TITLE:
Suicide ideation, depression and HIV among pregnant women in rural South Africa
AUTHORS:
Tamsen J. Rochat, Ruth M. Bland, Mark Tomlinson, Alan Stein
KEYWORDS:
uicide Ideation; Pregnancy; Depression; HIV; Rural; South Africa
JOURNAL NAME:
Health,
Vol.5 No.3A,
March
30,
2013
ABSTRACT: Background:
Despite public perception to the contrary, pregnancy does not offer a protective
effect for suicide ideation. In low and middle income countries (LMIC) multiple
concurrent risk factors including unplanned pregnancies, testing for HIV, intimate
partner violence and depression may increase suicide risk among pregnant women. We examine suicide ideation among women attending routine antenatal care in rural South Africa. Method: A consecutive
series of 109 women in the second half of pregnancy were enrolled in a cross-sectional
study at a large primary health care facility in a rural area of KwaZulu-Natal with
high HIV prevalence. Using a mixed-methods approach, women were assessed using the
Major Depression Section of the Structured Clinical Interview for Depression (SCID)
for DSM-IV diagnosis; qualitative interview data were collected on women’s experiences of suicide ideation and plans. Women were assessed two weeks after routine
HIV testing as part of Prevention of Mother-to-Child Transmission (PMTCT) screening.
Results: Both HIV-positive (49/109) and HIV-negative (60/109) women were assessed.
Depression was high (51/109, 46.7%) and equally common amongst HIV-positive and
negative women. Suicide ideation was high (30/109, 27.5%) with thoughts of self
harm closely linked to suicide plans. Age, previous history of depression and current
depression were significantly associated with suicide ideation. Close to equal
numbers of HIV-positive and negative women were suicidal. Suicide methods were
frequently violent and most women cited family and partnership conflict related
to an unplanned pregnancy or their newly HIV-positive
status as triggers to their suicide ideation. Conclusions: Rates of suicide ideation among pregnant
women testing for HIV are high. Testing HIV-positive causes considerable distress,
and among HIV-negative women unplanned and unwanted pregnancies are important risk factors for suicide ideation. Pregnancy
brings women into increased contact with the health services with important
opportunities for prevention and intervention.