Suicidal ideation among adolescents and young adults with cancer in Uganda

Adolescents and young adults (AYAs) living with cancer face unique psychosocial challenges that may heighten vulnerability to suicidality and other mental health challenges. However, evidence from low- and middle-income countries, including Uganda, remains scarce. This study examined the prevalence and factors associated with suicidal ideation among AYAs with cancer in Uganda. A cross-sectional analytical survey was conducted among 271 AYAs aged 10–24 years attending oncology clinics at the Uganda Cancer Institute and Mbarara Regional Referral Hospital, between March and May 2024. Sociodemographic and clinical characteristics were collected using a structured questionnaire. Suicidal ideation was assessed using four suicide-related items rated on a four-point Likert scale. Because depression and anxiety are established risk factors for suicidal ideation, depressive symptoms were assessed using the Patient Health Questionnaire-9 (PHQ-9) and anxiety symptoms using the Generalized Anxiety Disorder-7 (GAD-7) scale as potential explanatory variables. Descriptive statistics summarized participant characteristics, while multivariable logistic regression identified factors independently associated with suicidal ideation. Adjusted odds ratios (aORs) with 95% confidence intervals (CIs) were reported, and a sensitivity analysis using a stricter suicidal ideation threshold was performed. The overall prevalence of suicidal ideation was 63.5%. Probable anxiety showed the strongest association with suicidal ideation (aOR = 15.37, 95% CI: 1.88–125.65), followed by a history of cancer recurrence (aOR = 5.56, 95% CI: 1.84–16.77), duration of cancer diagnosis more than two years (aOR = 4.17, 95% CI: 1.38–12.57), and probable depression (aOR = 3.70, 95% CI: 1.03–13.29). Receiving a combination of treatment modalities was associated with reduced odds of suicidal ideation (aOR = 0.27, 95% CI: 0.09-0.78) Suicidal ideation is highly common among AYAs with cancer in Uganda, especially those with a longer duration since diagnosis, or recurrent disease, probable depression and anxiety symptoms, and those receiving a single modality of cancer treatment. Incorporating routine mental health screening and psychosocial support into oncology care can facilitate early identification, timely referral, and appropriate management of AYAs at risk, thereby potentially reducing suicide risk.