Abstract
BACKGROUND: The prevalence of suicidal ideation (SI) among HIV-positive pregnant women is a complex issue influenced by multiple risk factors. By addressing these risk factors and focusing on vulnerable regions, healthcare providers and policymakers can strive to alleviate the burden of SI in this population. The objective of this systematic review, meta-analysis, and meta-regression was to estimate the prevalence and identify risk factors for SI among HIV-positive pregnant women. METHODS: The review systematically searched PubMed, Scopus and Web of Science to identify relevant studies published until December 2024. A meta-analysis was conducted to summarize the prevalence and risk factors for SI among pregnant women with HIV infection. Sensitivity and meta-regression analysis were performed to explore the potential sources of heterogeneity in the distribution and determinants of suicidal behaviors within this at-risk group. RESULTS: The review identified 18 studies involving 5,242 participants. The overall prevalence of SI was 20.5%; 95% CI: 14.6 - 28.0% in pregnant women living with HIV, 19.8%; 95% CI: 12.6 - 29.6% in perinatal, and 14.9%; 95% CI: 7.8 - 26.5% in prenatal. The prevalence of SI was 17.1%, 20.3%, and 34.5% for the periods 2020-2024, 2015-2019, and 2000-2014, respectively. By gross domestic product (GDP), the prevalence was 16.9% in low, 23.0% in moderate, and 24.1% in high GDP countries, with the highest prevalence in the USA (24.2%). Among various risk factors, partner violence (OR = 1.44; 95% CI: 1.05-1.98), and higher education (OR = 0.80; 95% CI: 0.64-0.99) were identified as significant risk factors and protective factors, respectively. Meta-regression analysis indicated that GDP, partner violence, year, age, and depression were potential sources of heterogeneity, respectively. CONCLUSION: The results indicated a high prevalence of SI among perinatal women living with HIV. The educational level, GDP, partner violence, and year were significant risk factors and potential sources of heterogeneity. It is crucial to incorporate specific questions about suicidal ideation into routine prenatal care for this population, even when depressive symptoms are not apparent. These findings underscore the need for a multifaceted approach to addressing suicidal ideation in HIV-positive prenatal women.