It is a hard time for a lot of people right now, as we grapple with life changes and disruption as a result of the pandemic. Feelings of anxiety and depression are rising, and the future is uncertain. Day to day feelings of despair are especially prevalent for one group, however, and they experience them whether we are in a pandemic or not. A paper published last month in the AIDS Care journal states that persons living with HIV are significantly more likely to die by suicide compared to the general population. The study examined the impact of posttraumatic stress disorder (PTSD), major depressive disorder (MDD), insomnia, and substance use disorders on people living with HIV. It found that these conditions were positively associated with suicidal ideation and behavior in that population.
The research was undertaken in the Department of Psychiatry at the University of Pennsylvania. There were 2336 HIV+ participants who were recruited through the Center for AIDS research (CFAR). The electronic medical records (EMR) of participants were analyzed to isolate the clinical and demographic factors associated with suicidal thoughts and behaviors. The hypothesis tested in the study was that individuals with substance use disorders — alcohol, cocaine, and opioid use — and a diagnosis of PTSD — a psychiatric condition that can emerge after exposure to a traumatic event — would be at especially elevated risk for suicidal thoughts and behaviors. This research hypothesis was formed based on prior research known as the ‘SAVA Syndemic,’ that shows that substance abuse and exposure to violence interact result in worsened health outcomes among people living with HIV.
The researchers found that PTSD and a variety of substance use disorders were associated with increased risk for suicidal thoughts as well as diagnoses of depression and insomnia. Similar studies have been undertaken in other countries. According to a study in the Journal of International AIDS Society published last year,suicide rates have decreased substantially among people living with HIV in Switzerland in the last three decades. Swiss suicides among people living with HIV are still three times higher than in the general population, however.
A UC San Francisco study published in 2010 had similar results. “Even in the era of antiretroviral therapy (ART), the suicide rate remains elevated among HIV-positive persons,” the study read. “Individuals who are at increased risk for suicide often have a more pessimistic, hopeless view of the future and tend to preferentially attend to immediate sensations. These cognitive changes promote behavioral disinhibition, which places one at higher risk for attempting suicide and may also increase engagement in other risk-taking behaviors.”
Lily Brown, the lead researcher of the Penn study published recently, says more research is needed so the people living with HIV can see that their lives are worth living. She points to antiretroviral therapies that promote long-term physical health for HIV patients. “These findings have important implications for the care of PLWH,” Brown said. “To reduce suicide risk in this population, care teams must closely monitor patients for symptoms of PTSD, substance use, insomnia, and major depressive disorder.”
Brown points to the need for psychiatric diagnoses so that people living with HIV can get the help they need to cope. “As we demonstrated in our previous research, psychiatric diagnoses tend to be under-documented among PLWH,” Brown says. “To connect people living with HIV to appropriate mental health care, the first step is to conduct a thorough assessment for psychiatric comorbidities (or co-occurring conditions). Fortunately, evidence-based treatments can reduce symptoms of these disorders, which may also reduce suicide risk. As health care providers increase their assessment of psychiatric comorbidities, patients will be more likely to receive appropriate referrals for evidence-based treatments.”