|Year : 2016 | Volume
| Issue : 4 | Page : 196-200
Suicidality among HIV patients in a treatment center in Kaduna metropolis, Nigeria
Aremu Saad Bolakale1, Nuhu Folorunsho Taju2, Ajayi Olubukola3
1 Department of Psychiatry, Federal Medical Centre, Gusau, Zamfara, Nigeria
2 Federal Neuro Psychiatric Hospital, Barnawa, Kaduna, Nigeria
3 Department of Psychology, Ekiti State University, Ekiti, Nigeria
|Date of Web Publication||21-Dec-2016|
Aremu Saad Bolakale
Federal Medical Centre, Gusau, Zamfara
Background: Human immunodeficiency disease (HIV/AIDS) is a chronic medical condition with many psychological complications, one of which is suicide behavior. Many studies of this behavior have been reported in the developed countries while only a few in Africa. One, therefore, wonders whether this behavior is not found or rare in African people. If found, how common are they in a treatment center in Kaduna metropolis? Aim: The aim of the study was to determine the prevalence of suicidality among HIV/AIDS patients receiving care at AIDS relief center of St. Gerard's Catholic Hospital, Kaduna, Northwest Nigeria. Methods: The study was a cross-sectional, descriptive study involving 250 HIV-positive patients who can read and write in English selected through a convenience sampling. A self-administered sociodemographic questionnaire was given to the patients to fill after receiving written consent. Thereafter, all the participating patients were interviewed for suicidality using suicidality module of the Mini International Neuropsychiatric Interview. Results: There were 96 males (38.4%) and 154 females (61.6%) who participated in the study. The age range of the patients was 18-64 years with a mean of 35.58 (standard deviation + 8.8). The prevalence of suicidality among these patients was 16%. Low risk of suicidality was found among 26 (65%) of the forty patients who had suicidality. Moderate risk was found in 5 (12.5%) while 9 (22.5%) patients had high risk of suicidality. Conclusion: The implication of this finding is that suicidality as one of the psychological consequences of HIV/AIDS is found among these infected patients in Nigeria. Therefore, there is need for prompt recognition and prevention of suicidal behavior among these patients.
Keywords: Suicidality, HIV/AIDS, Kaduna treatment centre
|How to cite this article:|
Bolakale AS, Taju NF, Olubukola A. Suicidality among HIV patients in a treatment center in Kaduna metropolis, Nigeria. Sahel Med J 2016;19:196-200
|How to cite this URL:|
Bolakale AS, Taju NF, Olubukola A. Suicidality among HIV patients in a treatment center in Kaduna metropolis, Nigeria. Sahel Med J [serial online] 2016 [cited 2019 Oct 15];19:196-200. Available from: http://www.smjonline.org/text.asp?2016/19/4/196/196362
| Introduction|| |
Human immunodeficiency disease (HIV/AIDS) is a chronic medical condition that predisposes infected people to several psychological complications, one of which is suicide behavior. Suicidal behavior/suicidality is a continuum that ranges from suicidal ideation, suicide plans, and suicidal attempts to complete suicide. 
Studies of suicide in persons with HIV/AIDS indicate that the risk is relatively higher than what obtains in the general population. ,, In a cross-sectional study of an Australian sample of 164 HIV-positive (homosexual and bisexual) and 65 HIV-negative homosexual and bisexual men, Kelly et al. found increased levels of suicidal ideation among symptomatic HIV-positive men.  Ovuga and Petrushkin,  in 2005, using the Mini International Neuropsychiatric Interview (MINI) to ascertain Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) diagnosis of psychiatric disorder among 46 HIV/AIDS patients attending the AIDS Support Organization clinic at Mulago Hospital, Kampala, found 82.6% (38 patients) prevalence of psychiatric disorders with suicidal thought being 13%. Olley  in his report on assessment of psychiatric morbidity in recently diagnosed HIV patients in South Africa using MINI questionnaire revealed the following prevalence rates: Current depression = 38.7%, dysthymia = 28%, and suicidality = 8.7%. In Nigeria, Chikeze  reported 34.7% suicidal ideation and 9.3% suicidal attempt among HIV/AIDS patients in a study conducted in Benin, Edo state. Reports of two cases of attempted suicide presenting with penetrating abdominal injuries at the University of Maiduguri Teaching Hospital, Maiduguri, Nigeria, showed that suicidal behavior occurs among HIV-positive patients.  In the two cases, the attempted suicide occurred after the individuals learned of their HIV-positive status. The first case was that of a 30-year-old female student who presented with a history of cutthroat and stab wound in the abdomen. The second case was that of a 22-year-old businessman, a drug addict and homosexual, who stabbed himself twice with a knife in the lower part of his abdomen. Subsequent repeat investigations confirmed that they were HIV positive. The aim of this study is to assess the prevalence of suicidal ideation, suicide plans, and attempted suicide among HIV-positive patients in a treatment center in Kaduna, Nigeria.
| Methods|| |
The study was conducted at St. Gerard's Catholic Hospital, Kakuri, Kaduna South Local Government Area of Kaduna state, Nigeria. This mission hospital was established in 1957 and presently has 230 admission beds. The AIDS relief antiretroviral treatment project of the USA President's Emergency Plan for AIDS Relief is a program under the supervision of the hospital. It was established on February 6, 2006, with the aim of providing quality care and treatment for people living with HIV/AIDS in Kaduna state. The center has 67 staff strength, 13 different units and is being headed by a project team leader, an experienced general medical practitioner. They run five outpatients' clinic per week, four adult and one pediatric clinics. The total registered number of patients stands at 5626 with 1891 males and 3735 females.
Permission was obtained from the Ethical Committees of the Federal Neuro-Psychiatric Hospital Barnawa, Kaduna, and that of St. Gerard's Catholic Hospital, Kaduna. Informed consent was also obtained from all HIV-positive patients who participated in this study.
• Inclusion criteria: Eighteen years and above aged HIV-positive patients registered with the hospital, who can read and write in English language
• Exclusion criteria: Patients who are too physically and mentally ill to participate in the study and those who decline to participate despite explanation and reassurance.
The sample size was calculated using the formula:
where N is minimum sample size and Z from Z table for two-tailed study is 1.96. Average estimated prevalence of suicidality among HIV-positive patients from previous studies is 18.8%. ,, d is 0.05 that is degree of accuracy desired.
Using the above formula, the minimum sample size is
The minimum number will be rounded up to 250 for convenience in data analysis. Consecutive patients attending the clinic who meet inclusion criteria were used until the expected 250 patients were obtained. Chronically ill patients who could not withstand the study procedure were excluded from the study.
MINI instrument consists of some questions which are rated on points 1-10. Patients who score points between 1 and 5 are rated "low suicidal risk," those who score 6-9 points are rated "moderate" while those who score 10 points and above are rated "high suicidal risk."
- Sociodemographic questionnaire
- The MINI: This instrument was designed as a brief structured interview for the major axis 1 psychiatric disorder in DSM-IV and International Classification of Diseases, 10 th edition. It has acceptably high validity and reliability scores. 
The setting of the study was at the outpatient clinic of AIDS relief project of the St. Gerard's Catholic Hospital, Kaduna. About 20-25 patients participated on daily basis for 4 weeks (November-December 2009). Each patient was given a pencil containing eraser and a self-administered questionnaire (sociodemographic questionnaire) after taking a written consent. The seating arrangement was done to ensure privacy in completion of the questionnaire. Each patient was subsequently interviewed for suicidality using suicidality module of MINI.
The Statistical Package for Social Science (SPSS) (SPSS Incorporation, Chicago, United State of America) 15 th edition was used for analysis. Descriptive statistic such as mean and standard deviation (SD) was calculated. Chi-square was used for categorical variables analysis.
| Results|| |
Sociodemographic characteristics of the patients
The sociodemographic characteristics of the patients are shown in [Table 1]. Two hundred and fifty patients participated in the study. All patients were on outpatient treatment, with 234 (93.6%) of them currently on antiretroviral medications while 16 (6.4%) were yet to be commenced on medications. The state of origin of the patients spread across the six geopolitical zones of Nigeria, with one of the patients being a Ghanaian citizen. Northwest zone had 138 patients (55.2%), North-Central zone had 58 patients (23.2%), Southeast zone had 22 patients (8.8%), and Southwest zone had 10 patients (4%). Others were South-South zone with 13 patients (5.2%) and Northeast zone with 8 patients, constituting 3.2% of the participants. There were 96 males (38.4%) and 154 females (61.6%) who participated in the study. One hundred and twenty-five patients (50%) were married as compared with 85 (34%) who were single, 26 (10.4%) widow and widowers, 8 (3.2%) separated from their spouses while 6 (2.4%) were divorced. The age ranged of the patients was 18-64 years, with the mean of 35.58 (SD + 8.8). One hundred and seventy-two (68.8%) patients were between age of 18 and 40 years while 78 (31.2%) were between 41 and 64 years of age. One hundred and twenty-six (90%) patients were Christian while 24 (9.6) were Muslim. One hundred and thirty-seven patients (54.8%) had secondary education, 63 (25.5%) had tertiary education, and 49 (19.6%) had primary education while one had Islamic education. In terms of occupation, 126 (50.4%) of the participants were employed while 105 (42%) were unemployed and 19 (7.6%) were students.
Suicide behavior and its risk
[Table 2] shows the presence and risk of suicide behavior among the respondents. Forty (16%) of the participants had suicidal behavior while 210 (84%) had no suicidal behavior. Thirty-five (14%) had suicidal ideation, 3 (1.2%) had suicide plans while 12 (4.8%) had attempted suicide during their illness. It is to be noted that some of the participants had the three components of suicide behavior, some had two while others had only one. The prevalence of suicidality in this study was 16%. Twenty-six (65%) of those with suicidal behavior had low risk, 5 (12.5%) had moderate risk while 9 (22.5%) had high risk of suicidal behavior.
| Discussion|| |
The prevalence of suicidality in this study was found to be 16% among 250 patients who participated in the study. The patients spread across the geopolitical zones of Nigeria. Northwest zone to which Kaduna belongs had majority of the patients (55.2%). This can be attributed to the pull effect of the study location in Kaduna metropolis. The ratio of female to male participants in the study was 1.6:1. This is also similar to the report by UNAID 2004 which revealed that youths and young women were more vulnerable to HIV/AIDS with young women at risk than young men. The possible explanation for the difference was that more female registered with center than the male counterpart and the possible fact that female adjusted to the illness by seeking medical treatment earlier when compared with their male counterpart. The age range of the patients was 18-64 years, with mean of 35.58 years (SD 8.8). Similar age distribution was found in a study conducted by Iliyasu et al.,  which also reported a mean age of 33.7 (SD 8) among HIV-positive patients. Majority of the respondents were Christian while about one in ten were Muslim. Audu et al.  reported 70.6% of Christians in their study conducted in Jos Plateau state while Sale  reported more Muslim than Christian in his study conducted in Kano, Kano state of Nigeria. The difference in proportion of the patients along religious inclinations may be explained on the basis of the location of their respective studies. This study was conducted in a Christian Catholic Hospital while Sale's study was conducted in Muslim predominated area, and therefore, both were bound to attract patients from different religious inclinations.
Prevalence of suicidality
Forty of the patients had suicidality indicating 16% of the patients. The prevalence of suicidality in this study was therefore 16%. Majority of those with suicidality, 65% had low risk, 12.5% had moderate risk while 22.5% had high risk of suicidality. Suicidality in this study includes total patients who had suicidal ideation, suicidal plan, and those with history of suicide attempt. The prevalence of 16% found in this study is, however, similar to that reported by Perry et al. (16.3%) in a study conducted among HIV patients 2 months after diagnosis of seropositivity. Kalicman et al.  reported 27% prevalence of suicidal ideation among HIV patients who were 45 years and above as against 14% suicide ideation found in this study. Increased risk of suicidality is said to occur at teenage and 45 years and above.  Hence, the increased prevalence reported by Kalicman et al.  can be attributed to the older patients used in their study. Olley,  however, reported a much lower prevalence of 8.7% in his study conducted in South Africa. Olley's sample consists of patients who had diagnosis of seropositivity 6 months before their study. Informative pretest and posttest counseling as well as adequate social support might have accounted for the lower prevalence rate reported. In Nigeria, Chikeze  reported 34.7% suicidal ideation and 9.3% suicidal attempt among HIV/AIDS patients in a study conducted in Benin, Edo state. This finding contrasts the prevalence of 14% suicidal ideation and 4.8% suicide attempt found in this study. Self-administered Beck depression inventory was used in assessing suicide behavior as against the MINI interviewer rated instrument used in this study. Therefore, the increased prevalence reported by Chikeze  can be attributed to these differences. Among the general population in Nigeria, Asuni,  Eferakey,  and Odejide et al.  reported low suicidal attempt crude rate of 2/100,000, 1/100,000, and 2.6/100,000, respectively. These statistics are much lower than what was reported in this study. Suicide behavior has been reported to be associated with life-threatening medical conditions, for example, HIV/AIDS.  Hence, increase prevalence reported in this study can be attributed to this medical condition.
- Only patients who can read and write in English language were assessed. Hence, the prevalence may not be true reflection of prevalence of suicidality among HIV patients in the treatment center. The MINI suicidality questionnaire has not been modified in this environment, hence the use of patients who understand English
- Complete suicides were also not assessed because of unavailability of data on HIV patients who might have committed suicide at the studied treatment center.
| Conclusion|| |
The prevalence of suicidality in this study was 16%. Thirty-one (77.5%) suicidal patients had low to moderate risk while 9 (22.5%) had high suicidal risk. There is, therefore, need for treating health personnel and other stakeholders to screen and prevent suicide behavior as much possible since it can complicate HIV disease as found in above patients in a treatment center in Nigeria, West Africa.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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[Table 1], [Table 2]