Child Maltreatment, Problematic Alcohol Use, and Suicidal Ideation Among Youth Living in the Slums of Kampala, Uganda

Introduction: Youth living in the slums of Kampala, Uganda face dire environmental living conditions, poverty, food scarcity, exposure to violence, and a lack of government infrastructure. Furthermore, Uganda has one of the highest per capita alcohol consumption rates in the world. Additionally, suicide is a growing problem in sub-Saharan Africa, where the prevalence of suicidal ideation is approximately 20% among Ugandan youth. This is the first study to examine the interplay of alcohol use and child maltreatment on suicidal ideation among youth living in the slums of Kampala, Uganda, who are a unique and understudied population.

Methods: The study sample includes service-seeking youth who were attending Uganda Youth Development Link (UYDEL) drop-in centers in spring 2014 (n=1,134). Indicators of child maltreatment included parental physical abuse, parental neglect, and sexual abuse. These indicators were operationalized as sexual abuse, a child maltreatment sum score, and the interaction between sexual abuse and the child maltreatment sum score. Problematic alcohol use was specified using a confirmatory factor mixture model that distinguished current drinking status with the frequency and intensity of use among current drinkers. This novel approach is more flexible than restricting our analysis to only drinkers or analyzing only current drinking status. This approach also allows us to include all participants without listwise deleting youth who were missing on one of the alcohol indicators. The primary outcome of interest was suicidal ideation. All associations controlled for gender and age, and all associations were estimated simultaneously. All analyses were conducted in SAS 9.4 and Mplus 7.4.

Results: The overall prevalence of suicidal ideation was 23.5% (n=266). Approximately 34% of youth participants reported experiencing physical abuse, 17% reported sexual abuse, and 20% reported parental neglect. Among youth who reported current alcohol use, 37% reported alcohol use 2-3 times a week, and 9% reported consuming 5 or more drinks in a day. Overall, current drinking status (OR: 1.80; 95% CI: 1.31, 2.46), the child maltreatment sum score (OR: 1.88; 95% CI: 1.48, 2.39), and sexual abuse (OR: 2.88; 95% CI: 1.52, 5.47) were statistically significantly associated with reporting suicidal ideation. Additionally, sexual abuse was statistically significantly associated with current drinking status (OR: 2.31; 95% CI: 1.51, 3.56).

Conclusions: This study highlights a population that would potentially benefit from prevention efforts not only aimed at suicide prevention but also harm reduction in terms of alcohol use and experiences of child maltreatment.