Intimate Partner Violence and Suicidal Ideation Among a Sample of HIV-Positive Women in Kazakhstan, Central Asia

Background and Purpose: Suicide remains one of the leading causes of death worldwide, accounting for just over 1.5% of all deaths. The association between intimate partner violence (IPV) and mental health, specifically depression and PTSD, has been well established in the literature, however, suicide has received far less attention, despite the close linkage between depression and suicidality. Although research has demonstrated associations between IPV and suicide, limited studies have delineated the relationship between different types of IPV and suicidal ideation, and even fewer studies have examined the relationship between IPV and suicidal ideation among women who are HIV-positive. This is critical as extant literature has demonstrated both a relationship between IPV and HIV, and HIV and poor mental health outcomes, including suicidal ideation. This paper seeks to fill this gap by exploring the association between IPV and suicidal ideation among a sample of HIV-positive women in Kazakhstan, Central Asia. Kazakhstan not only maintains one of the highest suicide rates worldwide, but has an ongoing concentrated epidemic of HIV and high rates of IPV among women.

Methods: This paper uses data from a cross-sectional survey administered to 249 HIV-positive women across five areas of Kazakhstan between September-December, 2013. Participants were asked a range of questions pertaining to their socio-demographics, mental health, social support, exposure to IPV, among others. Using descriptive statistics and bivariate analyses, this paper examines the prevalence of suicidal ideation (specifically, suicidal thought disturbance), and its association with different forms of IPV (using the Revised Conflict Tactics Scale). Then, using multivariate logistic regression analyses, this paper examines the association between different forms of IPV and suicidal thought disturbance, with relevant covariates and confounders included in the model such as age, marital status, economic stability (food insecurity, housing), HIV stigma, drug and alcohol use, and social support.

Results: Findings indicated high prevalence of recent (past week) suicidal ideation (40.5%) and lifetime IPV (50.5%). Examining the different forms of IPV, women reported exposure to emotional abuse (44%), sexual violence (31%), physical violence (30%), and injurious abuse (23%). Bivariate analyses indicated significant associations between suicidal ideation and all individual forms of IPV (p<0.01) and lifetime IPV (p<0.01). Adjusted multivariate logistic analyses similarly indicated critical associations between individual forms of IPV, lifetime IPV variable and suicidal ideation: emotional abuse (OR=2.3, p<0.05); physical violence (OR=2.3, p<0.05); sexual violence (OR=3.6, p<.0.01); injurious abuse (OR=4.6, p<0.01); and any IPV (OR=2.3, p<0.05). Consistently significant covariates in the multivariate analyses included marital status, social support, injection drug use, and HIV-related stigma (p<0.05).

Conclusions and Implications: The findings suggest an urgent need for additional epidemiological studies examining the crossover rates of IPV, HIV, and suicidal ideation. Findings also point to a number of practical implications including capacity building of existing social workers and health professionals to identify and address co-occurring IPV and suicidal ideation among HIV-positive women through safety planning and linkage to care; and scaling up services to improve social support, reduce HIV-related stigma, and provide linkage to harm reduction programs for women who are also substance-involved.