Risk and protective factors for suicidal ideation and behaviour in Rwandan children

Abstract

Background Suicide is a leading cause of death for young people. Children living in sub-Saharan Africa, where HIV rates are disproportionately high, may be at increased risk. Aims To identify predictors, including HIV-status, of suicidal ideation and behavior in Rwandan children ages 10–17. Method Matched case-control study of 683 HIV-positive, HIV-affected (seronegative children with an HIV-positive caregiver), and unaffected children and their caregivers. Results Over 20% of HIV-positive and affected children engaged in suicidal behavior in the previous six months, compared to 13% of unaffected children. Children were at increased risk if they met criteria for depression, were at high-risk for conduct disorder, reported poor parenting, or had caregivers with mental health problems. Conclusions Policies and programs that address mental health concerns and support positive parenting may prevent suicidal ideation and behavior in children at increased risk related to HIV. Declaration of interest The authors have no conflicts to report.

Mental health challenges among adolescents living with HIV

“…One study found male sex to be associated with a greater risk of depression than female sex in Kenya [28], while another found female sex to be associated with higher BDI-II scores in Malawi [30]. Another study found depression rates to be higher among HIV-infected adolescent females than males in Rwanda, but this difference was not significant [31], while another found no significant association between sex and suicidal ideation or behaviour in Rwanda [35]. …”

“…The few studies that use comparison groups in these settings do suggest certain increased risks of mental health challenges for those living with HIV. A study of 683 children ages 10-17 years of age in Rwanda compared a group with either HIV infection themselves (HIV-infected) or who were HIV affected (living with an HIV-infected caregiver or had a caregiver who had died from HIV) to a control group that was neither HIV infected nor living with anyone HIV infected [35]. Twenty per cent of the HIV-infected or HIVaffected adolescents were reported to have attempted suicide or engaged in self-harm in the past 6 months, compared to 13% of HIV-uninfected, unaffected children, with child-reported HIV-related stigma significantly increasing the risk of suicidal ideation and behaviours [27].…”

Factors for Suicidal Ideation in Middle School Students by Gender

“…In this study, self-esteem and communication with one's parents presented a similar effect of abating suicidal ideation. Depression was cited as a critical factor in suicidal ideation psychologically [4,[10][11][12][13], and life events preceded suicidal ideation [2,4,14,26]. As discussed earlier, the suicidal ideation in the subject female students in this study was twofold higher than in the subject male students, and the smoking and alcohol consumption rates were higher in the suicidal-ideation group than in the non-suicidalideation group among the subject female students.…”

“…Based on the cut-off score for suicidal ideation (20), the academic stress and depression were higher and the selfesteem and communication with one's parents were lower in the suicidal-ideation group than in the non-suicidalideation group. In previous studies, self-esteem [15,16], familial alliance [12,16,18], and social support [2,3,5,15] were found to lessen the danger of suicidal ideation. In this study, self-esteem and communication with one's parents presented a similar effect of abating suicidal ideation.…”

“…In previous studies, the factors that affect the adolescent suicidal ideation rate were condensed into depression, stress [4,[9][10][11][12], hopelessness [2,3,14], low self-esteem [15,16], absence of social support [2,3,5,11,15], bullying [4,18], conflict with one's parents [4,12,16,17], and poor peer relationships [4,[16][17][18].…”