Madundo Kim, Perry Mirlene, Mwobobia Judith, Shekibula Ismail, Msoka Elizabeth F, Tarimo Clotilda S, Katiti Victor, Mmbaga Blandina T, Goldston David B, Relf Michael V, Knettel Brandon A
Department of Psychiatry and Mental Health, Kilimanjaro Christian Medical Centre, Moshi, Tanzania.
Kilimanjaro Christian Medical University College, Moshi, Tanzania.
Front Health Serv. 2025 Apr 24;5:1557348. doi: 10.3389/frhs.2025.1557348. eCollection 2025.
Depression and suicidal thoughts and behaviour are remarkably common among people living with HIV worldwide, leading to a higher burden of disease, poor HIV care engagement, and death. Suicidal behaviour is criminalized in 20 countries worldwide, including Tanzania, where context-appropriate interventions are lacking.
We describe the experiences of patients who were screened for depression and suicidal ideation by HIV clinic nurses, and how the socio-cultural context influences these experiences. This screening was the initial procedure in a randomized controlled clinical trial and parent study aimed at reducing suicide and depression and improving HIV care engagement in Kilimanjaro, Tanzania. We conducted in-depth interviews (IDIs) with 20 people living with HIV. Interviews were held 3 months post-enrollment of participants. Data was collected from July to November 2023. We referred to a brief screener developed for the trial, combining the PHQ-2 for depression and one question on suicidal ideation. IDIs focused on the experiences and appropriateness of being screened for depression and suicidal ideation, factors influencing these challenges, and opinions on the illegality of suicidal behaviour in Tanzania. Data was analyzed using Nvivo 14. Thematic analysis approach was utilized to identify, review and, label codes. Differences were resolved by the first three and final authors.
Our findings revealed high appreciation for the screening and occasional initial discomfort. Stigma, misinformation, and poverty contributed to mental health challenges. Patients favoured abolishment of laws against suicide due to their hindering support-seeking and impracticality for individuals in mental health crises.
In a mental health resource-limited setting, these findings highlight the need for targeted and integrated non-specialist screenings and interventions and outsourcing HIV and mental health support beyond healthcare facilities. Further research is needed to assess the sustainability of screening.
抑郁症以及自杀念头和行为在全球范围内感染艾滋病毒的人群中极为常见，导致疾病负担加重、艾滋病毒护理参与度低下以及死亡。在包括坦桑尼亚在内的全球20个国家，自杀行为被定为犯罪，而在这些国家缺乏适合当地情况的干预措施。
我们描述了由艾滋病毒诊所护士对抑郁症和自杀意念进行筛查的患者的经历，以及社会文化背景如何影响这些经历。此次筛查是一项随机对照临床试验和母研究的初始程序，该研究旨在减少自杀和抑郁症，并改善坦桑尼亚乞力马扎罗地区的艾滋病毒护理参与度。我们对20名艾滋病毒感染者进行了深入访谈（IDI）。访谈在参与者入组3个月后进行。数据收集于2023年7月至11月。我们参考了为该试验开发的简短筛查工具，该工具结合了用于抑郁症筛查的患者健康问卷-2（PHQ-2）和一个关于自杀意念的问题。深入访谈聚焦于抑郁症和自杀意念筛查的经历及适宜性、影响这些挑战的因素，以及对坦桑尼亚自杀行为非法性的看法。使用Nvivo 14对数据进行分析。采用主题分析方法来识别、审查和标记代码。差异由前三位作者和最后一位作者共同解决。
我们的研究结果显示，患者对筛查高度认可，但偶尔会有最初的不适感。耻辱感、错误信息和贫困导致了心理健康挑战。由于这些法律阻碍了寻求支持，且对处于心理健康危机中的个人不切实际，患者赞成废除反自杀法律。
在心理健康资源有限的环境中，这些研究结果凸显了有针对性的综合非专科筛查和干预措施的必要性，以及将艾滋病毒和心理健康支持外包至医疗机构之外的必要性。需要进一步研究来评估筛查的可持续性。
