Suicide ideation and depression in university students in Botswana

Symptoms of depression, anxiety, and thoughts of suicide/self-injury in adolescents and young adults living with HIV in Botswana

Globally, mental health problems have been reported to be more common in youth living with HIV (YLWH) than in the general population, but routine mental health screening is rarely done in high-volume HIV clinics. In 2019, YLWH in a large HIV clinic in Botswana were screened using the Generalized Anxiety Scale-7 (GAD-7) and Patient Health Questionnaire-9 (PHQ-9) in a pilot standard-of-care screening programme. Two-way ANOVA was used to describe the effects of age group (12-<16, 16-<20 and 20-25 years old) and sex on GAD-7 and PHQ-9 scores. Chi-square statistics were used to compare characteristics of YLWH with and without potential suicidality/self-harm symptoms based on question 9 in the PHQ-9. Among 1 469 YLWH, 33.1%, 44.3% and 15.0% had anxiety, depression and potential suicidality/self-harm symptoms respectively. YLWH of 20-25 years old and 16-<20 years old had higher GAD-7 scores compared to 12-<16-year-olds (p = 0.014 and p = <0.001 respectively). Female YLWH of 20-25 years old had higher PHQ-9 scores compared to 12-<16-year-olds (p = 0.002). There were no other sex-age dynamics that were statistically significant. Female YLWH endorsed more thoughts of suicidality/self-harm than males (17% versus 13%, p = 0.03 respectively). Given the proportion of YLWH with mental health symptoms, Botswana should enhance investments in mental health services for YLWH, especially for young female adults who bear a disproportionate burden.

Prevalence and predictors of suicidal behaviours among primary and secondary school going adolescents in Botswana

BACKGROUND

There is a scarcity of studies on the prevalence and predictors of suicide behaviors among primary and secondary school going adolescents aged 10-19 years in Botswana hence, this study would fill that gap.

METHODS

This study used cross-sectional secondary data from Botswana Youth Risk Behavior and Biological Surveillance Survey (BYRBBSS), 2010. Multivariable binary logistic regression models were used to investigate the predictors of suicide behaviours.

RESULTS

The study shows that 51.5% of the respondents reported having ever contemplated suicide while 40.1% of the respondents attempted suicide in the last 12 months before the survey. The study found that male learners (AOR = 0.61, 95% CI = 0.44-0.83), learners who were not attacked or threatened or injured by someone (AOR = 0.35, 95% CI = 0.17-0.72), who were not bullied (AOR = 0.22, 95% CI = 0.13-0.39), and who were confident of themselves (AOR = 0.55, 95% CI = 0.39-0.76) were less likely to contemplate suicide. Whereas learners with primary school level education were more likely to contemplate suicide (AOR = 2.12, 95% CI = 1.14-3.95). Males were less likely than their female counterparts to attempt suicide (AOR = 0.68, 95% CI = 0.47-0.97). Regarding attempt, learners who had self-confidence (AOR = 0.35, 95% CI = 0.24-0.50), not being bullied (AOR = 0.20, 95% CI = 0.11-0.35), not being attacked or threatened or injured by someone (AOR = 0.35, 95% CI = 0.18-0.69), not engaging in a physical fight that led to injury (AOR = 0.34, 95% CI = 0.19-0.61) were less likely to attempt suicide. Whereas being at primary school (AOR = 5.29, 95% CI = 2.58-10.86), and missing classes once or more in a week (AOR = 1.70, 95% CI = 1.05-2.76) were associated with increased likelihood of suicide attempt.

CONCLUSION

The study shows that suicide behaviours as big challenges in Botswana among primary and secondary school going adolescents aged 10-19 years. Thus, the study recommends policy interventions aiming at including education on peer bullying or fighting or attack at primary and secondary education levels if not already in existence. There should also be interventions aiming at educating guardians and teachers on consequences of bullying or fighting so that they should consistently remind their children not to bully and for them to open up if they are being bullied. The study further recommends that schools and communities at large should have a psychosocial system for bullying or fighting reporting, follow-up, and appropriate corrective interventions for the offenders. There should also be self-confidence instilling education as well as sex/gender-specific interventions for instance girls can be given platform (private if necessary) to express peculiar problems to them that need specific help.

Depression and suicidal behavior among adolescents living with HIV in Botswana: a cross-sectional study

BACKGROUND

Depression and suicidal behavior are the main causes of disability and morbidity, especially in adolescents living with HIV (ALWHIV). Data regarding these are lacking in Botswana, a country with a predominantly youthful population and ranked among the top four in the world most affected by HIV. Therefore, the present study aimed to estimate the prevalence of depression and suicidal behavior and explore their associated factors in Botswana ALWHIV.

METHODS

Responses were obtained from 622 ALWHIV using the DSM-5 and the Mini-International Neuropsychiatric Interview for Children and Adolescents.

RESULTS

The mean age (SD) of the participants was 17.7 (1.60) years and more males (54.3%) participated than females. Depression and suicidal behavior rates among adolescents were 23% and 18.9%, respectively. Female participants were more likely to be depressed (AOR = 1.96; 95% CI 1.11-3.45) and have suicidal behaviour (AOR = 6.60; 95% CI 3.19-13.7). Loss of mother (AOR = 2.87; 95% CI 1.08-7.62) and viral load of 400 copies and above (AOR = 5.01; 95% CI 2.86-8.78) were associated with depression. Alcohol use disorder (AOR = 3.82; 95% CI 1.83-7.96) and negative feelings about status (AOR = 8.79; 95% CI 4.62-16.7) were associated with suicidal behavior. Good support (AOR = 0.42; 95% CI 0.23-0.76) and increased frequency of religious activities were protective (AOR = 0.33; 95% CI 0.14-0.79) against depression and suicidal behaviour, respectively.

CONCLUSION

Therefore, routine psychologic screening, which includes identifying psychological stressors and maladaptive coping, family and caregiver support services, and psychosocial support platforms, should be integrated into the management package for ALWHIV in Botswana.

Suicidal behaviours among Ugandan university students: a cross-sectional study

BACKGROUND

Suicide remains the leading cause of death among university students often resulting from multiple physical and psychological challenges. Moreover, suicidal behaviours among students appear to have increased due to the COVID-19 pandemic according to some studies.

OBJECTIVE

To explore the prevalence and associated factors for suicidal ideation, suicide plans, and suicide attempts among university students in Uganda.

METHODS

Cross-sectional study data were collected from May to September 2021 from 540 undergraduate university students in south-western Uganda (363 males, mean age 23.3 years). Questions from the General Health Questionnaire (GHQ-28) were used to assess suicidal ideation, while other bespoke questions were used to assess suicide plans and attempts. The survey also investigated the suicide attempt/plan method, location of the suicidal activity, and reason for not enacting the suicide plan. Three independent regression analyses were used to determine the factors associated with different forms of suicidal behaviours.

RESULTS

The prevalence of past-year suicidal behaviours was 31.85% for suicidal ideation, 8.15% for suicide plans, and 6.11% for suicide attempts. Having a chronic physical medical condition increased the likelihood of having all forms of suicidal behaviours. Suicidal ideation was associated with having difficulty paying university tuition fees. However, being in the fifth year of university education, and feeling satisfied with current academic grades reduced the likelihood of suicidal ideation. Individuals feeling satisfied with academic performance appeared to be a protective factor against having suicide plans. Suicide attempts were associated with having a history of sexual abuse and having difficulty paying university tuition fees. The most common method used for attempted suicide was a drug overdose, and the most common location for attempted suicide was their homes.

CONCLUSION

University students have prevalent suicide behaviours especially among students with a chronic physical medical condition, a history of sexual abuse, and problems paying university tuition fees. Based on the present study, for students at risk, universities should provide appropriate interventions such as life skills education and suicide prevention techniques.

The Mental Health and Syndemic Effect on Suicidal Ideation among Migrant Workers in China: A Cross-Sectional Study

Background: Migrant workers are in a socially disadvantaged position and thus suffer from more stress and mental health disorders, resulting in a high risk of suicidal ideation. This study aimed to explore the association between psychosocial problems and suicidal ideation, and the syndemic effect of concurrent psychosocial problems on suicidal ideation among migrant workers. Methods: We conducted a cross-sectional study and recruited 1805 migrant workers in Shenzhen, China. Each participant completed a self-administered questionnaire to report sociodemographic information and mental health status. Univariate and multivariate logistic regression were used to explore the association between psychosocial variables and suicidal ideation, and their syndemic effect on suicidal ideation. Results: The prevalence of suicidal ideation among migrant workers was 7.5%. All selected psychosocial variables were independently associated with suicidal ideation. Multivariate logistic regression analysis showed that three psychosocial variables were associated with suicidal ideation: anxiety (ORm: 1783, 95% CI: 1.089–2.920), entrapment (ORm: 2.064, 95% CI: 1.257–3.388), and defeat (ORm: 2.572, 95% CI: 1.612–4.103). Various mental health issues can exist simultaneously to increase the risk of suicidal ideation (AOR: 5.762, 95% CI: 3.773–8.802). Workers with more psychosocial problems were more likely to have suicidal ideation. Conclusions: The association between poor mental health and suicidal ideation should not be overlooked among migrant workers. The co-occurring or syndemic effect of psychosocial problems may increase the risk of suicidal ideation.

The relationship between adverse childhood experiences and depression: A cross-sectional survey with university students in Botswana

BACKGROUND

Adverse childhood experiences (ACEs) are associated with severe life-long negative outcomes, including depression. Particularly in low- and middle-income countries, few studies have been conducted to assess the impact of ACEs.

AIM

To assess the influence of ACEs on depression among young adults.

SETTING

Participants were students at a large university in Gaborone, Botswana.

METHODS

Using a cross-sectional design, we investigated the associations between ACEs and depression in young adults in Botswana (n = 392, mean age = 22.2, ± 2.5, 53.4% female). Bivariate correlation analyses, t-tests and analyses of variance (ANOVA) were performed to assess associations and compare ACEs at different levels of depression.

RESULTS

A total of 73% (n = 287) reported one or more ACEs, whilst 15% (59) reported five or more ACEs. About 64% (38) of those who reported five or more ACEs were female respondents. Prevalence of specific ACEs ranged from 9.5% (child neglect) to 36.3% (separation and divorce). One in three respondents reported parental separation or divorce, psychological abuse and family dysfunction, whilst 19% (11% moderate and 8% severe) reported significant depressive symptoms. Adverse childhood experiences significantly predicted depression (β = 0.27, 95% confidence interval [CI]: 0.18, 0.37). Respondents at different levels of depression significantly differed on reporting ACEs (F (3, 389) = 11.43, p < 0.001).

CONCLUSION

Adverse childhood experiences are highly prevalent and key determinants of depression in young adulthood. A multifaceted and cross-system intervention (e.g. schools, social work, psychological services, health services and law enforcement) is required to protect, prevent and treat survivors of childhood adversity.

Psychiatric epidemiological survey of university students in Botswana: rationale and methods of the Youth Mental Health Study (YMHS)

BACKGROUND

While the burden of disease attributable to mental disorders in low/middle-income countries (LMICs) is lower than high-income countries, there is recognition that the dearth of evidence from the LMICs may underestimate the actual prevalence and burden associated with mental disorders. Such is likely the case for Botswana where there has been no nationally representative data on the prevalence of symptoms of mental disorders or even a subgroup estimation of mental disorders in the country. Thus, the Youth Mental Health Study (YMHS) aims to estimate the prevalence and identify predictors of symptoms of mental disorders among university students in Botswana to add to the evidence and contribute to the country's health service planning.

METHODS

The YMHS is a cross-sectional study of youth (18-29 years) attending six large universities (accounting for nearly half of the tertiary student population) in Botswana. A stratified sampling procedure with proportionate allocation and selection is used to select a representative sample of 1308 participants. An online survey comprising of a battery of reliable and validated self-report measures of symptoms of mental disorders is used. A developmental psychopathology framework is used in identifying the risk factors of mental disorders. Participant recruitment will span over 4 months beginning in February 2020.

ETHICS AND DISSEMINATION

The study has received ethics approval from the University of Botswana Institutional Review Board, and the Ministry of Health and Wellness. Participants will be provided with feedback of their own results. Aggregated findings will be disseminated to stakeholders in the tertiary education and health sector in Botswana, and through peer-reviewed journals, conference presentations and the media.

Mental health research in Botswana: a semi-systematic scoping review

Mental and substance use disorders are a leading cause of disability worldwide. Despite this, there is a paucity of mental health research in low- and middle-income countries, especially in sub-Saharan Africa. We carried out a semi-systematic scoping review to determine the extent of mental health research in Botswana. Using a predetermined search strategy, we searched the databases Web of Science, PubMed, and EBSCOhost (Academic Search Complete, CINAHL with Full Text, MEDLINE, MEDLINE with Full Text, MLA International Bibliography, Open Dissertations) for articles written in English from inception to June 2020. We identified 58 studies for inclusion. The most researched subject was mental health aspects of HIV/AIDS, followed by research on neurotic and stress-related disorders. Most studies were cross-sectional and the earliest published study was from 1983. The majority of the studies were carried out by researchers affiliated to the University of Botswana, followed by academic institutions in the USA. There seems to be limited mental health research in Botswana, and there is a need to increase research capacity.

Suicide among university students: prevalence, risks and protective factors

Background: Research evidence on suicide in Ghana so far has focused mostly on suicide in the adult population and less work on the younger population such as university students and other vulnerable groups such as children, youth and the aged. Aims: This study was conducted to determine lifetime and current prevalence of suicidal ideation or attempts and identify the associated risks and protective factors among university students in Ghana. Methods: Using a cross-sectional design, 1003 university students (507 males and 496 females) with a mean age of 20.5 years (SD = 5.95) were administered questionnaires that measured suicide, psychological distress, self-esteem and subjective wellbeing. Results: We found the following prevalence rates of suicidal behaviours: ideations 15.2%, attempted 6.3%, death wishes 24.3% and suicidal plan 6.8%. Psychological distress was a risk factor for both suicidal ideation and suicidal attempt. Subjective wellbeing was protective of suicide attempt while self-esteem was protective of suicidal ideation. Conclusions: These findings underscore the need for school-based mental health-promoting programmes that enhance young people's self-esteem, reduce psychological distress and boost subjective wellbeing.

The relationship between locus of control and depression: A cross-sectional survey with university students in Botswana

Background

Research has consistently revealed a positive association between external locus of control and depression. Little, if any, research has investigated locus of control and depression in the sociocultural context of Botswana.

Aim

To explore the relationship between locus of control and depression among undergraduate students in Botswana and to determine the impact of age and gender on this relationship.

Setting

University of Botswana.

Methods

A sample of 272 students was surveyed through a self-administered questionnaire, which included the Levenson's multidimensional locus of control scale, the Beck Depression Inventory-II and demographic questions. Data analysis utilised descriptive statistics, correlation analysis, independent samples t-tests and standard multiple regression analysis.

Results

Of the 272 participants, 47.3% scored low (minimal) levels of depression, 23.4% scored mild levels, 18.0% scored moderate levels and 11.3% scored severe levels of depression. Students who believed that they were in control of events in their lives were less likely to present with depressive symptoms (r = -0.29, p = 0.000), while students who believed that chance (r = 0.45, p = 0.000) or powerful others (r = 0.40, p = 0.000) controlled their lives were more likely to have high depression scores. Both internal and external locus of control, together with age, explained 31% of the variance in depression scores; gender made no significant contribution to levels of depression.

Conclusion

The study results draw attention to locus of control as one of the cognitive variables associated with depression. Further research is needed to determine how locus of control can be addressed in the treatment and prevention of depression in university contexts.

The influence of self-reported childhood sexual abuse on psychological and behavioural risks in young adults at a university in Botswana

Globally, childhood sexual abuse is a public health problem that affects millions of people. Few studies have considered its long-term ramifications, especially among young adults in developing countries. This study assessed the influence of childhood sexual abuse on depression and behaviours in young adults. Data were obtained from 362 students enrolled at a university in Botswana (Age: M = 21.40, standard deviation = 2.48) using the Childhood Sexual Abuse Scale, the 21-item Beck’s Depression Inventory–II, Revised Sociosexual Orientation Inventory, and Alcohol Use Disorders Identification Test (AUDIT). The t test and chi-square test of independence were used to assess subgroup differences and regression analyses were used to assess the extent to which childhood sexual abuse predicted depression and risky behaviours. About 25% ( n = 90) reported childhood sexual abuse, 18% reported harmful alcohol use ( n = 66, 18.2%), 7.82% ( n = 28) reported severe depression, and 24% ( n = 101) reported failure to use contraceptives. Childhood sexual abuse significantly predicted depression and all the behavioural outcomes in the study. The effect sizes of the associations between childhood sexual abuse on the one hand and mental health and behavioural outcomes on the other were modest. Consequently, the current study is a precursor to further studies on the long-term outcomes of childhood sexual abuse in Botswana. Consequently, a history of childhood sexual abuse should be considered in planning interventions to mitigate depression and behavioural problems on university campuses.

The associations between stressful life events and depression among students in a university in Botswana

Depression is common among university students and often impacts their career development and health. Stressful life events might be associated with depression but remain to be studied among young adults, especially in non-Western settings. Depression and stressful life events were assessed in 304 students at a university in Botswana ( M = 21.56, standard deviation = 1.86) using the 21-item Beck’s Depression Inventory (BDI) and the 26-Item Social Readjustment Rating Scale. Regression models were fitted to study the associations between stressful life events and depression while a one-way between-subjects analysis of variance was performed to compare subjects with minimal, mild, moderate, and severe depression on reporting stressful life events. Depression was present in 22 % of the participants (severe in 8.2% and moderate in 13.8%). More than half of the participants reported 10 or more stressful life events. Stressful life events significantly predicted depression (β = .37, 0.13–0.60). When all the other stressful life events and gender were adjusted for each other, loss of a cell phone, tablet, or laptop and relationship difficulties with peers, parents, and lecturers independently predicted depression. Subjects with minimal, mild, moderate, and severe depression significantly differed on reporting stressful life events ( F(3, 300) = 12.69, p < .001). Depression is not only common but significantly and increasingly associated with reporting more stressful life events. Types of stressful life events such as relationship difficulties and losses were uniquely associated with depression and should be considered in planning interventions and treatment of depression on university campuses.