In recent years, remarkable achievements in HIV testing and antiretroviral therapies have improved the detection, management, and care of persons living with HIV (PLWH). In the 1980s and 90s, patients with HIV infection faced a devastating prognosis. But now, Medical Xpress reports, with proper medications and support, PLWH can enjoy long and fulfilling lives. So, when the topic of suicide among PLWH is raised, many physicians are surprised.
Researchers led by Lily Brown at the psychiatry department, University of Pennsylvania, Philadelphia write that in their study, they found that suicidal thoughts and attempts remain a pressing concern among PLWH, who are significantly more likely to die by suicide compared to the general population. Given that HIV infection can be well-managed with proper care, what accounts for the elevated risk for suicide among PLWH?
In our study, we used the medical records of over 2,000 PLWH to isolate the clinical and demographic factors associated with suicidal thoughts and behaviours. We hypothesised that individuals with a diagnosis of posttraumatic stress disorder (PTSD) – a psychiatric condition that can emerge after exposure to a traumatic event – and substance use disorders would be at especially elevated risk for suicidal thoughts and behaviours.
This hypothesis was based on prior research which revealed important interactions between substance abuse, violence, and Aids, coined the “SAVA Syndemic,” wherein substance abuse and exposure to violence are thought to interact to predict worsened health outcomes among PLWH.
We found that PTSD and a variety of substance use disorders, including alcohol, cocaine, and opioid use disorders, were associated with increased risk for suicidal thoughts or behaviours among PLWH, as were diagnoses of depression and insomnia. Contrary to our predictions, we did not find an interaction between PTSD and substance use on the likelihood of suicidal thoughts or behaviours.
These findings have important implications for the care of PLWH. To reduce suicide risk in this population, care teams must closely monitor patients for symptoms of PTSD, substance use, insomnia, and major depressive disorder. As we demonstrated in our previous research, psychiatric diagnoses tend to be under-documented among PLWH. To connect PLWH to appropriate mental health care, the first step is to conduct thorough assessment for psychiatric comorbidities (or co-occurring conditions). Fortunately, evidence-based treatments can reduce symptoms of these disorders, which may also reduce suicide risk. As health care providers increase their assessment of psychiatric comorbidities, patients will be more likely to receive appropriate referrals for evidence-based treatments.
More research is needed so that PLWH who are considering suicide can see that their lives are worth living. Now that antiretroviral therapies can promote long-term physical health for PWLH, it’s time to attend to the emotional needs of PLWH as well.
Persons living with HIV (PLWH) are significantly more likely to die by suicide compared to the general population. This is the first study to examine the impact of posttraumatic stress disorder (PTSD), major depressive disorder (MDD), insomnia, and substance use disorders on suicidal ideation/behavior among PLWH using electronic medical record (EMR) data. We also evaluated the mutual influence of interactions between PTSD and substance use disorders on suicide risk, consistent with the substance abuse, violence exposure, and HIV/AIDS “SAVA” syndemic model. Participants (n = 2336) were HIV+ individuals recruited through the Center for AIDS Research (CFAR). Participants provided informed consent for extraction of their EMR. As hypothesized, univariate analyses revealed that PTSD, MDD, insomnia, alcohol and other substance use disorders (cocaine abuse and cocaine dependence, opioid abuse and dependence, cannabis abuse, other psychoactive substance abuse and dependence, and polysubstance use disorder) were each positively associated with suicidal ideation/behavior. Also as hypothesized, a multivariable analysis found that alcohol and cocaine dependence, MDD, and PTSD were significant predictors of suicidal ideation/behavior. Contrary to hypotheses, none of the interactions between PTSD and substance use disorders were significantly associated with suicidal ideation/behavior.
Lily A Brown, Ifrah Majeed, Wenting Mu, Jesse McCann, Stephen Durborow, Song Chen, Michael B Blank
Medical Xpress report
AIDS Care abstract