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HIV and Suicide Risk
PTSD, Depression, Insomnia, and Substance Use as Key Risk Factors
Date: 14 September, 2020
AUTHOR:Lily A. Brown, PhD
In recent years, remarkable achievements in HIV testing and antiretroviral therapies have improved the detection, management, and care of persons living with HIV (PLWH). In the 1980s and 90s, patients with HIV infection faced a devastating prognosis. But now, with proper medications and support, PLWH can enjoy long and fulfilling lives. Thus, when the topic of suicide among PLWH is raised, many physicians are surprised. They often ask me, “wasn’t suicide an issue of a time before we had access to antiretroviral therapies?”
In our recent study in AIDS Care, my colleagues and I foundthat suicidal thoughts and attempts remain a pressing concern among PLWH, who are significantly more likely to die by suicide compared to the general population. Given that HIV infection can be well-managed with proper care, what accounts for the elevated risk for suicide among PLWH?
In our study, we used the medical records of over 2,000 PLWH to isolate the clinical and demographic factors associated with suicidal thoughts and behaviors. We hypothesized that individuals with a diagnosis of posttraumatic stress disorder (PTSD)—a psychiatric condition that can emerge after exposure to a traumatic event—and substance use disorders would be at especially elevated risk for suicidal thoughts and behaviors. This hypothesis was based on prior research which revealed important interactions between Substance Abuse, Violence, and AIDS, coined the "AVA Syndemic," wherein substance abuse and exposure to violence are thought to interact to predict worsened health outcomes among PLWH.
We found that PTSD and a variety of substance use disorders, including alcohol, cocaine, and opioid use disorders, were associated with increased risk for suicidal thoughts or behaviors among PLWH, as were diagnoses of depression and insomnia. Contrary to our predictions, we did not find an interaction between PTSD and substance use on the likelihood of suicidal thoughts or behaviors.
These findings have important implications for the care of PLWH. To reduce suicide risk in this population, care teams must closely monitor patients for symptoms of PTSD, substance use, insomnia, and major depressive disorder. As we demonstrated in our previous research, psychiatric diagnoses tend to be under-documented among PLWH. To connect PLWH to appropriate mental health care, the first step is to conduct 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.
More research is needed so that PLWH who are considering suicide can see that their lives are worth living. Now that antiretroviral therapies can promote long-term physical health for PWLH, it’s time to attend to the emotional needs of PLWH as well.
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The study, Suicide risk among persons living with HIV, was published online in AIDS Care on August 3, 2020. Authors include Lily A. Brown, Ifrah Majeed, Wenting Mu, Jesse McCann, Stephen Durborow, Song Chen, and Michael B. Blank.
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About The Leonard Davis Institute of Health Economics
With a gift from Leonard and Sophie Davis, the University of Pennsylvania established the Leonard Davis Institute of Health Economics (LDI) in 1967, two years after Congress enacted Medicare. It was created to fill fundamental gaps in the evidence base that could inform policies critical to the financing and management of the nation's increasingly costly and complex health care system. Today, LDI is considered one of the world's leading university institutes dedicated to data-driven, policy-focused research that improves our nation's health and health care.
As Penn’s hub for research on population health, the health care system, and health policy, LDI supports, connects, engages, and amplifies interdisciplinary research among experts from all of Penn’s schools, the University of Pennsylvania Health System, and the Children’s Hospital of Philadelphia. LDI brings together more than 300 Senior Fellows whose work fits broadly within LDI’s four priority areas that highlight some of the most pressing challenges facing our nation’s health system today: (1) care for vulnerable populations; (2) coverage and access to health care; (3) improving care for older adults; and (4) the opioid epidemic.
LDI trains the next generation of health services and health policy researchers through a resource-rich environment and innovative educational programs at the undergraduate, masters, doctoral, and postdoctoral levels. LDI’s role as an active convener at Penn is augmented by a dynamic research and policy seminar series, conferences, and a growing number of research partnerships with academic and service organizations regionally and nationally.
Contact:
Janet Weiner, PhD, MPH (she/her/hers)
Co-Director, Health Policy
Leonard Davis Institute of Health Economics
University of Pennsylvania
3641 Locust Walk, Philadelphia, PA 19104
Phone: 215-573-9374
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Source: https://ldi.upenn.edu/healthpolicysense/hiv-and-suicide-risk
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University of Pennsylvania
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Leonard Davis Institute of Health Economics
University of Pennsylvania
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