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

2015 ◽  
Vol 207 (3) ◽  
pp. 262-268 ◽  
Author(s):  
Lauren C. Ng ◽  
Catherine M. Kirk ◽  
Frederick Kanyanganzi ◽  
Mary C. Smith Fawzi ◽  
Vincent Sezibera ◽  
...  
Keyword(s):  
Mental Health ◽  
Suicidal Ideation ◽  
Mental Health Problems ◽  
Sub Saharan Africa ◽  
Hiv Positive ◽  
Hiv Status ◽  
Increased Risk ◽  
Matched Case ◽  
Sub Saharan ◽  
Control Study

BackgroundSuicide 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.AimsTo identify predictors, including HIV status, of suicidal ideation and behaviour in Rwandan children aged 10–17.MethodMatched case–control study of 683 HIV-positive, HIV-affected (seronegative children with an HIV-positive caregiver), and unaffected children and their caregivers.ResultsOver 20% of HIV-positive and affected children engaged in suicidal behaviour in the previous 6 months, compared with 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.ConclusionsPolicies and programmes that address mental health concerns and support positive parenting may prevent suicidal ideation and behaviour in children at increased risk related to HIV.

scholarly journals The prevalence of mental health problems in sub-Saharan adolescents living with HIV: a systematic review

2020 ◽  
Vol 7 ◽  
Author(s):  
A.S. Dessauvagie ◽  
A. Jörns-Presentati ◽  
A.-K. Napp ◽  
D.J. Stein ◽  
D. Jonker ◽  
...  
Keyword(s):  
Mental Health ◽  
Associated Factors ◽  
Mental Health Problems ◽  
Health Problems ◽  
Hiv Treatment ◽  
Sub Saharan Africa ◽  
Hiv Care ◽  
Hiv Positive ◽  
Hand Search ◽  
Sub Saharan

Abstract Despite the progress made in HIV treatment and prevention, HIV remains a major cause of adolescent morbidity and mortality in sub-Saharan Africa. As perinatally infected children increasingly survive into adulthood, the quality of life and mental health of this population has increased in importance. This review provides a synthesis of the prevalence of mental health problems in this population and explores associated factors. A systematic database search (Medline, PsycINFO, Scopus) with an additional hand search was conducted. Peer-reviewed studies on adolescents (aged 10–19), published between 2008 and 2019, assessing mental health symptoms or psychiatric disorders, either by standardized questionnaires or by diagnostic interviews, were included. The search identified 1461 articles, of which 301 were eligible for full-text analysis. Fourteen of these, concerning HIV-positive adolescents, met the inclusion criteria and were critically appraised. Mental health problems were highly prevalent among this group, with around 25% scoring positive for any psychiatric disorder and 30–50% showing emotional or behavioral difficulties or significant psychological distress. Associated factors found by regression analysis were older age, not being in school, impaired family functioning, HIV-related stigma and bullying, and poverty. Social support and parental competence were protective factors. Mental health problems among HIV-positive adolescents are highly prevalent and should be addressed as part of regular HIV care.

scholarly journals Relationships with caregivers and mental health outcomes among adolescents living with HIV: a prospective cohort study in South Africa

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Yulia Shenderovich ◽  
Mark Boyes ◽  
Michelle Degli Esposti ◽  
Marisa Casale ◽  
Elona Toska ◽  
...  
Keyword(s):  
Mental Health ◽  
South Africa ◽  
Cohort Study ◽  
Mental Health Problems ◽  
Health Problems ◽  
Sub Saharan Africa ◽  
Depression Symptoms ◽  
Sub Saharan ◽  
Positive Caregiving ◽  
Living With Hiv

Abstract Background Mental health problems may impact adherence to anti-retroviral treatment, retention in care, and consequently the survival of adolescents living with HIV. The adolescent-caregiver relationship is an important potential source of resilience. However, there is a lack of longitudinal research in sub-Saharan Africa on which aspects of adolescent-caregiver relationships can promote mental health among adolescents living with HIV. We draw on a prospective longitudinal cohort study undertaken in South Africa to address this question. Methods The study traced adolescents aged 10–19 initiated on antiretroviral treatment in government health facilities (n = 53) within a health district of the Eastern Cape province. The adolescents completed standardised questionnaires during three data collection waves between 2014 and 2018. We used within-between multilevel regressions to examine the links between three aspects of adolescent-caregiver relationships (caregiver supervision, positive caregiving, and adolescent-caregiver communication) and adolescent mental health (depression symptoms and anxiety symptoms), controlling for potential confounders (age, sex, rural/urban residence, mode of infection, household resources), n=926 adolescents. Results Improvements in caregiver supervision were associated with reductions in anxiety (0.98, 95% CI 0.97–0.99, p=0.0002) but not depression symptoms (0.99, 95% CI 0.98–1.00, p=.151), while changes in positive caregiving were not associated with changes in mental health symptoms reported by adolescents. Improvements in adolescent-caregiver communication over time were associated with reductions in both depression (IRR=0.94, 95% CI 0.92–0.97, p<.0001) and anxiety (0.91, 95% CI 0.89–0.94, p<.0001) symptoms reported by adolescents. Conclusions Findings highlight open and supportive adolescent-caregiver communication and good caregiver supervision as potential factors for guarding against mental health problems among adolescents living with HIV in South Africa. Several evidence-informed parenting programmes aim to improve adolescent-caregiver communication and caregiver supervision, and their effect on depression and anxiety among adolescents living with HIV should be rigorously tested in sub-Saharan Africa. How to improve communication in other settings, such as schools and clinics, and provide communication support for caregivers, adolescents, and service providers through these existing services should also be considered.

scholarly journals Public health and research funding for childhood neurodevelopmental disorders in Sub-Saharan Africa: a time to balance priorities

2014 ◽  
Vol 2 (1) ◽  
Author(s):  
Muideen O. Bakare ◽  
Kerim M. Munir ◽  
Mashudat A. Bello-Mojeed
Keyword(s):  
Public Health ◽  
Mental Health ◽  
Neurodevelopmental Disorders ◽  
Research Funding ◽  
Mental Health Problems ◽  
Policy Formulation ◽  
Sub Saharan Africa ◽  
Under Five ◽  
Mortality Index ◽  
Sub Saharan

Sub-Saharan African (SSA) population consists of about 45% children, while in Europe and North America children population is 10- 15%. Lately, attention has been directed at mitigating childhood infectious and communicable diseases to reduce under-five mortality. As the under-five mortality index in Sub-Saharan Africa has relatively improved over the last two decades, more Sub-Saharan African children are surviving beyond the age of five and, apparently, a sizeable percentage of this population would be living with one or more childhood neurodevelopmental disorders (NDD). The distribution of child mental health service resources across the world is unequal. This manifests in the treatment gap of major childhood onset mental health problems in SSA, with the gap being more pronounced for childhood NDD. It is important to balance the public health focus and research funding priorities in Sub-Saharan Africa. We urgently need to define the burden of childhood NDD in the region for healthcare planning and policy formulation.

Working with vulnerable populations

2015 ◽  
Author(s):  
Theresa S. Betancourt ◽  
William Beardslee ◽  
Catherine Kirk ◽  
Katrina Hann ◽  
Moses Zombo ◽  
...  
Keyword(s):  
Mental Health ◽  
Vulnerable Populations ◽  
Mental Health Problems ◽  
Community Based Participatory Research ◽  
Sub Saharan Africa ◽  
Vulnerable Groups ◽  
Ethical Practices ◽  
Research Attention ◽  
Referral Networks ◽  
Sub Saharan

We discuss key issues to consider when conducting clinical trials with vulnerable children, youths, and families, with particular attention to groups affected by communal violence/war and families affected by HIV/AIDS. Across these settings, there is an overlap of several forms of adversity and vulnerability which require careful research attention. We also discuss ethical practices with vulnerable groups, including the use of qualitative methods to enhance understanding of local perspectives and language around mental health problems and resilience, planning for risk of harm referral networks, and applications of community-based participatory research (CBPR) techniques.  Such approaches can raise community awareness and increase engagement for addressing mental health in vulnerable populations while also informing and promoting practice and policy change. Drawing from examples of work in Sub-Saharan Africa and with refugees in the US, we conclude with a series of recommendations for advancing sensitive research practices with vulnerable populations.

scholarly journals Clinical Characteristics of Incident Lymphoma in Malawi before and after Implementation of Universal Anti-Retroviral Therapy

Blood ◽  
2021 ◽  
Vol 138 (Supplement 1) ◽  
pp. 1445-1445
Author(s):  
Yolanda Gondwe ◽  
Evaristar Kudowa ◽  
Tamiwe Tomoka ◽  
Cara Randall ◽  
Amy Lilly ◽  
...  
Keyword(s):  
Clinical Characteristics ◽  
B Cell Lymphoma ◽  
Cd4 Count ◽  
Sub Saharan Africa ◽  
Proliferation Index ◽  
Hiv Positive ◽  
Hiv Status ◽  
Time Period ◽  
The Us ◽  
Sub Saharan

Abstract Purpose: In 2016, Malawi implemented a universal test and treat (UTT) policy, expanding eligibility for antiretroviral therapy (ART) to anyone with confirmed HIV infection. Prior to 2016, Malawi restricted ART initiation to HIV-positive individuals with CD4 count ≤500 cells/µL, with WHO staging ≥III who were pregnant or breastfeeding, or who were younger than 5 years old. Here, we assess the impact on distribution of lymphoma presentation and baseline clinical characteristics at Kamuzu Central Hospital, Lilongwe, Malawi. Methods: Participants with newly diagnosed, pathologically confirmed lymphoproliferative disorders were enrolled from 2013 - 2020. We categorized participants as pre-universal ART (pre-UART) if enrolled during 2013-June 2016 or post-universal ART (post-UART) if enrolled during July 2016-2020 and evaluated clinical characteristics. Findings: Of 412 total participants, 156 were pre-UART and 256 were post-UART. The most common diagnoses were diffuse large B-cell lymphoma (DLBCL) (45%), low-grade lymphoma (11%), Burkitt lymphoma (10%), Hodgkin lymphoma (9%), and multicentric Castleman disease (7%) and there was no significant difference in distribution of diagnoses between pre-UART and post-UART periods (Figure 1). HIV prevalence was 50%, mean age 43, and 62% male. Sixty-six percent (48/73) of pre-UART HIV-positive participants knew their HIV status, for median 5 years (IQR 2-8) and 71% (41/58) were on ART for median 4 years (IQR 2-7). Eighty percent (94/117) of post-UART HIV positive participants knew their HIV status (p=0.02), for median 4 years (IQR 2-9) and 84% (89/106) were on ART (p=0.05) for median 4 years (IQR 2-8). HIV was suppressed &lt;1000 copies/mL in 56% (33/59) pre-UART and 71% (73/103) post-UART (p=0.05). Among DLBCL participants, 61% (23/38) of pre-UART HIV-positive participants knew their HIV status, for median 5 years (IQR 2-9), 61% (19/31) were on ART for median 4 years (IQR 2-6). Eighty-two percent (n=51/63) of post-UART DLBCL HIV-positive participants knew their HIV status (p=0.02) for median 5 years (IQR 2-9) and 89% (47/53) were on ART (p &lt; 0.01) for median 5 years (IQR 2-9). Post-UART DLBCL participants had median HIV viral load of 0 log copies/mL (IQR 0-10) compared to pre-UART (6.2; IQR 0-10) (p=0.09). CD4 count, age adjusted-IPI and Ki67 proliferation index were similar for DLBCL patients in the two groups. Interpretation: There were no significant differences in lymphoma subtypes diagnosed or in traditional DLBCL prognostic factors after implementation of universal ART in Malawi. However, HIV was better controlled in the post-UART period and differences in immunological status may have implications for therapy and prognosis. Strengths of this study include a deeply characterized cohort, both clinically and pathologically. As opposed to epidemiological data from the US and Europe, we did not see a major shift in diagnoses over this time period with increasing access to ART. However, possible explanations for the differences include that this is not a epidemiological survey as cancer registration data is not comprehensively collected in Malawi and that the roll out of ART across sub-Saharan Africa has been much more gradual than the abrupt increase in access that was seen in the US and Europe. Therefore, epidemiological chances may also be more gradual. In summary, this is some of the most comprehensive data on lymphoma presentation from sub-Saharan Africa across periods of increasing access to ART and despite improved HIV control among incident lymphoma cases, there was no change in the distribution of diagnoses in this time period. Figure 1 Figure 1. Disclosures No relevant conflicts of interest to declare.

scholarly journals Sexual violence and suicidal ideation among French adults, a mediation analysis

2019 ◽  
Vol 29 (Supplement_4) ◽  
Author(s):  
F El-Khoury ◽  
Keyword(s):  
Mental Health ◽  
Suicidal Ideation ◽  
Sexual Assault ◽  
Sexual Violence ◽  
Mediation Analysis ◽  
Suicide Attempts ◽  
Mental Health Problems ◽  
Adult Population ◽  
Cross Sectional ◽  
Increased Risk

Abstract Objectives Sexual violence against women is endemic and is linked with a host of mental health problems and suicidal behaviour. We test whether sexual violence is more prevalent and have more damaging psychological effects among women compared to men, and quantify its mediating role in the association between sex and suicidal ideation and behaviour. Methods We used data from the “Health Barometer” (Baromètre Santé) 2017 a cross-sectional phone survey, which recruited a nationally representative sample of French adults aged 18 to 75 years in 2017 (n = 25319). Data were weighted to be representative of the French adult population. Outcomes included suicidal ideation, imagery of suicide, and suicide attempts in the preceding year. We conducted mutlivariable mediation analysis using the counterfactual approach to evaluate the contribution that lifetime sexual violence has in the association between sex and suicidal ideation and behaviour. Results We found that women are five times more likely to have experienced sexual victimisation, and are more at risk of any suicidal ideation and imagery of suicide in the preceding year compared to men. Women and men had comparable rates of suicide attempts in the preceding year. We estimated that 47% of the increased risk of suicidal ideation in the preceding year women have compared to men is mediated by lifetime sexual assault. Lifetime sexual assault also explained 39% of the association between sex and having imagery of suicide. Discussion Our findings reiterate the importance of the prevention of sexual violence and an adequate care for sexual assault victims, especially women, in public health and mental health policies and initiatives. Key messages Women are five times more likely to have experienced sexual victimisation compared to men, and are more likely to suffer from suicidal ideation in the preceding year. Experience of lifetime sexual violence contributes substantially (around 50%) to women’s increased likelihood of suicidal ideation compared to men.

Toward the integration of comprehensive mental health services in HIV care: An assessment of psychiatric morbidity among HIV-positive individuals in sub-Saharan Africa

AIDS Care ◽  
2013 ◽  
Vol 25 (9) ◽  
pp. 1193-1198 ◽  
Author(s):  
Andrew T. Olagunju ◽  
Olasimbo A. Ogundipe ◽  
Adebayo R. Erinfolami ◽  
Abiola A. Akinbode ◽  
Joseph D. Adeyemi
Keyword(s):  
Mental Health ◽  
Mental Health Services ◽  
Health Services ◽  
Psychiatric Morbidity ◽  
Sub Saharan Africa ◽  
Hiv Care ◽  
Hiv Positive ◽  
Sub Saharan

scholarly journals Cannabis and suicide: longitudinal study

2009 ◽  
Vol 195 (6) ◽  
pp. 492-497 ◽  
Author(s):  
Ceri Price ◽  
Tomas Hemmingsson ◽  
Glyn Lewis ◽  
Stanley Zammit ◽  
Peter Allebeck
Keyword(s):  
Mental Health ◽  
Longitudinal Study ◽  
Suicidal Ideation ◽  
Military Service ◽  
Mental Health Problems ◽  
Strong Association ◽  
Cannabis Use ◽  
Completed Suicide ◽  
Increased Risk

BackgroundSome studies suggest that cannabis use is associated with suicidal ideation, but no detailed longitudinal study has examined suicide as an outcome.AimsTo examine the association between cannabis use and completed suicide.MethodA longitudinal study investigated 50 087 men conscripted for Swedish military service, with cannabis use measured non-anonymously at conscription. Suicides during 33 years of follow-up were identified by linkage with the National Cause of Death Register.ResultsThere were 600 (1.2% of cohort) suicides or deaths from undetermined causes. Cannabis use was associated with an increased risk of suicide (crude OR for ‘ever use’ 1.62, 95% CI 1.28–2.07), but this association was eliminated after adjustment for confounding (adjusted OR = 0.88, 95% CI 0.65–1.20).ConclusionsAlthough there was a strong association between cannabis use and suicide, this was explained by markers of psychological and behavioural problems. These results suggest that cannabis use is unlikely to have a strong effect on risk of completed suicide, either directly or as a consequence of mental health problems secondary to its use.

scholarly journals A multi-country analysis of the prevalence and factors associated with bullying victimisation among in-school adolescents in sub-Saharan Africa: evidence from the global school-based health survey

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Richard Gyan Aboagye ◽  
Abdul-Aziz Seidu ◽  
John Elvis Hagan ◽  
James Boadu Frimpong ◽  
Eugene Budu ◽  
...  
Keyword(s):  
Suicidal Ideation ◽  
Health Survey ◽  
Sub Saharan Africa ◽  
Suicidal Attempt ◽  
Network Systems ◽  
School Based ◽  
Increased Risk ◽  
Sub Saharan ◽  
Bullying Victimisation ◽  
Victims Of Bullying

Abstract Background Over the past few years, there has been growing public and research interest in adolescents’ experiences with various forms of bullying victimisation because of their psychological, emotional, and/ or physical consequences. The present study examined the prevalence of bullying victimisation and its associated factors among in-school adolescents in sub-Saharan Africa. Methods Using data from the Global School-based Health Survey (GSHS) from 2010 to 2017 of eleven sub-Saharan African countries, a sample of 25,454 in-school adolescents was used for analysis. Statistical analyses included frequencies, percentages, Pearson chi-square and multivariable logistic regression. Results were presented as adjusted odds ratios (aOR) at 95% confidence intervals (CIs). Results The overall prevalence of bullying victimisation among the respondents was 38.8%. The prevalence was lowest in Mauritius (22.2%) and highest in Sierra Leone (54.6%). Adolescents who felt lonely [aOR = 1.66, 95% CI = 1.53, 1.80], had history of anxiety [aOR = 1.53, 95% CI = 1.41, 1.66], suicidal ideation [aOR = 1.28, 95% CI = 1.17, 1.39], suicidal attempt [aOR = 1.86, 95% CI = 1.72, 2.02], current users of marijuana [aOR = 1.59, 95% CI = 1.38, 1.84], and truants at [aOR = 1.43, 95% CI = 1.34, 1.52] were more likely to be victims of bullying. Conversely, adolescents who had peer support were less likely to be victims of bullying [aOR = 0.78, 95% CI = 0.73, 0.82]. Adolescents aged 15 years or older had lower odds of experiencing bullying victimization compared to their counterparts aged 14 years or younger [aOR = 0.74, 95% CI = 0.69, 0.78]. Conclusion Our findings suggest that age, loneliness, anxiety, suicidal ideation, suicidal attempt, and current use of marijuana are associated with increased risk of bullying victimisation. School-wide preventative interventions (e.g., positive behavioural strategies- Rational Emotive Behavioral Education, [REBE], peer educator network systems, face-face counseling sessions, substance use cessation therapy) are essential in promoting a positive school climate and reduce students’ bullying victimisation behaviours.

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