Associations among depression, suicidal behavior, and quality of life in patients with human immunodeficiency virus

Co-occurring Intimate Partner Violence, Mental Health, Human Immunodeficiency Virus, and Parenting Among Women: A Scoping Review

Little research exists on the human immunodeficiency virus (HIV)-intimate partner violence (IPV)-mental health (MH) syndemic impact on parenting. The objective of this scoping review is to identify and summarize the available evidence regarding the syndemic relationship between HIV or Acquired Immune Deficiency Syndrome (AIDS), IPV, and poor MH among mothers and caregivers who identify as women. We conducted the review according to the Joanna Briggs Institute and Preferred Reporting Items for Systematic reviews and meta-analyses extension for scoping reviews guidelines, a comprehensive search was conducted from 2001 to September 2023. The inclusion criteria targeted studies examining at least two of the HIV, IPV, or MH epidemics among participants and their syndemic impact on parenting. Both qualitative and quantitative studies were included. Covidence software was used to screen and extract data. Twenty-three studies were included in the analysis. Most of the studies were conducted in the United States. Furthermore, all the studies used quantitative research designs, with most being longitudinal. Most of the research was concentrated on the IPV-MH syndemic with no research found on the HIV-IPV syndemic impact on parenting. Research on the HIV-IPV-MH syndemic found that an HIV diagnosis exacerbated the negative impacts of IPV-MH on parenting. Research on IPV-MH showed that this syndemic significantly influences parenting, leading to less nurturing and more punitive behaviors. Studies did not find a direct association between IPV and harsh parenting practices, the relationship was mediated by poor MH. Studies examining the HIV-MH syndemic found that anxiety and maternal depression were the most frequent MH disorders. The review revealed that living with the different syndemics, (IPV-MH-HIV, HIV-MH, and IPV-MH) adversely affects parenting practices, resulting in harsher parenting.

HIV Diagnosis in the Context of Stable Relationships: A Qualitative Study With Women Living in Portugal

ABSTRACT

The purpose of this phenomenological study is to explore the acceptance of HIV diagnosis of women in stable relationships. Based on eight semistructured interviews with cisgender Portuguese women, thematic analysis identified four interrelated themes that illustrated the emotional and psychosocial dynamics involved in this journey. Following an HIV diagnosis, participants grappled with complex emotions, societal perceptions, and the internalization of stigma. Marital relationships underwent profound changes, with trust breakdown and emotional distancing. Coping mechanisms ranged from seeking support to living in secrecy, which impacted psychological well-being. Acceptance of HIV diagnosis is influenced by self-stigmatization, societal perceptions of HIV, and gender dynamics. The findings contribute to the development of tailored interventions, emphasizing the interconnected nature of physical and psychological well-being in the diagnosis acceptance process.

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.

Epidemiology of fatal/non-fatal suicide among patients with chronic osteomyelitis (COM): a nationwide population-based study

Objective

Chronic osteomyelitis (COM) can induce systemic inflammation, and systemic inflammation may be associated with suicide tendency. However, no studies have investigated the correlation between COM and suicide tendency.

Methods

The aim of this population-based study was to determine the epidemiology of fatal/non-fatal suicide among COM patients. Subjects with at least two outpatient visits or one course of inpatient care diagnosed with COM were recruited into a COM cohort. The control/COM subject ratio was approximately 4:1 matched by age, sex, major depression coding and index year (COM patients). Subjects with suicide attempts before COM diagnosis and subjects aged <20 years were excluded.

Results

COM patients had 1.93 (95% confidence interval [CI]: 1.11–3.36) times the risk of fatal/non-fatal suicide as control subjects. Considering death as the competing event of fatal/non-fatal suicide, COM patients had 1.76 (95% CI: 1.03–3.01) times the risk of fatal/non-fatal suicide (competing risk regression model). The effect of COM on fatal/non-fatal suicide was more prominent among diabetic patients. COM severity also correlated with the risk of fatal/non-fatal suicide.

Conclusions

More attention must be paid to suicide tendency among COM patients.

Association between herpes simplex virus 1 exposure and the risk of depression in UK Biobank

BACKGROUND

Herpes simplex virus-1 (HSV-1) infection is reported to be associated with depression. But limited efforts were made to investigate the relationship between HSV-1 infection and the risk of depression, especially from the genetic perspective.

METHODS

In UK Biobank cohort, linear and logistic regression analyses were first performed to test the association of HSV-1 seropositivity/antibody with depression, including depression status (N = 2951) and Patient Health Questionnaire (PHQ) score (N = 2839). Using individual genotypic and phenotypic data from the UK Biobank, genome-wide environmental interaction study (GWEIS) was then conducted by PLINK2.0 to evaluate gene × HSV-1 interacting effect on the risk of depression. Finally, gene set enrichment analysis was conducted to identify the biological pathways involved in the observed gene × HSV-1 interaction for depression.

RESULT

In UK Biobank cohort, significant associations were observed between depression status and HSV-1 (odds ratio [OR] = 1.09; 95% confidence interval [CI], 1.02-1.16; P = 2.40 × 10^-2 for HSV-1 antibody and OR = 1.28; 95% CI, 1.12-1.47, P = 2.59 × 10^-3 for HSV-1 seropositivity). GWEIS revealed four significant gene × HSV-1 interaction signals for PHQ score (all P < 5.0 × 10^-8 ) and the leading loci was SULF2 (rs6094791, P = 8.60 × 10^-9 ). Pathway analyses identified 21 pathways for PHQ score and 19 for depression status, including multiple neural development- and immune-related ones, such as KEGG_NEUROACTIVE_LIGAND_RECEPTOR_INTERACTION (false discovery rate [FDR] = 3.18 × 10^-2 ) for depression and LU_AGING_BRAIN_UP (FDR = 4.21 × 10^-2 ) for PHQ score.

CONCLUSION

Our results suggested that HSV-1 was associated with the risk of depression, which was modulated by the several genes that were related to the nerve development or immune function.

HIV and Depression: Examining Medical Students Clinical Skills

Major depression is a prevalent psychiatric disorder among people living with HIV (PWH). Major depression symptoms, including suicidal ideation, can hinder clinical care engagement and anti-retroviral treatment adherence. Research suggests that inquiry about major depression symptomatology and suicidal ideation should be standard practice when offering primary care services to PWH. However, studies examining depression and suicidal ideation inquiry are scarce. This study's aim was to describe medical students' clinical skills for dealing with major depression symptomatology and suicidal ideation among PWH in Puerto Rico. A total of 100 4th year medical students participated in a Standardized Patient simulation with a trained actor posing as a PWH and with a previous major depression diagnosis. One-way frequency tables were used to characterize the sample and the percentage of each observed clinical skill. Two key findings stem from these results only 10% of the participants referred the patient to psychological/psychiatric treatment, and only 32% inquired about suicidal ideation. Our findings highlight the need for enhancing medical students' competencies regarding mental health issues, particularly when providing services to at risk populations such as PWH within primary care settings.

Depression and coping strategies among Vietnamese women living with HIV: A qualitative study

Women living with HIV (WLWH) are more likely to suffer from depression than seronegative women and are also more likely to suffer from depression than men living with HIV. There is limited depression research with WLWH in Vietnam. Twenty in-depth interviews with WLWH were conducted to identify pathways leading to depression and coping strategies for depression. Participants were recruited from an antiretroviral treatment clinic in northern Vietnam. Audio-recorded interviews were transcribed, translated, and analysed to identify key themes. All participants reported sudden loss of social support, debilitating depression, and suicidal ideation in the first six months after HIV diagnosis. While some were able to cope with their status after several months, others continued to struggle due to HIV-related stigma that was perceived as more isolating for WLWH than for men. Women who were able to effectively cope with depression found ways to re-establish connections to family and community. Interventions to improve mental wellbeing should link WLWH to mental health services immediately after diagnosis and address loss of support and stigma, as they contributed to the onset and persistence of depression after HIV diagnosis. Community-level HIV stigma reduction interventions may also help repair broken social bonds and foster new ones.

Suicide risk in people living with AIDS/HIV: the effect of childhood trauma is mediated by mental disorders and social vulnerability

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.

Factors influencing the quality of life in persons living with human immunodeficiency virus infection in Almaty, Kazakhstan

The study purpose was to determine the factors associated with health-related quality of life (HRQoL) among people living with HIV (PLHIV) in Kazakhstan. A convenience sample of 531 adult PLHIV registered at the Almaty City AIDS Center was used for this cross-sectional study. HRQoL data were collected with the World Health Organization’s Quality of Life HIV brief questionnaire, depression – with Patient Health Questionnaire-9, and clinical data were retrieved from medical records. Multivariate logistic and Tobit censored regressions were used to examine the relationship of socio-demographic, behavioral, and clinical factors with HRQoL and the six specific HRQoL domains: 35.8% of participants did not report good HRQoL. The following variables were identified as independent predictors of poor HRQoL: probable depression (adjusted odds ratio [AOR] 13.42, 95% confidence interval [CI]: 4.56–39.52); history of injecting drug use (AOR 2.10, 95% CI: 1.40–3.14); CD4+ T-cell count <200 cells/mm³ (AOR 2.17, 95% CI: 1.30–3.62); previously married status (AOR 2.23, 95% CI: 1.16–4.28); and co-infection with tuberculosis, syphilis, toxoplasmosis, Chlamydia, herpes simplex, or cytomegalovirus (AOR 1.59, 95% CI: 1.06–2.39). HRQoL of PLHIV in Almaty was independently influenced by several factors. An interdisciplinary approach is needed in planning healthcare and social services addressing improvement of HRQoL among PLHIV.

The Impact of Perceived Stigma, Quality of Life, and Spiritual Beliefs on Suicidal Ideations among HIV-Positive Patients

Background

Suicidal ideation is considered a major health problem associated with HIV/AIDS. Suicide rates among people living with HIV/AIDS (PLHA) are more than three times higher in the general population and that is a significant difference. This study aimed at investigating the related factors of suicidal ideations among HIV-positive patients in Southwest Iran.

Study Design

A cross-sectional study.

Methods

351 adult volunteer HIV-infected patients that referred to the Voluntary Counseling and Testing (VCT) center in the south of Iran were evaluated based on convenience sampling. Data was collected utilizing a structured questionnaire from March to August 2015.

Results

Over the six months prior to the study, 15.4% of the entire sample had been diagnosed with suicidal ideation. There was a significant correlation between the quality of life, spiritual beliefs, perceived stigma, and age with suicidal ideation. Suicidal ideation is significantly different in terms of gender and marital status. Perceived stigma and spiritual beliefs showed the highest effect on suicidal ideations, respectively.

Conclusions

Having religious beliefs due to accelerating psychological adaptation can motivate HIV patients to survive and have also been considered effective in preventing women from suicide. Perceived stigma and quality of life are other factors that should be taken into consideration as key elements in suicide preventive programs.

Suicidal Ideation Persists Among Individuals Engaged in HIV Care in the Era of Antiretroviral Therapy

Little research has focused on suicidality in the era of successful antiretroviral therapy among those engaged in HIV care. We performed a study of 648 clinic patients who completed a psychological and behavioral annual assessment in 2012. Depressive symptoms were measured using the Patient Health Questionnaire-9 (PHQ-9), suicidal ideation was measured by the last item of the scale. Anxiety symptoms were measured using the Generalized Anxiety Disorder-7 questionnaire (GAD-7). HIV biomedical markers were abstracted from medical records. Suicidal ideation was reported among 13% (n = 81) of the sample. Individuals endorsing suicidality were more likely to have unsuppressed viral loads, moderate to severe anxiety symptoms and consider themselves to be homeless (p < 0.01 for all). After adjusting for confounders, homeless individuals and those endorsing moderate to severe anxiety symptoms had higher odds of reporting suicidality. Results suggest basic needs must be met to complement HIV management efforts. Furthermore, better understanding of how psychological distress symptoms are expressed and how to manage them may better inform barriers to HIV management.

Association between serotonin transporter gene polymorphisms and increased suicidal risk among HIV positive patients in Uganda

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.

Facilitators and barriers for retention in HIV care between testing and treatment in Asia-A study in Bangladesh, Indonesia, Lao, Nepal, Pakistan, Philippines and Vietnam

Introduction

The need for efficient retention in HIV care is more evident than ever because of the expansion of earlier ART initiation and the shift towards ‘Test and Treat’. This study assesses factors affecting participation in the HIV care cascade among people living with HIV (PLHIV) in the Asia-Pacific Region.

Methods

A total of 7843 PLHIV aged 18–50 years were recruited using targeted and venue-based sampling between October 1, 2012, and May 31, 2013, across 59 sites in 7 countries (Bangladesh, Indonesia, Lao People's Democratic Republic (Lao PDR), Nepal, Pakistan, Philippines and Vietnam). Statistically significant associations between demographic and health system determinants, and various steps in the HIV care cascade were computed using a generalized structural equation model.

Results

A high proportion of PLHIV (40–51%) presented late for HIV care and delayed linkage to care in all seven countries. However, once PLHIV enrolled in care, retention in the various steps of the care cascade including adherence to antiretroviral treatment (ART) was satisfactory. The proportion still engaged in HIV care at 36 months post HIV diagnosis, varied from 78% in Nepal to >90% in Lao PDR. Similarly, the proportion of ART initiation who also were adherent to ART ranged from 91% in Bangladesh to >95% in Philippines/ Vietnam and from 70% in Lao PDR to 89% in the Philippines respectively. The following factors enhanced the likelihood of ART initiation and high adherence to HIV care and ART: good client-provider communication, high HIV treatment literacy, a referral from a health worker and TB/HIV co-infection. The following barriers were identified: young age, sex work, imprisonment, transgender identity, illiteracy, rural residence, alcohol/ injecting drug use, perceived poor health status, lack of health insurance, fear of confidentiality breach, self-referral for HIV testing, and public hospital as the place of HIV diagnosis.

Conclusions

HIV programme planners should ensure easy access to HIV testing and earlier linkage to HIV care among PLHIV. In addition, multiple socio-economic and health systems barriers need to be addressed along the HIV care cascade to reach the UNAIDS 90-90-90 target in the Asia-Pacific region.

Role of Inflammation in Suicide: From Mechanisms to Treatment

Suicidal behavior is complex and manifests because of a confluence of diverse factors. One such factor involves dysregulation of the immune system, which has been linked to the pathophysiology of suicidal behavior. This review will provide a brief description of suicidality and discuss the contribution of upstream and downstream factors in the etiology of suicidal behavior, within the contextual framework of inflammation. The contribution of inflammatory conditions such as traumatic brain injury, autoimmune disorders, and infections to neuropsychiatric symptoms and suicidality is only beginning to be explored. We will summarize studies of inflammation in the etiology of suicide, and provide a neurobiological basis for different mechanisms by which inflammation might contribute to the pathophysiology. Finally, we will review treatments that affect upstream and downstream pathways related to inflammation in suicidality.

Suicide risk and prevalence of major depressive disorder (MDD) among individuals infected with HIV-1 subtype C versus B in Southern Brazil

Major depressive disorder (MDD) is among the most prevalent neuropsychiatric disorders associated with HIV infection; however, its risks and neurobiologic correlates in diverse cultures are poorly understood. This study aimed to examine the frequency of MDD among HIV+ participants in southern Brazil. We hypothesized that the frequency and severity of MDD would be higher among individuals with HIV+ compared with HIV- and higher in HIV subtype B compared with C. Individuals with HIV (n = 39) as well as seronegative controls (n = 22) were enrolled in a cross-sectional, prospective, observational study. Current and lifetime history of MDD was diagnosed by MINI-Plus; symptom severity was assessed by Beck Depression Inventory-II (BDI-II). Current and past episodes of MDD were significantly more frequent in the HIV+ versus HIV- group: current MDD, 15 (38.5 %) vs. 0 (0 %), p = 0.0004; past MDD, 24 (61.5 %) vs. 3 (13.6 %), p = 0.0004. The median BDI-II score in the HIV+ group was significantly higher than that in the HIV- (13 (8-27.5) vs. 2.5 (1-5.5); p < 0.0001). Current suicide risk, defined as during the last month, was found in 18 % of participants in the HIV-positive and none in the HIV-negative group. Neither current MDD frequency (8 (57.1 %) vs. 6 (40 %), p = 0.47) nor BDI-II score differed across subtypes B and C. HIV+ group may be more likely to experience current MDD than HIV-. This was the first study to compare the frequency and severity of MDD in HIV subtypes B and C; we found no difference between HIV subtypes B and C.

Suicidal Behavior and Associations with Quality of Life among HIV-Infected Patients in Ibadan, Nigeria

BACKGROUND

Suicidality has rarely been studied in HIV-infected patients in sub-Saharan Africa. This study explored suicidal behavior in a clinic sample of people living with HIV, in Nigeria.

METHODS

Consecutive patients were interviewed using the Composite International Diagnostic Interview (CIDI-10.0) and the World Health Organization Quality of Life (WHO-QOL-HIV-BREF). Associations of suicidal behavior were explored using logistic regression models.

RESULTS

In this sample of 828 patients (71% female, mean age 41.3 ± 10 years), prevalence of suicidal behaviors were 15.1%, 5.8%, and 3.9% for suicidal ideation, plans, and attempts, respectively. Women were more likely than men to report suicidal ideation (odds ratio 1.7; 95% confidence interval 1.05-2.64). Depression and/or anxiety disorder was associated with increased odds of all suicidal behaviors. Suicidal behavior was associated with significantly lower overall and domain scores on the WHO-QOL.

CONCLUSION

Suicidal behaviors were common and significantly associated with the presence of mental disorders and lower quality of life.