Psychosocial health and suicidal ideation among people living with HIV/AIDS: A cross-sectional study in Nanjing, China

Suicidal ideation and associated factors among people living with HIV/AIDS in Ethiopia: a systematic review and meta-analysis

Background

Suicide is one of the main causes of mortality in the world, accounting for more fatalities than homicide, war, human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS), breast cancer, and malaria. Significantly, the biggest risk factors for suicide in the general population are having already attempted suicide and suicidal ideation. Despite the availability of studies on suicidal ideation among people living with HIV/AIDS (PLWHA) in Ethiopia, the results are inconsistent. Thus, a systematic review and meta-analysis was conducted to estimate the pooled prevalence of suicidal ideation among people living with HIV/AIDS.

Methods

A systematic review and meta-analysis was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline. To find papers published in the English language before 20 May 2023, the electronic databases of Medline, Science Direct, Excerpta Medica Database, Cochrane Library, African Journals Online (AJOL), and Google Scholar were searched. The DerSimonian and Laird method for random effects models was used to estimate the pooled prevalence of suicidal ideation with a 95% confidence interval in STATA V.14.0 statistical software. To test for heterogeneity between studies and publication bias, respectively, forest plots and funnel plots were used. Additionally, leave-one-out sensitivity was conducted.

Results

A total of nine studies with 3,411 study participants were included in this systematic review and meta-analysis. The pooled prevalence of suicidal ideation among PLWHA was 20.55% (95% CI 14.76, 26.33). Being female (Odds ratio (OR) = 4.27, 95% CI = 2.29, 7.97), living alone (OR = 5.02, 95% CI = 2.15, 11.64), poor social support (OR = 3.80, 95% CI = 2.56, 5.65), perceived stigma (OR = 3.50, 95% CI = 1.55, 7.87), depression (OR = 5.08, 95% CI = 2.55, 11.48), undisclosed HIV status (OR = 4.8, 95% CI = 2.10, 10.93), and World Health Organization HIV clinical stages of III or IV (OR = 4.40, 95% CI = 2.95, 6.58) were significantly associated with suicidal ideation.

Conclusion

Suicidal ideation among PLWHA is high in Ethiopia. Therefore, emphasis should be given to psychiatric assessment and interventions with a special focus on individuals having the associated factors.

Systematic Review Registration

PROSPERO (CRD42023429613).

Self-injury and suicide among people living with HIV/AIDS in China: a systematic review and meta-analysis

BACKGROUND

The prevalence of self-injury and suicide is higher than the general population of people living with HIV/AIDS (PLWHA). However, the results reported in existing studies are highly variable in China. The purpose of this systematic review and meta-analysis was to synthesize the currently available high-quality evidence to explore the prevalence and influence factors of self-injury and suicide among PLWHA in China.

METHOD

We retrieve literature written in Chinese and English through databases such as PubMed, Embase, Web of Science, Cochrane Library, SinoMed, CNKI, WanFang Database, and CQVIP from inception to 1 September 2022. Sata 16.0 software was used for analysis.

RESULTS

A total of 28 studies were included with a sample size of 1,433,971 and had a satisfactory quality score of ≥ 5. The prevalence among PLWHA in China were 30% for suicidal ideation (SI), 5% for suicide attempt (SA), 8% for suicide plan (SP), 7% for attempted suicide (AS), and 3‰ for completed suicide. High stigma (OR = 2.94, 95%CI: 1.90 - 4.57), depression (OR, 3.17; 95%CI, 2.20 - 4.57), anxiety (OR, 3.06; 95%CI, 2.23 - 4.20), low self-esteem (OR, 3.82, 95%CI, 2.22 - 6.57), high HIV related stress (OR, 2.53; 95%CI, 1.36 - 4.72), and unemployment (OR, 2.50; 95%CI, 1.51 - 4.15) are risk factors for SI; high social support (OR, 0.61; 95%CI, 0.44 - 0.84) and spouse infected with HIV (OR, 0.39; 95%CI, 0.21 - 0.74) are protective factors for SI; depression (OR, 1.62; 95%CI, 1.24 - 2.13), high aggression (OR, 4.66; 95%CI, 2.59 - 8.39), and more negative life events (OR, 2.51; 95%CI, 1.47 - 4.29) are risk factors for AS; high level of education (OR, 1.31; 95%CI, 1.21 - 1.43) is risk factor for CS.

CONCLUSION

Figures indicate that approximately one-third of PLWHA had suicidal ideation, and three out of 1,000 completed suicide in China. Positive events are protective factors for self-injury and suicide among PLWHA, while negative events are risk factors. This suggests that psychosocial support and risk assessment should be integrated into the care of PLWHA.

Suicidal ideation, attempt, and its associated factors among adult HIV/AIDS patients in Ethiopia: A systematic review and meta-analysis study

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.

The Unheard Stories: Experiences of Young People Living with Human Immunodeficiency Virus in Dealing with Discrimination in the Philippines

Purpose

The aim of this study is to gain an in-depth understanding of the experiences of young people living with the human immunodeficiency virus (YPLHIV) in dealing with discrimination and contribute to a more efficient response.

Patients and Methods

We utilised qualitative descriptive research-narrative inquiry. Twenty YPLHIV aged 19 to 24 under treatment from HIV hubs in Metro Manila, Philippines were purposely selected for an in-depth individual interview. Data were transcribed verbatim and manually coded and analysed using narrative thematic analysis.

Results

We found that HIV knowledge and beliefs of YPLHIV plays a huge role in their experience. Second, dealing with HIV stereotypes contributed to how they assume judgments from others (perceived stigma) and may have internalised the stigma which alters their belief toward self and the disease. Third, thoughts of suicide, experiencing emotional dissonance, and having difficulty embracing one's identity indicate declined mental health. Fourth, they continuously seek and may have received support from significant others and the community. Some may have directly received or perceived discrimination, but the YPLHIV reported that support received from others plays positively vital role in their journey. Finally, the disease helped change their behaviour and, in turn, brought them to lifestyle change as they are eager to be undetectable and untransmissible (U=U) and perpetually reflect on the ordeal challenge of adhering to treatment.

Conclusion

Our study concluded that the stigma and discrimination that YPLHIVs endured were caused by misinformation about the disease and stems from both within themselves and from others around them. Support received from friends, family members, and the community helped them deal with their circumstances. We recommend that efforts be made by both the government and non-government to develop programs distinctly for YPLHIV. Future research may explore the mental health aspect as this has been found concerning in the narratives among young population patients.

Suicide Ideation and Attempt Among People With HIV: A Statewide Population-level Cohort Analysis Between 2005 and 2020

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.

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

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.

Perceived HIV Stigma, Depressive Symptoms, Self-esteem, and Suicidal Ideation Among People Living with HIV/AIDS in China: a Moderated Mediation Modeling Analysis

OBJECTIVE

Suicidal ideation is an important public health challenge among people living with HIV (PLWH) across the world and in China. HIV stigma, depression, and self-esteem have been associated with suicidal ideation. However, the underlying mechanisms remain not fully understood.

METHODS

Study data were derived from a sample of 465 PLWH in China. Suicidal ideation after HIV diagnosis was used as outcome variable. HIV stigma, depressive symptoms, and self-esteem were measured using reliable instruments and used as predictor, mediator, and moderator, respectively. Mediation and moderated mediation model were used for data analysis.

RESULTS

31.6% of PLWH in China had suicidal ideation after HIV diagnosis. The association between perceived HIV stigma and suicidal ideation was partially mediated by depression (indirect effect = 0.02, 95% CI = [0.02, 0.03]) with the path from perceived HIV stigma to depressive symptoms being moderated by self-esteem (interaction effect =  - 0.02, 95% CI [- 0.03, - 0.01]).

CONCLUSIONS

Study findings suggested a mediation mechanism of HIV stigma on suicidal ideation through depressive symptoms, and self-esteem might weaken the mediation mechanism by moderating the perceived HIV stigma-depressive symptoms pathway.

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

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.

Global prevalence of suicide in patients living with HIV/AIDS: A systematic review and meta-analysis

BACKGROUND

In fact, people living with HIV are at a greater risk of mental health disorders. Based on lack of necessary information in this area the present systematic review and meta-analysis study was conducted to determine the magnitude of committed suicides among HIV/AIDS people as well as their associated factors in a global setting.

METHOD

Firstly we registered the protocol of study in PROSPRO. Then the publications were searched in the 4 main databases from January 2000 to April 2022. After removing duplication and inappropriate studies we applied inclusion and exclusion criteria. Finally 60 studies were included for analysis. Comprehensive meta-analysis software were used for analyzing.

RESULTS

After reviewing 60 articles published from January 2000 to April 2021 in 24 countries, the total prevalence rate of suicide among 61,904 patients was estimated at 0.249 (95 % CI, 0.2-0.306). Findings indicated that the highest suicide prevalence was related to single patients estimated at 0.257 (95 % CI, 0.184-0.347). A gender-based meta-analysis depicted that the prevalence of suicide/ suicidal ideation was higher among females estimated at 0.22 (95 % CI, 0.15-0.29) compared with men at 0.17 (95 % CI, 0.11-0.23).

CONCLUSION

Health planners and policymakers should develop suicide-prevention strategies aimed at female patients in younger age groups who live alone and are deprived of social support to effectively promote their self-efficacy in successful management of the disease. Integrating mental health services into anti-retroviral therapy for HIV/AIDS patients is also suggested in order to effectively design integrated programs for the management of individuals living with HIV/AIDS.

Psychosocial characteristics pattern correlated with HIV-related risky sexual behavior among HIV-negative men who have sex with men: a latent profile analysis

BACKGROUND

Men who have sex with men (MSM) have become a high risk population of HIV infection due to their risky sexual behaviors. The latent pattern of psychosocial characteristics plays an important effect in HIV-related risky behaviors among HIV-negative MSM.

METHOD

Participants were recruited from Wuhan, Nanchang, and Changsha city from September 2017 to January 2018. Social support was assessed by the multidimensional scale of social support, Connor-Davidson Resilience scale-10 items for reliance, the assessment of Stigma towards Homosexuality for sexual minority stigma, the Likert subscale of nondisclosure for identity concealment, the ACE questionnaire-Kaiser-CDC for adverse childhood experience, the Centers for Epidemiological Studies Depression Scale for depression. Latent profile analysis (LPA) and multivariate regression were used to analyze the data.

RESULTS

Three psychosocial characteristic patterns were revealed by the LPA. "Social support and resilience group" (SR group), "Identity concealment group" (IC group) and "Adverse childhood experience" (ACE group) were identified, respectively. In comparison with "SR group", "IC group" have a higher likelihood of one-night male partners (AOR = 2.74, 95%CI = [1.54, 4.90]), both fixed and one-night male partners (AOR = 2.01, 95%CI = [1.34, 3.01]) and HIV-unsure male partner (AOR = 2.12, 95%CI = [1.44, 3.13]). Similarly, "ACE group" were more likely having inconsistent condom use (AOR = 2.58, 95%CI = [1.41, 4.73]), and having sex with HIV-positive male partner (AOR = 4.90, 95%CI = [1.95, 12.30]) with comparison of "SR group". In addition, we further revealed that "ACE group" had a higher ratio (90.0%) of inconsistent condom use among MSM whose male partners were HIV-positive.

CONCLUSIONS

Six important psychosocial factors were divided into three latent pattern classes. Compared with "SR group", "IC group" and "ACE group" were more likely to engage in HIV-related risky sexual behaviors. Further research may pay more attention to "IC group" and "ACE group" for targeted intervention.

Prevalence of suicide ideation among HIV/AIDS patients in China: A systematic review and meta-analysis

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.

Gender differences in suicidal ideation, suicide attempts, and suicide death among people living with HIV : A systematic review and meta‐analysis

OBJECTIVE

Although excess mortality, especially suicide, is a critical trait in people living with HIV, consensus about gender differences in these areas is lacking. We conducted meta-analyses to examine gender differences in suicidal ideation, suicide attempts, and suicide death among people living with HIV.

METHODS

We systematically searched PubMed and Web of Science for studies written in English. In this review, suicide among people living with HIV includes suicide death, suicidal ideation, and suicide attempts. Studies reporting the suicide prevalence among males and females living with HIV were eligible for inclusion in our review. Odds ratios (ORs) and 95% confidence intervals (CIs) served as the effect size index. Fixed-effects or random-effects meta-analyses were chosen based on the size of the heterogeneity.

RESULTS

A total of 27 studies comprising 801 017 participants from 11 countries were included in the meta-analysis. The overall prevalence of suicidal ideation was 18.0% (95% CI 13.3%-22.8%) in males and 20.8% (95% CI 16.4%-25.1%) in females, and there was a statistically significant higher risk of suicidal ideation in females living with HIV (OR 1.30; 95% CI 1.09-1.56; p < 0.05). The overall prevalence of suicide attempts was 16.8% (95% CI 9.0%-24.5%) in males and 24.7% (95% CI 12.4%-37.1%) in females, and there was a statistically significant higher risk of suicide attempts in females living with HIV (OR 1.34; 95% CI 1.02-1.75; p < 0.05). The pooled prevalence of suicide death was 1.2% (95% CI 0.5%-1.9%) among males and 0.2% (95% CI 0.1%-0.3%) among females, and the risk of suicide death between genders was not statistically significant (OR 0.78; 95% CI 0.50-1.24; p = 0.298).

CONCLUSIONS

There were gender differences in suicidal ideation and suicide attempts among people living with HIV. Females living with HIV were more likely to experience suicidal ideation and make suicide attempts, but there were no statistically significant gender differences in suicide death. Appropriate initiatives to optimize the recognition, treatment, and management suicide behaviours of males and females living with HIV may narrow this gender gap.

Pandemics and Suicide Risk: Lessons From COVID and Its Predecessors

ABSTRACT

In its mortality and global reach, COVID-19 is among the worst pandemics to hit the globe since the 1918 influenza. During a pandemic, it is not uncommon for deaths from suicide to be downplayed as communities respond to the immediate mortality of the disease. In this analysis, we review pandemic history to uncover its impact on suicide rates, a frequent proxy for community mental health, and whether public health responses were effective. We incorporate lessons from more than 100 years of epidemics to assess whether the current public health response can benefit from the lessons of history.

Suicidality Among People Living With HIV From 2010 to 2021: A Systematic Review and a Meta-regression

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.

Prevalence and correlates of suicidal behavior in primary care settings in Mozambique

BACKGROUND

This study assessed the prevalence of suicidal behavior and associated risk factors in public primary health care in Mozambique.

METHODS

The Mini International Neuropsychiatric Interview was used to evaluate suicidal behavior among 502 adults attending three Primary Health Care (PHC) settings.

RESULTS

In the past month, 13% (n = 63) of PHC attendees expressed suicidal ideation, 8% (n = 40) had made a suicide plan, 4% (n = 20) had made a suicide attempt, and 5% (n = 25) reported a lifetime suicide attempt. Females had 2.8-fold increased odds of suicide plan (95% CI: 1.5, 5.5) and 3.3-fold increased odds of suicide attempt in the past month (95% CI: 1.2, 9.1). Each 10-year increase in age was associated with 0.61-fold the odds of suicide plan (95% CI: 0.38, 0.98) and 0.09-fold the odds of suicide attempt (95% CI: 0.01, 0.69) in the past month. People living with HIV (PLWHA) had 2.2-fold increased adjusted odds of past month suicide attempt (CI: 1.1, 4.1).

CONCLUSION

Suicidal behaviors are common among adults attending PHC clinics in Mozambique. Screening and linkage to effective preventive interventions are urgently needed in PHC settings. Females, younger individuals, and PLWHA are at elevated risk for suicidal behavior in PHC.

Trends in the psychosocial and mental health of HIV-positive women in China from 2015 to 2020: Results from two cross-sectional surveys

Background

The human immunodeficiency virus (HIV) continues to be one of the major public health challenges in the world. Despite the advancement in medication and changes in views towards HIV in Chinese society, little is known about the changes in the psychosocial and mental health of HIV‐positive women in recent years.

Objectives

The present study examined the change in depression, anxiety, stigma, relationship with the child, intimacy with a partner, and social support from family, friends, and health professionals, for HIV‐positive women in China from 2015 to 2020.

Methods

Two cross‐sectional surveys were conducted in 2015 and 2020, and 429 and 382 HIV‐positive women were recruited from the Women's Health Department in Yunnan and Guangxi, China between November 2015 to May 2016, and November 2019 to January 2020, respectively.

Results

After controlling for significant sociodemographic variables, participants recruited in 2019–2020 had significantly lower levels of depression and anxiety and higher scores on emotional and tangible support from friends. On the other hand, they had lower scores in intimacy with partners and emotional and tangible support from family. No significant changes were found in stigma, relationship with the child, and support from health professionals.

Conclusion

Results provide important information on the changes in psychosocial and mental health, which offer insights into the design of interventions to promote psychosocial and mental health among HIV‐positive women in China.

Patient or Public Contribution

HIV‐positive women contributed to the data of this study. Health care professionals were involved in the discussion of the methods and results.

Prevalence and psychosocial factors associated with self-injurious thoughts among people living with HIV presenting for HIV testing in Mozambique

Self-injurious thoughts have been associated with psychiatric morbidity and suicide. Little is known about psychosocial factors associated with self-injurious thoughts among people newly diagnosed with HIV in sub-Saharan Africa. This study examined whether food insufficiency, mental health symptoms, or social support were associated with recent self-injurious thoughts among people newly diagnosed with HIV in Mozambique. The sample included 2001 PLWH aged ≥ 18 newly diagnosed with HIV at 10 health clinics in Mozambique between April 2013 and June 2015. Data were collected at time of HIV diagnosis. Multivariable logistic regression modeled the association of social support, affective mental health symptom severity, somatic mental health symptom severity, and food insufficiency on recent self-injurious thoughts. Ten percent of respondents reported recent self-injurious thoughts, which was higher among women than men (11% vs 7%). In multivariable analyses, food insufficiency [adjusted odds ratio (aOR) 1.7 (95% CI 1.3, 2.2)], and low [aORvs no = 4.8, 95% CI 1.7, 13.4) and moderate/high affective symptom severity [aORvs no = 8.7, 95% CI 2.8, 27.6) were associated with greater odds of self-injurious thoughts. Interventions to address self-injurious thoughts should consider accompanying psychosocial stressors. Longitudinal research to examine mechanisms through which psychosocial stressors are associated with self-injurious thoughts is warranted.

HIV-related stigma, symptoms of depression and their association with suicidal ideation among people living with HIV in Ho Chi Minh City, Vietnam

To date, little are known about HIV-related stigma, symptoms of depression (SOD) and suicidal ideation among people living with HIV (PLHIV) in Vietnam. This study aimed to estimate the level of stigma, SOD and suicidal ideation and to explore the direction and magnitude of the relationship between stigma, SOD and suicidal ideation among Vietnamese PLHIV. A cross-sectional study was conducted in four outpatient clinics providing healthcare services including antiretroviral therapy (ART) for PLHIV in Ho Chi Minh City. At each clinic, patients were chosen using the systematic sampling technique. Participants underwent face-to-face interviews through a pre-defined structural questionnaire that included validated scales. Among 777 PLHIV in the analysis, most were male (81.1%) and the average age was 34.3 (SD = 8.8) years. Two-thirds of PLHIV had a moderate-to-high level of HIV stigma. Symptoms of depression were identified in 41.4% of PLHIV. Suicidal ideation was reported by 26.3% of PLHIV. Based on univariate and multivariate logistic regression, higher levels of SOD and HIV stigma were positively associated with suicidal ideation. For PLHIV with extreme stigma and SOD, the probability of having suicidal ideation was up to 80%. The prevalence and association found in this study indicates that interventions for SOD and stigma not only help reduce these two problems but also help address and minimize suicidal ideation in this vulnerable population. In Vietnam, to optimize such interventions, the involvement of families and communities is crucial.

Comparison of Psycho-Social Factors Associated With Suicidal Ideation and Suicide Attempts Among People Living With HIV in Central West China

Background

Previous studies have described the correlation of suicidal ideation (SI) or suicide attempts (SA) in people living with HIV (PLWH), whereas few studies compare the correlation between SI and SA in PLWH. Understanding specific risk factors for SI and SA among PLWH will help with developing tailored and effective suicide prevention strategies among this high-risk group.

Methods

A cross-sectional study was conducted from December 2020 to April 2021 in Baoji municipality, Shaanxi Province. The PLWH registered with the Baoji Municipal Center for Disease Control and Prevention (CDC) were recruited and interviewed. Questionnaires and interviews for this study consisted of socio-demographic variables, mental health history, and psychosocial characteristics. The HIV-related clinical features were obtained from CDC medical records. The PLWH included were divided into three groups, i.e., those with a history of suicide attempts (SA group), those with suicidal ideation only (SI group), and those without any suicidal behavior (NSB group). Multinomial logistic regression was used for three-way comparisons among these three groups of PLWH.

Results

In total, 995 PLWH were interviewed. The prevalence of probable depression, probable anxiety, SI, and SA in PLWH after being diagnosed as HIV+ was 18.6%, 13.5%, 26.7%, and 3.2%, respectively. Compared with the NSB group, the SI or SA groups were more likely to report probable depression [adjusted odds ratio (AOR) = 2.43, 4.44, respectively], probable anxiety (AOR = 2.80, 5.62, respectively), and high HIV-related stigma (AOR = 2.05, 2.65, respectively). The SI group was more likely to experience high HIV-related stress (AOR = 1.91) and lower quality of life (AOR = 0.56) than the NSB group. Social support and HIV-related clinical features were not associated with SI or SA in this sample. The SA group did not differ from the SI group on any of the psychosocial or HIV-related clinical features.

Conclusions

Mental health problems are serious in community residents identified with having an HIV infection in a Central West China municipality. It is important to deliver low-cost and effective psychological services tailored for PLWH that are focused on reducing mental health problems. Future studies should utilize sensitive screening measures and further clarify factors potentially associated with the transition from SI to SA in PLWH.

HIV related stigma associated with social support, alcohol use disorders, depression, anxiety, and suicidal ideation among people living with HIV: a systematic review and meta-analysis

Background

Stigma is a social phenomenon known to have a negative impact on the lives of people living with HIV (PLWH). However, defining HIV-related stigma (HRS) is difficult because of the intersection it has with structural inequalities, and cultural differences, discrimination by health care providers that measure stigma among PLWH. HIV/AIDS has been characterized as a traumatic experience and PLWH may experience stigma which can cause negative mental health disorders and experiences, including emotional distress, shame, depression, anxiety, suicidal ideation. A systematic review of the evidence on the mental disorders of PLWH is currently lacking. This study aimed to analyze the association between HRS and social support, alcohol use disorders and mental health disorders and experiences (depression, anxiety, and suicidal ideation) among PLWH.

Methods

In accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) this study searched PubMed, Scopus, Web of sciences, PsycInfo, SciELO and Cochrane library electronic databases to identify publications between January 1992 and August 2020 that discussed social support, alcohol use disorders, mental health disorders and experiences (i.e., depression and anxiety and suicidal ideation) associated with HRS. Pooled Odds Ratios (ORs) were utilized at a 95% confidence level, and as sampling methods differed between articles pooled estimates used a random effects model.

Results

Twenty-two studies with 9548 participants met the eligibility criteria. No association was observed between HRS and alcohol use disorders. PLWH who had higher levels of social supports were less likely to report HRS. Participants who had been diagnosed with anxiety were 1.89 times more likely to report HRS, while those diagnosed with depression were 1.61 times more. Respondents who reported suicidal ideation also were 1.83 times more likely to report HRS.

Conclusions

This meta-analysis supports that HRS has a detrimental association with anxiety, depression and suicidal ideation, but social support protects again HRS in PLWH. Applying interventions which focus on the mental health disorders of PLWH may decrease HRS. Provision of social support by practitioners, combined with mental health treatment and assessments, and designing methods to identify stigma at different stages of illness are warranted.

Global Systematic Review of Common Mental Health Disorders in Adults Living with HIV

PURPOSE OF THE REVIEW

By reviewing the most recent common mental health disorders (CMHD) studies in people living with HIV (PLWH) (2018-2020), this review discusses the prevalence of CMHD, factors associated with CMHD in PLWH, mental health in PLWH from vulnerable groups, the impact of CMHD on HIV disease progression and adherence to antiretroviral therapy and the efficacy of different treatment approaches.

RECENT FINDINGS

After screening for eligibility 142 studies were included in the final systematic review. Only 27% of studies were conducted in Sub-Saharan Africa, which carries the highest burn of HIV disease globally. Despite the well-established increased risk of CMHD in PLWH, the current prevalence remains high, with studies reporting 28%-62% of PLWH having mental health symptoms.

CONCLUSION

Despite the significant challenges that CMHDs present to successful HIV treatment, there are many mental health treatments and interventions which can improve outcomes in PLWH and opportunities to task-shift and integrate mental health care with HIV care.

Stigma, Social Support, Illicit Drug Use, and Other Predictors of Anxiety and Depression Among HIV/AIDS Patients in Pakistan: A Cross-Sectional Study

Introduction: Anxiety and depression in people living with HIV/AIDS (PLWHA) can lead to non-adherence to antiretroviral therapy (ART), morbidity, and mortality. Therefore, assessing the stigma, social support, and other determinants of anxiety and depression in PLWHA are important for developing further interventions. Methods: An institution-based cross-sectional study was conducted in 505 PLWHA, approached through systematic sampling, who paid routine visits to the ART center, Pakistan Institute of Medical Sciences (PIMS), Islamabad. Data was collected by pretested validated hospital anxiety and depression scale (HADS). Version 26 of the SPSS was used to apply Logistic regression analysis to identify determinants, and the 95% confidence interval (CI) adjusted odds ratio (AOR) was calculated to assess the magnitude of the relationships. Results: In PLWHA, the prevalence of co-morbid depression and anxiety was 80%. Separately, 89.9% had depression, and 80.3% had anxiety. Use of illicit drugs [AOR = 1.87, 95% CI (1.01, 3.27)], low social support [AOR = 1.21, 95% CI (1.02, 2.25)], being male [AOR = 2.21, 95% CI (1.11, 5.49)], and HIV related stigma [AOR = 2.48, 95% CI (1.25, 6.02)] were significant predictors of depression. Having detectable viral load [AOR = 3.04, 95% CI (1.04, 8.86)], young age [AOR = 5.31, 95% CI (1.19, 29.39)], no formal education [AOR = 21.78, 95% CI (4.03, 117.62)], low [AOR = 1.70, 95% CI (1.12, 6.93)] or moderate [AOR = 2.20, 95% CI (1.79, 6.09)] social support, illicit drugs addiction [AOR = 1.17, 95% CI (1.03, 2.55)], and HIV stigma [AOR = 54.3, 95% CI (21.20, 139.32)] had a remarkable association with anxiety. Conclusions: Given the high prevalence of anxiety and depression among PLWHA, the Pakistan Ministry of Health should focus more on monitoring mental health, expanding mental health services, and developing interventions based on identified factors to treat depression and anxiety among PLWHA.

The syndemic condition of psychosocial problems related to depression among sexually transmitted infections patients

BACKGROUND

The prevalence of depression in sexually transmitted infections (STIs) patients is much higher than general public. However, studies focusing on comprehensive psychosocial effects on depression among STIs patients are limited. This study aimed to examine association of multiple psychosocial syndemic conditions with depression among STIs patients in Shanghai, China.

METHODS

We conducted a cross-sectional study and recruited 910 STIs patients from Shanghai Skin Disease Hospital. Participants self-reported their demographics and themselves completed the scales of depression, self-esteem, loneliness, social support, entrapment, defeat and interpersonal needs. Logistic regressions were performed to detect the possible contributing psychosocial factors for depression and to verify the syndemic conditions of psychosocial problems.

RESULTS

Of the STIs patient sample, the prevalence of depression was 17.9%. Multivariable analysis showed low-level self-esteem (odds ratio [ORm]: 2.18, 95% CI [1.19-4.00]) and social support (ORm: 2.18, 95% CI [1.37-3.46]), high-level entrapment (ORm: 6.31, 95% CI [3.75-10.62]) and defeat (ORm: 2.60, 95% CI [1.51-4.48]) increased the risk of depression. Psychosocial syndemic conditions magnified effect in fusing depression (adjusted odds ratio [AOR]: 11.94, 95% CI [7.70-18.53]). Participants with more than 4 psychosocial problems were about 22 times more likely to have depression (AOR: 22.12, 95% CI [13.19-37.09]).

CONCLUSIONS

The psychosocial problems syndemic magnifying the risk of depression was confirmed and psychosocial interventions to prevent depression is needed among STIs patients.

Prevalence of suicidal ideation, suicide attempt, and suicide plan among HIV/AIDS: A systematic review and meta-analysis

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.

Suicide Prevention in HIV Treatment Centres: Population Attributable Risk Analysis of Treating Common Mental Disorders

The aim was to establish the potential reduction in non-fatal suicidal behaviour (NFSB) that could be achieved by treating common mental disorders (CMDs) among persons receiving HIV treatment. Data were collected from antiretroviral therapy (ART) patients in South Africa (n = 688). Structured Clinical Interviews assessed CMDs and the Mini International Neuropsychiatric Interview assessed 1-month prevalence of NFSB and suicide risk. Population Attributable Risk (PAR) analysis established the potential reduction in prevalence of NFSB and suicide risk that could be achieved by treating CMDs, with the simplifying assumption of a causal relationship between psychopathology and suicidality. Treating CMDs could result in as much as a 63.9% proportional reduction in the prevalence of suicide ideation, 84.2% proportional reduction in the prevalence of suicide plan, and 63.4% proportional decrease in prevalence of suicide risk. There is potential to significantly reduce NFSB among ART patients. Pragmatic trials are needed to evaluate the effects of treating CMDs in HIV treatment centres.

Analysis of factors influencing casual sexual behavior among male college students in Zhejiang Province, China

OBJECTIVE

The purpose of this study was to explore the situations and factors influencing casual sexual behavior among male college students, in order to provide scientific evidences and measures of the prevention and control for HIV/AIDS.

METHOD

Using the stratified cluster sampling method, male college students who self-reported sexual behavior were selected as survey subjects in 13 colleges and universities in 11 cities of Zhejiang Province from October to November 2018. We used a custom online questionnaire to collect information on the demographic characteristics, sexual attitudes, sexual behaviors, and HIV interventions of the respondents. The χ2 test was performed on the composition ratios between different groups. With the occurrence of casual sexual behavior as the dependent variable, logistic regression was used to analyze the factors influencing casual male sexual behavior.

RESULTS

A total of 2734 male college students were surveyed, aged 20.20±1.41 years, of which 595 had casual sex, accounting for 21.7%. The rate of HIV prevention awareness among the participants was 85.1%. Multivariate analysis showed that receiving a self-assessment of HIV risk conducted by the school (Ajusted OR = 1.45, 95% CI = 1.14-1.84), knowing that HIV self-test kits were available at school (Ajusted OR = 2.02, 95% CI = 1.56-2.62), accepting one-night stands (Ajusted OR = 2.82, 95% CI = 2.18-3.66), accepting commercial sex (Ajusted OR = 1.95, 95% CI = 1.53-2.48), being a man who has sex with men (Ajusted OR = 1.81, 95% CI = 1.37-2.39), being a senior (Ajusted OR = 0.46, 95% CI = 0.30-0.71), having knowledge of HIV/AIDS prevention and treatment (Ajusted OR = 0.66, 95% CI = 0.51-0.86), and knowing that the CDC provides HIV testing services (Ajusted OR = 0.56, 95% CI = 0.41-0.77) were factors influencing male college students' casual sexual behavior.

CONCLUSION

Male college students who have causal sexual behaviors have a high degree of openness in sexual attitudes, insufficient knowledge of AIDS prevention, and knowledge of HIV testing-related information but low testing rates. For male college students' HIV prevention education intervention, it is necessary to emphasize the establishment of correct sexual attitudes and concepts and promote safe sexual behaviors to prevent the spread of HIV.

Psychosocial characteristics and HIV-related sexual behaviors among cisgender, transgender, and gender non-conforming MSM in China

BACKGROUND

While a growing number of studies focus on men who have sex with men (MSM), they typically ignore the heterogeneity of gender minorities within the MSM population. The recognition of new sub-groups among gender minorities (i.e., transgender and gender non-conforming), who also identify as MSM, play a considerable role in new HIV infections in China. Information on the psychosocial factors and HIV-related sexual behaviors require further consideration to understand the prevalence of HIV infection among MSM within these gender minority sub-groups.

METHODS

From September 2017 to January 2018, MSM without HIV were recruited in Wuhan, Nanchang, and Changsha cities in China. Participants were asked to fill out a structured self-administered questionnaire to assess depression, perceived social support, resilience, identity concealment, and HIV-related risky sexual behaviors.

RESULTS

A total of 715 MSM completed the structured questionnaire, the number of MSM identifying as gender minorities were 63 and accounted for 8.8% of the population. Compared to the cisgender MSM population, transgender MSM were more likely to have a one-night stand/occasional partner (AOR = 3.49, 95% CI =1.02-11.98), to have sex after drug use in the past 6 months (AOR = 2.57, 95%CI =1.05-6.29), and to have reported a significantly lower likelihood of identity concealment (mean difference = - 3.30, 95%CI = -5.86, - 0.74, P = 0.01).

CONCLUSIONS

The findings highlight the significance of providing targeted interventions for different gender minorities within the MSM population. Research is required to further understand the relationship between gender identity, mental health, and HIV-related sexual behaviors.

Psychosocial Factors Associated with Suicidal Ideation Among HIV/AIDS Patients on Follow-Up at Dessie Referral Hospital, Northeast Ethiopia: A Cross-Sectional Study

Background

Psychosocial and mental health problems are common among HIV/AIDS patients that affect sustained utilization of healthcare services. To date, information is scarce regarding the perceived stigma, level of social support, and suicidal ideation among HIV/AIDS patients in the study setting. Therefore, this study aimed to assess psychosocial factors associated with suicidal ideation among HIV/AIDS patients on follow-up in the study setting.

Methods

A hospital-based cross-sectional study was conducted among people living with HIV/AIDS (PLWH) on antiretroviral therapy follow-up for at least six months at a referral hospital in northeastern Ethiopia from November to January 2019. A total of 395 study participants of antiretroviral therapy clinic visitors were selected systematically. A binary logistic regression model was fitted to identify factors associated with suicidal ideation among PLWH. An adjusted odds ratio (AOR) with 95% confidence interval (CI) and variables having less than or equal 0.05 p-value used to declare statistical significant association.

Results

This study revealed that 45.3%, 56.5%, and 20%, had perceived stigma, poor social support, and depression, respectively. Moreover, the prevalence of suicidal ideation was 9.4% (95% CI: 6.7 to 12.7) of which, 3.3% had attempted to kill themselves. Low body mass index (AOR=4.11, 95% CI: 1.70 9.91), stages three and above illnesses (AOR=6.63, 95% CI: 1.30 33.79), depression (AOR=4.67, 95% CI: 4.67, 95% CI: 1.75 3.93), poor social support (AOR=4.18, 95% CI: 1.46 11.94), and fair and poor adherence (AOR=3.51, 95% CI: 1.14 10.85) were factors associated with suicidal ideation among PLWH.

Conclusion

This study showed that mental disorders and psychosocial problems were common among PLWH. The poor social support, depression, low body mass index, and poor adherence to ART medications were factors associated with suicidal ideation. This finding underscores the importance of regular screening for common mental health disorders and the strengthening of counseling services, nutritional, and psychosocial support programs.

Rates and risk factors for suicidal ideation, suicide attempts and suicide deaths in persons with HIV: a systematic review and meta-analysis

BACKGROUND

People living with HIV/AIDS (PLWHA) must contend with a significant burden of disease. However, current studies of this demographic have yielded wide variations in the incidence of suicidality (defined as suicidal ideation, suicide attempt and suicide deaths).

AIMS

This systematic review and meta-analysis aimed to assess the lifetime incidence and prevalence of suicidality in PLWHA.

METHODS

Publications were identified from PubMed (MEDLINE), SCOPUS, OVID (MEDLINE), Joanna Briggs Institute EBP and Cochrane Library databases (from inception to before 1 February 2020). The search strategy included a combination of Medical Subject Headings associated with suicide and HIV. Researchers independently screened records, extracted outcome measures and assessed study quality. Data were pooled using a random-effects model. Subgroup and meta-regression analyses were conducted to explore the associated risk factors and to identify the sources of heterogeneity. Main outcomes were lifetime incidence of suicide completion and lifetime incidence and prevalence of suicidal ideation and suicide attempt.

RESULTS

A total of 185 199 PLWHA were identified from 40 studies (12 cohorts, 27 cross-sectional and 1 nested case-control). The overall incidence of suicide completion in PLWHA was 10.2/1000 persons (95%CI: 4.5 to 23.1), translating to 100-fold higher suicide deaths than the global general population rate of 0.11/1000 persons. The lifetime prevalence of suicide attempts was 158.3/1000 persons (95%CI: 106.9 to 228.2) and of suicidal ideation was 228.3/1000 persons (95%CI: 150.8 to 330.1). Meta-regression revealed that for every 10-percentage point increase in the proportion of people living with HIV with advanced disease (AIDS), the risk of suicide completion increased by 34 per 1000 persons. The quality of evidence by Grading of Recommendations, Assessment, Development and Evaluations for the suicide deaths was graded as 'moderate' quality.

CONCLUSIONS

The risk of suicide death is 100-fold higher in people living with HIV than in the general population. Lifetime incidence of suicidal ideation and attempts are substantially high. Suicide risk assessments should be a priority in PLWHA, especially for those with more advanced disease.

Integration of mental health services into HIV healthcare facilities among Thai adolescents and young adults living with HIV

Introduction

To assess the burden of depression, anxiety and suicidality; and to determine the impact of integrated mental health and HIV services on treatment outcomes among Thai adolescents and young adults living with HIV (AYHIV).

Methods

A multicentre prospective cohort study was conducted among AYHIV (15 to 25 years), and age‐ and sex‐matched HIV‐uninfected adolescents and young adults (HUAY). The Patient Health Questionnaire 9‐item (PHQ‐9) and Generalized Anxiety Disorder 7‐item scales (GAD‐7) were used as screening tools for depressive and anxiety symptoms respectively. History of lifetime and recent suicidal ideations/attempts were ascertained. Elevated mental health screening scores were defined as having either significant depressive symptoms (PHQ‐9 ≥9), significant anxiety symptoms (GAD‐7 ≥10) or suicidality (lifetime; and recent [within two weeks]). Participants meeting these criteria were referred to psychiatrists for confirmatory diagnosis and mental health services. Follow‐up assessment with PHQ‐9 and GAD‐7 was performed one year after psychiatric referral.

Results

From February to April 2018, 150 AYHIV and 150 HUAY were enrolled, median age was 19.0 (IQR:16.8 to 21.8) years and 56% lived in urban areas. Among AYHIV, 73% had HIV RNA <50 copies/mL, and median CD4 count was 580 (IQR:376 to 744) cells/mm³. At enrolment, 31 AYHIV (21%; 95%CI:14% to 28%) had elevated mental health screening scores; 17 (11%) significant depressive symptoms, 11 (7%) significant anxiety symptoms and 21 (14%) suicidality. Seven AYHIV (5%) had all three co‐existing conditions. These prevalences were not substantially different from HUAY. Urban living increased risk, whereas older age decreased risk of elevated mental health screening scores (p < 0.05). All AYHIV with elevated mental health screening scores were referred to study psychiatrists, and 19 (13%; 95%CI: 8% to 19%) had psychiatrist‐confirmed mental health disorders (MHDs), including adjustment disorder (n = 5), major depression (n = 4), anxiety disorders (n = 2), post‐traumatic stress disorder (n = 1) and mixed MHDs (n = 4). One year after psychiatric referral, 42% of AYHIV who received mental health services demonstrated an absence of significant mental health symptoms from the reassessments, and 26% had an improved score.

Conclusions

With the significant burden of MHDs among AYHIV, an integration of mental health services, including mental health screenings, and psychiatric consultation and referral, is critically needed and should be scaled up in HIV healthcare facilities.

Association between social capital and suicide ideation, plan and attempt among men living with HIV in China

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.

Suicidal ideation, attempt, and its associated factors among HIV/AIDS patients in Africa: a systematic review and meta-analysis study

BACKGROUND

Suicidal ideation and suicidal attempt are warning signs for and determine the prognosis of completed suicide. These suicidal behaviors are much more pronounced in people living with HIV/AIDS. Despite this, there is a scarcity of aggregate evidence in Africa. This study was therefore aimed to fill this gap.

METHODS

we extensively searched Psych-info, PubMed, Scopus, and EMBASE to obtain eligible studies. Further screening for a reference list of articles was also done. Meta XL package was used to extract data and the Stata-11 was also employed. Cochran's Q- and the Higgs I² test were engaged to check heterogeneity. Sensitivity and subgroup analysis were implemented. Egger's test and funnel plots were used in detecting publication bias.

RESULTS

The pooled prevalence of suicidal ideation was 21.7% (95% CI 16.80, 26.63). The pooled prevalence of suicidal ideation in Ethiopia, Nigeria, Uganda, and South Africa was 22.7%, 25.3%, 9.8%, and 18.05% respectively. The pooled prevalence of suicidal ideation was larger; 27.7% in studies that used Composite International Diagnostic Interview (CIDI) than Mini-international Neuropsychiatric Interview (MINI); 16.96%. Moreover, the prevalence of suicidal ideation in studies with a sample size of < 400 was 23.42% whereas it was 18.3% in studies with a sample size ≥ of 400 participants. The pooled prevalence of suicidal attempts in this study was 11.06% (95% CI 6.21, 15.92). A suicidal attempt was higher in Ethiopia (16.97%) and Nigeria (16.20%) than Uganda (3.51%). This pooled prevalence of suicidal attempt was higher among studies that used a smaller sample (< 400 participants) (15.5%) than studies that used a larger sample size (≥ 400 participants) (8.4%). The pooled prevalence of suicidal attempt was 3.75%, and 16.97% in studies that used MINI and CIDI respectively. Our narrative synthesis revealed that advanced stages of AIDS, co-morbid depression, perceived HIV stigma, and poor social support was among the factors strongly associated with suicidal ideation and attempt.

CONCLUSION

The pooled magnitude of suicidal ideation and attempt was high and factors like advanced stages of AIDS, co-morbid depression, perceived stigma, and poor social support were related to it. Clinicians should be geared towards this mental health problem of HIV patients during management.

Evaluation of the Behavioural, Antioxidative and Histomorphological Effects of Folic Acid-supplemented Diet in Dexamethasone-induced Depression in Mice

BACKGROUND

The effect of folic acid in mitigating depression has remained pivotal in research.

OBJECTIVE

To determine the effects of folate supplementation on neurobehaviour oxidative stress and cerebral cortex histomorphology in the dexamethasone mouse model of depression.

METHODS

Male mice were assigned to six groups (A-F) of 10 mice each. Animals in groups A and D were fed a standard diet, while those in B and E were fed folic acid supplemented diet (25 mg/kg of feed), while C and F were fed folate supplemented diet at 50 mg/kg of feed for 8 weeks. At the beginning of the sixth 6th week, mice in groups A-C were administered distilled water, while animals in groups D-F were administered dexamethasone (DEX) at 4 mg/kg body weight by gavage. Open-field, forced swim, and tail-suspension tests were conducted at the end of the experimental period, following which animals were euthanised and blood was taken for the estimation of Malondialdehyde (MDA), reduced Glutathione, Glutathione Peroxidase, Catalase activity, and Superoxide Dismutase. Sections of the cerebral cortex were prepared for histological examination.

RESULTS

Folic acid supplementation increased body weight, locomotor, rearing and self-grooming behaviours, and decreased immobility time in the tail suspension and forced swim tests. There was also a reduction of lipid peroxidation and an increase in the antioxidant status. Folic acid supplementation was also found to be protective against the development of dexamethasone-induced changes in body weight, open-field behaviours, behavioural despair, oxidative stress and cerebrocortical morphology.

CONCLUSION

Folic-acid supplementation improves the behavioral, some antioxidant, and cerebral morphological parameters.

Prevalence and Factors Associated With Suicidal Ideation Among Children and Adolescents Attending a Pediatric HIV Clinic in Uganda

Background: Suicidal behavior and HIV/AIDS are vital public health challenges especially in low and middle-income countries. As suicide in adults is perturbing for those closest to them, this sentiment is much more intense and generalized in the case of a child or adolescent. Knowledge of factors associated with suicidal ideation in HIV infected children and adolescents may inform suicide prevention strategies needed to improve their quality of life. This study aimed to assess the prevalence and factors associated with suicidal ideation among HIV infected children and adolescents attending a pediatric HIV clinic in Uganda. Methods: Data from a sample of 271 children and adolescents aged 6-18 years living with HIV/AIDS attending a pediatric HIV clinic was analyzed. Child characteristics and clinical variables were assessed using a socio-demographic questionnaire and medical records respectively. Suicidal ideation and depression were assessed using the Child Depression Inventory. The types of behavioral problems and the parent-child relationship were assessed using Child Behavioral Check List (6-18 years) and the Parent Child Relationship Scale respectively. Child exposure to different stressful life events was assessed with a series of standardized questions. Logistic regression models were used to explore factors independently associated with suicidal ideation. Results: The prevalence of suicidal ideation was 17%. In the multivariate analysis; Child exposure to family or friend's death (prevalence rate ratio (PRR = 2.02; 95% CI, 1.01-4.03), p = 0.046), HIV wasting syndrome (PRR = 0.39; 95% CI, 0.21-0.75, p = 0.04), Depression (PRR = 1.08; 95% CI, 1.03-1.12, p = 0.001), Anxiety symptoms (PRR = 1.10; 95% CI, 1.01-1.20, p = 0.024) and Rule breaking behavior (PRR = 1.06; 95% CI, 0.99-1.13, p = 0.051) were independently associated with suicidal ideations. Conclusion: The prevalence of suicidal ideation among children and adolescents living with HIV/AIDS is substantial. Children and adolescents with exposure to family or friend's death, those with higher depression scores, anxiety symptoms and rule breaking behavior are more likely to report suicidal ideation. Those with HIV wasting syndrome were less likely to report suicidal ideation. There is urgent need for HIV care providers to screen for suicide and link to mental health services.

The Prevalence of Suicidal Ideation and Attempt Among Young People with HIV/AIDS: a Systematic Review and Meta-Analysis

Studies have suggested that suicidal ideation and attempt are highly prevalent among young people with HIV/AIDS and have been linked with increased risk of complete suicide. However, thus far, there are no worldwide systematic reviews and meta-analysis of the prevalence of suicidal ideation and attempt among young people with HIV/AIDS. A systematic search of PubMed, Scopus, and Web was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Prevalence rates from individual studies were pooled by using a random-effect meta-analysis. The quality of included studies was assessed by the Joanna Briggs Institute's quality assessment checklist. We used the Cochran's Q and the I² tests to measure heterogeneity across the studies. In total, 14 studies involving 4842 young people with HIV/AIDS were included in this meta-analysis. Our random effect meta-analysis indicated that roughly a quarter of young people with HIV/AIDS had lifetime suicidal ideations [24.38% (95% CI; 18.49-31.44)], and more than one in ten had current [10.33% (95% CI; 6.13-16.88)], and 6 month [13.03% (95% CI; 4.71-31.24)] suicidal ideations. Likewise, a significant proportion of young people with HIV/AIDS had current [3.75% (95% CI; 2.30-6.06)], 6 month [15.33% (95% CI; 10.00-22.78)], and lifetime [13.05% (95% CI; 7.55-21.61)] suicidal attempts. The pooled prevalence estimate of both suicidal ideation and attempts varied according to the sample size of the participants. This study found that a considerable proportion of young people with HIV/AIDS had suicidal ideation and attempt, suggesting the urgent needs of intervention strategies to relieve the suffering and possibly prevent death due to suicide.

Prevalence and risk factors for youth suicidality among perinatally infected youths living with HIV/AIDS in Uganda: the CHAKA study

BACKGROUND

Research from high income countries indicates that suicide is a major mental health care concern and a leading cause of preventable deaths among children and adolescents. Proper assessment and management of youth suicidality is crucial in suicide prevention, but little is known about its prevalence and associated risk factors in Sub-Saharan Africa. In low income countries there is an increased risk of suicide among persons with HIV/AIDS even in the presence of the highly active antiretroviral therapy.

OBJECTIVE

To determine the prevalence of and risk factors for youth suicidality among perinatally infected youth living with HIV/AIDS in Uganda.

METHODS

We studied 392 HIV positive children (5-11 years) and adolescents (12-17 years) and their caregivers in Kampala and Masaka districts. Caregivers were administered the suicide assessment section of the MINI International Psychiatric Interview. Socio-demographic characteristics, psychiatric diagnoses, and psychosocial and clinical factors were assessed and suicidality (suicidal ideation and or suicidal attempt) was the outcome variable. Logistic regression was used to calculate odds ratios adjusting for study site and sex at 95% confidence intervals.

RESULTS

Caregivers reported a suicidality rate of 10.7% (CI 8-14.1) in the past one month with higher rates among urban female (12.4%, CI 8.6-17.7) than male (8.7%, CI 5.4-13.8) youth. Lifetime prevalence of attempted suicide was 2.3% (n = 9, CI 1.2-4.4) with the highest rates among urban female youth. Among children, caregivers reported a lifetime prevalence of attempted suicide of 1.5%. The self-reported rate of attempted suicide in the past month was 1.8% (n = 7, CI 0.8-3.7) with lifetime prevalence of 2.8% (n = 11, CI 1.6-5.0). The most common methods used during suicide attempts were cutting, taking overdose of HIV medications, use of organophosphates, hanging, stabbing and self-starvation. Clinical correlates of suicidality were low socioeconomic status (OR = 2.27, CI 1.06-4.87, p = 0.04), HIV felt stigma (OR = 2.10, CI 1.04-3.00, p = 0.02), and major depressive disorder (OR = 1.80, CI 0.48-2.10, p = 0.04). Attention-deficit/hyperactivity disorder was protective against suicidality (OR = 0.41, CI 0.18-0.92, p = 0.04).

CONCLUSION

The one-month prevalence of suicidality among CA-HIV was 10.7%.

Prevalence and factors associated with depression among adult HIV patients attending ART clinics: a cross-sectional study in Western Bhutan

Depression is highly prevalent among people living with human immunodeficiency virus across the globe. Data regarding prevalence and factors associated with depression among HIV-infected individuals in Bhutan remained unknown. Therefore, a cross-sectional study was undertaken among 103 adult (≥18 years) HIV patients attending anti-retroviral therapy clinics located at four different hospitals in Western Bhutan. Depression was assessed using the translated and validated Bhutanese version of centre for epidemiologic studies depression scale-revised. The overall response rate of our participants was 73.6%. Age of our participants ranged from 23 to 79 (mean = 40.29, standard deviation ± 11.22) years. The overall prevalence of depression among our participants was 27.2% (95% confidence interval [CI]: 19.4-35.9). Multivariate binary logistic regression analysis showed that females (adjusted odds ratio (AOR) = 3.96, 95% CI: 1.37-11.41) and the poor perceived family support (AOR = 3.31, 95% CI: 1.20-9.10) were significantly associated with depression. Divorced, low income, drinking alcohol and CD₄ <200 cells/mm³ had no associations with depression. We recommend mental health interventions to be integrated into routine HIV care in Bhutan for proper management of depression.

Psychosocial Syndemic of suicidal ideation: a cross-sectional study among sexually transmitted infection patients in Shanghai, China

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.

[Suicidal behavior in light of COVID-19 outbreak: Clinical challenges and treatment perspectives]

OBJECTIVE

The COVID-19 pandemic affected today more than 3,000,000 worldwide, and more than half of humanity has been placed in quarantine. The scientific community and the political authorities fear an epidemic of suicide secondary to this crisis. The aim of this review is to analyze the impact of the COVID-19 pandemic on the dimensions of the suicidal process and its interaction with the various risk factors. We also propose innovative strategies to manage suicidal behavior in the context of pandemic.

METHODS

We carried out a narrative review of international publications dealing with major pandemics (COVID-19, SARS) and their influence on suicidal vulnerability.

RESULTS

Many factors are likely to increase the emergence of suicidal ideation and suicide attempts during this crisis. Social distancing and quarantine could increase the feeling of disconnection and the perception of social pain in vulnerable individuals. Some populations at high suicidal risk could be further impacted by the current pandemic: the elderly, medical staff and individuals exposed to economic insecurity. Several innovative tools adapted to the constraints of social distancing and quarantine may prevent suicide risk: e-health, VigilanS, buddhist-derived practices and art engagement.

CONCLUSIONS

This unprecedented crisis may interact with certain dimensions of the suicidal process. However, it is time to innovate. Several suicide prevention tools all have their place in new modes of care and should be tested on a large scale.

Association of Adverse Childhood Experience and Attention Deficit Hyperactivity Disorder with depressive symptoms among men who have sex with men in China: moderated mediation effect of resilience

Background

Adverse childhood experience (ACE), attention deficit hyperactivity disorder (ADHD), and resilience can all contribute to depressive symptoms. However, little is known regarding the complex relationships between these factors and their joint effects on depressive symptoms. This study aimed to explore the underlying mechanism of ACE, ADHD, and resilience on depressive symptoms among men have sex with men (MSM) in China.

Methods

A total of 714 MSM were recruited from gay/bisexual men-serving venues in Wuhan, Changsha, and Nanchang of China. The data was collected using computer-assisted self-interview. The mediated and moderated mediation models were employed to explore the underlying mechanisms between ACE, ADHD, resilience, and depressive symptoms.

Results

Among 714 MSM, 51.4% reported at least one ACE and 13.0% reported three or more. ACE had a direct (β = 1.01, 95% CI: 0.45–1.57) effect on depressive symptoms. ADHD partially mediated the correlation between ACE and depressive symptoms (indirect effect: 0.55; 95% CI: 0.34–0.79). Additionally, the effect of ACE on depressive symptoms was moderated and buffered by resilience (β = −0.09, 95% CI: -0.15 - −0.03).

Conclusion

The findings suggested that, programs and policies that promote resilience and address ADHD might protect Chinese MSM exposed to ACE from depressive symptoms.

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

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.

Altered topological connectivity of internet addiction in resting-state EEG through network analysis

The results of some neuroimaging studies have revealed that people with internet addiction (IA) exhibit structural and functional changes in specific brain areas and connections. However, the understanding about global topological organization of IA may also require a more integrative and holistic view of brain function. In the present study, we used synchronization likelihood combined with graph theory analysis to investigate the functional connectivity (FC) and topological differences between 25 participants with IA and 27 healthy controls (HCs) based on their spontaneous EEG activities in the eye-closed resting state. There were no significant differences in FC (total network or sub-networks) between groups (p > .05 for all). Graph analysis showed significantly lower characteristic path length and clustering coefficient in the IA group than in the HC group in the beta and gamma bands, respectively. Altered nodal centralities of the frontal (FP₁, FPz) and parietal (CP₁, CP₅, PO₃, PO₇, P₅, P_6, TP₈) lobes in the IA group were also observed. Correlation analysis demonstrated that the observed regional alterations were significantly correlated with the severity of IA. Collectively, our findings showed that IA group demonstrated altered topological organization, shifting towards a more random state. Moreover, this study revealed the important role of altered brain areas in the neuropathological mechanism of IA and provided further supportive evidence for the diagnosis of IA.

The relationship between family acceptance and quality of life and self esteem of PLWH MSM in Medan, North Sumatera, Indonesia

OBJECTIVE

To identify the correlation between family acceptance and quality of life and self-esteem of People Living with HIV Men Who Have Sex With Men (PLWH MSM) in Medan.

METHOD

This cross-sectional study applied a purposive sampling technique and involved 175 PLWH MSM from H. Adam Malik Public Central Hospital, Medan Pringadi Hospital, Padang Bulan, and Teladan Public Health Centers. The research instruments used are the Perceived Acceptance Scale (PAS), WHOQOL-BREF, and the Rosenberg Self-Esteem Scale. This research has passed the ethical test of the Faculty of Nursing Universitas Indonesia with number 157/UN2/F12.D/HKP.02.04/2018.

RESULTS

Bivariate analysis found that family acceptance was related to quality of life and self-esteem (p=0.006, α=0.05; p<0.001, α=0.05). Family acceptance has a positive relation with QOL and self-esteem. These results show that high family acceptance is associated with good QOL and high self-esteem.

CONCLUSIONS

Family acceptance is correlated with quality of life and self-esteem. If family acceptance is promoted by especially nursing, quality of life and self-esteem can play an optimum role in decreasing risky sexual behaviors.

Suicide Risk in Persons with HIV/AIDS in South Korea: a Partial Test of the Interpersonal Theory of Suicide

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.

A pathway analysis of exploring how HIV-related stigma affects social capital among people living with HIV/AIDS in China

HIV-related stigma is the most common and serious social problem which people living with HIV/AIDS (PLWHA) have to face. However, the impact of HIV stigma on social capital is not yet clear. Therefore, this study aims to understand the relationship between HIV stigma and social capital, and explore the mechanism of how HIV stigma influences social capital among Chinese PLWHA on this basis. An institutional based cross-sectional study was conducted from Nov 2015 to Jan 2016 in Wuhan, China, using a self-reporting questionnaire. A total of 552 PLWHA participated, and 520 valid questionnaires were included. Multiple linear regression analysis showed that lower education level, lower monthly income, higher internalized stigma, and anticipated stigma were significantly associated with lower social capital. Results of path analysis showed that although perceived community stigma has no direct effect on social capital, but it can affect social capital through internalized stigma and anticipated stigma. In conclusion, increased HIV stigma and reduced social capital are frequent among PLWHA in China. Perceived community stigma may cause PLWHA to internalize stigma and anticipate stigmatizing experiences, resulting in the reduction of social capital. These findings suggest that perceived community stigma should become the target of stigma intervention strategy among Chinese PLWHA.

The changes and the predictors of suicide ideation and suicide attempt among HIV-positive patients at 6-12 months post diagnosis: A longitudinal study

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.

Comparison of Zidovudine and Tenofovir Based Regimens With Regard to Health-Related Quality of Life and Prevalence of Symptoms in HIV Patients in a Kenyan Referral Hospital

Aim: Zidovudine and tenofovir form the backbone of antiretroviral therapy in Kenya. However, their side-effects may affect the quality of life (QoL) of patients. The aim was to compare the health-related quality of life (HRQoL) of adult patients on tenofovir versus zidovudine based regimens in a referral hospital in Kenya to provide future guidance.

Methods: A comparative cross sectional study among 501 adult out-patients on either tenofovir or zidovudine was undertaken in Kenyatta National Hospital between 2015 and 2016. The Medical Outcome Study HIV Health Survey (MOS-HIV) was administered along with other key aspects of treatment. Linear regression analysis was performed to identify determinants of HRQoL.

Results: Patients on zidovudine had a higher Physical Health Summary Score (PHSS) and Mental Health Summary Score (MHSS) compared to those on tenofovir. The presence of any symptom of the disease and a stated inability to cope were negatively associated with PHSS, whilst having a regular source of income improved PHSS. Being on tenofovir, symptom of illness [β = -1.24; 95% CI (-2.253, -0.226)], absence of pain [β=0.413; 95% CI (0.152, 0.674)] and patient stated inability to cope with HIV [β = -1.029; 95% CI (-1.441, -0.617)] affected the MHSS. Patients on tenofovir and second line regimens had more signs and symptoms of illness.

Conclusion: Participants on zidovudine based regimens showed a better performance across all aspects of HRQoL. These are considerations for the future.