Lupine Publishers| Online Journal of Neurology and Brain Disorders (OJNBD)
Abstract
Background: Suicidal ideation has long been associated with HIV infected populations worldwide. It has been found that HIV does not only attack the immune system of an individual but also the nervous system leading to psychological dysfunction of an individual. Objective: To establish the prevalence of suicidal ideation among people living with HIV and AIDS. Method: A cross sectional quantitative design was adopted. Systematic random sampling method was used to select the sample. The total sample comprised of 280 participants. A social demographic questionnaire and Suicidal Risk Screening Scale (SRSS) were used to collect data. Results: The study findings from the SRSS test revealed that (n=193, 69%) of the participants had lower suicide risk while (n=87, 31%) fell into the higher suicide risk category. The study therefore showed that the prevalence of suicidal ideation was 31%. Conclusion: Suicidal ideation was prevalent among people living with HIV and Aids.
Keywords: Suicidal ideation; Human immunodeficiency virus; Psychological dysfunction
Introduction
IHuman Immunodeficiency Virus (HIV) was first reported in 1981 and has since become a major worldwide epidemic. HIV attacks the immune system of the body and causes the Acquired Immune Deficiency Syndrome (AIDS) [1]. When an individual has HIV the body becomes susceptible to diseases since the immune system has been reduced and can neither fight infections nor protect the person from diseases. This condition tends to trigger different psychological challenges among the people who are infected [2] found that since 1990, 271 or nearly 2% of approximately 14,000 people living with HIV who died in the United Kingdom had taken their own lives, and the proportion of deaths due to suicide had increased in the period since effective HIV treatment became available. It is generally believed that non-adherence to treatment is an expression of suicidal thoughts. The evidence from literature reveals that those who make suicidal attempts have seriously thought about doing so earlier. Sub-Saharan Africa has one of the highest global prevalence rates of HIV and AIDS. There are an estimated 24.7 million (23.5-26.1 million) People Living with HIV and AIDS (PLWHA) in sub-Saharan Africa [3]. The infection is more prevalent in Africa among developing countries and South Africa is considered to be one of the world’s worst affected by HIV and AIDS and about 5.7 million people are affected and one in three pregnant women are living with HIV and AIDS [4].
Zambia being a developing country has not been spared from prevalence of HIV, and the adult HIV prevalence rate stood at 14.3% in 2007 [5] and is still high at 12.5% [3]. Furthermore, the knowledge of HIV status has major implications for individuals who are positive with the infection. A study conducted in South Africa among PLWHA revealed that 24% who were tested had suicidal ideation [6]. In South Africa, many suicides and attempted suicides go unreported, but available statistics are alarming, with prevalence rate of between 17-25 per 100,000 of the population and an attempted suicide ratio of about 1:20 [7]. Suicide accounts for about 9.5% of non-natural deaths in young people and 11% in adults in the country, with the average age of suicide being 35 years and for suicide attempts 20-29 years followed by the 10- 19-year age group. Consequently suicidal ideation, attempts, and completions remain alarmingly common among people living with HIV and AIDS (PLWHA), despite a recorded decline in suicide rates since the advent of Highly Active Antiretroviral Therapy (HAART) in the 1990s to levels comparable with those of other chronic disease afflicted populations [7].
Statement of the problem
Suicidal ideation is one of the public concerns among people living with HIV and AIDS. Suicidal thinking may occur among people living with HIV and AIDS, triggering harmful impacts on the quality of life, treatment adherence, and disease progression [8]. The HIV and AIDS infection attacks the immune and nervous systems leading to psychological dysfunction. Prolonged conditions of HIV and AIDS subject people to suicidal ideation and attempted suicide and in some cases lives have been lost [8] and [7]. Suicidal ideations are significantly common among persons living with HIV and AIDS compared to non-infected controls and have been reported in most cases to be associated with psychiatric disorder [9]. Yet the psychosocial factors contributing to these psychiatric disorders remain unreported, particularly in the developing country context and mostly, in sub-Saharan African countries [10]. In Zambia, there has been no evidence of research publications on the prevalence of suicidal ideation among people living with HIV and AIDS. Therefore, this research sought to investigate the prevalence of suicidal ideation among people living with HIV and AIDS.
Objective of the study
To investigate the prevalence of suicidal ideation among people living with HIV and AIDS attending ART clinic at Adult Centre of Excellence at UTH in Lusaka.
Literature Review
Introduction
High rates of suicide and accidental or violent death have also been described in HIV infected populations including in those receiving effective ART [11]. The extent to which HIV infection is also associated with increased risk of suicidal ideation is not well documented. Hence, most HIV-related studies focus on suicide as an endpoint [12]. As such this has resulted in less studies focussing on the aspect of prevalence suicidal ideation. According to [13,14]. Suicidal thought involves a range of suicidal behaviours, which sometimes may be fatal or non-fatal. In a study of British private households, some researchers found differences in the risk pattern of suicidal thoughts compared to completed suicide [15]. In that study the incidence of suicidal thoughts was seen to be over 200 times greater than the incidence of suicide. Therefore, from the literature given, people living with HIV and AIDS tend to be more subjected to negative thoughts which lead to poor quality of life with suicidal thoughts.
Neurological changes
The researchers [16] stated that the nervous system is the worst impaired system in HIV condition after the immune systems. This dysfunction has an effect on the psychological aspect of PLWHA which makes them vulnerable to self-harming. Several studies have reported that, HIV infection has an effect on neuropsychological functioning ranging from mild to severe [17]. Hence, neurological changes are some of the causes of suicidal ideation as these substrates also affect the ability to initiate action or thought and regulate mood, and they promote persistent perseveration dysfunctions [18,19]. These neurological changes may bring about negative thoughts towards physical appearances and psychological dysfunctions.
In addition, the prevalence of self-harm or suicidal ideation will tend to persist in the condition of repeated suicidal thinking among individuals living with HIV and AIDS. Therefore, Emotional difficulties along with the tendency for perseveration may influence the ability to think about problems while impairing the ability to think logically. In fact, according to [20] adults who have a ruminative personality style are more likely to contemplate suicide. These adults are likely to become stressed up on negative issues as they go into deeper thoughts with anxiety. Consequently, more severe side effects of ART, detectable HIV viral load, and a critically low T-helper CD4 cell counts may also be related to suicidal ideation. As individuals have low CD4 cell counts, they are subjected to poor health conditions in which contracting of multiple infections cannot be prevented and suicidal ideation is likely to persist on their psychological well-being [21].
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