Suicide ideation, depression and HIV among pregnant women in rural South Africa

Abstract

Background: Despite public perception to the contrary, pregnancy does not offer a protective effect for suicide ideation. In low and middle in- come countries (LMIC) multiple concurrent risk factors including unplanned pregnancies, test- ing for HIV, intimate partner violence and de- pression may increase suicide risk among preg- nant 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. Us-ing 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 inter- view data were collected on women’s experi- ences of suicide ideation and plans. Women were assessed two weeks after routine HIV test- ing 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 idea-tion was high (30/109, 27.5%) with thoughts of self harm closely linked to suicide plans. Age, previous history of depression and current de-pression were significantly associated with sui- cide ideation. Close to equal numbers of HIV- positive and negative women were suicidal. Sui- cide methods were frequently violent and most women cited family and partnership conflict re- lated to an unplanned pregnancy or their newlyHIV-positive status as triggers to their suicideideation. Conclusions: Rates of suicide ideation among pregnant women testing for HIV are high. Testing HIV-positive causes considerable dis- tress, and among HIV-negative women unplan- ned and unwanted pregnancies are important risk factors for suicide ideation. Pregnancy brings women into increased contact with the health services with important opportunities for pre- vention and intervention.