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

Pelton, Matthew; Ciarletta, Matt; Wisnousky, Holly; Lazzara, Nicholas; Manglani, Monica; Ba, Djibril M.; Chinchillli, Vernon M; Du, Ping; Ssentongo, Anna E.; Ssentongo, Paddy

doi:10.1136/gpsych-2020-100247

Cited by 43 publications

(45 citation statements)

References 65 publications

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“…According to this study's findings, the prevalence of suicidal ideation among PLHIV within the included studies was 22.3%. This result was consistent to that obtained in a recent systematic review and meta-analysis based on studies in Africa on persons with HIV/AIDS that reported the prevalence of suicidal ideation as 21.7% (66) and 22.8% according to a study conducted by Pelton et al (16). However, the results of the present study were lower than those of a meta-analysis that showed that approximately 19.6% of young people with HIV/AIDS had lifetime suicidal ideation and that the global prevalence of suicidal ideation was 24.38% during the study period (67).…”

Section: Discussionsupporting

confidence: 92%

“…Also, our included suicide-related studies in this review are cross-sectional studies. Furthermore, a long-term observational study or database analysis is recommended for future studies ( 16 , 42 , 43 ). Third, we assessed the pooled prevalence of suicidal behaviors, including suicidal ideation, suicide attempts, and suicides, as well as risk factors associated with each behavior for PLHIV.…”

Section: Discussionmentioning

confidence: 99%

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

Tsai

Mudiyanselage

et al. 2022

Psychosom Med

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ObjectiveThe 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.MethodsA 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.ResultsA 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).ConclusionsThe 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.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionmentioning

confidence: 99%

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

Tsai

Mudiyanselage

et al. 2022

Psychosom Med

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“…Another meta-analysis showed that the risk of successful suicide in HIV-infected individuals was 100-fold that of the general population. HIV progression (AIDS) may be associated with this increased risk of suicide through the direct effects of a high viral load on the brain and HAART, and a high level of CD4 was associated with decreased level of suicidal attempts [ 28 ]. The stigma and physiological effects of HAART could affect personal relationships and may also be associated with suicidal ideation or attempts [ 28 ].…”

Section: Discussionmentioning

confidence: 99%

“…HIV progression (AIDS) may be associated with this increased risk of suicide through the direct effects of a high viral load on the brain and HAART, and a high level of CD4 was associated with decreased level of suicidal attempts [ 28 ]. The stigma and physiological effects of HAART could affect personal relationships and may also be associated with suicidal ideation or attempts [ 28 ]. Thus, routine suicide risk assessment, psychological counseling, and mental health care should be included in the HIV treatment plan, which currently focuses on HAART to decrease the viral load and increase CD4 counts.…”

Section: Discussionmentioning

confidence: 99%

Mortality and Causes of Death among Individuals Diagnosed with Human Immunodeficiency Virus in Korea, 2004–2018: An Analysis of a Nationwide Population-Based Claims Database

Park

Choi

Kim

et al. 2022

IJERPH

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The mortality rate and causes of death among individuals diagnosed with human immunodeficiency virus (HIV) infection in Korea were described and compared to those of the general population of Korea using a nationwide population-based claims database. We included 13,919 individuals aged 20–79 years newly diagnosed with HIV between 2004 and 2018. The patients’ vital status and cause of death were linked until 31 December 2019. Standardized mortality ratios (SMRs) for all-cause death and specific causes of death were calculated. By the end of 2019, 1669 (12.0%) of the 13,919 HIV-infected participants had died. The survival probabilities of HIV-infected individuals at 1, 5, 10, and 15 years after diagnosis in Korea were 96.2%, 91.6%, 85.9%, and 79.6%, respectively. The main causes of death during the study period were acquired immunodeficiency syndrome (AIDS; 59.0%), non-AIDS-defining cancer (8.2%), suicide (7.4%), cardiovascular disease (4.9%), and liver disease (2.7%). The mortality rate of men and women infected with HIV was 5.60-fold (95% CI = 5.32–5.89) and 6.18-fold (95% CI = 5.30–7.09) that of men and women in the general population, respectively. After excluding deaths due to HIV, the mortality remained significantly higher, with an SMR of 2.16 (95% CI = 1.99–3.24) in men and 3.77 (95% CI = 3.06–4.48) in women. HIV-infected individuals had a higher overall mortality than the general population, with AIDS the leading cause of mortality. Additionally, mortality due to non-AIDS-related causes was higher in HIV-infected individuals.

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“…Although suicidality is a serious problem among PLWH, few studies have focused on suicide death, suicide attempt (SA), and suicidal ideation (SI) in this population (5). Worldwide, the incidence of suicide death and lifetime prevalence of SA and SI were substantially higher in PLWH than in the general population (6). In China, among PLWH, suicide is one of the leading causes of non-AIDS death (7).…”

Section: Introductionmentioning

confidence: 99%

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

Wang

Yan²,

Tong

et al. 2022

Front. Public Health

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BackgroundPrevious 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.MethodsA 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.ResultsIn 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.ConclusionsMental 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.

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

Cited by 43 publications

References 65 publications

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

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

Mortality and Causes of Death among Individuals Diagnosed with Human Immunodeficiency Virus in Korea, 2004–2018: An Analysis of a Nationwide Population-Based Claims Database

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

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