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Satre DD, Sarovar V, Levine T, Leibowitz AS, Lea AN, Ridout KK, Hare CB, Luu MN, Flamm J, Dilley JW, Davy-Mendez T, Sterling SA, Silverberg MJ. Factors associated with suicidal ideation among people with HIV engaged in care. J Affect Disord 2024; 358:369-376. [PMID: 38723683 DOI: 10.1016/j.jad.2024.05.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2023] [Revised: 04/29/2024] [Accepted: 05/06/2024] [Indexed: 05/16/2024]
Abstract
BACKGROUND People with HIV (PWH) are at elevated risk for suicidal ideation (SI), yet few studies have examined how substance use, clinical and sociodemographic factors are associated with SI among PWH. METHOD We used substance use (Tobacco, Alcohol, Prescription Medication, and Other Substance Use [TAPS]) and depression (PHQ-9) data from computerized screening of adult PWH in primary care clinics in Northern California, combined with health record data on psychiatric diagnoses, HIV diagnosis, treatment, and control (HIV RNA, CD4), insurance, and neighborhood deprivation index (NDI) to examine factors associated with SI (PHQ-9 item 9 score > 0). Adjusted odds ratios (aOR) for SI were obtained from logistic regression models. RESULTS Among 2829 PWH screened (92 % male; 56 % white; mean (SD) age of 54 (13) years; 220 (8 %) reported SI. Compared with no problematic use, SI was higher among those reporting one (aOR = 1.65, 95 % CI = 1.17, 2.33), two (aOR = 2.23, 95 % CI = 1.42, 3.49), or ≥ 3 substances (aOR = 4.49, 95 % CI = 2.41, 8.39). SI risk was higher for those with stimulant use (aOR = 3.55, 95 % CI = 2.25, 5.59), depression (aOR = 4.18, 95 % CI = 3.04, 5.74), and anxiety diagnoses (aOR = 1.67, 95 % CI = 1.19, 2.34), or Medicaid (aOR = 2.11, 95%CI = 1.24, 3.60) compared with commercial/other insurance. SI was not associated with HIV-related measures or NDI. LIMITATIONS SI was assessed with a single PHQ-9 item. Simultaneous SI and exposure data collection restricts the ability to establish substance use as a risk factor. CONCLUSIONS HIV care providers should consider multiple substance use, stimulant use, depression or anxiety, and public insurance as risk factors for SI and provide interventions when needed.
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Affiliation(s)
- Derek D Satre
- University of California, San Francisco, Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences, San Francisco, CA 94107, United States of America; Kaiser Permanente Northern California, Division of Research, Pleasanton, CA 94588, United States of America.
| | - Varada Sarovar
- Kaiser Permanente Northern California, Division of Research, Pleasanton, CA 94588, United States of America
| | - Tory Levine
- Kaiser Permanente Northern California, Division of Research, Pleasanton, CA 94588, United States of America
| | - Amy S Leibowitz
- Kaiser Permanente Northern California, Division of Research, Pleasanton, CA 94588, United States of America
| | - Alexandra N Lea
- Kaiser Permanente Northern California, Division of Research, Pleasanton, CA 94588, United States of America
| | - Kathryn K Ridout
- Kaiser Permanente Northern California, Division of Research, Pleasanton, CA 94588, United States of America; The Permanente Medical Group, Oakland, CA 94612, United States of America
| | - C Bradley Hare
- Kaiser Permanente Northern California, Division of Research, Pleasanton, CA 94588, United States of America
| | - Mitchell N Luu
- Kaiser Permanente Northern California, Division of Research, Pleasanton, CA 94588, United States of America
| | - Jason Flamm
- Kaiser Permanente Northern California, Division of Research, Pleasanton, CA 94588, United States of America
| | - James W Dilley
- University of California, San Francisco, Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences, San Francisco, CA 94107, United States of America
| | - Thibaut Davy-Mendez
- University of North Carolina at Chapel Hill, Department of Medicine, Division of Infectious Diseases, Chapel Hill, NC 27599, United States of America
| | - Stacy A Sterling
- University of California, San Francisco, Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences, San Francisco, CA 94107, United States of America; Kaiser Permanente Northern California, Division of Research, Pleasanton, CA 94588, United States of America
| | - Michael J Silverberg
- Kaiser Permanente Northern California, Division of Research, Pleasanton, CA 94588, United States of America
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Bogale EK, Zewdie A, Kassie TD, Anagaw TF, Mazengia EM, Gelaw SS, Fenta ET, Eshetu HB, Kebede N. Suicidal ideation, attempt, and its associated factors among adult HIV/AIDS patients in Ethiopia: A systematic review and meta-analysis study. PLoS One 2024; 19:e0294078. [PMID: 38484019 PMCID: PMC10939232 DOI: 10.1371/journal.pone.0294078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Accepted: 10/24/2023] [Indexed: 03/17/2024] Open
Abstract
BACKGROUND WHO statistics show that someone attempts suicide every three seconds and commits suicide every 40 seconds somewhere in the world. There is a scarcity of aggregate evidence in Ethiopia. The aim of this review was to assess the pooled prevalence of suicidal ideation, attempts, and associated factors among adult HIV/AIDS patients in Ethiopia to fill this gap. METHODS We extensively searched the bibliographic databases of PubMed, MEDLINE, Scopus, Google Scholar, and the Web of Science to obtain eligible studies. Further screening for a reference list of articles was also done. The Microsoft Excel Spreadsheet was used to extract data, and Stata 17 was used for analysis. To check heterogeneity, the Higgs I2 and Cochran's Q tests were employed. Sensitivity and subgroup analysis were implemented. To detect publication bias, Egger's test and funnel plots were used. RESULTS The pooled prevalence of suicidal ideation and attempts among adult HIV/AIDS patients in Ethiopia was 20.3 with a 95% CI (14, 26.5) and 11.1 with a 95% CI (6.6, 15.5), respectively. Living alone (AOR 4.98; 95% CI: 2.96-8.37), having comorbidity or other opportunistic infection (AOR 4.67; 95% CI: 2.57-8.48), female sex (AOR 2.86; 95% CI: 1.76, 4.62), having WHO clinical stage III of HIV (AOR 3.69; 95% CI: 2.15, 6.32), having WHO clinical stage IV of HIV (AOR 5.43; 95% CI: 2.81, 10.53), having co-morbid depression (AOR 5.25; 95% CI: 4.05, 6.80), having perceived HIV stigma (AOR 2.53; 95% CI: 1.67, 3.84), and having family history of suicidal attempt (AOR 2.79; 95% CI: 1.38, 5.66) were significantly associated with suicidal ideation. Being female (AOR 4.33; 95% CI: 2.36, 7.96), having opportunistic infections (AOR 2.73; 95% CI: 1.69, 4.41), having WHO clinical stage III of HIV (AOR 3.78; 95% CI: 2.04, 7.03), having co-morbid depression (AOR 3.47; 95% CI: 2.38, 5.05), having poor social support (AOR 3.02; 95% CI: 1.78, 5.13), and having WHO clinical stage IV (AOR 7.39; 95% CI: 3.54, 15.41) were significantly associated with suicidal attempts. CONCLUSION The pooled magnitude of suicidal ideation and attempt was high, and factors like opportunistic infection, WHO clinical stage III of HIV, WHO clinical stage III of HIV, and co-morbid depression were related to both suicidal ideation and attempt. Clinicians should be geared towards this mental health problem in HIV patients during management.
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Affiliation(s)
- Eyob Ketema Bogale
- Department of Health Promotion and Behavioral Science, School of Public Health, College of Medicine and Health Science, Bahir Dar University, Bahir Dar, Ethiopia
| | - Amare Zewdie
- Department of Public Health, Collage of Medicine and Health Science, Wolkite University, Wolkite, Ethiopia
| | - Tadele Derbew Kassie
- Department of Public Health, College of Medicine and Health Science, Debre Markos University, Debre Markos, Ethiopia
| | - Tadele Fentabil Anagaw
- Department of Health Promotion and Behavioral Science, School of Public Health, College of Medicine and Health Science, Bahir Dar University, Bahir Dar, Ethiopia
| | - Elyas Melaku Mazengia
- Department of Public Health, College of Medicine and Health Science, Debre Markos University, Debre Markos, Ethiopia
| | - Sintayehu Shiferaw Gelaw
- Department of Public Health, College of Medicine and Health Science, Debre Markos University, Debre Markos, Ethiopia
| | - Eneyew Talie Fenta
- Department of Public Health, College of Medicine and Health Sciences, Injibara University, Injibara, Ethiopia
| | - Habitu Birhan Eshetu
- Department of Health Promotion and Health Behaviour, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Natnael Kebede
- Department of Health Promotion, School of Public Health, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
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Mi T, Zhang J, Yang X, Chen S, Weissman S, Olatosi B, Li X. Suicide Ideation and Attempt Among People With HIV: A Statewide Population-level Cohort Analysis Between 2005 and 2020. J Acquir Immune Defic Syndr 2024; 95:117-125. [PMID: 37977196 DOI: 10.1097/qai.0000000000003342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 10/19/2023] [Indexed: 11/19/2023]
Abstract
BACKGROUND Risk factors for suicidality among people with HIV (PWH) may evolve over their disease course, particularly as they develop comorbidities such as mental health disorders over time. SETTING This study compared the leading risk factors of suicide ideation/attempt among PWH in South Carolina across different combination antiretroviral therapy (cART) eras. METHODS A statewide cohort of PWH who were diagnosed between 2005 and 2016, with a follow-up record until 2020, was involved in the study. A Cox proportional hazards model was used to examine the association of suicide ideation/attempt and predictors, including demographics, HIV-related characteristics, and mental health conditions. RESULTS Among 8567 PWH, the incidence of suicide ideation/attempt increased from 537.7 per 100,000 person-years [95% confidence interval (CI): 460.2 to 615.1] in the early cART cohort (2005-2008) to 782.5 (95% CI: 697.6 to 867.4) in the late cART cohort (2009-2016). Leading risk factors of suicide ideation/attempt changed across the cART cohort. In the early cART cohort, PWH with suicide ideation/attempt were more likely to be White and diagnosed with bipolar disorder ( P' s < 0.05). In the late cART cohort, suicide ideation/attempt was positively associated with transmission through injection drug use, anxiety, posttraumatic stress disorder, schizophrenia, and personality disorder ( P' s < 0.05). CONCLUSIONS Mental health conditions have emerged as more prominent risk factors for suicide ideation/attempt in the late cART cohort. Enhanced access to psychiatric care could facilitate the early identification of mental health conditions, enabling timely counseling or psychosocial interventions that may mitigate mental health issues and, consequently, reduce the likelihood of suicide ideation/attempts among PWH.
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Affiliation(s)
- Tianyue Mi
- Department of Health Promotion, Education, and Behavior & South Carolina SmartState Center for Healthcare Quality (CHQ), University of South Carolina, Arnold School of Public Health, Columbia, SC
| | - Jiajia Zhang
- Department of Epidemiology and Biostatistics, University of South Carolina, Arnold School of Public Health, Columbia, SC
| | - Xueying Yang
- Department of Health Promotion, Education, and Behavior & South Carolina SmartState Center for Healthcare Quality (CHQ), University of South Carolina, Arnold School of Public Health, Columbia, SC
| | - Shujie Chen
- Department of Epidemiology and Biostatistics, University of South Carolina, Arnold School of Public Health, Columbia, SC
| | - Sharon Weissman
- Department of Internal Medicine, School of Medicine, University of South Carolina, Columbia, SC; and
| | - Bankole Olatosi
- Department of Health Services Policy and Management, University of South Carolina, Arnold School of Public Health, Columbia, SC
| | - Xiaoming Li
- Department of Health Promotion, Education, and Behavior & South Carolina SmartState Center for Healthcare Quality (CHQ), University of South Carolina, Arnold School of Public Health, Columbia, SC
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Song X, Zou S, Li Y, Chen L, Feng P, Xu P, Zhang H, Deng F, Xu H, Tao Y, Jin M, Ran M, Zhang H, Ma F, Wang Y, Yin L. Correlation between negative life events and suicide attempts among Yi adolescents with HIV/AIDS in Liangshan Prefecture. BMC Public Health 2023; 23:1600. [PMID: 37608310 PMCID: PMC10463523 DOI: 10.1186/s12889-023-16377-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 07/24/2023] [Indexed: 08/24/2023] Open
Abstract
OBJECTIVE To investigate the incidence of suicide attempts among adolescents with HIV/AIDS in Liangshan Prefecture, Sichuan Province, as well as the correlation between negative life events, sleep, exercise, drug therapy and suicide attempts. METHODS A total of 180 Yi adolescents aged 11-19 years with HIV/AIDS in a county of Liangshan Prefecture, Sichuan Province, China, were investigated by census. The main outcome indicators included the incidence of suicide attempts and whether negative life events, sleep, exercise, drug therapy and other factors were related to suicide attempts. RESULTS We found that the incidence rate of suicide attempts among Yi adolescents with HIV/AIDS in Liangshan Prefecture was 13.9%. Negative life events were a risk factor for suicide attempts (OR = 1.047, p < 0.001, 95% CI 1.027-1.067). In the factors of negative life events, adaptation was a risk factor for suicide attempts (OR = 1.203, p = 0.026, 95% CI 1.022-1.416), and academic pressure showed a tendency to be a risk factor for suicide attempts (OR = 1.149, p = 0.077, 95% CI 0.985-1.339). However, the punishment factor, interpersonal stress factor and loss factor had no significant correlation with suicide attempts. There was no significant correlation between sleep, exercise, drug therapy and suicide attempts. CONCLUSION The proportion of suicide attempts among Yi adolescents with HIV/AIDS in Liangshan Prefecture is high and should be considered. Negative life events are independent risk factors for suicide attempts, and it is necessary to strengthen the screening and early intervention for suicide attempts in HIV/AIDS adolescents with definite negative life events.
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Affiliation(s)
- Xiaozhen Song
- Mental Health Center, West China Hospital, Sichuan University, Chengdu, China
| | - Shoukang Zou
- Mental Health Center, West China Hospital, Sichuan University, Chengdu, China
- The Fourth People's Hospital of Chengdu, Chengdu, China
| | - Yangling Li
- Mental Health Center, West China Hospital, Sichuan University, Chengdu, China
| | - Liyu Chen
- Center for Infectious Diseases, West China Hospital, Sichuan University, Chengdu, China
| | - Ping Feng
- Center for Infectious Diseases, West China Hospital, Sichuan University, Chengdu, China
| | - Peiwei Xu
- Mental Health Center, West China Hospital, Sichuan University, Chengdu, China
| | - Hang Zhang
- Mental Health Center, West China Hospital, Sichuan University, Chengdu, China
| | - Fang Deng
- Mental Health Center, West China Hospital, Sichuan University, Chengdu, China
- The Fourth People's Hospital of Chengdu, Chengdu, China
| | - Hanmei Xu
- Mental Health Center, West China Hospital, Sichuan University, Chengdu, China
| | - Yuanmei Tao
- Mental Health Center, West China Hospital, Sichuan University, Chengdu, China
| | - Meijiang Jin
- Mental Health Center, West China Hospital, Sichuan University, Chengdu, China
| | - Maojia Ran
- Mental Health Center, West China Hospital, Sichuan University, Chengdu, China
| | - Hong Zhang
- Mental Health Center, West China Hospital, Sichuan University, Chengdu, China
| | - Fanghua Ma
- Antiviral Treatment Center, Zhao jue County People's Hospital, Shenzhen, China
| | - Ying Wang
- Center for Infectious Diseases, West China Hospital, Sichuan University, Chengdu, China.
| | - Li Yin
- Mental Health Center, West China Hospital, Sichuan University, Chengdu, China.
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Tesera Kendie M, Worku L, Abebaw E, Solomon D, Ogeto Luke A, Hayilu S, Bogale EK. Predictors of suicidal ideation, attempts among adults living with HIV attending ART follow-ups at Tirunesh Beijing General Hospital, Addis Ababa, Ethiopia: a cross-sectional study. BMJ Open 2023; 13:e069683. [PMID: 37202134 DOI: 10.1136/bmjopen-2022-069683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/20/2023] Open
Abstract
OBJECTIVE To assess the magnitude of suicidal ideation, attempts and associated factors among adults living with HIV attending antiretroviral therapy follow-ups at Tirunesh Beijing General Hospital, Addis Ababa. DESIGN Hospital-based observational, descriptive, cross-sectional study was conducted. SETTING A study was conducted in Tirunesh Beijing General Hospital, Addis Ababa from 8 February 2022 to 10 July 2022. PARTICIPANTS Two hundred and thirty-seven HIV-positive youth were recruited for interviews, using the systematic random sampling technique. The Composite International Diagnostic Interview was used to assess suicide. Patient Health Questionnaire-9, the Oslo social support and HIV perceived stigma scale instruments were used to assess the factors. Bivariate and multivariate logistic regressions were computed to assess factors associated with suicidal ideation and attempt. Statistical significance was declared at p value <0.05. RESULTS The finding of the study revealed magnitude of suicide ideation and suicide attempt was 22.8% and 13.5%, respectively. Disclosure status (adjusted odd ratio (AOR)=3.60, 95% CI 1.44 to 9.01), history of using substances (AOR)=2.86, 95% CI 1.07 to 7.61), living alone (AOR=6.47, 95% CI 2.31 to 18.10) and having comorbidity or other opportunistic infection (AOR=3.74, 95% CI 1.32 to 10.52) are factors associated with suicide ideation while disclosure status (AOR=5.02, 95% CI 1.95 to 12.94), living arrangement (AOR=3.82, 95% CI 1.29 to 11.31) and depression history is a factor associated with suicide attempts (AOR=3.37, 95% CI 1.09 to 10.40). CONCLUSION The finding of the study indicated the magnitude of suicide ideation and attempt is high among the subjects included in this study. Disclosure status, history of using substances, living alone and having comorbidity or other opportunistic infection are factors associated with suicide ideation while disclosure status, living arrangement and depression history are factors associated with a suicide attempt.
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Affiliation(s)
- Mikiyas Tesera Kendie
- Department of General Public Health, Gamby Medical and Business College, Addis Ababa, Ethiopia
| | - Lelisa Worku
- Department of Public Health Nutrition, Rift Valley University, Addis Ababa, Ethiopia
| | - Ermias Abebaw
- Public Health, GAMBY Medical and Business College, Bahir Dar, Ethiopia
| | - Damtew Solomon
- Anatomy Department, Madda Walabu University, Robe, Ethiopia
| | | | - Sisay Hayilu
- Department of Public Health Nutrition, Hidasse Health Center, Addis Ababa, Ethiopia
| | - Eyob Ketema Bogale
- Department of Health Promotion and Behavioral Sciences, Bahir Dar University College of Medicine and Health Sciences, Bahir Dar, Ethiopia
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Tsai YT, K. M. SP, Ku HC, Wu YL, Ko NY. Global overview of suicidal behavior and associated risk factors among people living with human immunodeficiency virus: A scoping review. PLoS One 2023; 18:e0269489. [PMID: 36940193 PMCID: PMC10029973 DOI: 10.1371/journal.pone.0269489] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2021] [Accepted: 05/22/2022] [Indexed: 03/21/2023] Open
Abstract
Death by suicide is a major public health problem. People living with human immunodeficiency virus (PLHIV) have higher risk of suicidal behavior than the general population. The aim of this review is to summarize suicidal behavior, associated risk factors, and risk populations among PLHIV. Research studies in six databases from January 1, 1988, to July 8, 2021, were searched using keywords that included "HIV," "suicide," and "risk factors." The study design, suicide measurement techniques, risk factors, and study findings were extracted. A total of 193 studies were included. We found that the Americas, Europe, and Asia have the highest rates of suicidal behavior. Suicide risk factors include demographic factors, mental illness, and physiological, psychological, and social support. Depression is the most common risk factor for PLHIV, with suicidal ideation and attempt risk. Drug overdosage is the main cause of suicide death. In conclusion, the current study found that PLHIV had experienced a high level of suicidal status. This review provides an overview of suicidal behavior and its risk factors in PLHIV with the goal of better managing these factors and thus preventing death due to suicide.
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Affiliation(s)
- Yi-Tseng Tsai
- Department of Nursing, An Nan Hospital, China Medical University, Tainan,
Taiwan
- Department of Nursing, College of Medicine, National Cheng Kung
University, Tainan, Taiwan
| | - Sriyani Padmalatha K. M.
- Department of Nursing, College of Medicine, National Cheng Kung
University, Tainan, Taiwan
- Operating Room Department, National Hospital of Sri Lanka, Colombo, Sri
Lanka
| | - Han-Chang Ku
- Department of Nursing, An Nan Hospital, China Medical University, Tainan,
Taiwan
- Department of Nursing, College of Medicine, National Cheng Kung
University, Tainan, Taiwan
| | - Yi-Lin Wu
- Department of Nursing, College of Medicine, National Cheng Kung
University, Tainan, Taiwan
| | - Nai-Ying Ko
- Department of Nursing, College of Medicine, National Cheng Kung
University, Tainan, Taiwan
- Department of Public Health, College of Medicine, National Cheng Kung
University, Tainan, Taiwan
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Incidence and risk factors for suicide, death due to substance use, and violent/accidental death in people with HIV. AIDS 2023; 37:161-171. [PMID: 36250262 DOI: 10.1097/qad.0000000000003402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Deaths due to suicide, substance use and violence/accident may reflect similar risk factors and overlap in their classification. This study aimed to investigate incidence and risk factors of mortality among people with HIV (PWH) due to these three related causes. DESIGN Prospectively collected data from PWH at least 18 years old and under active follow-up in the EuroSIDA study from 2007 to 2019 were analysed. METHODS Cause-specific Cox regression analysis was used to assess risk factors. RESULTS A total of 17 881 participants were included, comprising 149 327 person-years of follow-up (PYFU). Forty participants died by suicide {incidence rate [IR] [95% confidence interval (CI)]: 0.3/1000 PYFU (0.2, 0.4)} 93 from substance use [IR (95% CI): 0.6/1000 PYFU (0.5, 0.8)], and 57 by violence/accident [IR (95% CI): 0.4/1000 PYFU (0.3, 0.5)]. An AIDS diagnosis within the last 12 months was associated with nine-fold increased risk of suicide vs. no history of AIDS [adjusted hazard ratio (aHR): 9.06; 95% CI: 2.07, 39.7]. Male gender was associated with double the risk of violent/accidental death (aHR: 2.28; 95% CI: 1.09, 4.78). PWH in Eastern Europe and those who acquired HIV by injection drug use (IDU) demonstrated a greater risk of death due to substance use or violence/accident. CONCLUSIONS The association between a recent diagnosis of AIDS and suicide highlights a critical period for intervention. HIV infection acquired through IDU demonstrated an expected relationship with death due to substance use and violent/accidental deaths. Increased risk of death due to substance use and violence/accident in Eastern Europe demands investigation into specific differences that may drive that association.
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Li S, Yu S, Yang Q, Yin J, Zhu H, Jiang Y, Ji Y. Prevalence of suicide ideation among HIV/AIDS patients in China: A systematic review and meta-analysis. Front Public Health 2023; 11:1082521. [PMID: 36908478 PMCID: PMC9996003 DOI: 10.3389/fpubh.2023.1082521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Accepted: 02/07/2023] [Indexed: 02/25/2023] Open
Abstract
Objective A systematic review and meta-analysis was performed to evaluate the prevalence of suicide ideation among HIV/AIDS patients in China. Methods Systematic search of CNKI, Wanfang, China biology medicine database, Weipu, EMBASE, Web of science and PubMed for studies related to the suicide ideation of HIV/AIDS patients. The incidence of suicide ideation of HIV / AIDS patients in China was investigated by meta-analysis. Results A total of 16 studies were included (n = 6,174). The incidence of suicidal ideation in HIV/AIDS patients was 30.6% (95%CI: 21.4-39.9%). The results of subgroup analysis showed that the incidence of suicidal ideation in male was 36.1%, which was higher than that in female (32.8%), homosexual patients (39.7%) higher than heterosexual patients (27.1%), 2013-2021 survey (35.2%) higher than 2003-2012 survey (26.5%), the unmarried patients (39.6%) were higher than the married patients (34.5%), the patients diagnosed >1 year (28.4%) were higher than the patients diagnosed <1 year (27.6%), and the depression patients (34.3%) were higher than patients without depression (20.5%) and CD4 cell counts ≤200 cells/ul group (20.6%) were higher than those in >400 cells/ul group (19.8%). Conclusion The incidence of suicide ideation in HIV/AIDS patients in China is relatively high.
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Affiliation(s)
- Shiming Li
- The Affiliated Mental Health Center of Jiangnan University, Wuxi Central Rehabilitation Hospital, Wuxi, Jiangsu, China
| | - Shui Yu
- The Affiliated Mental Health Center of Jiangnan University, Wuxi Central Rehabilitation Hospital, Wuxi, Jiangsu, China
| | - Queping Yang
- The Affiliated Mental Health Center of Jiangnan University, Wuxi Central Rehabilitation Hospital, Wuxi, Jiangsu, China
| | - Jieyun Yin
- School of Public Health, Medical College of Soochow University, Suzhou, Jiangsu, China
| | - Haohao Zhu
- The Affiliated Mental Health Center of Jiangnan University, Wuxi Central Rehabilitation Hospital, Wuxi, Jiangsu, China
| | - Ying Jiang
- The Affiliated Mental Health Center of Jiangnan University, Wuxi Central Rehabilitation Hospital, Wuxi, Jiangsu, China
| | - Yingying Ji
- The Affiliated Mental Health Center of Jiangnan University, Wuxi Central Rehabilitation Hospital, Wuxi, Jiangsu, China
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Zhu Y, Rodebaugh T, Narine K, Brown LA. Idiographic Dynamics between Suicide Ideation and Depression, Anxiety and Posttraumatic Stress Symptoms in Persons Living with HIV: A Pilot Study. J Pers Oriented Res 2022; 8:71-86. [PMID: 36589929 PMCID: PMC9773944 DOI: 10.17505/jpor.2022.24856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Given that suicide ideation (SI) fluctuates drastically over short periods of time and is heterogenous across individuals, idiographic suicide research is warranted. In this pilot study, we used intensive ecological momentary assessment (EMA) to examine whether anxiety, depression, and PTSD symptoms on a given day predicted next-day SI on a person-to-person basis. METHODS PLWH (N = 10) with past-month SI completed daily randomly assessed ratings of suicidal urges using the Suicide-Visual Analogue Scale (S-VAS) and daily assessed ratings of anxiety, depression, and PTSD symptoms for 28 days. We used N = 1 Dynamic Structural Equation Modeling to test whether depression, anxiety or PTSD symptoms in the prior day predicted next-day S-VAS for each individual. RESULTS Across all participants, S-VAS on a given day was not predicted by prior-day anxiety, PTSD symptoms or S-VAS. In one participant, higher depression symptoms predicted lower next-day S-VAS. CONCLUSIONS Daily-level data may be insufficient to predict near-term increases in suicide risk based on anxiety, depression, or PTSD symptoms in PLWH. These findings suggest the importance of finer-grained assessments (e.g., assessing suicide risk and its correlates multiple times per day) to better understand changes in suicide risk over time among PLWH.
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Affiliation(s)
- Yiqin Zhu
- Department of Psychiatry, University of Pennsylvania
| | - Thomas Rodebaugh
- Department of Psychological and Brain Science, Washington University at St. Louis
| | - Kevin Narine
- Department of Clinical Psychology, William James College
| | - Lily A. Brown
- Department of Psychiatry, University of Pennsylvania,Corresponding author: Lily A. Brown, Ph.D., Department of Psychiatry, University of Pennsylvania, 3535 Market Street, Suite 600N, Philadelphia, PA, 19104. , Tel: 215-746-3346; Fax: 215-746-3311
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Tsai YT, Padmalatha S, Ku HC, Wu YL, Yu T, Chen MH, Ko NY. Suicidality Among People Living With HIV From 2010 to 2021: A Systematic Review and a Meta-regression. Psychosom Med 2022; 84:924-939. [PMID: 36162070 PMCID: PMC9553271 DOI: 10.1097/psy.0000000000001127] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Revised: 04/11/2022] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The association between human immunodeficiency virus (HIV)/AIDS and suicidality is not well understood, partly because of variability in results. This meta-analysis aimed to investigate the predictive value of HIV/acquired immune deficiency syndrome for incident suicidality. METHODS A literature review was conducted of articles published between January 1, 2010, and October 31, 2021. The following databases were searched: Embase, MEDLINE, CINAHL, Web of Science, and Scopus. The search terms included human immunodeficiency virus (HIV), suicidal behavior, auto mutilation, and self-injurious behavior. Observational studies were screened following a registered protocol, and eligible ones were meta-analyzed and followed by meta-regression. RESULTS A total of 43 studies were included in this systematic review, and a meta-regression included 170,234 participants. The pooled prevalence estimates of suicidal ideation, attempted suicide, and deaths by suicide were 22.3%, 9.6%, and 1.7%, respectively. The following significant risk factors for suicide ideation were found: substance use, depression, low quality of life, low social support, without HIV status disclosure, living alone, low level of memory problems, family history of suicide, and stage III of HIV. Risk factors for suicide attempts were depression and family history of suicide. An elevated risk for suicide-related death was found for people living with HIV (PLHIV) who had a psychiatric disorder and in studies conducted in hospital-based settings (versus national database studies or HIV clinic settings). CONCLUSIONS The risk of suicidality is high among PLHIV within all six World Health Organization regions during the modern antiretroviral therapy era. Assessment of socioeconomic and psychological factors is recommended for further management to prevent suicide among PLHIV. The present findings are useful for design of intervention protocols and development of clinical practice guidelines intended to manage the well-being of PLHIV worldwide.
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Pei JH, Pei YX, Ma T, Du YH, Wang XL, Zhong JP, Xie Q, Zhang LH, Yan LX, Dou XM. Prevalence of suicidal ideation, suicide attempt, and suicide plan among HIV/AIDS: A systematic review and meta-analysis. J Affect Disord 2021; 292:295-304. [PMID: 34134028 DOI: 10.1016/j.jad.2021.05.064] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2020] [Revised: 05/09/2021] [Accepted: 05/30/2021] [Indexed: 02/06/2023]
Abstract
BACKGROUND Suicidality is common in people living with HIV/AIDS. However, the prevalence estimates of the suicidality vary between studies. Here, we performed a systematic review and estimated the prevalence of suicidal behavior in this population. METHODS Systematic search of PubMed, Embase, Web of Science, CINAHL, Scopus and PsycINFO for relevant studies published before August 29, 2020. A random-effects model was used to pool the estimates of the prevalence of suicidal ideation, attempts and plans, which were also stratified by continent or region and screening instrument from the studies included in this meta-analysis. RESULTS Suicide prevalence data were extracted from 36 studies(n=32,818) from 15 countries. The overall pooled crude prevalence estimates of suicidal ideation, plans, and attempts were 20.9% [95% confidence interval (CI) 16.5-21.6%],8.1% (95% CI 5.4-11.3%), and 7.5% (95% CI 5.7-9.5%), respectively. For lifetime suicidal ideation and attempts prevalence, this was 22.4% (95% CI 15.9-29.8%), and 12.0% (95% CI 6.9- 18.1%), respectively. Summary prevalence estimates ranged across assessment modalities from 6.5% to 33.7%. Pooled estimates were generally higher for females, as compared with males (risk ratios in the range 1.48-1.85). The leave-one-out analysis showed that no single study significantly affected the final pooled results.
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Affiliation(s)
- Ju-Hong Pei
- School of Nursing, Lanzhou university, Lanzhou, Gansu, People's Republic of China
| | - Yi-Xuan Pei
- Performance Operation Office, The Second People's Hospital of Gansu Province, Lanzhou, Gansu, People's Republic of China
| | - Tong Ma
- Department of Spine Minimally Invasive Orthopedics, Gansu Provincial Hospital of Traditional Chinese Medicine, Gansu, People's Republic of China
| | - Ye-Hui Du
- School of Nursing, Lanzhou university, Lanzhou, Gansu, People's Republic of China
| | - Xing-Lei Wang
- Department of liver diseases branch, Lanzhou University Second Hospital, Lanzhou, Gansu, People's Republic of China
| | - Juan-Ping Zhong
- School of Nursing, Lanzhou university, Lanzhou, Gansu, People's Republic of China
| | - Qi Xie
- School of Nursing, Lanzhou university, Lanzhou, Gansu, People's Republic of China
| | - Li-Hong Zhang
- School of Nursing, Lanzhou university, Lanzhou, Gansu, People's Republic of China
| | - Li-Xin Yan
- Second Department of Mental Health, Lanzhou University Second Hospital, Lanzhou, Gansu
| | - Xin-Man Dou
- School of Nursing, Lanzhou university, Lanzhou, Gansu, People's Republic of China;; Department of Nursing, Lanzhou University Second Hospital, Lanzhou, Gansu, People's Republic of China
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Gizachew KD, Chekol YA, Basha EA, Mamuye SA, Wubetu AD. Suicidal ideation and attempt among people living with HIV/AIDS in selected public hospitals: Central Ethiopia. Ann Gen Psychiatry 2021; 20:15. [PMID: 33608017 PMCID: PMC7896396 DOI: 10.1186/s12991-021-00335-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Accepted: 02/07/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Suicide is the act of intentionally causing one's own death. HIV/AIDS continues to be associated with an under-recognized risk for suicidal behavior. Suicidal behavior among people living with HIV/AIDS is not only a predictor of future attempted suicide and completed suicide, but it is also associated with poor quality of life and poor adherence with antiretroviral therapy. OBJECTIVE The aim of this study was to assess the prevalence of suicidal ideation and attempt and associated factors among people living with HIV/AIDS in selected public hospitals of Amhara region, central Ethiopia. METHODS Institutional based cross-sectional study design was employed. The study was conducted in four public hospitals in North Shewa Zone from May to December 2017. Study population comprised all HIV-infected individuals from Antiretroviral Therapy (ART) clinic. A total of 348 study subjects were recruited using systematic random sampling and 326 completed the interview. Suicidality module from Composite International Diagnostic Interview (CIDI) was modified to assess suicidal behavior. Crude and adjusted OR was analyzed using logistic regression and the level of significance of association was determined at P value < 0.05. RESULT A total of 326 (93.7%) study subjects were interviewed. The magnitude of suicidal ideation and attempt was found to be 16% and 7.1%, respectively. Low monthly income, living alone, suicidal thought before knowing seropositive status, family history of suicide, experiencing mild and moderate-to-severe depression and anxiety symptoms, being gossiped sometimes in the last 12 months of the study period due to HIV status and ever use of khat (a psychoactive substance) was statistically significant associated factor with suicidal ideation. And low monthly income, experiencing mild and moderate-to-severe depression and anxiety symptoms, being gossiped sometimes and often in the previous 12 months of the study period due to HIV status and using alcohol currently were significantly associated factors with suicidal attempt. CONCLUSION Suicidal ideation and attempt among people living with HIV/AIDS (PLWHA) in this study were higher than prevalence in the general population. This shows suicidal ideation and attempt is a mental health concern of PLWHA and it needs great attention in Ethiopia.
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Affiliation(s)
- Kefyalew Dagne Gizachew
- Department of Psychiatry, College of Health Sciences and Medicine, Debre Berhan University, P.O. Box 445, Debre Berhan, Ethiopia. .,Department of Psychiatry, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia.
| | - Yigrem Ali Chekol
- Department of Psychiatry, College of Health Sciences, Dilla University, Dilla, Ethiopia
| | - Elyas Admasu Basha
- Department of Psychiatry, College of Health Sciences and Medicine, Debre Berhan University, P.O. Box 445, Debre Berhan, Ethiopia
| | - Shiferaw Abeway Mamuye
- School of Nursing and Midwifery, Department of Pediatric and Child Health Nursing, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Abate Dargie Wubetu
- Department of Psychiatry, College of Health Sciences and Medicine, Debre Berhan University, P.O. Box 445, Debre Berhan, Ethiopia
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13
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Wang W, Chen X, Yan H, Yu B, Li S. Association between social capital and suicide ideation, plan and attempt among men living with HIV in China. J Affect Disord 2021; 280:173-179. [PMID: 33212409 DOI: 10.1016/j.jad.2020.11.088] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Revised: 10/05/2020] [Accepted: 11/08/2020] [Indexed: 11/17/2022]
Abstract
BACKGROUND Better understanding of the relationship between social capital and risk of suicide is essential for suicide prevention and control among people living with HIV (PLWH). METHODS Participants were 494 male PLWH recruited with a venue-based method from Wuhan in China. Data were collected using a self-reported questionnaire during November 2015 and January 2016. Social capital was measured using the short-version Personal Social Capital Scale. Multivariate logistic regression was used to assess the association between social capital and suicidal ideations post HIV+ diagnosis and in the past month, as well as suicide plan and attempt. RESULTS Scatter plots showed a nonlinear trend in the prevalence of the three suicide measures along with social capital. Logistic regression analyses stratified by quartiles of social capital indicated a significant nonlinear association between social capital and the risk of suicide. The estimated odds ratio [95% CI] of suicidal ideation was 0.87 [0.51.1.42], 0.68 [0.40, 1.14] and 0.24 [0.12, 0.46] for the second, third and fourth quartile of social capital scores respectively with the first quartile as the reference. Similar results were observed for suicidal ideation in the past month and suicidal plan/attempt. CONCLUSIONS Findings of this study suggest that social capital is only associated with lower suicidal ideation at very high levels of social capital. If verified with longitudinal data, this finding suggests an effective suicide prevention intervention among male PLWH must foster social capital to a level greater than average.
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Affiliation(s)
- Wei Wang
- School of Public Health, Xuzhou Medical University, Xuzhou, Jiangsu, China; School of Health Sciences, Wuhan University, Wuhan, Hubei, China.
| | - Xinguang Chen
- Department of Epidemiology, University of Florida, Gainesville, FL, USA
| | - Hong Yan
- School of Health Sciences, Wuhan University, Wuhan, Hubei, China.
| | - Bin Yu
- Department of Epidemiology, University of Florida, Gainesville, FL, USA
| | - Shiyue Li
- School of Health Sciences, Wuhan University, Wuhan, Hubei, China
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Ali O, Deribe K, Semrau M, Mengiste A, Kinfe M, Tesfaye A, Bremner S, Davey G, Fekadu A. A cross-sectional study to evaluate depression and quality of life among patients with lymphoedema due to podoconiosis, lymphatic filariasis and leprosy. Trans R Soc Trop Med Hyg 2020; 114:983-994. [PMID: 33190154 PMCID: PMC7738660 DOI: 10.1093/trstmh/traa130] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 09/23/2020] [Accepted: 11/09/2020] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Podoconiosis, lymphatic filariasis (LF) and leprosy are neglected tropical diseases (NTDs) that cause lymphoedema. When left untreated, they lead to substantial disability. This study determined the quality of life (QOL) and depression associated with lymphoedema in patients with podoconiosis, LF and leprosy. The study was conducted in northwestern Ethiopia. METHODS This baseline cross-sectional study, nested within an interventional, non-comparative, longitudinal study, included patients with lymphoedema. Depression and QOL were assessed using versions of the 9-item Patient Health Questionnaire and Dermatologic Life Quality Index (DLQI), respectively, that had been translated into Amharic and validated. Factors associated with depression and QOL were assessed using multivariate linear regression analysis. RESULTS Of the 251 patients with lymphoedema included in the study, 119 (47.4%) had moderate to severe depression and overall QOL was poor (mean±standard deviation [SD] DLQI score: 11.4±4.2). Disability was significantly associated with depression (β=0.26 [95% confidence interval {CI} 0.19 to 0.33]). Currently receiving treatment (β=-3.05 [95% CI -5.25 to -0.85), disability (β=-0.08 [95% CI -0.15 to -0.01]) and social support (moderate support: β=-2.27 [95% CI -3.66 to -0.89] and strong support: β=-2.87 [95% CI -5.35 to -0.38]) were significantly associated with better QOL. CONCLUSION High levels of depression and low QOL were found among patients with lymphoedema due the three NTDs in Ethiopia.
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Affiliation(s)
- Oumer Ali
- Center for Innovative Drug Development and Therapeutic Trials for Africa (CDT)-Africa, College of Health Sciences, Addis Ababa University, Addis Ababa, 9086, Ethiopia
- Centre for Global Health Research, Brighton and Sussex Medical School, University of Sussex, Falmer, Brighton BN1 9PX, UK
| | - Kebede Deribe
- Centre for Global Health Research, Brighton and Sussex Medical School, University of Sussex, Falmer, Brighton BN1 9PX, UK
- School of Public Health, College of Health Sciences, Addis Ababa University, Addis Ababa, 1176, Ethiopia
| | - Maya Semrau
- Centre for Global Health Research, Brighton and Sussex Medical School, University of Sussex, Falmer, Brighton BN1 9PX, UK
| | - Asrat Mengiste
- Center for Innovative Drug Development and Therapeutic Trials for Africa (CDT)-Africa, College of Health Sciences, Addis Ababa University, Addis Ababa, 9086, Ethiopia
| | - Mersha Kinfe
- Center for Innovative Drug Development and Therapeutic Trials for Africa (CDT)-Africa, College of Health Sciences, Addis Ababa University, Addis Ababa, 9086, Ethiopia
| | - Abraham Tesfaye
- Center for Innovative Drug Development and Therapeutic Trials for Africa (CDT)-Africa, College of Health Sciences, Addis Ababa University, Addis Ababa, 9086, Ethiopia
| | - Stephen Bremner
- Centre for Global Health Research, Brighton and Sussex Medical School, University of Sussex, Falmer, Brighton BN1 9PX, UK
| | - Gail Davey
- Centre for Global Health Research, Brighton and Sussex Medical School, University of Sussex, Falmer, Brighton BN1 9PX, UK
- School of Public Health, College of Health Sciences, Addis Ababa University, Addis Ababa, 1176, Ethiopia
| | - Abebaw Fekadu
- Center for Innovative Drug Development and Therapeutic Trials for Africa (CDT)-Africa, College of Health Sciences, Addis Ababa University, Addis Ababa, 9086, Ethiopia
- Centre for Global Health Research, Brighton and Sussex Medical School, University of Sussex, Falmer, Brighton BN1 9PX, UK
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15
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Wang S, Ni Y, Gong R, Shi Y, Cai Y, Ma J. Psychosocial Syndemic of suicidal ideation: a cross-sectional study among sexually transmitted infection patients in Shanghai, China. BMC Public Health 2020; 20:1314. [PMID: 32867729 PMCID: PMC7457481 DOI: 10.1186/s12889-020-09404-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Accepted: 08/18/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Patients with sexually transmitted infections (STIs) experience difficulties with stability and trust in long-term relationships and have poor mental health, factors that may lead to suicidal ideation. We sought to verify whether psychosocial health problems among patients with STIs were associated with these patients' suicidal ideation and to examine the syndemic effect of multiple psychosocial problems on suicidal ideation. METHODS This was a cross-sectional study of 519 STI patients at the Shanghai Skin Disease Hospital. Demographic, psychosocial, and suicidal ideation information about the participants was collected by questionnaire. Logistic regressions were performed to detect the association between demographic variables and suicidal ideation, as well as each individual psychosocial variable and suicidal ideation, and to verify the syndemic effect of psychosocial factors. RESULTS Of the participants, 25.0% (130/519) reported having suicidal ideation. In univariable analysis, low self-esteem, loneliness, depression, entrapment, defeat, and unsatisfied interpersonal needs were associated with suicidal ideation. Multivariable analysis found depression (odds ratio [OR]: 4.1; 95% confidence interval [CI]: 2.3-7.2) and entrapment (OR: 2.1; 95%CI: 1.1-4.1) each had a more significant relation with suicidal ideation than the other psychosocial problems examined. STI patients who experienced two or more psychosocial health problems had approximately fourfold odds of suicide ideation (adjusted OR [AOR]: 4.2; 95%CI: 2.6-6.8) compared with those in the non-syndemic group, especially in the high-level (five or more psychosocial problems) group (AOR: 7.0; 95%CI: 3.9-12.5). CONCLUSIONS The study found the participants had a high rate of suicidal ideation and suffered from severe psychosocial problems. These results show a syndemic effect of psychosocial problems on increasing the odds of suicidal ideation. Our findings suggest an urgent need for efforts to prevent suicidal ideation among STI patients toward improving the social and health conditions of this population.
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Affiliation(s)
- Suping Wang
- School of Public Health, Shanghai Jiao Tong University School of Medicine, No. 227 South Chongqing Road, Shanghai, 200025, China
| | - Yang Ni
- Shanghai Skin Disease Hospital, Tongji University School of Medicine, No. 1278 Baode Road, Shanghai, 200443, China
| | - Ruijie Gong
- School of Public Health, Shanghai Jiao Tong University School of Medicine, No. 227 South Chongqing Road, Shanghai, 200025, China.,Shanghai Xuhui Center for Disease Control and Prevention, No. 50 Yongchuan Road, Shanghai, 200237, China
| | - Yuan Shi
- School of Public Health, Shanghai Jiao Tong University School of Medicine, No. 227 South Chongqing Road, Shanghai, 200025, China
| | - Yong Cai
- School of Public Health, Shanghai Jiao Tong University School of Medicine, No. 227 South Chongqing Road, Shanghai, 200025, China.
| | - Jin Ma
- School of Public Health, Shanghai Jiao Tong University School of Medicine, No. 227 South Chongqing Road, Shanghai, 200025, China.
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16
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Gebreegziabhier Kindaya G, Kassaw Demoze C. Lifetime Prevalence and Determinants of Suicidal Ideation and Attempt Among All Patients Living with HIV/AIDS in Hiwot Fana Specialized Hospital, Harar, Ethiopia, 2020. HIV AIDS-RESEARCH AND PALLIATIVE CARE 2020; 12:331-339. [PMID: 32821172 PMCID: PMC7418163 DOI: 10.2147/hiv.s257502] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Accepted: 07/31/2020] [Indexed: 11/23/2022]
Abstract
Background Suicide is a psychiatric emergency and the second leading cause of death among youths. Suicide risk is 7 to 36 times greater among PLWHA as compared to the general population. This study was aimed at determining the prevalence of suicide and its associated factors among PLWHA and attendings at Hiwot Fana Specialized University Hospital, Ethiopia, 2020. Patients and Methods We conducted a cross-sectional study on 412 randomly selected respondent PLWHA and attendingz at Hiwot Fana Specialized University Hospital from February 1–March 1, 2020. The interviewers administered a structured questionnaire consisting of the World Health Organization Composite International Diagnostic Interview (CIDI) tool to measure suicidality. We used the clinical records to collect clinical variables of the respondents. We used simple logistic regression ≤ 0.25 at p-value ≤ 0.25 and multiple logistic regression at p-value ≤ 0.05 to identify the predictor variables of the outcome. Results A total of 412 participants have completed the questionnaire, with a response rate of 97.4%. The majority, 252 (61.2) of the participants were female, while 112 (27.2%) of the respondents were in the age group of 28–37. The prevalence of suicidal ideation and attempt among PLWHA was 24.3% (CI; 20.4, 28.4) and 12.6% (9.5–15.8), respectively. Predictors for suicidal ideation were being in extreme poverty, living alone, widowed, CD4 level less than 250, and current alcohol use, and for suicidal attempt were an urban residence, stage IV HIV, family history of suicide, and depression. Conclusion Nearly one-fourth of the respondents reported suicidal ideation. So, early screening and working on those identified predictors of suicidality is vital to prevent the mortality of it in PLWHA.
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Affiliation(s)
| | - Chalachew Kassaw Demoze
- Department of Psychiatry, College of Medicine and Health Science, Dilla University, Dilla, Ethiopia
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17
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Brown LA, Majeed I, Mu W, McCann J, Durborow S, Chen S, Blank MB. Suicide risk among persons living with HIV. AIDS Care 2020; 33:616-622. [PMID: 32741212 DOI: 10.1080/09540121.2020.1801982] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
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.
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Affiliation(s)
- Lily A Brown
- Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, USA
| | - Ifrah Majeed
- Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, USA
| | - Wenting Mu
- Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, USA
| | - Jesse McCann
- Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, USA
| | - Stephen Durborow
- Clinical Research Computing Unit, University of Pennsylvania, Philadelphia, PA, USA
| | - Song Chen
- Department of Mathematics and Statistics, University of Wisconsin, La Crosse, WI, USA
| | - Michael B Blank
- Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, USA
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18
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Zhornitsky S, Le TM, Dhingra I, Adkinson BD, Potvin S, Li CR. Interpersonal Risk Factors for Suicide in Cocaine Dependence: Association with Self-Esteem, Personality Traits, and Childhood Abuse. Suicide Life Threat Behav 2020; 50:867-883. [PMID: 32030810 PMCID: PMC7518050 DOI: 10.1111/sltb.12621] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Accepted: 01/10/2020] [Indexed: 01/31/2023]
Abstract
OBJECTIVE Studies have linked cocaine dependence to suicidality. According to the Interpersonal Theory of Suicide, suicidal behavior becomes likely with the simultaneous presence of perceived burdensomeness (PB), lack of (or thwarted) belongingness (TB), and acquired fearlessness about death (FAD). Here, we examined personality and other variables, including depression, self-esteem, childhood abuse, and substance use, as predictors of these risk factors in cocaine-dependent individuals (CDs). METHODS Seventy CDs and 70 healthy controls (HCs) participated. We examined group differences in a group-by-sex analysis of variance and identified predictors of PB, TB, and FAD in stepwise regressions. RESULTS CDs exhibited elevated PB and TB but not FAD, compared to HCs. CDs also exhibited elevated harm avoidance, novelty seeking, depression, and lower self-esteem and reward dependence. Females reported elevated sexual abuse, harm avoidance, reward dependence, depression, but lower FAD, relative to males, among CDs and HCs. Among CDs, PB was predicted by lower self-esteem and greater emotional abuse; TB was predicted by lower self-esteem and reward dependence, as well as greater emotional and sexual abuse; and FAD was predicted by lower harm avoidance and greater physical abuse. CONCLUSIONS Interventions targeting suicidality in cocaine dependence should take into consideration self-esteem, personality traits, and childhood abuse.
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Affiliation(s)
- Simon Zhornitsky
- Department of Psychiatry Yale University School of Medicine New Haven Connecticut
| | - Thang M. Le
- Department of Psychiatry Yale University School of Medicine New Haven Connecticut
| | - Isha Dhingra
- Department of Psychiatry Yale University School of Medicine New Haven Connecticut
| | - Brendan D. Adkinson
- Interdepartmental Neuroscience Program Yale University School of Medicine New Haven Connecticut
| | - Stephane Potvin
- Centre de recherche de l'Institut Universitaire en Santé Mentale de Montréal Montreal QC Canada
- Department of Psychiatry Faculty of Medicine Université de Montréal Montréal QC Canada
| | - Chiang‐shan R. Li
- Department of Psychiatry Yale University School of Medicine New Haven Connecticut
- Interdepartmental Neuroscience Program Yale University School of Medicine New Haven Connecticut
- Department of Neuroscience Yale University School of Medicine New Haven Connecticut
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19
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Ernst M, Kallenbach-Kaminski L, Kaufhold J, Negele A, Bahrke U, Hautzinger M, Beutel ME, Leuzinger-Bohleber M. Suicide attempts in chronically depressed individuals: What are the risk factors? Psychiatry Res 2020; 287:112481. [PMID: 31377008 DOI: 10.1016/j.psychres.2019.112481] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Revised: 07/09/2019] [Accepted: 07/10/2019] [Indexed: 11/29/2022]
Abstract
Chronically depressed individuals have a high suicide risk. However, it is an open question whether previously observed risk factors for suicide attempts also apply to chronic depression or whether there are specific risk factors related to chronic-recurrent illness. We drew from a large group of chronically depressed individuals seeking psychotherapy to investigate demographic and psychological factors related to previous suicide attempts. Participants took part in the SCID and filled out established questionnaires. Among 368 chronically depressed individuals (68.7% women; Mage = 40.95 years), 75 participants (19.4%) reported previous suicide attempts. Men were more likely to have used violent methods. We tested the links of having attempted suicide with different variables using logistic regression analyses. Our findings corroborate previously observed risk factors (e.g. sexual abuse, personality disorders) and suggest other risk factors which could be especially relevant in chronic depression (e.g. depression severity, interpersonal problems, self-injurious behavior, and overall years of depression). Other risk factors from previous studies were not related to suicidal behavior within our sample (e.g. anxiety disorders, PTSD). Thus, mental health professionals should be aware that risk factors for suicidal behavior might vary between diagnosis groups and that chronic illness might be a risk factor in itself.
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Affiliation(s)
- Mareike Ernst
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany.
| | | | | | - Alexa Negele
- Frankfurt Psychoanalytic Institute, Frankfurt, Germany
| | - Ulrich Bahrke
- Frankfurt Psychoanalytic Institute, Frankfurt, Germany; Sigmund-Freud-Institute Frankfurt, Frankfurt, Germany
| | - Martin Hautzinger
- Department of Psychology, Clinical Psychology, and Psychotherapy, Eberhard Karls University Tübingen, Tübingen, Germany
| | - Manfred E Beutel
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Marianne Leuzinger-Bohleber
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany; Frankfurt Psychoanalytic Institute, Frankfurt, Germany
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Durham MD, Armon C, Mahnken JD, Novak RM, Palella FJ, Tedaldi E, Buchacz K. Rates of suicidal ideation among HIV-infected patients in care in the HIV Outpatient Study 2000-2017, USA. Prev Med 2020; 134:106011. [PMID: 32027915 PMCID: PMC10132173 DOI: 10.1016/j.ypmed.2020.106011] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Revised: 01/21/2020] [Accepted: 02/01/2020] [Indexed: 11/17/2022]
Abstract
BACKGROUND Suicidal ideation (SI) refers to an individual thinking about, considering or planning suicide. Identifying and characterizing persons with HIV (PWH) at greater risk for SI may lead to better suicide prevention strategies and quality of life improvement. METHODS Using clinical data gathered from medical chart abstraction for HIV Outpatient Study (HOPS) participants from 2000 to 2017, we assessed SI frequency among PWH in care and explored factors associated with the presence of SI diagnoses using linear mixed models analyses. RESULTS Among 6706 participants, 224 (3.3%) had a charted diagnosis of SI. Among those with SI, median age (interquartile range [IQR]) was 43.4 years [IQR: 38.7-50.3], median (IQR) CD4+ cell count was 439 cells/mm3 (IQR: 237-686), 71.4% were male, 54% were men who have sex with men (MSM), 25.4% heterosexual, and 13.4% persons who inject drugs. In multivariable analysis, persons at increased risk for SI were more likely to be: <50 years old (adjusted rate ratio [aRR] 1.86, 95% confidence interval [95%CI] 1.36-2.53), non-Hispanic/Latino black (aRR 1.75; 95%CI 1.29-2.38), have CD4+ cell count <350 cells/mm3 (aRR 1.32; 95%CI 1.05-1.65), have a viral load ≥50 copies/mL (aRR 1.49; 95%CI 1.12-1.98), have stopped antiretroviral therapy (aRR 1.46; 95%CI 1.10-1.95), have a history of: alcohol dependence (aRR 2.75; 95%CI 1.67-4.52), and drug overdose (aRR 4.09; 95%CI 2.16-7.71). CONCLUSION Routine mental health assessment and monitoring are needed in HIV clinical practice to better understand factors associated with SI and to inform the development of preventive interventions.
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Affiliation(s)
- Marcus D Durham
- Division of HIV/AIDS Prevention Centers for Disease Control and Prevention, Atlanta, GA, USA.
| | - Carl Armon
- Cerner Corporation, Kansas City, MO, USA
| | - Jonathan D Mahnken
- Department of Biostatistics, University of Kansas Medical Center, Kansas City, KS, USA
| | | | | | - Ellen Tedaldi
- Lewis Katz School of Medicine, Temple University, Philadelphia, PA, USA
| | - Kate Buchacz
- Division of HIV/AIDS Prevention Centers for Disease Control and Prevention, Atlanta, GA, USA
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21
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Kelbert EF, Pinheiro LM, Souza LDM, Pinheiro CAT, Pinheiro KAT, Motta JVS, Barros MMD, Coelho FMC, Souza MS, Martins CSR, Pinheiro RT. Suicide risk in people living with AIDS/HIV: the effect of childhood trauma is mediated by mental disorders and social vulnerability. AIDS Care 2019; 32:512-517. [PMID: 31801367 DOI: 10.1080/09540121.2019.1695732] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Suicide is an important problem in people living with HIV/AIDS (PLWHA). The importance of mental disorders and social vulnerability on suicidal behaviors is described in the literature; however, the impact of childhood traumatic events in this scenario is not clear. The aim of this study was to verify the mediation effect of mental disorder comorbidities and social vulnerability in association with childhood trauma intensity and suicide risk level. This cross-sectional study of HIV-positive outpatients was conducted in a specialized care service in the city of Pelotas in Southern Brazil. Sociodemographic data and HIV-related information were collected and the Childhood Trauma Questionnaire was applied. A total of 364 patients underwent psychiatric evaluation using MINI Plus including module C of suicide risk severity. Suicide risk was present in 39.3% of the sample. The relation between childhood traumatic events and the level of suicide risk is mediated by mental disorder comorbidities and socioeconomic vulnerability. Specific psychosocial interventions in PLWHA should consider the potential role of abusive traumatic experiences in the current mental health conditions and suicidal behaviors.
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Affiliation(s)
- E F Kelbert
- Programa de Graduação em Saúde e Comportamento, Universidade Católica de Pelotas, Pelotas, Brazil
| | - L M Pinheiro
- Programa de Graduação em Saúde e Comportamento, Universidade Católica de Pelotas, Pelotas, Brazil
| | - L D M Souza
- Programa de Graduação em Saúde e Comportamento, Universidade Católica de Pelotas, Pelotas, Brazil
| | - C A T Pinheiro
- Programa de Graduação em Saúde e Comportamento, Universidade Católica de Pelotas, Pelotas, Brazil.,Serviço de Assistência Especializada, Universidade Federal de Pelotas, Pelotas, Brazil
| | - K A T Pinheiro
- Programa de Graduação em Saúde e Comportamento, Universidade Católica de Pelotas, Pelotas, Brazil
| | - J V S Motta
- Programa de Graduação em Saúde e Comportamento, Universidade Católica de Pelotas, Pelotas, Brazil
| | - M M D Barros
- Programa de Graduação em Saúde e Comportamento, Universidade Católica de Pelotas, Pelotas, Brazil
| | - F M C Coelho
- Programa de Graduação em Saúde e Comportamento, Universidade Católica de Pelotas, Pelotas, Brazil
| | - M S Souza
- Programa de Graduação em Saúde e Comportamento, Universidade Católica de Pelotas, Pelotas, Brazil
| | - C S R Martins
- Programa de Graduação em Saúde e Comportamento, Universidade Católica de Pelotas, Pelotas, Brazil
| | - R T Pinheiro
- Programa de Graduação em Saúde e Comportamento, Universidade Católica de Pelotas, Pelotas, Brazil
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22
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Mandell LN, Rodriguez VJ, De La Rosa A, Abbamonte JM, Sued O, Cecchini D, Cassetti I, Cahn P, Weiss SM, Jones DL. Suicidal Ideation Among Adults Re-engaging in HIV Care in Argentina. AIDS Behav 2019; 23:3427-3434. [PMID: 31049810 DOI: 10.1007/s10461-019-02526-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Argentina has one of the highest suicide rates in Latin America and the Caribbean. Though people living with HIV are at increased risk for suicidal behavior, little research on suicide risk has been conducted among HIV-positive people in this region. This study examined risk factors for suicidal ideation among HIV-infected adults (N = 360) re-engaging in care in Argentina. Overall, 21% of participants reported suicidal ideation in the past week. In adjusted logistic regression models, younger age, increased depressive symptomatology, and drug abuse were associated with suicidal ideation (p < 0.05); decreased motivation for adherence and fewer months since initiating antiretroviral therapy approached significance (p = 0.07). Suicidal ideation was common in this sample of HIV-positive patients in Argentina. Findings highlight the need for routine risk assessment and interventions integrated into the HIV care continuum, addressing depression, substance use, and suicidal behavior.
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Affiliation(s)
- Lissa N Mandell
- Department of Psychiatry & Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Violeta J Rodriguez
- Department of Psychiatry & Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
- Department of Psychology, University of Georgia, Athens, GA, USA
| | - Aileen De La Rosa
- Department of Psychiatry & Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | - John M Abbamonte
- Department of Psychiatry & Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Omar Sued
- Fundación Huésped, Buenos Aires, Argentina
| | | | | | - Pedro Cahn
- Fundación Huésped, Buenos Aires, Argentina
| | - Stephen M Weiss
- Department of Psychiatry & Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Deborah L Jones
- Department of Psychiatry & Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL, USA.
- University of Miami Miller School of Medicine, 1400 NW 10th Ave., Suite 404A, Miami, FL, 33136, USA.
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23
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Li Y, Guo Y, Hong YA, Zhu M, Zeng C, Qiao J, Xu Z, Zhang H, Zeng Y, Cai W, Li L, Liu C. Mechanisms and Effects of a WeChat-Based Intervention on Suicide Among People Living With HIV and Depression: Path Model Analysis of a Randomized Controlled Trial. J Med Internet Res 2019; 21:e14729. [PMID: 31774411 PMCID: PMC6906623 DOI: 10.2196/14729] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2019] [Revised: 08/25/2019] [Accepted: 08/31/2019] [Indexed: 01/03/2023] Open
Abstract
Background People living with HIV and depression have high rates of suicide. Studies of mobile health (mHealth) interventions have shown feasibility, acceptability, and efficacy in improving mental health in people living with HIV and depression. However, few studies have examined the mechanisms and effects of mHealth interventions on suicide. Objective This study was designed to examine the mechanisms and effects of a WeChat-based intervention, Run4Love, on suicide among people living with HIV and depression in China, while considering perceived stress and depressive symptoms as mediators. Methods A sample of 300 People living with HIV and depression was recruited from the outpatient clinic of a large HIV or AIDS treatment hospital and was randomized to the Run4Love group or a control group. Data were collected at baseline, 3-, 6-, and 9-month follow-ups. Path analysis modeling, with longitudinal data, was used in data analyses. Results The Run4Love mHealth intervention had a direct effect on reducing suicide rate at the 6-month follow-up (beta=−.18, P=.02) and indirect effect through reducing perceived stress and depressive symptoms at the 3-month follow-up (beta=−.09, P=.001). A partial mediating effect between perceived stress and depressive symptoms accounted for 33% (–0.09/–0.27) of the total effect. Conclusions Through path analyses, we understood the mechanisms and effects of an mHealth intervention on suicide prevention. The findings underscored the importance of stress reduction and depression treatment in such a program. We call for more effective suicide prevention, especially mHealth interventions targeting the vulnerable population of people living with HIV and depression. Trial Registration Chinese Clinical Trial Registry ChiCTR-IPR-17012606; http://www.chictr.org.cn/showprojen.aspx?proj=21019
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Affiliation(s)
- Yiran Li
- Department of Epidemiology and Biostatistics, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Yan Guo
- Department of Epidemiology and Biostatistics, School of Public Health, Sun Yat-sen University, Guangzhou, China.,Sun Yat-sen Center for Migrant Health Policy, Guangzhou, China.,Sun Yat-sen Center for Global Health, Institute of State Governance, Guangzhou, China
| | - Y Alicia Hong
- Department of Health Administration and Policy, College of Health and Human Services, George Mason University, Fairfax, VA, United States
| | - Mengting Zhu
- Department of Epidemiology and Biostatistics, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Chengbo Zeng
- South Carolina SmartState Center for Healthcare Quality, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States.,Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States
| | - Jiaying Qiao
- Department of Epidemiology and Biostatistics, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Zhimeng Xu
- Department of Epidemiology and Biostatistics, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Hanxi Zhang
- National Center of AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Yu Zeng
- Department of Epidemiology and Biostatistics, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Weiping Cai
- Department of Infectious Diseases, Eight People's Hospital, Guangzhou, China
| | - Linghua Li
- Department of Infectious Diseases, Eight People's Hospital, Guangzhou, China
| | - Cong Liu
- Department of Infectious Diseases, Eight People's Hospital, Guangzhou, China
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24
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Wonde M, Mulat H, Birhanu A, Biru A, Kassew T, Shumet S. The magnitude of suicidal ideation, attempts and associated factors of HIV positive youth attending ART follow ups at St. Paul's hospital Millennium Medical College and St. Peter's specialized hospital, Addis Ababa, Ethiopia, 2018. PLoS One 2019; 14:e0224371. [PMID: 31689299 PMCID: PMC6830816 DOI: 10.1371/journal.pone.0224371] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Accepted: 10/12/2019] [Indexed: 11/26/2022] Open
Abstract
Background Suicide which is considered a psychiatric emergency, is a serious cause of mortality worldwide. Youth living with HIV/AIDS (YLWHA) have higher rates of suicidal behavior than the general public. This study aimed to assess the magnitude and associated factors of suicide ideation and attempt among the Human Immune deficiency Virus (HIV) positive youth attending anti-retroviral therapy (ART) follow up at St. Paul`s hospital Millennium Medical College and St. Peter`s specialized hospital, Addis Ababa, Ethiopia. Methods In this cross-sectional study, 413 HIV positive youth were recruited for interviews, using the systematic random sampling technique. The Composite International Diagnostic Interview (CIDI) was used to assess suicide. PHQ-9, the Oslo social support and HIV perceived stigma scale instruments were used to assess the factors. We computed bivariate and multivariable binary logistic regressions to assess factors associated with suicidal ideation and attempt. Statistical significance was declared at P-value <0.05. Result The magnitude of suicidal ideation and attempts were found to be 27.1% and 16.9%, respectively. In the multivariate analysis, female sex (adjusted odd ratio(AOR) = 3.1, 95% CI, 1.6–6.0), family death (AOR = 2.1, 95%CI 1.15–3.85), WHO clinical stage III of HIV (AOR = 3.1 95% CI 1.3–7.35), WHO clinical stage IV of HIV (AOR = 4.76, 95%CI, 1.3–7.35), co-morbid depression (AOR = 7.14, 95%CI, 3.9–12.9), and perceived HIV stigma (AOR = 4.2, 95%CI, 2.27–8.2) were significantly associated with suicidal ideation, whereas female sex (AOR = 4.12, 95%CI, 1.82–9.78), opportunistic infections (AOR = 3.1, 95%CI, 1.6–6.04), WHO clinical stage III of HIV (AOR = 3.1 95%CI 1.24–7.81), co-morbid depression (AOR = 5.6 95% CI, 2.8–11.1), and poor social support (AOR = 3.4, 95%CI, 1.2–9.4) were statistically significant with suicidal attempt. The result suggests that the magnitude of suicidal ideation and attempts among HIV positive youth were high. We recommend that clinicians consider youth with comorbid depression, perceived HIV stigma and poor social support.
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Affiliation(s)
- Mesele Wonde
- Department of Psychiatry, University of Gondar, Gondar, Ethiopia
| | - Haregewoin Mulat
- Department of Psychiatry, University of Gondar, Gondar, Ethiopia
| | - Addis Birhanu
- Amanuel Mental Specialized Hospital, Addis Ababa, Ethiopia
| | - Aynalem Biru
- Amanuel Mental Specialized Hospital, Addis Ababa, Ethiopia
| | - Tilahun Kassew
- Department of Psychiatry, University of Gondar, Gondar, Ethiopia
| | - Shegaye Shumet
- Department of Psychiatry, University of Gondar, Gondar, Ethiopia
- * E-mail:
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25
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Tyree GA, Vaida F, Zisook S, Mathews WC, Grelotti DJ. Clinical correlates of depression chronicity among people living with HIV: What is the role of suicidal ideation? J Affect Disord 2019; 258:163-171. [PMID: 31426014 PMCID: PMC6909554 DOI: 10.1016/j.jad.2019.07.081] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Revised: 07/16/2019] [Accepted: 07/29/2019] [Indexed: 12/25/2022]
Abstract
BACKGROUND Chronicity of depression among people living with HIV (PLWH) is associated with poorer viral suppression and mortality risk. The extent to which suicidal ideation (SI) and other baseline characteristics predict a prolonged duration of depressive illness among PLWH is not known but could help identify PLWH most at risk. METHODS Data were drawn from a sample of 1002 depressed PLWH engaged in primary care at a metropolitan HIV clinic from 2007-2018, representing 2,569 person-years. Depression characteristics were derived from the Patient Health Questionnaire 9 (PHQ-9), administered during routine screening. Other characteristics were derived from clinic data. Unadjusted and covariate-adjusted survival analyses compared the time to depression remission between depressed participants with and without SI at their initial screening. RESULTS At baseline, 38.4% of depressed PLWH endorsed SI. Depressed PLWH with SI took significantly longer to achieve remission from depression than those without SI. The association appeared to be mediated by depression symptom severity. When adjusted for age, depression diagnosis, any recent drug use, and depression symptom severity, baseline SI no longer predicted remission hazard. LIMITATIONS Participants were assessed for depression with variable frequency. The analysis assumed all patients received comparable treatment for their depression. Some variables were based on clinic measurements that may be subject to misclassification bias. CONCLUSIONS These data suggest that depressed PLWH with SI are at risk for greater chronicity of depression because their depression is more severe. Accordingly, PLWH should be urgently engaged in psychiatric care in the event of SI or severe depressive symptoms.
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Affiliation(s)
- Griffin A Tyree
- School of Medicine, University of California San Diego, La Jolla, CA, USA
| | - Florin Vaida
- Department of Family Medicine and Public Health, University of California San Diego, La Jolla, CA, USA; HIV Neurobehavioral Research Program, University of California San Diego, San Diego, CA, USA
| | - Sidney Zisook
- Department of Psychiatry, University of California San Diego, La Jolla, CA, USA
| | - William C Mathews
- Center for AIDS Research, University of California San Diego, La Jolla, CA, USA
| | - David J Grelotti
- HIV Neurobehavioral Research Program, University of California San Diego, San Diego, CA, USA; Department of Psychiatry, University of California San Diego, La Jolla, CA, USA; Center for AIDS Research, University of California San Diego, La Jolla, CA, USA.
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26
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Depression and aging with HIV: Associations with health-related quality of life and positive psychological factors. J Affect Disord 2019; 251:1-7. [PMID: 30884371 PMCID: PMC6705595 DOI: 10.1016/j.jad.2019.03.025] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Revised: 12/31/2018] [Accepted: 03/04/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND Depression is prevalent among persons living with HIV (PLWH). This study investigated the relationships between depressive symptomatology, health-related quality of life (HRQoL), and positive psychological factors in PLWH and age-matched HIV-individuals. METHODS One hundred twenty-two PLWH and 94 HIV- individuals, recruited in three age cohorts (36-45, 46-55, 56-65 years old), completed self-report questionnaires on depressive symptoms (CES-D), HRQoL, and positive psychological factors (resilience, grit, and self-rated successful aging [SRSA]). Participants were classified based on HIV status (H+ vs H-) and elevated depressive symptoms (D+ vs D-) into four groups (H+/D+; H-/D+; H+/D-; H-/D-). RESULTS Fifty-eight percent of PLWH had elevated depressive scores, compared to 33% of HIV- individuals (p < 0.001). The proportion of individuals reporting elevated depressive symptoms only differed among individuals 36-45 years old (H+: 61.5%; H-: 17.9%; p < 0.001). Individuals in the H+/D+ group reported the lowest HRQoL, resilience, grit, and SRSA across age cohorts. However, there were no differences on HRQoL or positive psychological factors between H+/D- and H-/D- groups; in fact, individuals 56-65 years in the H+/D- group endorsed aging the most successfully. LIMITATIONS Small sample size within the groups and the cross-sectional nature of the analysis limit the ability to address onset of depressive symptoms in relation to HRQoL or positive psychological factors. CONCLUSIONS Among PLWH depressive symptoms show a strong association with HRQoL and positive psychological factors compared to HIV- individuals. In the absence of elevated depressive symptoms, however, PLWH report similar HRQoL and positive psychological factors to HIV- individuals.
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27
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Shim EJ, Lee SH, Kim NJ, Kim ES, Bang JH, Sohn BK, Park HY, Son KL, Hwang H, Lee KM, Hahm BJ. Suicide Risk in Persons with HIV/AIDS in South Korea: a Partial Test of the Interpersonal Theory of Suicide. Int J Behav Med 2019; 26:38-49. [PMID: 30255219 DOI: 10.1007/s12529-018-9749-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
PURPOSE The high disease burden associated with human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) is linked to the elevated suicide risk in this population. Informed by the interpersonal theory of suicide, this study examined how and under which conditions depression is related to suicide risk in people living with HIV/AIDS. METHODS A total of 202 outpatients with HIV/AIDS participated in a cross-sectional and multi-center survey involving four university hospitals in South Korea. This self-reported survey included the Hospital Anxiety and Depression Scale, Interpersonal Needs Questionnaire, and Mini-International Neuropsychiatric Interview suicidality module. RESULTS Participants' mean age was 48.6 (SD = 13.4) and the majority was male (89.1%). The proportions of those at high, medium, and low suicide risk were 18.5%, 20%, and 15.4%, respectively. Depression was associated with suicide risk directly and indirectly by increasing perceived burdensomeness (PB) and the indirect effect of depression on suicide risk mediated by PB was contingent on the level of thwarted belongingness (TB). PB was associated with suicide risk even after controlling for depression, suggesting its independent effect on suicide risk. CONCLUSIONS PB and TB are potential mechanisms through which depression is associated with suicide risk, supporting the applicability of the interpersonal theory of suicide to understanding a complex interplay of risk factors in people with HIV/AIDS. Moreover, given the independent association of PB with suicide risk, as well as a protective effect of TB in suicide risk, monitoring and management of these factors should be included in the care of people with HIV/AIDS.
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Affiliation(s)
- Eun-Jung Shim
- Department of Psychology, Pusan National University, Busan, South Korea
| | - Sun Hee Lee
- Department of Internal Medicine, Pusan National University School of Medicine, Busan, South Korea
| | - Nam Joong Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea
| | - Eu Suk Kim
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Ji Hwan Bang
- Division of Infectious Diseases, Seoul National University-Seoul Metropolitan Government Boramae Medical Center, Seoul, South Korea
| | - Bo Kyung Sohn
- Department of Psychiatry, Sanggye Paik Hospital, Seoul, South Korea.,Department of Psychiatry, Inje University College of Medicine, Busan, South Korea
| | - Hye Youn Park
- Department of Neuropsychiatry, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Kyung-Lak Son
- Department of Psychiatry, Dongguk University Ilsan Hospital, Goyang, South Korea
| | - Heesung Hwang
- Department of Psychiatry and Behavioral Science, Seoul National University College of Medicine, Seoul, South Korea
| | - Kwang-Min Lee
- Public Health and Medical Service, Seoul National University Hospital, Seoul, South Korea
| | - Bong-Jin Hahm
- Department of Psychiatry and Behavioral Science, Seoul National University College of Medicine, Seoul, South Korea. .,Department of Neuropsychiatry, Seoul National University Hospital, Seoul, Korea.
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28
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Abstract
BACKGROUND Depression is prevalent among people living with HIV/AIDS (PLWHA), but there are few longitudinal studies investigating the prevalence of depression among HIV respondents in Taiwan. OBJECTIVES This study examined the trend in the prevalence of depression and its main predictors among PLWHA in Taiwan. METHODS This study analyzed the 2-million random-sample data set of the Taiwanese longitudinal health research database using data from 2000 to 2011and applied the Internal Classification of Diseases, 9th Revision, Clinical Modification diagnostic codes for the detection of HIV infection and depression. Chi-square tests and logistic regression analyses were conducted to determine predictive factors for depression. RESULTS A total of 769 PLWHA who met the criterion of HIV infection were extracted from the database. Of these respondents, 20.03% had a diagnosis of depression after their HIV-positive diagnosis. The annual prevalence of depression among the study respondents increased significantly from 1.95% in 2000 to 6.93% in 2011 according to time trend analysis (χ = 6.428, df =11, p = .03). Multivariate, logistic regression analysis indicated a history of drug abuse was the main predictor of a diagnosis of depression. DISCUSSION The increasing trend in the prevalence of depression revealed an urgent need for the development of care programs for PLWHA with depression. Such programs should take into consideration a history of drug abuse as a strong risk factor for the development of depression.
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29
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Cysique LA, Brew BJ. Comorbid depression and apathy in HIV-associated neurocognitive disorders in the era of chronic HIV infection. HANDBOOK OF CLINICAL NEUROLOGY 2019; 165:71-82. [PMID: 31727231 DOI: 10.1016/b978-0-444-64012-3.00006-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
This chapter provides an overview of the current research on the question of depression and apathy in HIV-associated neurocognitive disorders (HAND) in the era of chronic HIV infection. After presenting the epidemiology of each condition showing that depression and apathy are the two most frequent psychiatric comorbidities of HAND, we review the current research, particularly in relation to the milder forms of HAND that characterize treated HIV cohorts. Doing so, we include findings on depression and apathy in non-HIV aging population and the risk of dementia, findings that are relevant to the aging HIV cohorts carrying a high burden of psychiatric comorbidities. We then present a review of the research pertaining to the differentiation between depression and apathy. A section is dedicated to the question of suicidality in chronic HIV infection, which is underappreciated. An overview of the pharmacologic and psychosocial interventions relevant to depression and apathy in HIV cohorts treated with antiretroviral treatment is provided. The chapter concludes with future directions for the research on apathy and depression with emphasis on the question of aging and the need for longitudinal studies.
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Affiliation(s)
- Lucette A Cysique
- Neuroscience Research Australia, Randwick, NSW, Australia; Peter Duncan Neurosciences Unit, St. Vincent's Centre for Applied Medical Research, Sydney, NSW, Australia
| | - Bruce J Brew
- Neurology and HIV Departments, St. Vincent's Hospital, Sydney, NSW, Australia; Peter Duncan Neurosciences Unit, St. Vincent's Centre for Applied Medical Research, Sydney, NSW, Australia.
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30
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Lu HF, Sheng WH, Liao SC, Chang NT, Wu PY, Yang YL, Hsiao FH. The changes and the predictors of suicide ideation and suicide attempt among HIV-positive patients at 6-12 months post diagnosis: A longitudinal study. J Adv Nurs 2018; 75:573-584. [PMID: 30334591 DOI: 10.1111/jan.13883] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Revised: 08/19/2018] [Accepted: 09/13/2018] [Indexed: 02/05/2023]
Abstract
AIMS This study examined the changes and the predictors of suicide ideation/suicide attempt and the moderating effects of psychosocial factors on the suicide ideation/suicide attempts among human immunodeficiency virus (HIV)-positive patients at 6-12 months post-diagnosis. BACKGROUND Suicide behaviours are prevalent among newly diagnosed HIV-positive patients, but the changes in suicide behaviours after diagnosis and the role of psychosocial factors in these behaviours are not well studied. DESIGN This study used a prospective longitudinal design. METHODS A total of 113 participants diagnosed as HIV-positive for 6-12 months were recruited from the outpatient department. Data were collected from June 2015 - October 2016. They were asked to complete Beck's Scale for Suicide Ideation, the Beck Depression Inventory-II, the Body Image Scale, the Meaning in Life Questionnaire and the Multidimensional Scale of Perceived Social Support at baseline, the third month and the sixth month. RESULTS The results showed the high occurrence rates for suicide ideation ranging from 27.2%, 21.6%, and 25.8% and suicide attempt ranging from 14.7%, 8.6%, and 13.3% at the baseline, the third month and the sixth month, respectively. The education level, social support from family and depressive symptoms were the predictors of suicide ideation. The history of depression disorders, depressive symptoms and social support from friends significantly predicted suicide attempt. Meaning in life-presence moderated the relationship between depressive symptoms and suicide ideation. CONCLUSIONS After diagnosed for 6-12 months, HIV-positive patients remain the high-risk group for suicide ideation and attempt. Suicide intervention targeting the risk and protective factors are required for HIV-positive patients.
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Affiliation(s)
- Hsing-Fei Lu
- School of Nursing, College of Medicine, National Taiwan University, Taipei, Taiwan.,Department of Nursing, Hsin Sheng Junior College of Medical Care and Management, Taoyuan, Taiwan
| | - Wang-Huei Sheng
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Shih-Cheng Liao
- Department of Psychiatry, National Taiwan University Hospital, Taipei, Taiwan
| | - Nien-Tzu Chang
- School of Nursing, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Pei-Ying Wu
- Department of Infectious disease, National Taiwan University Hospital, Taipei, Taiwan
| | - Ya-Ling Yang
- School of Nursing, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Fei-Hsiu Hsiao
- School of Nursing, College of Medicine, National Taiwan University, Taipei, Taiwan.,Nursing Department, National Taiwan University Hospital, Taipei, Taiwan
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Hsu R, Fusco J, Henegar C, Mounzer K, Wohlfeiler M, Vannappagari V, Aboud M, Curtis L, Fusco G. Psychiatric outcomes observed in patients living with HIV using six common core antiretrovirals in the Observational Pharmaco-Epidemiology Research and Analysis database. Ther Adv Drug Saf 2018; 9:675-686. [PMID: 30546862 DOI: 10.1177/2042098618798350] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Accepted: 08/06/2018] [Indexed: 12/11/2022] Open
Abstract
Background Psychiatric outcomes are common among people living with HIV and may be associated with specific antiretroviral use. We evaluated the occurrence of psychiatric outcomes in patients taking dolutegravir (DTG)-containing regimens compared with five other core agents. Methods Patients in the OPERA database prescribed regimens based on DTG, efavirenz (EFV), raltegravir (RAL), darunavir (DRV), rilpivirine (RPV), or elvitegravir (EVG) for the first time between 1 January 2013 and 31 December 2015 were analyzed. Psychiatric outcomes included diagnoses of anxiety, depression, insomnia, or suicidality during core agent exposure. Multivariable Cox analysis models were used to assess time to psychiatric outcomes between core agents stratified by psychiatric history, with DTG as the referent. Results A total of 13,261 patients initiated a regimen of interest (DTG: 2783; RAL: 979; EVG: 3895, EFV: 1746, RPV: 1921, DRV: 1937). Psychiatric history was common, with varied prevalence across groups (DTG 38%, EFV 24%, RAL 40%, DRV 34%, RPV 29%, EVG 31%). Among patients without a psychiatric history, the likelihood of a psychiatric outcome during follow up did not differ between DTG and the other core agents. Among patients with a psychiatric history, risk during follow up for patients taking DTG was equivalent (versus RPV), marginally reduced (versus RAL and EFV), or reduced (versus EVG and DRV). Conclusions In a large cohort of HIV+ patients in care, patients with a psychiatric history appeared channeled towards drugs with known favorable psychiatric safety profiles, including DTG. Despite this, DTG exposure was not associated with an increased risk of psychiatric outcomes during follow up in patients with or without a psychiatric history.
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Affiliation(s)
- Ricky Hsu
- AIDS Healthcare Foundation, New York, NY, USA, and New York University Langone Medical Center, New York, NY, USA
| | - Jennifer Fusco
- Epividian, Inc., 4505 Emperor Blvd, Suite 220, Durham, NC 27703, USA
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Wang YY, Dong M, Zhang Q, Xu DD, Zhao J, Ng CH, Ungvari GS, Jia FJ, Xiang YT. Suicidality and clinical correlates in Chinese men who have sex with men (MSM) with HIV infection. PSYCHOL HEALTH MED 2018; 24:137-143. [PMID: 30175922 DOI: 10.1080/13548506.2018.1515495] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Little is known about suicidality in Chinese men who has sex with men (MSM) infected with human immunodeficiency virus (HIV). This study investigated suicidality and its clinical correlates in Chinese MSM with HIV infection. Suicidality, demographic and clinical characteristics were assessed in 410 MSM with HIV infection consecutively recruited from a public HIV clinic in China. The prevalence of suicidality was 10.7% in Chinese HIV-infected MSM. Compared with those without suicidality, MSM with suicidality were more likely to be younger, unmarried and unemployed, and have more frequent insomnia, lower CD4 lymphocyte counts, and higher GAD-7 and CSE-D total scores. Multiple logistic regression analyses revealed that suicidality was independently associated with unemployment (p = 0.03, OR = 0.3, 95% CI = 0.1-0.9), age (p < 0.01, OR = 0.9, 95% CI = 0.8-0.9), CD4 lymphocyte counts (p = 0.02, OR = 0.9, 95% CI = 0.9-1.0), and the GAD-7 total score (p < 0.001, OR = 1.3, 95% CI = 1.1-1.5). Suicidality is common in Chinese MSM with HIV infection. There is an urgent need to develop comprehensive suicide prevention program and mental health services for this population.
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Affiliation(s)
- Yuan-Yuan Wang
- a Faculty of Health Sciences, Unit of Psychiatry , University of Macau , Macao SAR , China
| | - Min Dong
- a Faculty of Health Sciences, Unit of Psychiatry , University of Macau , Macao SAR , China
| | - Qinge Zhang
- b The National Clinical Research Center for Mental Disorders, China &Center of Depression , Beijing Institute for Brain Disorders & Mood Disorders Center, Beijing Anding Hospital, Capital Medical University , Beijing , China
| | - Dan-Dan Xu
- a Faculty of Health Sciences, Unit of Psychiatry , University of Macau , Macao SAR , China
| | - Jin Zhao
- c Shenzhen Center for Disease Control and Prevention , Guangdong City , Guangdong province , China
| | - Chee H Ng
- d Department of Psychiatry , University of Melbourne , Melbourne , Victoria , Australia
| | | | - Fu-Jun Jia
- f Guangdong Mental Health Center , Guangdong General Hospital & Guangdong Academy of Medical Sciences , Guangdong City , Guangdong Province , China
| | - Yu-Tao Xiang
- a Faculty of Health Sciences, Unit of Psychiatry , University of Macau , Macao SAR , China
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Parreco J, Alawa N, Rattan R, Tashiro J, Sola JE. Teenage Trauma Patients Are at Increased Risk for Readmission for Mental Diseases and Disorders. J Surg Res 2018; 232:415-421. [PMID: 30463750 DOI: 10.1016/j.jss.2018.06.065] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2017] [Revised: 05/28/2018] [Accepted: 06/20/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Most studies of readmission after trauma are limited to single institutions or single states. The purpose of this study was to determine the risk factors for readmission after trauma for mental illness including readmissions to different hospitals across the United States. MATERIALS AND METHODS The Nationwide Readmission Database for 2013 and 2014 was queried for all patients aged 13 to 64 y with a nonelective admission for trauma and a nonelective readmission within 30 d. Multivariable logistic regression was performed for readmission for mental diseases and disorders. RESULTS During the study period, 53,402 patients were readmitted within 30 d after trauma. The most common major diagnostic category on readmission was mental diseases and disorders (12.1%). The age group with the highest percentage of readmissions for mental diseases and disorders was 13 to 17 y (38%). On multivariable regression, the teenage group was also the most likely to be readmitted for mental diseases and disorders compared to 18-44 y (odds ratio [OR] 0.45, P < 0.01) and 45-64 y (OR 0.24, P < 0.01). Other high-risk comorbidities included HIV infection (OR 2.4, P < 0.01), psychosis (OR 2.2, P < 0.01), drug (OR 2.0, P < 0.01), and alcohol (OR 1.4, P < 0.01) abuse. CONCLUSIONS Teenage trauma patients are at increased risk for hospital readmission for mental illness. Efforts to reduce these admissions should be targeted toward individuals with high-risk comorbidities such as HIV infection, psychosis, and substance abuse.
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Affiliation(s)
- Joshua Parreco
- Department of Surgery, DeWitt-Daughtry Family, Leonard M. Miller School of Medicine, University of Miami, Miami, Florida
| | - Nawara Alawa
- Department of Surgery, DeWitt-Daughtry Family, Leonard M. Miller School of Medicine, University of Miami, Miami, Florida
| | - Rishi Rattan
- Department of Surgery, DeWitt-Daughtry Family, Leonard M. Miller School of Medicine, University of Miami, Miami, Florida
| | - Jun Tashiro
- Department of Surgery, DeWitt-Daughtry Family, Leonard M. Miller School of Medicine, University of Miami, Miami, Florida
| | - Juan E Sola
- Department of Surgery, DeWitt-Daughtry Family, Leonard M. Miller School of Medicine, University of Miami, Miami, Florida.
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Rodriguez VJ, Sued O, Cecchini D, Mandell LN, Bofill LM, Weiss SM, Cassetti I, Cahn P, Jones DL. Suicidality among nonadherent patients living with HIV in Buenos Aires, Argentina: prevalence and correlates. AIDS Care 2018; 30:1380-1387. [PMID: 29607661 DOI: 10.1080/09540121.2018.1458974] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Of those in the general population hospitalized for suicidal ideation and suicide attempts in Argentina, many reattempt suicide and are readmitted. However, few studies in Argentina have examined suicidal ideation and suicide-related behaviors among people living with HIV (PLHIV) and none have examined these factors among nonadherent PLHIV, though the prevalence of suicidal ideation in this group may be higher than in the general population and also than in other groups of PLHIV. This study of PLHIV in Buenos Aires, Argentina, examined the correlates of suicidal ideation in nonadherent PLHIV. Nonadherent patients with HIV (N = 118) were recruited from two clinics providing outpatient healthcare services to PLHIV in Buenos Aires, Argentina. Participants completed assessments on demographic characteristics, depression and suicidality, stigma, and self-efficacy. Participants were HIV-infected men (51%) and women (49%) with a median age of 40 years (IQR = 11). About half had completed high school or more, two-thirds were employed, and had a mean monthly income of 4196.79 (SD = 3179.64) Argentine pesos (USD$221). Thirty-three (28% [95% CI 20.3, 37.3]) participants reported suicidal ideation in the past two weeks, and one-third (35.6% [27.1, 44.9]) reported lifetime suicidal ideation. In bivariate analyses, attending a public clinic, being female, younger, unemployed, and experiencing greater stigma and depression were associated with suicidal ideation. In multivariable logistic regression, stigma interacted with the number of years since HIV diagnosis to predict suicidal ideation. The impact of stigma on suicidal ideation decreased with time since HIV diagnosis, suggesting that suicidal ideation may arise following HIV diagnosis due to perception of HIV-related stigma. Interventions to reduce perceived stigma during the period following HIV diagnosis may reduce suicidal ideation in this population. Organizational initiatives that explore HIV stigma microagressions in the healthcare setting may be needed to optimize health outcomes.
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Affiliation(s)
- Violeta J Rodriguez
- a Department of Psychiatry and Behavioral Sciences , University of Miami Miller School of Medicine , Miami , FL , USA.,d Department of Psychology , University of Georgia
| | - Omar Sued
- b Fundación Huésped , Buenos Aires , Argentina
| | | | - Lissa N Mandell
- a Department of Psychiatry and Behavioral Sciences , University of Miami Miller School of Medicine , Miami , FL , USA
| | - Lina M Bofill
- a Department of Psychiatry and Behavioral Sciences , University of Miami Miller School of Medicine , Miami , FL , USA
| | - Stephen M Weiss
- a Department of Psychiatry and Behavioral Sciences , University of Miami Miller School of Medicine , Miami , FL , USA
| | | | - Pedro Cahn
- b Fundación Huésped , Buenos Aires , Argentina
| | - Deborah L Jones
- a Department of Psychiatry and Behavioral Sciences , University of Miami Miller School of Medicine , Miami , FL , USA
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Wang W, Xiao C, Yao X, Yang Y, Yan H, Li S. Psychosocial health and suicidal ideation among people living with HIV/AIDS: A cross-sectional study in Nanjing, China. PLoS One 2018; 13:e0192940. [PMID: 29470532 PMCID: PMC5823403 DOI: 10.1371/journal.pone.0192940] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2016] [Accepted: 01/18/2018] [Indexed: 01/28/2023] Open
Abstract
Background Suicide is a serious cause of mortality worldwide and is considered as a psychiatric emergency. People living with HIV/AIDS (PLWHA) have higher rates of suicidal behavior than the general population. This study assessed the prevalence and verified the syndemic effect of psychosocial health conditions on suicidal ideation among PLWHA in China. Methods An institutional-based cross-sectional study was conducted from July to August 2016 in Nanjing, China, using a self-report questionnaire. Sociodemographic characteristics, infection status, psychosocial variables and suicide ideation reports of participants were collected. Logistic regressions were used to identify potential factors associated with suicidal ideation and to verify the syndemic effect of psychosocial factors. Additionally, odds ratios (ORs) with 95% confidence intervals (95% CI) were computed. Results In total, four hundred sixty-five PLWHA participated, 31.6% (n = 147) of whom had suicidal ideation. The results from univariate analysis showed that older age, low education level, being married, having children, and psychosocial variables (high perceived stigma, depression, low self-esteem, social support and resilience) were significantly associated with increased suicidal ideation. Multiple logistic regression models revealed that depression (OR = 2.70, 95%CI = 1.62–4.51), perceived stigma (OR = 1.97, 95%CI = 1.17–3.32), and low social support (OR = 1.85, 95%CI = 1.08–3.20) and self-esteem (OR = 4.11, 95%CI = 2.06–8.16) were statistically significant. PLWHA with at least two psychosocial health problems were nearly 5 times more likely (OR = 4.72, 95% CI 3.11–7.17) to have had suicidal ideation. Conclusions Suicidal ideation is frequent among PLWHA in China and is consistent with prevalence estimates from abroad. Psychosocial health problems were the determining factors associated with suicidal ideation, and a syndemic effect of psychosocial health conditions was confirmed in predicting suicidal ideation. Therefore, early screening of high-risk groups for suicidal ideation and more psychosocial health care among PLWHA are needed.
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Affiliation(s)
- Wei Wang
- School of Health Sciences, Wuhan University, Wuhan, P.R. China
- Department of Epidemiology, University of Florida, Gainesville, FL, United States of America
| | - Chenchang Xiao
- School of Health Sciences, Wuhan University, Wuhan, P.R. China
- Wuhan University of Science and Technology City College, Wuhan, P.R. China
| | - Xing Yao
- School of Health Sciences, Wuhan University, Wuhan, P.R. China
| | - Yinmei Yang
- School of Health Sciences, Wuhan University, Wuhan, P.R. China
| | - Hong Yan
- School of Health Sciences, Wuhan University, Wuhan, P.R. China
| | - Shiyue Li
- School of Health Sciences, Wuhan University, Wuhan, P.R. China
- * E-mail:
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Muldoon AL, Kuhns LM, Supple J, Jacobson KC, Garofalo R. A Web-Based Study of Dog Ownership and Depression Among People Living With HIV. JMIR Ment Health 2017; 4:e53. [PMID: 29117933 PMCID: PMC5700404 DOI: 10.2196/mental.8180] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2017] [Revised: 09/01/2017] [Accepted: 09/06/2017] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND People living with human immunodeficiency virus (PLHIV) are approximately twice as likely to be depressed compared with HIV-negative individuals. Depression is consistently associated with low antiretroviral therapy (ART) adherence, an important step within the HIV care continuum related to HIV disease progression and overall health. One factor that may have positive psychosocial benefits and promote ART adherence is dog ownership. Research indicates that dog ownership is associated with lower depression, and initial evidence suggests its positive impact on psychosocial outcomes for PLHIV. OBJECTIVE The aim of our study was to expand the existing research by examining the relationship between current dog ownership and depression for a sample of PLHIV while controlling for demographic characteristics and other potential confounders. METHODS Participants aged 18 years or older and who self-reported an HIV diagnosis were recruited via social media into When Dogs Heal, a cross-sectional Web-based survey to collect data among adult PLHIV. The research visit was conducted via a Web-based survey, and there was no in-person interaction with the participant. Primary outcome measures included demographic questions (age, race, ethnicity, gender, and sexual orientation), pet ownership (type of pet owned and current dog ownership), depression (Center for Epidemiologic Studies Depression Scale, 10 items), and resilience (Resilience Research Centre Adult Resilience Measure, 28 items). RESULTS A total of 252 participants were enrolled into the study in January 2016, with a final analytic sample of 199 participants. Mean age was 49 years, 86.4% (172/199) of participants were male, and 80.4% (160/199) were white. Current dog ownership was prevalent among the sample (68.3%, 136/199). Bivariate analysis indicated that there was no significant relationship between depression and demographic characteristics (age, race, ethnicity, gender, and sexual orientation), with P>.05. The multivariate logistic regression, including age, race, ethnicity, gender, resilience, and current dog ownership, was significant, with P<.001. Of the 6 predictor variables, only 2 were statistically significant: dog ownership and resilience. Noncurrent dog owners had 3 times higher odds of depression in comparison with current dog owners: odds ratio 3.01; 95% CI 1.54-6.21. CONCLUSIONS Growing evidence suggests that dog ownership reduces the likelihood of depression and, therefore, may confer long-term health benefits on PLHIV. Future studies should explore whether dog-specific interventions are a feasible and efficacious intervention to improve outcomes among PLHIV.
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Affiliation(s)
- Abigail L Muldoon
- Division of Adolescent Medicine, Ann & Robert H Lurie Children's Hospital of Chicago, Chicago, IL, United States
| | - Lisa M Kuhns
- Division of Adolescent Medicine, Ann & Robert H Lurie Children's Hospital of Chicago, Chicago, IL, United States.,Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Julie Supple
- Test Positive Aware Network, Chicago, IL, United States
| | - Kristen C Jacobson
- Department of Psychiatry & Behavioral Neuroscience, The University of Chicago, Chicago, IL, United States
| | - Robert Garofalo
- Division of Adolescent Medicine, Ann & Robert H Lurie Children's Hospital of Chicago, Chicago, IL, United States.,Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
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Kalungi A, Seedat S, Hemmings SMJ, van der Merwe L, Joloba ML, Nanteza A, Nakassujja N, Birabwa H, Serwanga J, Kaleebu P, Kinyanda E. Association between serotonin transporter gene polymorphisms and increased suicidal risk among HIV positive patients in Uganda. BMC Genet 2017; 18:71. [PMID: 28743254 PMCID: PMC5526289 DOI: 10.1186/s12863-017-0538-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Accepted: 07/18/2017] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Persons living with HIV/AIDS (PLWHA) are at an increased risk of suicide. Increased suicidal risk is a predictor of future attempted and completed suicides and has been associated with poor quality of life and poor adherence with antiretroviral therapy. Clinical risk factors have low predictive value for suicide, hence the interest in potential neurobiological correlates and specific heritable markers of suicide vulnerability. The serotonin transporter gene has previously been implicated in the aetiology of increased suicidal risk in non-HIV infected study populations and its variations may provide a platform for identifying genetic risk for suicidality among PLWHA. The present cross-sectional study aimed at identifying two common genetic variants of the serotonin transporter gene and their association with increased suicidal risk among human immunodeficiency virus (HIV)-positive adults in Uganda. RESULTS The prevalence of increased suicidal risk (defined as moderate to high risk suicidality on the suicidality module of the Mini Neuropsychiatric Interview (M.I.N.I) was 3.3% (95% CI, 2.0-5.3). The 5-HTTLPR was found to be associated with increased suicidal risk before Bonferroni correction (p-value = 0.0174). A protective effect on increased suicidal risk was found for the 5-HTTLPR/rs25531 S A allele (p-value = 0.0046)- which directs reduced expression of the serotonin transporter gene (5-HTT). CONCLUSION The S A allele at the 5-HTTLPR/rs25531 locus is associated with increased suicidal risk among Ugandan PLWHA. Further studies are needed to validate this finding in Ugandan and other sub-Saharan samples.
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Affiliation(s)
- Allan Kalungi
- Department of Biotechnical and Diagnostic Sciences, College of Veterinary Medicine, Animal Resources and Biosafety (COVAB), Makerere University, Kampala, Uganda
- Mental Health Project, Medical Research Council/Uganda Virus Research Institute (MRC/UVRI) Research Unit on AIDS, Kampala, Uganda
| | - Soraya Seedat
- Department of Psychiatry, Stellenbosch University, Cape Town, South Africa
| | - Sian M. J. Hemmings
- Division of Molecular Biology and Human Genetics, Faculty of Health Sciences, University of Stellenbosch, Cape Town, South Africa
| | - Lize van der Merwe
- Department of Statistics, University of the Western Cape, Cape Town, South Africa
| | - Moses L. Joloba
- School of Biomedical Sciences, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Ann Nanteza
- Department of Biotechnical and Diagnostic Sciences, College of Veterinary Medicine, Animal Resources and Biosafety (COVAB), Makerere University, Kampala, Uganda
| | - Noeline Nakassujja
- Department of Psychiatry, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Harriet Birabwa
- Butabika National Psychiatric Referral Hospital, Kampala, Uganda
| | - Jennifer Serwanga
- Basic Science Programme, MRC/UVRI Uganda Research Unit on AIDS, Kampala, Uganda
| | - Pontiano Kaleebu
- Basic Science Programme, MRC/UVRI Uganda Research Unit on AIDS, Kampala, Uganda
| | - Eugene Kinyanda
- Mental Health Project, Medical Research Council/Uganda Virus Research Institute (MRC/UVRI) Research Unit on AIDS, Kampala, Uganda
- Department of Psychiatry, College of Health Sciences, Makerere University, Kampala, Uganda
- Faculty of Epidemiology & Population Health, London School of Hygiene & Tropical Medicine, London, UK
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Quinlivan EB, Gaynes BN, Lee JS, Heine AD, Shirey K, Edwards M, Modi R, Willig J, Pence BW. Suicidal Ideation is Associated with Limited Engagement in HIV Care. AIDS Behav 2017; 21:1699-1708. [PMID: 27380390 DOI: 10.1007/s10461-016-1469-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PHQ-9 data from persons living with HIV (PLWH, n = 4099) being screened for depression in three clinics in the southeastern USA were used to determine the prevalence of suicidal ideation (SI). SI was reported by 352 (8.6 %); associated with <3 years since HIV diagnosis (1.69; 95 %CI 1.35, 2.13), and HIV RNA >50 copies/ml (1.70, 95 %CI 1.35, 2.14). Data from PLWH enrolled in a depression treatment study were used to determine the association between moderate-to-high risk SI (severity) and SI frequency reported on PHQ-9 screening. Over forty percent of persons reporting that SI occurred on "more than half the days" (by the PHQ-9) were assessed as having a moderate-to-high risk for suicide completion during the Mini International Neuropsychiatric Interview. SI, including moderate-to-high risk SI, remains a significant comorbid problem for PLWH who are not fully stabilized in care (as indicated by detectable HIV RNA or HIV diagnosis for less than 3 years).
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Affiliation(s)
- E Byrd Quinlivan
- Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, 103 Wild Turkey Trail, Chapel Hill, NC, 27516-9041, USA.
- Center for AIDS Research, University of North Carolina at Chapel Hill, 103 Wild Turkey Trail, Chapel Hill, NC, 27516-9041, USA.
| | - Bradley N Gaynes
- Center for AIDS Research, University of North Carolina at Chapel Hill, 103 Wild Turkey Trail, Chapel Hill, NC, 27516-9041, USA
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Jennifer S Lee
- Department of Epidemiology, Gillings School of Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Amy D Heine
- Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, 103 Wild Turkey Trail, Chapel Hill, NC, 27516-9041, USA
| | - Kristen Shirey
- Departments of Psychiatry and Behavioral Sciences and Medicine, Duke University, Durham, NC, USA
| | - Malaika Edwards
- Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, 103 Wild Turkey Trail, Chapel Hill, NC, 27516-9041, USA
| | - Riddhi Modi
- Department of Medicine, University of Alabama - Birmingham, Birmingham, AL, USA
| | - James Willig
- Department of Medicine, University of Alabama - Birmingham, Birmingham, AL, USA
| | - Brian W Pence
- Center for AIDS Research, University of North Carolina at Chapel Hill, 103 Wild Turkey Trail, Chapel Hill, NC, 27516-9041, USA
- Department of Epidemiology, Gillings School of Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Prevalence and Associated Factors of Suicidal Ideation and Attempt among People Living with HIV/AIDS at Zewditu Memorial Hospital, Addis Ababa, Ethiopia: A Cross-Sectional Study. PSYCHIATRY JOURNAL 2017; 2017:2301524. [PMID: 28491869 PMCID: PMC5405386 DOI: 10.1155/2017/2301524] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/22/2016] [Revised: 02/21/2017] [Accepted: 03/27/2017] [Indexed: 11/18/2022]
Abstract
Background. Human Immune Deficiency Virus (HIV/AIDS) continues to be an underrecognized risk for suicidal ideation, suicidal attempt, and completion of suicide. Suicidal ideation and attempt in HIV/AIDS is not only a predictor of future attempted suicide and completed suicide. Methods. An institution based cross-sectional study was conducted among HIV-positive patients attending HIV care at Zewditu Memorial Hospital. Systematic random sampling technique was used to recruit 423 participants from April to May 2014. Composite International Diagnostic Interview was used to collect data. Multivariable logistic regression was computed to assess factors associated with suicidal ideation and attempt. Result. Suicidal ideation and suicidal attempt were found to be 22.5% and 13.9%, respectively. WHO clinical stage of HIV, not being on HAART, depression, family history of suicidal attempt, and perceived stigma were associated with suicidal ideation. WHO clinical stage, being female, not being on HAART, use of substance, and depression were associated with suicidal attempt. Conclusion. Early diagnosis and treatment of opportunistic infections, depression, and early initiation of ART need to be encouraged in HIV-positive adults. Furthermore, counseling on substance use and its consequences and early identification of HIV-positive people with family history of suicidal ideation have to be considered.
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Lian Q, Zuo X, Mao Y, Luo S, Zhang S, Tu X, Lou C, Zhou W. Anorexia nervosa, depression and suicidal thoughts among Chinese adolescents: a national school-based cross-sectional study. Environ Health Prev Med 2017; 22:30. [PMID: 29165137 PMCID: PMC5664580 DOI: 10.1186/s12199-017-0639-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2016] [Accepted: 01/25/2017] [Indexed: 12/05/2022] Open
Abstract
Background Although there is much literature on adolescent suicide, combined effects of depression and anorexia nervosa on suicide were rarely investigated. The aims of this study are to examine the association between anorexia nervosa and suicidal thoughts and explore the interaction between anorexia nervosa and depression. Methods This is a cross-sectional study, in the study, a sample of 8,746 Chinese adolescents was selected by multistage stratified method in 2012/2013 from 20 middle schools in 7 provinces across China Mainland. Multilevel logistic model was introduced to explore association between anorexia nervosa and suicidal thoughts. And subgroup analyses were conducted on participants with or without depression. Results Multilevel logistic model revealed that demographic variables, including academic achievement, were not the predictive risk factors of suicidal thoughts. Those who suffered from worse severity of perceived anorexia nervosa were at increased risk of thinking about suicide. The interaction between depression and anorexia nervosa was significant, however, subgroup analyses showed that the associations were significant only among the adolescents without depression. Conclusions Our results indicate that all levels of anorexia nervosa serve as predictable indicators of suicidal thoughts in Chinese adolescents, and the effects of anorexia nervosa are modified by depression status.
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Affiliation(s)
- Qiguo Lian
- School of Public Health, Fudan University, Shanghai, China.,Key Lab. of Reproduction Regulation of NPFPC, SIPPR, IRD, Fudan University, 779 Laohumin Road, Shanghai, 200237, China
| | - Xiayun Zuo
- Key Lab. of Reproduction Regulation of NPFPC, SIPPR, IRD, Fudan University, 779 Laohumin Road, Shanghai, 200237, China
| | - Yanyan Mao
- School of Public Health, Fudan University, Shanghai, China.,Key Lab. of Reproduction Regulation of NPFPC, SIPPR, IRD, Fudan University, 779 Laohumin Road, Shanghai, 200237, China
| | - Shan Luo
- West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Shucheng Zhang
- National Research Institute for Family Planning, Beijing, China
| | - Xiaowen Tu
- Key Lab. of Reproduction Regulation of NPFPC, SIPPR, IRD, Fudan University, 779 Laohumin Road, Shanghai, 200237, China
| | - Chaohua Lou
- Key Lab. of Reproduction Regulation of NPFPC, SIPPR, IRD, Fudan University, 779 Laohumin Road, Shanghai, 200237, China.
| | - Weijin Zhou
- Key Lab. of Reproduction Regulation of NPFPC, SIPPR, IRD, Fudan University, 779 Laohumin Road, Shanghai, 200237, China
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Aremu SB, Nuhu FT, Ajayi B. Risk factors of suicidality among HIV positive subjects in a treatment centre, Kaduna Metropolis, Nigeria. ACTA ACUST UNITED AC 2016. [DOI: 10.5897/jahr2015.0360] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Walter KN, Petry NM. Lifetime suicide attempt history, quality of life, and objective functioning among HIV/AIDS patients with alcohol and illicit substance use disorders. Int J STD AIDS 2016; 27:476-85. [PMID: 25953963 PMCID: PMC5023430 DOI: 10.1177/0956462415585668] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2015] [Accepted: 04/10/2015] [Indexed: 12/13/2022]
Abstract
This cross-sectional study evaluated lifetime prevalence of suicide attempts in 170 HIV/AIDS patients with substance use disorders and the impact of suicide attempt history on subjective indices of quality of life and objective indices of cognitive and physical functioning. All patients met the diagnostic criteria for past-year cocaine or opioid use disorders and 27% of patients also had co-occurring alcohol use disorders. Compared to their counterparts without a history of a suicide attempt, patients with a history of a suicide attempt (n = 60, 35.3%) had significantly poorer emotional and cognitive quality of life scores (ps < .05), but not physical, social, or functional/global quality-of-life scores. Lifetime suicide attempt status was unrelated to objective indices of cognitive functioning, but there was a non-significant trend (p = .07) toward lower viral loads in those with a lifetime suicide attempt relative to those without. The findings indicate that suicide attempt histories are prevalent among HIV/AIDS patients with substance use disorders and relate to poorer perceived emotional and cognitive quality of life, but not objective functioning. HIV/AIDS patients with substance use disorders should be screened for lifetime histories of suicide attempts and offered assistance to improve perceived emotional and cognitive functioning.
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Affiliation(s)
| | - Nancy M Petry
- University of Connecticut School of Medicine, Farmington, CT, USA
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Choi BY, DiNitto DM, Marti CN, Choi NG. Impact of Mental Health and Substance Use Disorders on Emergency Department Visit Outcomes for HIV Patients. West J Emerg Med 2016; 17:153-64. [PMID: 26973741 PMCID: PMC4786235 DOI: 10.5811/westjem.2016.1.28310] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2015] [Revised: 01/03/2016] [Accepted: 01/07/2016] [Indexed: 11/28/2022] Open
Abstract
Introduction A disproportionate number of individuals with human immunodeficiency virus (HIV) have mental health and substance-use disorders (MHSUDs), and MHSUDs are significantly associated with their emergency department (ED) visits. With an increasing share of older adults among HIV patients, this study investigated the associations of MHSUDs with ED outcomes of HIV patients in four age groups: 21–34, 35–49, 50–64, and 65+ years. Methods We used the 2012 Nationwide Emergency Department Sample (NEDS) dataset (unweighted n=23,244,819 ED events by patients aged 21+, including 115,656 visits by patients with HIV). Multinomial and binary logistic regression analyses, with “treat-and-release” as the base outcome, were used to examine associations between ED outcomes and MHSUDs among visits that included a HIV diagnosis in each age group. Results Mood and “other” mental disorders had small effects on ED-to-hospital admissions, as opposed to treat-and-release, in age groups younger than 65+ years, while suicide attempts had medium effects (RRR=3.56, CI [2.69–4.70]; RRR=4.44, CI [3.72–5.30]; and RRR=5.64, CI [4.38–7.26] in the 21–34, 35–49, and 50–64 age groups, respectively). Cognitive disorders had medium-to-large effects on hospital admissions in all age groups and large effects on death in the 35–49 (RRR=7.29, CI [3.90–13.62]) and 50–64 (RRR=5.38, CI [3.39–8.55]) age groups. Alcohol use disorders (AUDs) had small effects on hospital admission in all age groups (RRR=2.35, 95% CI [1.92–2.87]; RRR=2.15, 95% CI [1.95–2.37]; RRR=1.92, 95% CI [1.73–2.12]; and OR=1.93, 95% CI [1.20–3.10] in the 21–34, 35–49, 50–64, and 65+ age groups, respectively). Drug use disorders (DUDs) had small-to-medium effects on hospital admission (RRR=4.40, 95% CI [3.87–5.0]; RRR=4.07, 95% CI [3.77–4.40]; RRR=4.17, 95% CI [3.83–4.55]; and OR=2.53, 95% CI [2.70–3.78] in the 21–34, 35–49, 50–64, and 65+ age groups, respectively). AUDs and DUDs were also significantly related to the risk of death, and DUDs had a small effect on the risk of discharge against medical advice in the 35–49 and 50–64 age groups. Conclusion The high prevalence of MHSUDs and their significant roles in ED visit outcomes in patients with HIV provide support for integrated care for these patients outside the ED to reduce their ED visits and costly hospital admissions and institutional care that follows, especially for the increasing numbers of older adults with HIV.
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Affiliation(s)
- Brian Y Choi
- Warren Alpert Medical School at Brown Univeristy and Rhode Island Hospital, Department of Emergency Medicine, Providence, Rhode Island
| | - Diana M DiNitto
- The University of Texas at Austin, School of Social Work, Austin, Texas
| | - C Nathan Marti
- The University of Texas at Austin, School of Social Work, Austin, Texas
| | - Namkee G Choi
- The University of Texas at Austin, School of Social Work, Austin, Texas
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May AM, Klonsky ED. What Distinguishes Suicide Attempters From Suicide Ideators? A Meta-Analysis of Potential Factors. CLINICAL PSYCHOLOGY-SCIENCE AND PRACTICE 2016. [DOI: 10.1111/cpsp.12136] [Citation(s) in RCA: 185] [Impact Index Per Article: 23.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Alexis M. May
- Department of Psychology; University of British Columbia; Vancouver BC Canada
| | - E. David Klonsky
- Department of Psychology; University of British Columbia; Vancouver BC Canada
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45
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O'Donnell JK, Gaynes BN, Cole SR, Edmonds A, Thielman NM, Quinlivan EB, Shirey K, Heine AD, Modi R, Pence BW. Ongoing life stressors and suicidal ideation among HIV-infected adults with depression. J Affect Disord 2016; 190:322-328. [PMID: 26544615 PMCID: PMC4685465 DOI: 10.1016/j.jad.2015.09.054] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2015] [Revised: 09/17/2015] [Accepted: 09/25/2015] [Indexed: 11/19/2022]
Abstract
BACKGROUND Suicidal ideation is the most proximal risk factor for suicide and can indicate extreme psychological distress; identification of its predictors is important for possible intervention. Depression and stressful or traumatic life events (STLEs), which are more common among HIV-infected individuals than the general population, may serve as triggers for suicidal thoughts. METHODS A randomized controlled trial testing the effect of evidence-based decision support for depression treatment on antiretroviral adherence (the SLAM DUNC study) included monthly assessments of incident STLEs, and quarterly assessments of suicidal ideation (SI). We examined the association between STLEs and SI during up to one year of follow-up among 289 Southeastern US-based participants active in the study between 7/1/2011 and 4/1/2014, accounting for time-varying confounding by depressive severity with the use of marginal structural models. RESULTS Participants were mostly male (70%) and black (62%), with a median age of 45 years, and experienced a mean of 2.36 total STLEs (range: 0-12) and 0.48 severe STLEs (range: 0-3) per month. Every additional STLE was associated with an increase in SI prevalence of 7% (prevalence ratio (PR) (95% confidence interval (CI)): 1.07 (1.00, 1.14)), and every additional severe STLE with an increase in SI prevalence of 19% (RR (95% CI): 1.19 (1.00, 1.42)). LIMITATIONS There was a substantial amount of missing data and the exposures and outcomes were obtained via self-report; methods were tailored to address these potential limitations. CONCLUSIONS STLEs were associated with increased SI prevalence, which is an important risk factor for suicide attempts and completions.
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Affiliation(s)
- Julie K O'Donnell
- University of North Carolina at Chapel Hill, Department of Epidemiology, United States.
| | - Bradley N Gaynes
- University of North Carolina at Chapel Hill School of Medicine, Department of Psychiatry, United States
| | - Stephen R Cole
- University of North Carolina at Chapel Hill, Department of Epidemiology, United States
| | - Andrew Edmonds
- University of North Carolina at Chapel Hill, Department of Epidemiology, United States
| | - Nathan M Thielman
- Duke University, Center for Health Policy, Duke Global Health Institute, United States
| | - E Byrd Quinlivan
- University of North Carolina at Chapel Hill, Institute for Global Health, Infectious Diseases and Center for AIDS Research, United States
| | - Kristen Shirey
- Duke University School of Medicine, Department of Psychiatry, United States
| | - Amy D Heine
- University of North Carolina at Chapel Hill, Institute for Global Health and Infectious Diseases, United States
| | - Riddhi Modi
- University of Alabama at Birmingham, Division of Infectious Diseases, United States
| | - Brian W Pence
- University of North Carolina at Chapel Hill, Department of Epidemiology, United States
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46
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Rukundo GZ, Mishara B, Kinyanda E. Psychological correlates of suicidality in HIV/AIDS in semi-urban south-western Uganda. Trop Doct 2016; 46:211-215. [PMID: 26738768 DOI: 10.1177/0049475515623110] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
There is a paucity of data on the prevalence of suicidality in HIV/AIDS, and associated psychological factors in sub-Saharan Africa, shown to be high in Uganda. Yet, the region accounts for over 70% of the world HIV burden. Our study used a cross-sectional survey of 226 HIV-positive (HIV+) adults and adolescents (aged 15-17 years) in Mbarara, Uganda. The relationship between suicidality and depressed mood, anxiety symptoms, state anger, self-esteem, trait anger and hopelessness was examined; anger was the predominant factor in suicidality, suggesting that anger management could potentially lower the prevalence of suicidality.
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Affiliation(s)
- Godfrey Zari Rukundo
- Senior Lecturer of Psychiatry, Department of Psychiatry, Mbarara University of Science and Technology, Uganda
| | - Brian Mishara
- Professor of Psychology, Centre for Research and Intervention on Suicide and Euthanasia, Université du Québec à Montréal, Canada
| | - Eugene Kinyanda
- Associate Professor of Psychiatry, Uganda Medical Research Council, Entebbe and Department of Psychiatry, Makerere College of Health Sciences, Uganda
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47
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Nkhoma ET, Coumbis J, Farr AM, Johnston SS, Chu BC, Rosenblatt LC, Seekins D, Villasis-Keever A. No Evidence of an Association Between Efavirenz Exposure and Suicidality Among HIV Patients Initiating Antiretroviral Therapy in a Retrospective Cohort Study of Real World Data. Medicine (Baltimore) 2016; 95:e2480. [PMID: 26817882 PMCID: PMC4998256 DOI: 10.1097/md.0000000000002480] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Recently, published studies have reported conflicting results regarding the association between efavirenz exposure and the risk of suicidality among patients with human immunodeficiency virus. The objective of this analysis was to compare the rate of suicidality among patients initiating efavirenz-containing versus efavirenz-free antiretroviral (ARV) regimens.This retrospective cohort study used US administrative claims data for commercially and Medicaid-insured individuals for the years 2006 to 2013. ARV-naive patients aged ≥12 years initiating an efavirenz-containing or efavirenz-free ARV regimen with ≥6 months of continuous insurance enrollment prior to ARV initiation were selected. The primary outcome was suicidality, defined as the occurrence of any medical claim with a diagnosis code for suicidal ideation or an inpatient or emergency department medical claim for suicide attempt. Unadjusted incidence rates were calculated and propensity score-adjusted hazard ratios were estimated to account for differences in patient characteristics.There were 19,983 patients (efavirenz-containing, n = 11,187; efavirenz-free, n = 8796) in the commercial database and 5154 patients (efavirenz-containing, n = 2224; efavirenz-free, n = 2930) in the Medicaid database. Unadjusted incidence rates (95% confidence interval [CI]) of suicidality per 1000 person-years were: commercial, efavirenz-containing (3.3 [2.4-4.4]), efavirenz-free (4.0 [2.7-5.8]); Medicaid, efavirenz-containing (25.7 [18.8-34.4]), efavirenz-free (40.6 [31.9-50.9]). In propensity score-adjusted analyses, efavirenz use was not associated with suicidality: adjusted hazard ratio (95% CI) of suicidality compared with efavirenz-free regimen, commercial, 1.029 (0.636-1.665); Medicaid, 0.902 (0.617-1.319).This analysis found no conclusive evidence of an increased risk of suicidality among patients initiating an efavirenz-containing ARV regimen. However, channeling bias may exist even after adjusting for measured patient characteristics.
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Affiliation(s)
- Ella T Nkhoma
- From the Bristol-Myers Squibb, Global Pharmacovigilance and Epidemiology, Wallingford, Connecticut (ETN); Bristol-Myers Squibb, Global Pharmacovigilance and Epidemiology, Hopewell, New Jersey (JC, DS); Truven Health Analytics, Bethesda, Maryland (AMF, SSJ, BCC); Bristol-Myers Squibb, Health Economics and Outcomes Research (LCR); and Bristol-Myers Squibb, US Medical, Plainsboro, New Jersey (AV-K)
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48
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Fellows RP, Spahr NA, Byrd DA, Mindt MR, Morgello S. Psychological trauma exposure and co-morbid psychopathologies in HIV+Men and Women. Psychiatry Res 2015; 230:770-6. [PMID: 26599389 PMCID: PMC4801502 DOI: 10.1016/j.psychres.2015.11.011] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2014] [Revised: 10/27/2015] [Accepted: 11/08/2015] [Indexed: 11/26/2022]
Abstract
This study examined the association between trauma exposure, PTSD, suicide attempts, and other psychopathology among 316 racially/ethnically diverse HIV-infected men and women who underwent semi-structured psychiatric assessment. In addition, the role of psychological resilience in trauma exposure was examined in the context of neurological symptoms and functional status. Nearly half (47.8%; 151/316) of the participants reported trauma exposure, of which 47.0% (71/151) developed PTSD. Among trauma-exposed individuals, those with a current psychiatric diagnosis reported more neurological symptoms and lower functional status. Trauma exposure without PTSD was associated with a higher rate of panic disorder and substance-induced mental disorders. Trauma-exposed individuals who did not develop PTSD were less likely than those who reported no trauma exposure to meet criteria for major depressive disorder (MDD). Trauma exposure, MDD, borderline personality disorder, and substance-induced mental disorders were independently associated with increased odds of suicide attempt. These results indicate that co-morbid psychiatric disorders are common among trauma exposed individuals with a history of PTSD, but those with trauma exposure who do not develop PTSD are less likely to experience MDD. The role of other co-morbid psychopathologies in the genesis of suicidal behavior among individuals living with HIV deserves further study.
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Affiliation(s)
- Robert P. Fellows
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Nayeli A. Spahr
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Desiree A. Byrd
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA,Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA,Corresponding author at: Department of Neurology, Box 1152 Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place, New York, 10029 NY, USA. (D.A. Byrd)
| | - Monica Rivera Mindt
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA,Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Susan Morgello
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA,Department of Pathology, Icahn School of Medicine at Mount Sinai, New York, NY, USA,Department of Neuroscience, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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49
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Signoracci GM, Stearns-Yoder KA, Holliman BD, Huggins JA, Janoff EN, Brenner LA. Listening to Our Patients: Learning About Suicide Risk and Protective Factors From Veterans With HIV/AIDS. J Holist Nurs 2015; 34:318-328. [PMID: 26578552 DOI: 10.1177/0898010115610688] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE We sought to gather perspectives of veterans with human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) regarding suicide risk factors, warning signs, and protective factors. We also aimed to modify an existing Veterans Health Administration tool, the Suicide Risk Assessment Guide Pocket Card, for HIV/AIDS provider use. METHODS Twenty male veterans participated in audio-recorded semistructured interviews that were transcribed and coded for themes. FINDINGS Veterans highlighted personally relevant psychosocial stressors (i.e., poverty, social isolation and loneliness, and physical health). Although the concept of warning signs did not seem salient to participants, they named indicators of elevated imminent risk for self-directed violence (i.e., "relapse," "not take'n medications," and "miss'n appointments") and few protective factors. No themes emerged regarding recommended pocket card changes. CONCLUSIONS This sample of veterans identified self-directed violence risks noted in the general population and others with HIV/AIDS, as well as proximal events associated with increased risk. Care providers are encouraged to explore the relevance of noted imminent and persistent indicators of increased risk with veterans seeking care.
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Affiliation(s)
- Gina M Signoracci
- Rocky Mountain MIRECC at the Denver VAMC .,University of Colorado, Aurora
| | - Kelly A Stearns-Yoder
- Rocky Mountain MIRECC at the Denver VAMC.,University of Colorado, Aurora.,Rocky Mountain MIRECC at the Denver VAMC.,Rocky Mountain MIRECC at the Denver VAMC.,University of Colorado, Aurora
| | - Brooke Dorsey Holliman
- Rocky Mountain MIRECC at the Denver VAMC.,University of Colorado, Aurora.,Rocky Mountain MIRECC at the Denver VAMC.,Rocky Mountain MIRECC at the Denver VAMC.,University of Colorado, Aurora
| | | | - Edward N Janoff
- Rocky Mountain MIRECC at the Denver VAMC.,University of Colorado, Aurora.,Rocky Mountain MIRECC at the Denver VAMC.,Rocky Mountain MIRECC at the Denver VAMC.,University of Colorado, Aurora
| | - Lisa A Brenner
- Rocky Mountain MIRECC at the Denver VAMC.,University of Colorado, Aurora.,Rocky Mountain MIRECC at the Denver VAMC.,Rocky Mountain MIRECC at the Denver VAMC.,University of Colorado, Aurora
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50
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Gurm J, Samji H, Nophal A, Ding E, Strehlau V, Zhu J, Montaner JS, Hogg RS, Guillemi S. Suicide mortality among people accessing highly active antiretroviral therapy for HIV/AIDS in British Columbia: a retrospective analysis. CMAJ Open 2015; 3:E140-8. [PMID: 26389091 PMCID: PMC4565174 DOI: 10.9778/cmajo.20140101] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Suicide rates have been reported at elevated levels among people living with HIV/AIDS. We sought to characterize longitudinal suicide rates among people living with HIV/AIDS who are accessing free highly active antiretroviral treatment (HAART) in British Columbia and evaluate the sociodemographic, clinical and behavioural factors associated with suicide in this population. METHODS Retrospective analysis of all patients in the HAART Observational Medical Evaluation and Research (HOMER) cohort who were 19 years of age and older who started treatment between August 1996 and June 2012. The primary outcome variable was death due to suicide. Data on deaths were obtained monthly through a linkage with the British Columbia Ministry of Health Vital Statistics Agency. Logistic regression and Cox proportional hazards models were used to identify factors independently associated with suicide mortality. RESULTS A total of 993 deaths among 5229 patients accessing treatment were recorded, of which 82 (8.2%) were caused by suicide. Death from suicide peaked at 961 deaths per 100 000 person-years in 1998 and declined to 2.81 deaths per 100 000 person-years in 2010. Cox regression analysis showed that a history of injection drug use (adjusted hazard ratio [AHR] = 3.95, 95% confidence interval [CI] 1.99-7.86) or having no experience with an AIDS-defining illness (AHR = 4.45, 95% CI 1.62-12.25) were factors independently associated with suicide. This model showed a 51% reduction (AHR = 0.49, 95% CI 0.45-0.54) in the suicide rate per calendar year. INTERPRETATION Deaths from suicide declined substantially over time, and factors other than progression of HIV disease, such as injection drug use, may be important targets for intervention to reduce suicide risk.
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Affiliation(s)
- Jasmine Gurm
- BC Centre for Excellence in HIV/AIDS, St. Paul’s Hospital, Vancouver, BC
| | - Hasina Samji
- BC Centre for Excellence in HIV/AIDS, St. Paul’s Hospital, Vancouver, BC
| | - Adriana Nophal
- BC Centre for Excellence in HIV/AIDS, St. Paul’s Hospital, Vancouver, BC
| | - Erin Ding
- BC Centre for Excellence in HIV/AIDS, St. Paul’s Hospital, Vancouver, BC
| | - Verena Strehlau
- The University of British Columbia, Department of Psychiatry, Vancouver, BC
| | - Julia Zhu
- BC Centre for Excellence in HIV/AIDS, St. Paul’s Hospital, Vancouver, BC
| | - Julio S.G. Montaner
- BC Centre for Excellence in HIV/AIDS, St. Paul’s Hospital, Vancouver, BC
- The University of British Columbia, Faculty of Medicine, Vancouver, BC
| | - Robert S. Hogg
- BC Centre for Excellence in HIV/AIDS, St. Paul’s Hospital, Vancouver, BC
- Simon Fraser University, Faculty of Health Sciences, Burnaby, BC
| | - Silvia Guillemi
- BC Centre for Excellence in HIV/AIDS, St. Paul’s Hospital, Vancouver, BC
- The University of British Columbia, Faculty of Medicine, Vancouver, BC
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