Association of chronic diseases and lifestyle factors with suicidal ideation among adults aged 18-69 years in Eswatini: evidence from a population-based survey

The relationship between underage initiation of selling sex and depression among female sex workers in Eswatini

Background

Minors who sell sex are likely to have complex mental health needs that may persist into adulthood. This topic is understudied in sub-Saharan Africa. This study hypothesized that adult female sex workers in Eswatini who started selling sex as minors have a higher prevalence of depression than those who started as adults. We also examined correlates of depression and underage initiation of selling sex, including stigma and condom-related behaviors.

Methods

From October-December 2014, women aged 18 or older who sold sex in the past 12 months in Eswatini were recruited through venue-based sampling. Participants completed a survey including the 9-item Patient Health Questionnaire (PHQ-9) and a question about the age at which they first sold sex for money. T-tests, χ² tests and multivariable logistic regression were used to assess associations.

Results

Overall, 43.1% of participants (332/770) had probable depression, and 16.6% (128/770) started selling sex as minors under the age of 18. Over half (55.5%, 71/128) of those who started selling sex as minors had depression. This was significantly higher than the 40.7% (261/642) prevalence of depression among participants who started selling sex as adults (p = 0.002). After adjusting for confounders, female sex workers who started selling sex as minors had higher odds of depression than those who started as adults (adjusted odds ratio [aOR] 1.70, 95% confidence interval 1.11-2.60).

Conclusion

Results highlight the need for trauma-informed and adolescent-friendly mental health services in settings free of stigma toward female sex workers in Eswatini.

Urban green spaces and suicide mortality in Belgium (2001-2011): A census-based longitudinal study

BACKGROUND

Exposure to green spaces is associated with improved mental health and may reduce risk of suicide. Here, we investigate the association between long-term exposure to residential surrounding greenness and suicide mortality.

METHODS

We used data from the 2001 Belgian census linked to mortality register data (2001-2011). We included all registered individuals aged 18 years or older at baseline (2001) residing in the five largest urban areas in Belgium (n = 3,549,514). Suicide mortality was defined using the tenth revision of the World Health Organisation International Classification of Diseases (ICD-10) codes X60-X84, Y10-Y34, and Y870. Surrounding greenness was measured using the Normalized Difference Vegetation Index (NDVI) within a 300 m and 1,000 m buffer around the residential address at baseline. To assess the association between residential surrounding greenness and suicide mortality, we applied Cox proportional hazards models with age as the underlying time scale. Models were adjusted for age, sex, living arrangement, migrant background, educational attainment, neighbourhood socio-economic position. We additionally explored potential mediation by residential outdoor nitrogen dioxide (NO₂) concentrations. Finally, we assessed potential effect modification by various socio-demographic characteristics of the population (sex, age, educational attainment, migrant background, and neighbourhood socio-economic position). Associations are expressed as hazard ratios and their 95% confidence intervals (CI) for an interquartile range (IQR) increase in residential surrounding greenness.

RESULTS

We observed a 7% (95%CI 0.89-0.97) and 6% (95%CI 0.90-0.98) risk reduction of suicide mortality for an IQR increase in residential surrounding greenness for buffers of 300 m and 1,000 m, respectively. Furthermore, this association was independent of exposure to NO₂. After stratification, the inverse association was only apparent among women, and residents of Belgian origin, and that it was stronger among residents aged 36 or older, those with high level of education, and residents of most deprived neighbourhoods.

CONCLUSION

Our results suggest that urban green spaces may protect against suicide mortality, but this beneficial effect may not be equally distributed across all strata of the population.

Regular Exercise with Suicide Ideation, Suicide Plan and Suicide Attempt in University Students: Data from the Health Minds Survey 2018–2019

Background: Participating in exercise has been frequently recognized as a protective factor of suicide-related outcome (e.g., suicidal ideation) in children and adolescents, albeit with less of a focus on university/college students (especially using nationally representative sample). This study aimed to explore the associations between regular exercise with suicide ideation, plan, and suicide attempts using the data from Health Minds Survey (2018–2019 round). Methods: Using the cross-sectional data from a nationally representative sample (n = 62,026; mean age = 23.1 years) with self-reported information on exercise and the three suicide-related measures, binary logistic regression was used to estimate the associations of exercise with suicide ideation, plans, and attempts, respectively, while controlling for age, gender, being an international student or not, and race/ethnicity. Results: Compared with university students reporting five or more hours for exercise a week, those reporting less were more likely to report yes in terms of suicide ideation and a similar association was also observed in exercise and suicide plan. However, exercise was not significantly associated with suicide attempts. Conclusion: Spending more time exercising may be a protective factor against suicide ideation and plan for university students. Owing to the cross-sectional design nature, our research findings should be further investigated for confirmation or negation.