Thoughts of suicide are common amongst HIV-positive individuals, American researchers have found. However, in a study published in the May 31st edition of AIDS, they report that few people living with HIV actually plan suicide or would kill themselves given the opportunity.
The study, which involved a diverse population of 2,909 HIV-positive patients in four large US cities, found that gay, bisexual and transgender individuals were significantly more likely to have thoughts of suicide, as were individuals who regularly smoked cannabis or who had depressive symptoms. Conversely, Hispanic patients, and individuals of any ethnicity or sexuality in a relationship, were less likely to think of suicide.
Studies conducted before potent anti-HIV treatment became available showed that HIV-positive individuals were more likely than their HIV-negative peers to both think about suicide and to kill themselves. However, as these studies often only included gay men or had a small sample size, it is questionable how capable these findings were of being generalised for larger, more diverse HIV-positive populations.
US investigators therefore wished to determine the rates of suicide ideation, and the factors associated with such thoughts, in a large and diverse population of HIV-positive individuals in the period after HIV therapy became available.
Between 2000 and 2002 patients in San Francisco, Los Angeles, Milwaukee, and New York City, completed computer-assisted questionnaires to see if they had thoughts or plans to commit a suicide.
Information was also gathered on the patients’ demographics (including age, race, education, sexual orientation and relationship status), CD4 cell count, viral load, experience of HIV-related illness and treatment side-effects, use of alcohol and drugs, perceived level of social support, self-reported coping skills and depressive symptoms.
Three-quarters of the study population were male, 24% were female, and 1% transgender. A little under two-thirds (61%) were gay or bisexual, 46% were African American, 28% Caucasian and 20% Hispanic. The mean age was 42 years and 50% had completed at least some college. Potent anti-HIV therapy was being taken by 76% of individuals and the mean duration of HIV infection was a little under nine years.
Thoughts of suicide in the last week were reported by 19% (541) of individuals. Of these 541 individuals, only 7% (41) said that they would 'like to kill themselves' or would 'try and kill themselves if they had the chance.' The other 500 individuals who had thought of suicide reported, 'I have thoughts of killing myself, but would never carry them out.'
Individuals who were gay, bisexual or transgender were 47% more likely to report suicidal ideation. The investigators believe “this may partly be explained by the increased stigma, discrimination and violence experienced by this population.”
The investigators also found that individuals reporting HIV-related symptoms or treatment side-effects were 15% more likely to report thoughts of suicide. They comment, “this highlights the importance of poor quality of life as a crucial determinant of suicidal ideation in HIV-positive individuals.”
Patients reporting regular cannabis use were 34% more likely to report suicidal ideation. There is evidence that HIV-positive individuals use cannabis not only recreationally, but also to relieve symptoms and treatment side-effects. Previous studies have shown that cannabis use increases the risk of a major depression, and the investigators write that the results of the current study “indicate that regular marijuana use was an independent correlate of suicidal ideation after accounting for affective symptoms of depression.”
Unsurprisingly, individuals reporting symptoms of depression were 1.5 times more likely to report thoughts of suicide.
The investigators also found that certain factors seemed to be associated with a lower risk of suicidal thoughts. Hispanics in Los Angeles were 21% less likely to have suicidal ideation. The investigators believe “cultural norms such as a moral objection to suicide” may be an explanation.
Regardless of ethnicity or sexuality, being in a romantic relationship was also protective against suicidal thoughts. The investigators suggest “this may be because of the enhanced social support received from a primary partner.”
Finally, individuals with enhanced coping skills were 18% less likely to report thoughts of suicide.
The investigators conclude, “suicidal ideation in the current study was common,” and although they believe further longitudinal studies looking at this issue are needed, they express the hope that their findings will “assist with identifying HIV-positive individuals who may be at increased risk of suicidal ideation so that they can be assessed regularly and referred for psychological treatment when appropriate.”