Africa Mental Health Research and Training Foundation, Nairobi, Kenya.
Department of Psychology and Assisting Living and Learning Institute, Maynooth University, Maynooth, Ireland.
PLoS One. 2020 Jul 22;15(7):e0236269. doi: 10.1371/journal.pone.0236269. eCollection 2020.
Suicide is one of the most common causes of death among female adolescents. A greater risk is seen among adolescent mothers who become pregnant outside marriage and consider suicide as the solution to unresolved problems. We aimed to investigate the factors associated with suicidal behavior among adolescent pregnant mothers in Kenya.
A total of 27 Focus Group Discussions (FGDs) and 8 Key Informant Interviews (KIIs) were conducted in a rural setting (Makueni County) in Kenya. The study participants consisted of formal health care workers and informal health care providers (traditional birth attendants and community health workers), adolescent and adult pregnant and post-natal (up to six weeks post-delivery) women including first-time adolescent mothers, and caregivers (husbands and/or mothers-in-law of pregnant women) and local key opinion leaders. The qualitative data was analyzed using Qualitative Solution for Research (QSR) NVivo version 10.
Five themes associated with suicidal behavior risk among adolescent mothers emerged from this study. These included: (i) poverty, (ii) intimate partner violence (IPV), (iii) family rejection, (iv) social isolation and stigma from the community, and (v) chronic physical illnesses. Low economic status was associated with hopelessness and suicidal ideation. IPV was related to drug abuse (especially alcohol) by the male partner, predisposing the adolescent mothers to suicidal ideation. Rejection by parents and isolation by peers at school; and diagnosis of a chronic illness such as HIV/AIDS were other contributing factors to suicidal behavior in adolescent mothers.
Improved social relations, economic and health circumstances of adolescent mothers can lead to reduction of suicidal behaviour. Therefore, concerted efforts by stakeholders including family members, community leaders, health care workers and policy makers should explore ways of addressing IPV, economic empowerment and access to youth friendly health care centers for chronic physical illnesses. Prevention strategies should include monitoring for suicidal behavior risks during pregnancy in both community and health care settings. Additionally, utilizing lay workers in conducting dialogue discussions and early screening could address some of the risk factors and reduce pregnancy- related suicide mortality in LMICs.
自杀是少女死亡的最常见原因之一。那些非婚怀孕并认为自杀是解决未解决问题的方法的少女母亲，自杀风险更高。我们旨在调查肯尼亚未成年孕妇自杀行为的相关因素。
本研究在肯尼亚农村（马库埃尼县）共进行了 27 次焦点小组讨论（FGD）和 8 次关键知情人访谈（KII）。研究参与者包括正规医疗保健工作者和非正规医疗保健提供者（传统助产士和社区卫生工作者）、未成年和成年孕妇及产后（分娩后 6 周内）妇女，包括初次怀孕的未成年母亲、照顾者（孕妇的丈夫和/或婆婆）以及当地的主要意见领袖。使用 Qualitative Solution for Research (QSR) NVivo 版本 10 对定性数据进行分析。
本研究提出了与未成年母亲自杀行为风险相关的五个主题。这些主题包括：（i）贫困，（ii）亲密伴侣暴力（IPV），（iii）家庭拒绝，（iv）社会孤立和社区耻辱，以及（v）慢性身体疾病。经济地位低下与绝望和自杀意念有关。IPV 与男性伴侣滥用药物（尤其是酒精）有关，使未成年母亲容易产生自杀意念。父母的拒绝、学校同伴的孤立；以及慢性疾病（如艾滋病毒/艾滋病）的诊断，也是未成年母亲自杀行为的其他促成因素。
改善未成年母亲的社会关系、经济和健康状况可以减少自杀行为。因此，包括家庭成员、社区领袖、医疗保健工作者和政策制定者在内的利益攸关方应共同努力，解决亲密伴侣暴力、经济赋权以及获得青年友好型慢性疾病保健中心的问题。预防策略应包括在社区和医疗保健环境中监测怀孕期自杀行为风险。此外，利用非专业人员开展对话讨论和早期筛查，可以解决一些风险因素，降低中低收入国家与怀孕相关的自杀死亡率。
