Suicidal ideation, depressive experiences, and resilience among adolescents living with HIV in rural Ghana: a qualitative exploration of psychological experiences and coping

Background Adolescents living with HIV/AIDS (ALHIV) in sub-Saharan Africa face significant mental and emotional burdens compromising treatment adherence and quality of life. Despite growing evidence of psychological morbidity, the subjective experiences, stigma mechanisms, and coping processes of ALHIV in rural Ghanaian contexts remain poorly understood. This study addressed these gaps guided by Lazarus and Folkman's (1984) Stress and Coping Theory and Link and Phelan's (2001) stigma framework, enabling an integrated analysis of how HIV-related stressors are appraised, how stigma depletes coping resources, and why specific psychological outcomes arise. Methods A qualitative descriptive design was employed. Data were collected from 12 adolescents living with HIV through two focus group discussions and three in-depth interviews at Atua Government Hospital, Lower Manya Krobo District, Ghana, via purposive sampling and analysed using Braun and Clarke’s (2017) six-step reflexive thematic analysis. Findings Five themes emerged. Emotional and mental distress, encompassing suicidal ideation, fear of death, and depressive tendencies, reflected catastrophic primary appraisal of HIV as an irreversible existential threat. Multi-dimensional stigma, encompassing family-based, religious, and community/peer forms, depleted coping resources at every relational level; religious stigma was identified as a distinct form operating through perceived divine authority, a culturally specific pathway through which Link and Phelan’s existing stigma mechanisms (labelling, stereotyping, and status loss) operate, rather than an extension of the framework itself. Social isolation represented both a consequence of depleted secondary appraisal resources and a self-perpetuating cycle further limiting them. For some participants, fatalistic appraisal of treatment futility appeared to inform reduced motivation to adhere to antiretroviral therapy, one plausible coping-related interpretation among several, alongside structural and relational barriers also documented in the data. Coping mechanisms including religious practices, family connection, and personal resilience mapped onto emotion-focused, meaning-focused, and problem-focused coping respectively; religious contexts functioned paradoxically as both the most potent stigma source and the most widely accessed coping resource. Conclusion Findings suggest that ALHIV in this setting encounter HIV through catastrophic appraisal, multi-level stigma, and severely depleted coping resources. These findings suggest that effective interventions should address cognitive appraisal, family systems, and religious contexts simultaneously, rather than targeting symptoms or adherence behaviours in isolation.