AIDS/HIV Infection, Comorbid Psychiatric Illness, and Risk for Subsequent Suicide: A Nationwide Register Linkage Study
To explore socioeconomic and psychiatric characteristics of persons with acquired immunodeficiency syndrome (AIDS) or human immunodeficiency virus (HIV) infection and to assess the effect of AIDS/HIV infection on risk for subsequent suicide in the context of psychiatric comorbidity and socioeconomic status.
In this study based on the entire population of Denmark, we interlinked 5 national registers to retrieve personal data on AIDS/HIV infection and covariates for 9,900 men who died of suicide during 1986-2006 and 189,037 controls matched for sex and date of birth. Suicide risk associated with AIDS/HIV infection was assessed using a conditional logistic regression model.
People with AIDS/HIV infection, especially those who died of suicide, mostly lived as single people, had low income, and were dwellers of the Capital area of Denmark (Copenhagen and Frederiksberg). While presence of other physical illness was common in these patients, 38.6% of suicide and 29.0% of control patients developed psychiatric illness after being diagnosed with AIDS or HIV infection. Meanwhile, AIDS/HIV infection constituted a significant risk factor for subsequent suicide (adjusted incidence rate ratio [IRR] = 3.84; 95% confidence interval, 2.53-5.81); the risk was substantially higher for persons who were diagnosed for the first time recently, were treated as inpatients, had a recent hospital contact, or had multiple hospital contacts because of the illness. The increased suicide risk associated with AIDS/HIV infection was slightly stronger before the introduction in 1997 of highly active antiretroviral therapy (HAART) (adjusted IRR = 5.55; 95% CI, 3.07-10.06), but remained highly significant in the HAART era (adjusted IRR = 2.77; 95% CI, 1.55-4.94). Moreover, AIDS/HIV infection significantly interacted with psychiatric illness (P < .0001), and their comorbidity increased the risk of suicide substantially.
Suicide risk is increased in individuals with AIDS/HIV infection, particularly those with a recent diagnosis, more intensive and frequent hospital care, or comorbid psychiatric illness. The findings call for improvement of clinical capacities to address psychosocial and existential needs in the treatment of patients with AIDS/HIV infection.
Available from: synapse.koreamed.org
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ABSTRACT: This study was to identify the attitude of Korean HIV (Human Immunodeficiency Virus) -positive men toward death.
01/2014; 17(3):142. DOI:10.14475/kjhpc.2014.17.3.142
Available from: Catherine C O'Connor
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ABSTRACT: Rates of suicide and accidental or violent death remain high in HIV-positive populations despite significantly improved prognosis since the introduction of cART.
We conducted a nested case-control study of suicide and accidental or violent death in the Australian HIV Observational Database (AHOD) between January 1999 and March 2012. For each case, 2 controls were matched by clinic, age, sex, mode of exposure and HIV-positive date to adjust for potential confounding by these covariates. Risk of suicide and accidental or violent death was estimated using conditional logistic regression.
We included 27 cases (17 suicide and 10 violent/accidental death) and 54 controls. All cases were men who have sex with men (MSM) or MSM/ injecting drug use (IDU) mode of exposure. Increased risk was associated with unemployment (Odds Ratio (OR) 5.86, 95% CI: 1.69-20.37), living alone (OR 3.26, 95% CI: 1.06-10.07), suicidal ideation (OR 6.55, 95% CI: 1.70-25.21), and >2 psychiatric/cognitive risk factors (OR 4.99, 95% CI: 1.17-30.65). CD4 cell count of >500 cells/µL (OR 0.25, 95% CI: 0.07-0.87) and HIV-positive date ≥1990 (1990-1999 (OR 0.31, 95% CI: 0.11-0.89), post-2000 (OR 0.08, 95% CI: 0.01-0.84)) were associated with decreased risk. CD4 cell count ≥500 cells/µL remained a significant predictor of reduced risk (OR 0.15, 95% CI: 0.03-0.70) in a multivariate model adjusted for employment status, accommodation status and HIV-positive date.
After adjustment for psychosocial factors, the immunological status of HIV-positive patients contributed to the risk of suicide and accidental or violent death. The number of psychiatric/cognitive diagnoses contributed to the level of risk but many psychosocial factors were not individually significant. These findings indicate a complex interplay of factors associated with risk of suicide and accidental or violent death.
PLoS ONE 02/2014; 9(2):e89089. DOI:10.1371/journal.pone.0089089 · 3.23 Impact Factor
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ABSTRACT: Latinos living with HIV residing in the US-Mexico border region frequently seek care on both sides of the border. Given this fact, a border health perspective to understanding barriers to care is imperative to improve patient health outcomes. This qualitative study describes and compares experiences and perceptions of Mexican and US HIV care providers regarding barriers to HIV care access for Latino patients living in the US-Mexico border region. In 2010, we conducted in-depth qualitative interviews with HIV care providers in Tijuana (n = 10) and San Diego (n = 9). We identified important similarities and differences between Mexican and US healthcare provider perspectives on HIV care access and barriers to service utilisation. Similarities included the fact that HIV-positive Latino patients struggle with access to ART medication, mental health illness, substance abuse and HIV-related stigma. Differences included Mexican provider perceptions of medication shortages and US providers feeling that insurance gaps influenced medication access. Differences and similarities have important implications for cross-border efforts to coordinate health services for patients who seek care in both countries.
Culture Health & Sexuality 03/2014; 16(5). DOI:10.1080/13691058.2014.886131 · 1.55 Impact Factor
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