Sounding the Alarm: Perinatally HIV-Infected Youth More Likely to Attempt Suicide Than Their Uninfected Cohort Peers

Kreniske, Philip; Mellins, Claude A.; Dolezal, Curtis; Korich, Rehema; Leu, Cheng-Shiun; Wiznia, Andrew; Abrams, Elaine J.

doi:10.1016/j.jadohealth.2019.06.006

Cited by 13 publications

(11 citation statements)

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“…Adolescence and young adulthood is a high‐risk period for attempting suicide [ 1 , 2 , 3 , 4 ], with AYALPHIV a particularly vulnerable group [ 49 , 50 ]. The current findings extend the field, not only by providing additional evidence that AYALPHIV are at greater risk for suicide attempts across adolescence and into young adulthood than AYAPHEU peers [ 23 , 49 , 50 ], but also by showing proximal risk and protective factors for both groups as they age through this developmental period. For AYALPHIV, stigma and pregnancy were associated with attempted suicide and for AYAPHEU, substance use was a risk factor.…”

Section: Discussionsupporting

confidence: 65%

“…neighbourhood violence) [19][20][21] factors may also contribute to increased suicide risk among specific sub-groups of AYA, such http://onlinelibrary.wiley.com/doi/10.1002/jia2.25984/full | https://doi.org/10.1002/jia2.25984 as sexual and racial minorities. Youth with chronic illnesses have shown higher suicidality in some studies [22], including AYA affected by HIV [23], yet, no studies to our knowledge have investigated proximal risk factors for suicidality among AYA affected by HIV as they age across this critical developmental period [24]. Given the staggering numbers globally of young people growing up with HIV or affected by maternal HIV [25,26], understanding suicidality in this population is critical to informing much-needed evidence-based prevention interventions [27,28], particularly because the history of attempted suicide is a strong predictor of later death by suicide [29][30][31].…”

Section: Introductionmentioning

confidence: 99%

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HIV and suicide risk across adolescence and young adulthood: an examination of socio‐demographic, contextual and psychosocial risk factors for attempted suicide in a longitudinal cohort of ageing adolescents affected by HIV living in the New York City Area

et al. 2022

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Introduction As children become adolescents and young adults (AYA), their risk for attempting suicide increases dramatically, with chronic health conditions an important risk factor. This study examined correlates of suicidality across development in AYA living with perinatally acquired HIV (AYALPHIV) and those perinatally HIV‐exposed but uninfected (AYAPHEU). Methods Data come from an ongoing longitudinal New York City‐based study (N = 339) with AYALPHIV and AYAPHEU interviewed every 12–18 months from 2003 to 2019 (mean enrolment age = 12 years; current mean age = 27 years). The Diagnostic Interview Schedule for Children (adolescent or young adult version) assessed psychiatric disorders and first‐reported suicide attempt. Generalized estimating equations were used to examine associations between first‐reported suicide attempt and socio‐demographic, contextual and psychosocial correlates measured concurrently across six timepoints. Results At enrolment, 51% of participants were female, 72% heterosexual, 60% Black and 50% Latinx. Attempted suicide was significantly higher among AYALPHIV (27%, CI 21–33%) compared to AYAPHEU (16%, CI 10–22%), with an OR of 1.74 (CI 1.04–2.92) in a model adjusting for age. For AYALPHIV, anxiety (OR 2.66, CI 1.46–4.85), mood (OR 3.62, CI 1.49–8.81) and behaviour disorders (OR 5.05, CI 2.15–11.87) and past‐year arrest (OR 3.05, CI 1.26–7.4), negative life events (OR 1.27, CI 1.11–1.46), city stress (OR 2.28, CI 1.46–3.57), pregnancy (OR 2.28, CI 1.08–4.81) and HIV stigma (OR 2.46, CI 1.27–4.75) were associated with increased odds of attempted suicide, while identifying as heterosexual (OR 0.27, CI 0.14–0.52), higher personal (OR 0.45, CI 0.26–0.80) and family self‐concept (OR 0.36, CI 0.22–0.57) were protective. Interactions by HIV status and age were found: substance use was more strongly associated with attempted suicide among AYAPHEU than AYALPHIV, while negative life events and higher religiosity were more strongly associated with increased odds of attempted suicide among AYA ≥ 19 versus ≤ 18 years. Conclusions AYALPHIV compared to AYAPHEU faced unique risks for attempted suicide as they age into adulthood, with the highest risk among AYALPHIV experiencing HIV stigma or pregnancy and the highest risk among AYAPHEU with substance use. Assessing for suicide risk and correlates with attention to ageing can inform preventive interventions tailored to meet AYALPHIV and AYAPHEU needs.

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Section: Discussionsupporting

confidence: 65%

Section: Introductionmentioning

confidence: 99%

HIV and suicide risk across adolescence and young adulthood: an examination of socio‐demographic, contextual and psychosocial risk factors for attempted suicide in a longitudinal cohort of ageing adolescents affected by HIV living in the New York City Area

et al. 2022

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“…Reducing suicide among AYA remains a significant challenge, and the findings in this study identify AYALPHIV as a high-risk subgroup. 9 Depressive symptoms (measured by the CDI) in early adolescence were a predictor of attempted suicide across all groups over time (total sample and AYALPHIV and AYALPHEU subgroups). Among AYAL-PHIV, higher religiosity seemed protective, whereas in the overall group and among AYALPHIV, having a DISC behavior disorder was associated with increased odds of attempted suicide.…”

Section: Discussionmentioning

confidence: 94%

Predictors of Attempted Suicide Among Youth Living With Perinatal HIV Infection and Perinatal HIV-Exposed Uninfected Counterparts

Kreniske

Mellins

Dolezal

et al. 2021

JAIDS Journal of Acquired Immune Deficiency Syndromes

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Background: Suicide is a leading cause of death among adolescents and young adults (AYA). AYA living with perinatally acquired HIV infection (AYALPHIV) are at higher risk of attempted suicide when compared with AYA who were perinatally HIV-exposed but uninfected (AYAPHEU). To inform interventions, we identified risk and protective factors of attempted suicide among AYALPHIV and AYAPHEU.Setting: Data were obtained from a longitudinal New York City-based study of AYALPHIV and AYAPHEU (n = 339; enrollment age 9-16 years) interviewed approximately every 12-18 months.Method: Our main outcome was suicide attempt at any follow-up.The DISC was used to assess psychiatric disorder diagnoses and attempted suicide and the Child Depression Inventory to assess depressive symptoms. Psychosocial and sociodemographic risk factors were also measured. Analyses used backward stepwise logistic regression modeling.Results: At enrollment, 51% was female individuals, 49% Black, 40% Latinx, and 11% both Black and Latinx. Attempted suicide prevalence was significantly higher among AYALPHIV compared with AYAPHEU (27% vs 16%, P = 0.019), with AYALPHIV having 2.21 times the odds of making an attempt [95% confidence interval: (1.18 to 4.12), P = 0.013]. Higher Child Depression Inventory scores were associated with an increased risk of attempted suicide in both groups and the total sample. The presence of DISCdefined behavior disorder increased the risk of attempted suicide in the total sample and the AYALPHIV subgroup. Religiosity was protective of attempted suicide in AYALPHIV.Conclusions: AYALPHIV had increased suicide attempts compared with AYAPHEU. Religiosity was protective in AYALPHIV. Highlighting a need for prevention, early mental health challenges were associated with risk.

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“…There are numerous individual, familial, social and environmental risks that can profoundly influence life trajectories and mental health in both AYALH and AYAAH [7,27]. Both groups typically face ongoing and cumulative psychological stressors exacerbated by adverse environments including poverty, violence, discrimination, familial and environmental substance abuse or mental illness, as well as HIV-related illness and loss of caregivers.…”

Section: Introductionmentioning

confidence: 99%

“…Importantly, both groups have shown higher rates of mental health problems than the general population [8,25,26]. In low-resource contexts, where the majority of AYALH and AYAAH reside, limited availability of psychosocial supports adds to the challenges of coping with poor mental health [7,[27][28][29].…”

Section: Introductionmentioning

confidence: 99%

Interventions to address the mental health of adolescents and young adults living with or affected by HIV: state of the evidence

et al. 2021

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Introduction Adolescents and young adults (AYA) remain vulnerable to HIV‐infection and significant co‐morbid mental health challenges that are barriers to treatment and prevention efforts. Globally millions of AYA are living with HIV (AYALH) and/or have been affected by HIV in their families (AYAAH), with studies highlighting the need for mental health programmes. With no current guidelines for delivering mental health interventions for AYALH or AYAAH, a scoping review was undertaken to explore current evidence‐based mental health interventions for AYALH and AYAAH to inform future work. Methods The review, targeting work between 2014 and 2020, initially included studies of evidence‐based mental health interventions for AYALH and AYAAH, ages 10 to 24 years, that used traditional mental health treatments. Given the few studies identified, we expanded our search to include psychosocial interventions that had mental health study outcomes. Results and discussion We identified 13 studies, seven focused on AYALH, five on AYAAH, and one on both. Most studies took place in sub‐Saharan Africa. Depression was targeted in eight studies with the remainder focused on a range of emotional and behavioural symptoms. Few studies used evidence‐based approaches such as Cognitive Behaviour Therapy; psychosocial approaches included mental health treatments, group‐based and family strengthening interventions, economic empowerment combined with family strengthening, group‐based mindfulness and community interventions. Eleven studies were randomized control trials with four pilot studies. There was variation in sample size, treatment delivery mode (individual focus, group‐based, family focus), and measures of effectiveness across studies. Most used trained lay counsellors as facilitators, with few using trained mental health professionals. Eleven studies reported positive intervention effects on mental health. Conclusions Despite the need for mental health interventions for AYALH and AYAAH, we know surprisingly little about mental health treatment for this vulnerable population. There are some promising approaches, but more work is needed to identify evidence‐based approaches and corresponding mechanisms of change. Given limited resources, integrating mental health treatment into healthcare settings and using digital health approaches may support more standardized and scalable treatments. Greater emphasis on implementation science frameworks is needed to create sustainable mental health treatment for AYALH and AYAAH globally.

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Sounding the Alarm: Perinatally HIV-Infected Youth More Likely to Attempt Suicide Than Their Uninfected Cohort Peers

Cited by 13 publications

References 7 publications

HIV and suicide risk across adolescence and young adulthood: an examination of socio‐demographic, contextual and psychosocial risk factors for attempted suicide in a longitudinal cohort of ageing adolescents affected by HIV living in the New York City Area

HIV and suicide risk across adolescence and young adulthood: an examination of socio‐demographic, contextual and psychosocial risk factors for attempted suicide in a longitudinal cohort of ageing adolescents affected by HIV living in the New York City Area

Predictors of Attempted Suicide Among Youth Living With Perinatal HIV Infection and Perinatal HIV-Exposed Uninfected Counterparts

Interventions to address the mental health of adolescents and young adults living with or affected by HIV: state of the evidence

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