title: Risk and protective factors for suicidal ideation and behaviour in Rwandan children.
abstract: BACKGROUND
  Suicide is a leading cause of death for young people. Children living in sub-Saharan Africa, where HIV rates are disproportionately high, may be at increased risk.
  
  
  OBJECTIVE
  To identify predictors, including HIV status, of suicidal ideation and behaviour in Rwandan children aged 10-17.
  
  
  METHODS
  Matched case-control study of 683 HIV-positive, HIV-affected (seronegative children with an HIV-positive caregiver), and unaffected children and their caregivers.
  
  
  RESULTS
  Over 20% of HIV-positive and affected children engaged in suicidal behaviour in the previous 6 months, compared with 13% of unaffected children. Children were at increased risk if they met criteria for depression, were at high-risk for conduct disorder, reported poor parenting or had caregivers with mental health problems.
  
  
  CONCLUSIONS
  Policies and programmes that address mental health concerns and support positive parenting may prevent suicidal ideation and behaviour in children at increased risk related to HIV.
authors.affiliation: Lauren C. Ng, PhD, Catherine M. Kirk, MPH, François-Xavier Bagnoud Center for Health and Human Rights, Harvard University, Boston, Massachusetts, USA; Frederick Kanyanganzi, MBA, Partners In Health/Inshuti Mu Buzima, Rwinkwavu, Rwanda; Mary C. Smith Fawzi, ScD, Program in Infectious Disease and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA; Vincent Sezibera, PhD, Department of Clinical Psychology, University of Rwanda, Butare, Rwanda; Evelyne Shema, BS, Department of Social Work, Rwinkwavu District Hospital, Rwinkwavu, Rwanda; Justin I. Bizimana, BS, Department of Mental Health, Rwinkwavu District Hospital, Rwinkwavu, Rwanda; Felix R. Cyamatare, MD, Partners In Health/Inshuti Mu Buzima, Rwinkwavu, Rwanda; Theresa S. Betancourt, ScD, MA, Department of Global Health and Population, Harvard School of Public Health, Boston, Department of Global Health and Population, Harvard School of Public Health, Boston, Massachusetts, USA.
authors.forename: Lauren C
authors.initials: LC
authors.lastname: Ng
authors.affiliation: Lauren C. Ng, PhD, Catherine M. Kirk, MPH, François-Xavier Bagnoud Center for Health and Human Rights, Harvard University, Boston, Massachusetts, USA; Frederick Kanyanganzi, MBA, Partners In Health/Inshuti Mu Buzima, Rwinkwavu, Rwanda; Mary C. Smith Fawzi, ScD, Program in Infectious Disease and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA; Vincent Sezibera, PhD, Department of Clinical Psychology, University of Rwanda, Butare, Rwanda; Evelyne Shema, BS, Department of Social Work, Rwinkwavu District Hospital, Rwinkwavu, Rwanda; Justin I. Bizimana, BS, Department of Mental Health, Rwinkwavu District Hospital, Rwinkwavu, Rwanda; Felix R. Cyamatare, MD, Partners In Health/Inshuti Mu Buzima, Rwinkwavu, Rwanda; Theresa S. Betancourt, ScD, MA, Department of Global Health and Population, Harvard School of Public Health, Boston, Department of Global Health and Population, Harvard School of Public Health, Boston, Massachusetts, USA.
authors.forename: Catherine M
authors.initials: CM
authors.lastname: Kirk
authors.affiliation: Lauren C. Ng, PhD, Catherine M. Kirk, MPH, François-Xavier Bagnoud Center for Health and Human Rights, Harvard University, Boston, Massachusetts, USA; Frederick Kanyanganzi, MBA, Partners In Health/Inshuti Mu Buzima, Rwinkwavu, Rwanda; Mary C. Smith Fawzi, ScD, Program in Infectious Disease and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA; Vincent Sezibera, PhD, Department of Clinical Psychology, University of Rwanda, Butare, Rwanda; Evelyne Shema, BS, Department of Social Work, Rwinkwavu District Hospital, Rwinkwavu, Rwanda; Justin I. Bizimana, BS, Department of Mental Health, Rwinkwavu District Hospital, Rwinkwavu, Rwanda; Felix R. Cyamatare, MD, Partners In Health/Inshuti Mu Buzima, Rwinkwavu, Rwanda; Theresa S. Betancourt, ScD, MA, Department of Global Health and Population, Harvard School of Public Health, Boston, Department of Global Health and Population, Harvard School of Public Health, Boston, Massachusetts, USA.
authors.forename: Frederick
authors.initials: F
authors.lastname: Kanyanganzi
authors.affiliation: Lauren C. Ng, PhD, Catherine M. Kirk, MPH, François-Xavier Bagnoud Center for Health and Human Rights, Harvard University, Boston, Massachusetts, USA; Frederick Kanyanganzi, MBA, Partners In Health/Inshuti Mu Buzima, Rwinkwavu, Rwanda; Mary C. Smith Fawzi, ScD, Program in Infectious Disease and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA; Vincent Sezibera, PhD, Department of Clinical Psychology, University of Rwanda, Butare, Rwanda; Evelyne Shema, BS, Department of Social Work, Rwinkwavu District Hospital, Rwinkwavu, Rwanda; Justin I. Bizimana, BS, Department of Mental Health, Rwinkwavu District Hospital, Rwinkwavu, Rwanda; Felix R. Cyamatare, MD, Partners In Health/Inshuti Mu Buzima, Rwinkwavu, Rwanda; Theresa S. Betancourt, ScD, MA, Department of Global Health and Population, Harvard School of Public Health, Boston, Department of Global Health and Population, Harvard School of Public Health, Boston, Massachusetts, USA.
authors.forename: Mary C Smith
authors.initials: MC
authors.lastname: Fawzi
authors.affiliation: Lauren C. Ng, PhD, Catherine M. Kirk, MPH, François-Xavier Bagnoud Center for Health and Human Rights, Harvard University, Boston, Massachusetts, USA; Frederick Kanyanganzi, MBA, Partners In Health/Inshuti Mu Buzima, Rwinkwavu, Rwanda; Mary C. Smith Fawzi, ScD, Program in Infectious Disease and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA; Vincent Sezibera, PhD, Department of Clinical Psychology, University of Rwanda, Butare, Rwanda; Evelyne Shema, BS, Department of Social Work, Rwinkwavu District Hospital, Rwinkwavu, Rwanda; Justin I. Bizimana, BS, Department of Mental Health, Rwinkwavu District Hospital, Rwinkwavu, Rwanda; Felix R. Cyamatare, MD, Partners In Health/Inshuti Mu Buzima, Rwinkwavu, Rwanda; Theresa S. Betancourt, ScD, MA, Department of Global Health and Population, Harvard School of Public Health, Boston, Department of Global Health and Population, Harvard School of Public Health, Boston, Massachusetts, USA.
authors.forename: Vincent
authors.initials: V
authors.lastname: Sezibera
authors.affiliation: Lauren C. Ng, PhD, Catherine M. Kirk, MPH, François-Xavier Bagnoud Center for Health and Human Rights, Harvard University, Boston, Massachusetts, USA; Frederick Kanyanganzi, MBA, Partners In Health/Inshuti Mu Buzima, Rwinkwavu, Rwanda; Mary C. Smith Fawzi, ScD, Program in Infectious Disease and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA; Vincent Sezibera, PhD, Department of Clinical Psychology, University of Rwanda, Butare, Rwanda; Evelyne Shema, BS, Department of Social Work, Rwinkwavu District Hospital, Rwinkwavu, Rwanda; Justin I. Bizimana, BS, Department of Mental Health, Rwinkwavu District Hospital, Rwinkwavu, Rwanda; Felix R. Cyamatare, MD, Partners In Health/Inshuti Mu Buzima, Rwinkwavu, Rwanda; Theresa S. Betancourt, ScD, MA, Department of Global Health and Population, Harvard School of Public Health, Boston, Department of Global Health and Population, Harvard School of Public Health, Boston, Massachusetts, USA.
authors.forename: Evelyne
authors.initials: E
authors.lastname: Shema
authors.affiliation: Lauren C. Ng, PhD, Catherine M. Kirk, MPH, François-Xavier Bagnoud Center for Health and Human Rights, Harvard University, Boston, Massachusetts, USA; Frederick Kanyanganzi, MBA, Partners In Health/Inshuti Mu Buzima, Rwinkwavu, Rwanda; Mary C. Smith Fawzi, ScD, Program in Infectious Disease and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA; Vincent Sezibera, PhD, Department of Clinical Psychology, University of Rwanda, Butare, Rwanda; Evelyne Shema, BS, Department of Social Work, Rwinkwavu District Hospital, Rwinkwavu, Rwanda; Justin I. Bizimana, BS, Department of Mental Health, Rwinkwavu District Hospital, Rwinkwavu, Rwanda; Felix R. Cyamatare, MD, Partners In Health/Inshuti Mu Buzima, Rwinkwavu, Rwanda; Theresa S. Betancourt, ScD, MA, Department of Global Health and Population, Harvard School of Public Health, Boston, Department of Global Health and Population, Harvard School of Public Health, Boston, Massachusetts, USA.
authors.forename: Justin I
authors.initials: JI
authors.lastname: Bizimana
authors.affiliation: Lauren C. Ng, PhD, Catherine M. Kirk, MPH, François-Xavier Bagnoud Center for Health and Human Rights, Harvard University, Boston, Massachusetts, USA; Frederick Kanyanganzi, MBA, Partners In Health/Inshuti Mu Buzima, Rwinkwavu, Rwanda; Mary C. Smith Fawzi, ScD, Program in Infectious Disease and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA; Vincent Sezibera, PhD, Department of Clinical Psychology, University of Rwanda, Butare, Rwanda; Evelyne Shema, BS, Department of Social Work, Rwinkwavu District Hospital, Rwinkwavu, Rwanda; Justin I. Bizimana, BS, Department of Mental Health, Rwinkwavu District Hospital, Rwinkwavu, Rwanda; Felix R. Cyamatare, MD, Partners In Health/Inshuti Mu Buzima, Rwinkwavu, Rwanda; Theresa S. Betancourt, ScD, MA, Department of Global Health and Population, Harvard School of Public Health, Boston, Department of Global Health and Population, Harvard School of Public Health, Boston, Massachusetts, USA.
authors.forename: Felix R
authors.initials: FR
authors.lastname: Cyamatare
authors.affiliation: Lauren C. Ng, PhD, Catherine M. Kirk, MPH, François-Xavier Bagnoud Center for Health and Human Rights, Harvard University, Boston, Massachusetts, USA; Frederick Kanyanganzi, MBA, Partners In Health/Inshuti Mu Buzima, Rwinkwavu, Rwanda; Mary C. Smith Fawzi, ScD, Program in Infectious Disease and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA; Vincent Sezibera, PhD, Department of Clinical Psychology, University of Rwanda, Butare, Rwanda; Evelyne Shema, BS, Department of Social Work, Rwinkwavu District Hospital, Rwinkwavu, Rwanda; Justin I. Bizimana, BS, Department of Mental Health, Rwinkwavu District Hospital, Rwinkwavu, Rwanda; Felix R. Cyamatare, MD, Partners In Health/Inshuti Mu Buzima, Rwinkwavu, Rwanda; Theresa S. Betancourt, ScD, MA, Department of Global Health and Population, Harvard School of Public Health, Boston, Department of Global Health and Population, Harvard School of Public Health, Boston, Massachusetts, USA Theresa_Betancourt@harvard.edu.
authors.forename: Theresa S
authors.initials: TS
authors.lastname: Betancourt
mesh_terms: D000293:Adolescent; D017028:Caregivers / Q000523:psychology; D016022:Case-Control Studies; D002648:Child; D019955:Conduct Disorder / Q000453:epidemiology / Q000523:psychology; D003866:Depressive Disorder / Q000453:epidemiology / Q000523:psychology; D005260:Female; D015658:HIV Infections / Q000453:epidemiology / Q000523:psychology*; D018023:HIV Seronegativity; D006801:Humans; D008297:Male; D008603:Mental Health; D016487:Parenting / Q000523:psychology; D065840:Protective Factors; D012307:Risk Factors; D012432:Rwanda / Q000453:epidemiology; D012944:Social Support; D013240:Stereotyping; D059020:Suicidal Ideation