Suicidality and Anxiety Sensitivity in Adults with HIV

Abstract

Suicide rates among HIV-positive individuals are more than three times higher than in the general population. Anxiety sensitivity (AS) may be clinically relevant to increasing our understanding of suicide among individuals with HIV. Specifically, relations between AS cognitive concerns and suicide related outcomes have been observed across a range of populations. The current investigation sought to examine the effect of AS and individual AS subfactors (i.e., cognitive, physical, and social concerns) in relation to suicidality in a sample of adults with HIV. Participants were 164 adults with HIV (17.1% women; mean age=48.40) recruited from AIDS service organizations in Vermont/New Hampshire and New York City. Findings from the current study indicate that AS cognitive concerns (β=0.46, p=0.001), but not the global AS factor, are positively associated with elevated rates of suicidality among persons with HIV above and beyond demographics, HIV relevant factors, and negative affectivity. There was also a negative trend for AS physical concerns in terms of suicidality (β=-0.25, p=0.07). Clinicians may benefit from implementing AS reduction strategies with HIV-positive persons who endorse elevated suicide risk as well as elevated AS cognitive concerns. The current study is limited by a cross-sectional design and lack of suicide attempt history. Future work would benefit from longitudinal examination of the observed relations, further inquiry regarding the relation between AS physical concerns and suicidality and a more comprehensive assessment of suicidality.

Sadness in the SUN: Using Computerized Screening to Analyze Correlates of Depression and Adherence in HIV-Infected Adults in the United States

“…Reported rates of depression and depressive symptoms range from 22 to 54 percent in HIV-infected communities in the United States and typically exceed the prevalence found in the general population. [1][2][3][4][5][6] The frequency of depression does not appear to vary according to the use of highly active antiretroviral therapy (HAART). In both the pre and post HAART era, depression as well as other disorders of anxiety and dysthymia are common.…”

“…3,15,16 Women living with HIV infection often have many sociodemographic and lifestyle characteristics associated with depression, such as poverty, isolation, higher rates of smoking, traumatic life events, and substance abuse. 2,[27][28][29][30] Several reports indicate that cellular immune responses in women may be altered with depression. 29 Fortunately, treatment of depression pharmacologically or through other behavioral interventions can be beneficial with demonstrated improved clinical outcomes and HAART adherence; 12,[31][32][33][34][35][36] however, differential use of antidepressants has been documented.…”

Examining Associations Between Cognitive-Affective Vulnerability and HIV Symptom Severity, Perceived Barriers to Treatment Adherence, and Viral Load Among HIV-Positive Adults

“…e Education (1 = "Less than high school"; 2 = "High school or part college"; 3 = "Graduated from 2-or 4-year college"; 4 = "Completed graduate or professional school") f Anxiety sensitivity [42] g Distress tolerance [44] h Emotion regulation [41] i Barriers to HAART Adherence Questionnaire [40] j Race (1 = "White/Caucasian"; 2 = "Black/Non-Hispanic"; 3 = "Black/ Hispanic"; 4 = "Hispanic"; 5 = "Asian"; 6 = "Other") k Log-transformed viral load [34] Analyses focused on the association between AS, DT, and ER and log-transformed viral load provided little insight into the clinical utility of these cognitive-affective vulnerabilities in relation to a biomarker of HIV, with just a trend relation observed for ER. That being said, in combination with the finding suggesting ER is relevant to medication adherence, this trend level relation further highlights the potential importance of targeting difficulties in emotion regulation among individuals with HIV.…”

“…*p<.05; **p<.01 a HIV symptom severity [39] b Barriers to HAART Adherence Questionnaire [40] c Log-transformed viral load [34] d Alcohol Use Disorders Identification Test [37] e Anxiety sensitivity [42] f Distress tolerance [44] g Emotion regulation [41] [39] b Cannabis group (1 = "No use"; 2 = "Non-dependent"; 3="Dependent") c Gender (1 = "male"; 2 = "female") d Education (1 = "Less than high school"; 2 = "High school or part college"; 3 = "Graduated from 2-or 4-year college"; 4 = "Completed graduate or professional school") e Race (1 = "White/Caucasian"; 2 = "Black/Non-Hispanic"; 3 = "Black/ Hispanic"; 4 = "Hispanic"; 5 = "Asian"; 6 = "Other") f Barriers to HAART Adherence Questionnaire [40] g Log-transformed viral load [34] one of the model accounted for 2.9 % of the variance (F(1, 137)=4.03, p<.05), with cannabis group membership significantly relating to VL, such that those with cannabis dependence had greater VL (please see Table 3). …”

“…Relevant work indicates that, among HIV+ individuals, higher levels of AS are correlated with greater somatization symptoms, as well as elevated symptoms of anxiety, depression, and suicidality [32][33][34]. With regard to DT, a recent longitudinal study of HIV+ individuals indicated that both lower DT and greater past 6-month life events (excluding health-related events) independently and interactively predicted elevations in symptoms of depression, cocaine use, and medication adherence, suggesting that vulnerability to distress exacerbates the impact of life events on these outcomes [35].…”