Suicidal thoughts and behaviour among South African adolescents livingwith HIV: Can social support buffer the impact of stigma?

Abstract

Background:Adolescents living with HIV represent a high-risk population for suicidal ideation and attempts,especially in low-income settings. Yet little is known about risk and protective factors for suicide in this po-pulation.Methods:A moderated mediation model was employed to test for potential (a) effects of stigma on suicidalideation and attempts, both direct and mediated through depression and (b) direct and stress-buffering effects ofsocial support resources on depression and suicidal ideation and attempts, among 1053 HIV-positive 10–19-year-old adolescents from a resource-scarce health district in South Africa. The survey data was collected using fullcommunity sampling of 53 clinics and tracing to over 180 communities. Effects of two support resources weretested: perceived support availability from the adolescents’social network and structured clinic support groups.Stigma was measured using the ALHIV-SS scale, depression through the CDI short form and social supportthrough items from the MOS-SS.Results:Stigma was a risk factor for depression (B= 0.295;p< 001) and for suicidal thoughts and behaviour(B= 0.185;p< .001). Only perceived support availability was directly associated with less depression(B=−0.182,p< .001). However, both perceived support availability and support group participation con-tributed to the overall stress-buffering effects moderating the direct and indirect relationships between stigmaand suicidal thoughts and behaviour.Limitations:The data used in this study was self-reported and cross-sectional.Conclusions:Findings suggest that strengthening multiple social support resources for HIV-positive adolescents,through early clinic and community-based interventions, may protect them from experiencing poor mentalhealth and suicidal tendencies.