Suicidal Ideations and Attempts Among Adolescents in Kampala Urban Settlements in Uganda: A Case Study of Adolescents Receiving Care From the Uganda Youth Development Link

The effect of the COVID-19 pandemic and school closures on self-harming and suicidal behaviors in adolescents: A comprehensive meta-analysis

INTRODUCTION

The COVID-19 pandemic has significantly affected adolescents' mental health, raising concerns about the potential increase in self-harming and suicidal behaviors (SIB). This study aimed to evaluate the pandemic's impact on SIB among adolescents and explore the effects of school closures and psychiatric vulnerabilities to inform future interventions.

METHODS

A systematic review and meta-analysis were conducted using PubMed, resulting in 420 studies, of which 36 studies (comprising 53 samples) met the inclusion criteria, encompassing 1,754,106 adolescents. Effect sizes were calculated using proportion effect size. Heterogeneity across studies was assessed using Q-statistics and I², while Egger's test was applied to evaluate publication bias. Differences between clinical and community samples, as well as the influence of psychiatric symptoms or disorders, were examined.

RESULTS

Clinical samples demonstrated higher rates of SIB compared to community samples, with adolescents having psychiatric symptoms or disorders being more vulnerable. Overall, the pandemic was associated with a decline in SIB rates compared to pre-pandemic levels. Suicidal ideation decreased by 4.14% in combined samples and by 7.13% in community samples. Self-harm rates fell by 5.38% and 6.62% in combined and community samples, respectively. In contrast, clinical samples showed a distinct trend, with suicidal ideation decreasing by 29.39%, while self-harm rates increased by 32.51% and suicide attempts rose by 22.41%.

CONCLUSION

The COVID-19 pandemic's impact on adolescents' SIB varied significantly across population types and levels of psychiatric vulnerability. While general declines were observed, the pronounced increases in self-harm and suicide attempts among clinical samples highlight the need for tailored mental health interventions. Addressing these disparities is essential for future mental health strategies and crisis preparedness.

Suicidal Ideation and Attempts Among Youth Living With HIV/AIDS Attending Botswana-Baylor Children's Clinical Centre of Excellence: A Comparison Between Substance Users and Non-Substance Users

Introduction

Young people with HIV/AIDS (YLWHIV) who use substances early in life are at higher risk of suicidal thoughts and attempts. In Botswana, there is a lack of data needed to provide comprehensive care for this group. This study aimed to compare rates and predictors of suicidal ideation (SI) and attempts (SA) between substance users and non-users among YLWHIV at Botswana-Baylor Children's Clinical Centre of Excellence (BBCCCE).

Methods

This cross-sectional study, conducted from August 2022 to January 2023, involved 255 participants aged 15 to 24 and used the Youth Risk Behavior Surveillance System, the Oslo Social Support Scale, and the Patient Health Questionnaire-9. Chi-square tests were used to compare the prevalence of suicidal ideation and attempts among substance users and non-users, while logistic regression was used to identify factors associated with SI and SA.

Results

SI was found in 29.4%, SA in 6%, and depression in 39.6% of the participants, while tobacco, alcohol, and illicit drug use were 20.4%, 45.9%, and 11.8%. Depression (adjusted odds ratios [AOR] 9.71, 95% CI: 4.23-22.33), being bullied (AOR = 5.42, 95% CI: 1.97-14.91), and family history of completed suicide (AOR = 6.56, 95% CI: 1.16-37.12) were associated with the outcome, SI. Self-reported good health status (AOR = 0.23, 95% CI: 0.05-0.98), lack of family support (AOR = 5.92, 95% CI: 1.45-24.10), and past-year tobacco use (AOR = 7.37, 95% CI: 1.18-46.10) were associated with SA.

Conclusion

Due to the high rates of suicidal behavior among YLWHIV in BBCCCE, health facilities should scale up mental health services for this vulnerable group. This includes suicide risk assessments, bullying prevention, depression screenings, and counseling by trained lay health workers to promote their mental well-being.

Child maltreatment and suicidal ideation among justice-and welfare-involved adolescents in Nigeria: Investigating the mediating role of social support and emotion regulation

BACKGROUND

Suicidal ideation is a global public health burden and justice and welfare-involved adolescents are more affected than the general population. Past studies have examined its risk and protective factors among adolescents. However, the association between child maltreatment and suicidal ideation remains an under-studied topic among at-risk adolescents in low- and middle-income countries. This study filled this gap by examing the association between child maltreatment and suicidal ideation among two high-risk adolescents in Nigeria METHODS: The purpose of this study was to examine the nexus between child maltreatment and suicidal ideation. A cross-sectional design was adopted through multi-stage sampling. Suicidal ideation was measured using a validated self-report Massachusetts Youth Screening Instrument (MAYSI-2). Child maltreatment was measured using a validated self-report intrusment (ICAST-C). The sample comprised 205 respondents: justice-involved adolescents (102 (49.8 %) and welfare-involved adolescents (103 (50.2 %). Among them, 151 (73.7 %) were males, while 54 (26.3 %) were females.

RESULTS

Half (51 %) of the adolescents in detention and 39 % of the adolescents in residential care reported suicidal ideation. Emotional abuse (OR = 0.072; 95CI% -412, 0.75, p < .001), no parent is alive (OR = 0.502; 95CI% 0.234-3.15; p < .001), one parent is alive (OR = 0.522; 95 %CI 0.207, 3.09; p < .025) and female gender (OR = -0.22; 95CI% -1.37- 207; p < .008) predicted suicidal ideation. Suicidal ideation was comorbid with depressed-anxious symptoms (OR = 1.46; 95 %CI 1.172, 1.83; p < .001) accounting for 31 % (Nagelkerke R2) of the variance. Social support had an indirect effect on suicidal ideation via emotional abuse (OR = 0.072; 95 % CI = -412-0.75).

CONCLUSION

The findings underscore the influence of child maltreatment and family background on suicidal ideation. Interventions should include emotional abuse in suicide screening. Children who have lost one or both parents should be the primary focus of interventions.

Suicidal Ideation Among Kenyan Youth: A Qualitative Analysis of Online Life Stories

This study examines the experiences of suicidal ideation among Kenyan youth through a qualitative analysis of online narratives, a sample that comprised 15 young individuals aged 17-26 who shared their stories on online platforms. Employing Interpretative Phenomenological Analysis (IPA), the study highlights complex interactions of societal pressures, mental health challenges, and identity struggles that contribute to suicidal ideation. Key themes identified include the impact of cultural expectations, mental health stigma, isolation, and identity crises. By prioritizing the personal voices of the youth, the study sheds light on the deeply contextual nature of suicidal ideation and offers insights into the meanings individuals ascribe to their experiences. The findings advocate for culturally sensitive interventions and underscore the need to address mental health stigma, aiming to foster a supportive societal environment for Kenyan youth grappling with these issues.

Prevalence of probable substance use disorders among children in Ugandan health facilities

BACKGROUND

Globally, there is a concerning surge in the prevalence of substance use among adolescents and children, creating a substantial public health problem. Despite the magnitude of this issue, accessing healthcare explicitly for substance use remains challenging, even though many substance users frequently visit healthcare institutions for other health-related issues. To address this gap, proactive screening for substance use disorders has emerged as a critical strategy for identifying and engaging patients at risk of substance use. The purpose of this study was to investigate the prevalence of probable alcohol and other substance use disorders, and associated factors, among children aged 6 to 17 years old attending health facilities in Mbale, Uganda.

METHODS

We conducted a health facility cross-sectional study, involving 854 children aged 6-17 years. The prevalence of probable alcohol and other substance use disorders was assessed using a validated Car, Relax, Alone, Forget, Friends, Trouble (CRAFFT) screening tool. Univariable and multivariable modified Poisson regression analyses were performed using STATA 15 software.

RESULTS

The overall prevalence of probable alcohol use disorders (AUD) and other substance use disorders (SUD) was 27.8% (95% CI 1.24-1.31) while that of probable AUD alone was 25.3% (95% CI 1.22-1.28). Peer substance use (APR = 1.24, 95% CI 1.10-1.32), sibling substance use (APR = 1.14, 95% CI 1.06-1.23), catholic caregiver religion (APR = 1.07 95% CI 1.01-1.13), caregiver income of more than $128 (APR = 0.90, 95% CI 0.82-0.98), having no parental reprimand for substance use (APR = 1.05, 95% CI 1.01-1.10) and having no knowledge of how to decline an offer to use substances (APR = 1.06, 95% CI 1.01-1.12) were found to be significantly associated with probable AUD/SUD.

CONCLUSIONS

Our findings suggest a high prevalence of probable AUD and SUD among children and adolescents visiting healthcare facilities for other conditions, along with a strong link between AUD and SUD prevalence and social factors. The implication for our healthcare system is to actively screen for and treat these conditions at primary healthcare facilities.

Prevalence of suicidal ideation and correlated risk factors during the COVID-19 pandemic: A meta-analysis of 113 studies from 31 countries

The purpose of this study was to estimate the prevalence of suicidal ideation and correlated risk factors during the COVID-19 pandemic. Web of Science (WOS) and PubMed were searched according to a pre-set strategy. A total of 132 studies were identified, 104 of which were included in the meta-analysis. The prevalence of suicidal ideation was approximately 14.7% (95%CI: 12.5%, 16.8%, P < 0.01) in the general population, approximately 22.4% (95%CI: 17.1%, 27.8%, P < 0.01）in adolescents, approximately 21.0% (95%CI: 12.8%, 29.2%, P < 0.01) in psychiatric patients, approximately 20.6% (95%CI: 18.7%, 22.5%, P < 0.01）in university students, approximately 18.9% (95%CI: 8.3%, 29.5%, P < 0.01) in younger adults, approximately 10.6% (95%CI: 1.0%, 20.2%, P = 0.031) in COVID-19 patients and approximately 7.4% (95%CI: 4.3%, 10.5%, P < 0.01) in healthcare workers. The prevalence in North America was approximately 16.0% (95%CI: 13.6%-18.4%, P < 0.001), approximately 14.5% in Asia (95%CI: 9.5%-19.4%, P < 0.001), approximately 10.5% in Europe (95%CI: 8.5%-12.4%, P < 0.001), and approximately 20.5% in South America (95%CI: 19.5%-21.5%, P < 0.001). The following were risk factors which might be correlated with suicidal ideation: severe anxiety symptoms, mild to moderate depression, a strong feeling of loneliness/social isolation, poor sleep quality, having COVID-19-related experience, having quarantine or lockdown experience, being female, being single or divorced, having financial problems and having a history of suicidal ideation/attempt. This article reports the prevalence of suicidal ideation and discussing potential risk factors during the pandemic among general population and vulnerable groups. Early detection and follow-up were necessary for the noteworthy population.

Suicidal behavior among inpatients with severe mental conditions in a public mental health hospital in Uganda

BACKGROUND

Suicidal behaviors are prevalent among inpatients with severe mental conditions and may result in many dying by suicide. Few studies have focused on the burden of suicidal behaviors among these inpatients in low-income settings, despite suicide being consistently higher in lower-income countries such as Uganda. This study, therefore, provides the prevalence and associated factors of suicidal behaviors and suicide attempts among inpatients with severe mental conditions in Uganda.

METHOD

This was a retrospective chart review of all individuals admitted with severe mental conditions to a large psychiatry inpatient unit in Uganda for four years (2018-2021). Two separate logistic regressions were conducted to determine the factors associated with suicidal behaviors or suicidal attempts among the admitted individuals.

RESULTS

The prevalence of suicidal behavior and suicidal attempts among 3104 (mean age = 33, Standard deviation [SD] = 14.0; 56% were males) were 6.12% and 3.45%, respectively. Having a diagnosis of depression increased the likelihood of both suicidal behaviors (adjusted odds ratio [aOR]: 5.36; 95% confidence interval [CI]: 2.14-13.37; p =0.001) and attempts (aOR: 10.73; 95% CI: 3.44-33.50; p < 0.001). However, a diagnosis of substance-related disorder increased the likelihood of having attempted suicide (aOR: 4.14; 95% CI: 1.21-14.15; p = 0.023). The likelihood of having suicidal behavior decreased as one increased in age (aOR: 0.97; 95% CI: 0.94-0.99; p = 0.006) and increased among individuals reporting stress from financial constraints (aOR: 2.26; 95% CI: 1.05-4.86; p = 0.036).

CONCLUSION

Suicidal behaviors are common among inpatients managed for severe mental health conditions in Uganda, especially those with substance use and depressive disorders. In addition, financial stressors are a main predictor in this low-income country. Therefore, regular screening for suicide behaviors is warranted, especially among individuals with depression, and substance use, among those who are young, and among those reporting financial constraints/stress.

Lifetime violence and suicidal ideation among young women (18-24 years) in Uganda: Results from a population-based survey

Introduction

Violence is a major global public health issue that threatens the physical and mental health of victims. Of particular concern is the increasing evidence which suggests that violence is strongly associated with suicidal behavior including ideation.

Methods

This study uses data from the 2015 Violence Against Children Survey (VACS). This study seeks to highlight the relationship between lifetime violence and suicidal ideation using a nationally representative sample of 1,795 young women (18-24 years) in Uganda.

Results

Results indicate that respondents who experienced lifetime sexual violence (aOR = 1.726; 95%CI = 1.304-2.287), physical violence (aOR = 1.930; 95%CI = 1.293-2.882) or emotional violence (aOR = 2.623; 95%CI = 1.988-3.459) were more likely to experience suicidal ideation. Respondents who were not married (aOR = 1.607; 95%CI = 1.040-2.484), not having too much trust with community members (aOR = 1.542; 95%CI = 1.024-2.320) or not having a close relationship with biological parents (aOR = 1.614; 95%CI = 1.230-2.119) were more likely to experience suicidal ideation. Respondents who did not engage in work in the past 12 months prior to the survey (aOR = 0.629; 95%CI = 0.433-0.913) were less likely to experience suicidal ideation.

Conclusion

The results can be used to inform policy and programming and for integration of mental health and psychosocial support in programming for prevention and response to violence against young women.

Suicide spectrum among young people during the COVID-19 pandemic: A systematic review and meta-analysis

Background

There are concerns that suicidal behaviors are arising among adolescents. The COVID-19 pandemic could have worsened the picture, however, studies on this topic reported contrasting results. This work aimed to summarise findings from the worldwide emerging literature on the rates of suicidality among young people during the COVID-19 pandemic.

Methods

A systematic review and meta-analysis were performed, searching five electronic databases for studies published from January 1, 2020 until July 27, 2022. Studies reporting rates for each of the three considered outcomes (suicide, suicidal behaviors, and suicidal ideation) among young people under 19 years old during the COVID-19 pandemic were included. Random-effects meta-analyses were conducted, and the intra-study risk of bias was assessed. When pre-COVID-19 data were available, incidence rate ratio (IRR) and prevalence ratio (PR) estimates were calculated between the two periods. All the analyses were performed according to the setting explored: general population, emergency department (ED), and psychiatric services. The review protocol was registered on PROSPERO (CRD42022308014).

Findings

Forty-seven observational studies were selected for more than 65 million subjects. The results of the meta-analysis showed a pooled annual incidence rate of suicides of 4.9 cases/100,000 during 2020, accounting for a non-statistically significant increase of 10% compared to 2019 (IRR 1.10, 95% CI: 0.94-1.29). The suicidal behaviors pooled prevalence during the COVID-19 pandemic was higher in the psychiatric setting (25%; 95% CI: 17-36%) than in the general population (3%; 1-13%) and ED (1%; 0-9%). The pooled rate of suicidal ideation was 17% in the general population (11-25%), 36% in psychiatric setting (20-56%) and 2% in ED (0-12%). The heterogeneity level was over 97% for both outcomes in all settings considered. The comparison between before and during COVID-19 periods highlighted a non-statistically significant upward trend in suicidal behaviors among the general population and in ED setting. The only significant increase was found for suicidal ideation in psychiatric setting among studies conducted in 2021 (PR 1.15; 95% CI: 1.04-1.27), not observed exploring 2020 alone.

Interpretation

During the pandemic, suicide spectrum issues seemed to follow the known pattern described in previous studies, with higher rates of suicidal ideation than of suicidal behaviors and suicide events. Governments and other stakeholders should be mindful that youth may have unique risks at the outset of large disasters like the COVID-19 pandemic and proactive steps are necessary to address the needs of youth to mitigate those risks.

Funding

The present study was funded by the University of Torino (CHAL_RILO_21_01).