HIV and suicide risk

PTSD, depression, insomnia, and substance use are key risk factors.

In recent years, remarkable achievements in HIV testing and antiretroviral therapies have improved the detection, management, and care of persons living with HIV (PLWH). In the 1980s and 90s, patients with HIV infection faced a devastating prognosis. But now, with proper medications and support, PLWH can enjoy long and fulfilling lives. So when the topic of suicide among PLWH is raised, many physicians are surprised. 

Person standing on frozen lake with back turned on a grey day.

In a recent study in AIDS Care, Lily A. Brown, an assistant professor of psychology, and her colleagues find that suicidal thoughts and attempts remain a pressing concern among PLWH, who are significantly more likely to die by suicide compared to the general population. Given that HIV infection can be well-managed with proper care, what accounts for the elevated risk for suicide among PLWH?

The study used the medical records of over 2,000 PLWH to isolate the clinical and demographic factors associated with suicidal thoughts and behaviors. The hypothesis was that individuals with a diagnosis of post-traumatic stress disorder (PTSD)—a psychiatric condition that can emerge after exposure to a traumatic event—and substance use disorders would be at especially elevated risk for suicidal thoughts and behaviors. This was based on prior research which revealed important interactions between Substance Abuse, Violence, and AIDS, coined the “SAVA Syndemic,” wherein substance abuse and exposure to violence are thought to interact to predict worsened health outcomes among PLWH.

The researchers found that PTSD and a variety of substance use disorders, including alcohol, cocaine, and opioid use disorders, were associated with increased risk for suicidal thoughts or behaviors among PLWH, as were diagnoses of depression and insomnia. Contrary to predictions, the study did not find an interaction between PTSD and substance use on the likelihood of suicidal thoughts or behaviors. 

This story is by Lily A. Brown. Read more at Penn LDI.