A study following people living with HIV in Denmark for up to 20 years shows a three-times greater risk of suicide than in the general population, and a doubling of the risk of depression. However, depression was far more common (around one in 25 people living with HIV) than suicide (one in 140 people with HIV). These data were presented at the European Congress of Clinical Microbiology & Infectious Diseases this week.
Previous studies on suicide in people with HIV have produced a wide range of estimates, not all of them reliable. For example, some studies have focused on particular sub-groups of people living with HIV or have not been able to make a direct comparison with HIV-negative people.
Danish researchers have access to anonymised health records for almost all people in the country, allowing comparisons to be made between HIV-positive and HIV-negative people. Nonetheless, these records do not include information on a number of other factors that may be relevant, such as social class, employment, sexuality and substance use.
The analysis included 5,943 individuals diagnosed with HIV between 1995 and 2021. In line with the epidemiology of HIV in Denmark, three quarters were men. Each person with HIV was matched with ten people of the same age and sex who had not been diagnosed with HIV.
In the first two years after diagnosis, people with HIV had over three times the risk of depression, although this reduced to twice the risk in subsequent years. After ten years, 3.9% of those living with HIV and 1.8% of those without HIV had received hospital treatment for depression at least once. Differences were apparent throughout the 20 years of follow-up both in the incidence of depression and in prescription of anti-depressant medications.
The risk of suicide was especially elevated in the first two years after diagnosis, with a rate over ten times that of people in the general population. After this particularly vulnerable period had passed, people with HIV still had over three times the risk of suicide (hazard ratio 3.6, 95% confidence interval 2.3-5.6). While those figures may give the impression that suicide is very common, the absolute number of suicides was low – after ten years, 0.7% of people with HIV had committed suicide, compared to 0.2% of people without HIV. The increased risk continued throughout the 20-year follow up.
In order to try to take some account of environmental and genetic factors that might influence these risks, the researchers also collected data on siblings. This showed higher rates of suicide and depression in people living with HIV than in their brothers and sisters, while rates were similar between siblings of people with HIV and siblings of the comparator group. This suggests that familial factors are not that important.
“Our findings clearly highlight the serious mental health implications of being given a diagnosis of HIV and the importance of clinicians looking out for of symptoms of depression in this high-risk population,” commented lead author Dr Lars Omland of Copenhagen University. “Caring for people with HIV, which has traditionally focused on their physical health, should place more emphasis on their mental health.”
If you've been affected by the issues in this article, Samaritans can be contacted in the UK on 116 123, and in the US, the National Suicide Prevention Lifeline is 1-800-273-8255. Other international helplines can be found at www.befrienders.org or via this Wikipedia page.
Vollmond CV et al. Risk of depression in people living with HIV, a nationwide population-based matched cohort study. European Congress of Clinical Microbiology and Infectious Diseases (ECCMID), Copenhagen, abstract MAK0806, April 2023.