Prevalence of depression and suicidal ideation and associated risk factors in adolescents receiving care and treatment for HIV/aids at a tertiary health facility in Kilimanjaro region, Tanzania

Abstract

Background: The HIV/AIDS pandemic is a significant health concern worldwide since the first case emerged in the early 1980’s. Most of the HIV disease burden is in Sub Saharan Africa (SSA). Depression and suicidal ideation have been found to be higher among people living with HIV/AIDS (PLWHA) than persons not infected with HIV. Adolescents living with HIV/AIDS (ALWH) are more at risk of suffering from depression and suicidal ideation than their unaffected peers. Several factors such as social demographics, poor social support, clinical and other contextual factors such as HIV related stigma have been found to be significantly associated with depression and suicidal ideation among adolescents living with HIV/AIDS. Moreover, depression and suicidal ideation may lead to poor ART adherence, lower viral load suppression and development of opportunistic infections. Screening and treatment of mental disorders may improve the health and quality of life of ALWH. Few studies have evaluated the mental health of ALWH in SSA. However, these studies do not provide information on the magnitude of suicidality among this population subgroup despite them being at high risk. Objective: -The aim of the study is to determine the prevalence of depression and suicidal ideation and explore associated risk factors in adolescents receiving care and treatment for HIV/AIDS at a tertiary health facility in Kilimanjaro region, Tanzania. Materials and methods: - A hospital based cross-sectional analytical study using quantitative approach was conducted. Adolescents receiving care and treatment for HIV/AIDS in a youth clinic at Kilimanjaro Christian Medical Centre (KCMC) were sampled. Data collection on depression was done using Patient Health Questionnaire for Adolescents (PHQ-A) a screening instrument that is used to screen for probable depression in adolescents henceforth referred for diagnosis. A semi-structured questionnaire captured the socio-demographic and clinical information characteristics of the participants, also included a short version of the HIV Stigma Scale measured HIV related stigma, a social support measure (Multidimensional Perceived Social Support Scale (MSPSS)) and a locally developed Hope Scale assessed hopefulness. Captured data were analyzed using SPSS version 23; Frequency distributions described the participants’ sociodemographic characteristics. Chi-Square test established the univariate association between the independent and the dependent variables. While analysis to identify independent risk factors of suicidality and depression used a multivariate logistic regression model. Associated risk factors and the strengths of association are summarized using odds ratios (ORs) and 95% confidence intervals. Ethical clearance was obtained from MUHAS Senate Research and Publications Committee and permission sought from the administration of KCMC. Results: A total 170 adolescents were studied, 96 (56.5%) were females while 74 (43.5%) were males. Mean age (standard deviation) of participants was 15.06 (2.2) years. The prevalence of depression was 15.9% and that of suicidal ideation was 31.2%. Based on univariate analysis relatively high levels of HIV related stigma and lower levels of hope were significantly associated with depression and suicidal ideation. From multivariable analyses adolescents with low levels of hope were 9.2 times more likely to develop depression compared to those with high levels of hope (OR, 9.21, 95% CI: 2.16-39.32). Participants who experienced high level of HIV related stigma were 2.7 times more likely to have suicidal ideation compared to those with lowe levels(OR, 2.7, 95% CI: 1.01-7.37). Furthermore participants with low levels of hope were also 3.8 times more likely to have suicidal ideation compared to those with high levels (OR, 3.84, 95% CI: 1.50-9.84). Conclusion and recommendation: This study reveals depression and suicidal ideation among adolescents living with HIV to be 16% and 31% respectively. High levels of stigma and low hope were identified as risk factors. I recommend further studies to be done to evaluate mental health of adolescents living with HIV and integration of mental health services in the clinic providing services for these adolescents.