)(CI 1.6–7.1)9(4.9%)(CI 2.5–9.2)0Youth Self-reportAttempted suicide last monthc7(1.8%)(CI 0.8–3.7)1(0.6%)(CI 0.07–3.8)6(2.9%)(CI 1.2–6.3)5(2.3%)(CI 1.1–6.1)2(1.0%)(CI 0.2– 4.0)Attempted suicide lifetimed11(2.8%)(CI 1.6–5.0)4(2.2%)(CI 0.8–5.7)7(3.4%)(CI 1.6–6.9)9(4.7%)(CI 2.4–8.7)2(1.0%)(CI 0.2–3.9)Frequency of attempted suicide (N = 11)1 time6 (54.5%)4(100%)2(28.6%)4(44.4%)2(100)2 times3 (27.3%)03(42.9%)3(33.3%)06 times1 (9.1%)01(14.3%)1(11.1%)09 times1 (9.1%)01(14.3%)1(11.1%)0Methods of attempted suicide (N = 11)Cutting2(18.2%)2(50%)02(22.2%)Use of HIV medications2(18.2%)1(25%)1(14.3%2(22.2)0Others(organophosphates, hanging, stabbing, self-starvation)6(54.5%)06(85.7%)5(22.2)1(11.1%)
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Lifetime: The caregivers reported a lifetime suicidal attempt prevalence of 2.3% (n= 9, CI 1.2–4.4) among youths. According to reports by the youths themselves, the reported life time prevalence of attempted suicide was 2.8% (n=11, CI 1.6–5.0 (see Table 1).
Methods of attempted suicide
Variable | (n = 392) n (%) | Crude odds ratio (95% CI) | P value | Adjusted odds ratio (95% CI) | P-value |
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Psychosocial vulnerability/protective factors | |||||
Sex | |||||
Male | 16/183(8.7%) | 1 | P = 0.238 | 1 | P = 0.172 |
Female | 26/209(12.4%) | 1.5(0.77–2.86) | 1.6(0.78–2.91) | ||
Study site | |||||
Rural | 17/199(8.54%) | 1 | P = 0.158 | 1 | P = 0.172 |
Urban | 25/193(12.95%) | 1.6(0.83–3.05) | 1.6(0.84–3.10) | ||
Age | |||||
Above 15 | 18/154(11.69%) | 1.07(0.55–2.09) | P = 0.840 | 1.03(0.52 –2.06) | P = 0.07 |
Less 14 | 21/191(10.99%) | 1 | 1 | ||
Adolescent’s education | 1 | ||||
Less than primary | 29/289(10.03%) | 1 | P = 0.47 | 1.16(0.56–2.36) | P = 0.29 |
Primary and above | 13/103(12.62%) | 1.29(0.64–2.59) | |||
Caregiver Education level | |||||
Less than primary | 20/208(9.62%) | 1 | P = 0.351 | 1 | P = 0.23 |
Primary and above | 21/166(12.65%) | 1.36(0.71–2.6) | 1.16(0.59–2.28) | ||
Religion | |||||
Christian | 35/314(11.15%) | 1.27(0.54–2.98) | P = 0.57 | 1.27(0.54–3.00) | P = 0.28 |
Non-Christian | 7/78(8.97%) | 1 | 1 | ||
Socio-economic status | |||||
High SES | 10/144(6.94%) | 1 | P = 0.06 | 1 | P = 0.04 |
Low SES | 32/248(12.90%) | 1.98(0.95–4.17) | 2.27(1.06 –4.87) | ||
Tribe | |||||
Muganda | 28/280(10.00%) | 0.78(0.39–1.54) | P = 0.48 | 0.89(0.43P = 0.301.83) | P = 0.30 |
Non Muganda | 14/112(12.50%) | 1 | 1 | ||
Living arrangement | |||||
Both parents | 8/76(10.26%) | 1 | 1 | ||
Others | 34/314(10.83%) | 1.06(0.47 – 2.40) | P = 0.88 | 1.09(0.48 – 2.48) | P = 0.31 |
Orphan status | |||||
Orphan | 28/245(11.43%) | 1.23(0.62 –2.41) | P = 0.56 | 1.27(0.64–2.50) | P = 0.26 |
Not orphan | 14/147(9.52%) | 1 | 1 | ||
Substance use | |||||
Ever used a substance | 1/2(50%) | 8.47(0.52 –138.27) | P = 0.16 | 9.03(0.–153.70) | P = 0.14 |
Never used any substance | 41/389(10.54%) | 1 | 1 | ||
Suffered sexual abuse | |||||
Yes | 2/8(25.00%) | 2.87(0.56 – 14.68) | P = 0.25 | 2.51(0.48 – 13.02) | P = 0.21 |
No | 40/384(10.42%) | 1 | 1 | ||
Suffered physical abuse | |||||
Yes | 17/140(12.14%) | 1.24(0.64 –2.39) | P = 0.52 | 1.16(0.60–2.24) | P = 0.29 |
No | 25/250(10.00%) | 1 | 1 |
Variable | (n = 479) n (%) | Crude Odds Ratio (95% CI) | P-value | Adjusted Odds Ratio (95% CI) | P-value |
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Comorbid psychiatric disorders | |||||
Major depressive disorder | |||||
Yes | 18/161(11.18%) | 1.79(0.57–2.07) | P = 0.06 | 1.80(0.48–2.10) | P = 0.04 |
No | 24/231(10.39%) | 1 | 1 | ||
Social anxiety disorder | |||||
Yes | 25/203(12.32%) | 1.42(0.74–2.72) | P = 0.29 | 1.6(0.8–3.15) | P = 0.14 |
No | 17/189(8.99%) | ||||
PTSD | |||||
Yes | 16/115(13.91%) | 1.56(0.80–3.03) | P = 0.19 | 1.37(0.70–2.73) | P = 0.23 |
No | 26/277(9.39%) | 1 | 1 | ||
ADHD | |||||
Yes | 31/325(9.54%) | 0.54(0.25 –1.13) | P = 0.097 | 0.41(0.18 –0.92) | P = 0.04 |
No | 11/67(16.42%) | 1 | 1 | ||
Oppositional defiant disorder | |||||
Yes | 35/296(11.82%) | 1.7(0.73–3.97) | P = 0.19 | 1.65(0.70–3.89) | P = 0.17 |
No | 7/96(7.26%) | 1 | 1 | ||
Conduct disorder | |||||
Yes | 22/158(13.92%) | 1.73(0.91–3.29) | P = 0.09 | 1.60(0.81–3.14) | P = 0.14 |
No | 20/234(8.55%) | 1 | 1 | ||
Caregiver psychological distress | |||||
No | 16/133(12.03%) | 1 | 1 | ||
Yes | 26/259(10.04%) | 0.82(0.42–1.58) | P = 0.55 | 0.75(0.38–1.47) | P = 0.24 |
HIV illness factors | |||||
Current CD4 count | |||||
<= 500 | 16/127(12.60%) | 1.35(0.69–2.63) | P = 0.38 | 1.39(0.71–2.71) | P = 0.22 |
>500 | 25/259(9.65%) | 1 | 1 | ||
Lowest CD4 count | |||||
<= 400 | 18/167(10.78%) | 1.04(0.53–2.04) | P = 0.89 | 1.03(0.52–2.04) | P = 0.58 |
>400 | 20/193(10.36%) | 1 | 1 | ||
HIV felt stigma | |||||
Yes | 12/79(15.19%) | 2.03(1.03–3.01) | P = 0.03 | 2.10(1.04–3.00) | P = 0.02 |
No | 30/313(9.6%) | 1 | 1 | ||
Child caregiver relationship | |||||
Poor | 16/132(12.12%) | 1.24(0.64–2.41) | P = 0.52 | 1.22(0.62–2.39) | P = 0.27 |
Good | 26/260(10.00%) | 1 | 1 | ||
Childhood trauma | |||||
Yes | 17/140(12.14%) | 1.24(0.64–2.39) | P = 0.52 | 1.16(0.59–2.24) | P = 0.29 |
No | 25/250(10.00%) | 1 | 1 | ||
Stress factors | |||||
Negative life events | 13/97(13.40%) | P = 0.33 | 1.31(0.64 –2.68) | P = 0.25 | |
Yes | 29/295(9.83%) | 1.4(0.71–2.85) | 1 | ||
No | 1 | ||||
Family has enough food | 29/309(9.39%) | ||||
Yes | 13/80(16.25%) | 1 | P = 0.08 | 1 | P = 0.13 |
No | 1.87(0.92–3.80) | 1.73(0.84–3.54) |