HIV infection and mental health: Suicidal behaviour – Systematic review

Abstract

Suicide has long been associated with serious illness generally and HIV specifically. New treatments have affected prognosis in HIV positively, but it is unclear how they impact on suicidal burden (thoughts, self-harm and completions). This review examines all published suicide and HIV data for a definitive account of (1) prevalence of HIV-related suicidality, (2) measurement within studies and (3) effectiveness of interventions. Standard systematic research methods were used to gather quality published papers on HIV and suicide, searching published databases according to quality inclusion criteria. From the search, 332 papers were generated and hand searched resulting in 66 studies for analysis. Of these, 75% were American/European, but there was representation from developing countries. The breakdown of papers provided 12, which measured completed suicides (death records), five reporting suicide as a cause of attrition. Deliberate self-harm was measured in 21, using 22 instruments; 16 studies measured suicidal ideation using 14 instruments, suicidal thoughts were measured in 17, using 15 instruments. Navigating the diverse range of studies clearly points to a high-suicidal burden among people with HIV. The overview shows that autopsy studies reveal 9.4% of deceased HIV+ individuals had committed suicide; 2.4% HIV+ study participants commit suicide; approximately 20% of HIV+ people studied had deliberately harmed themselves; 26.9% reported suicidal ideation, 28.5% during the past week and 6.5% reported ideation as a side effect to medication; 22.2% had a suicide plan; 19.7% were generally “suicidal” (11.7% of people with AIDS, 15.3% at other stages of HIV); 23.1% reported thoughts of ending their own life; and 14.4% expressed a desire for death. Only three studies recruited over 70% female participants (39 studies recruited over 70% men), and six focussed on injecting drug users. Only three studies looked at interventions – predominantly indirect. Our detailed data suggest that all aspects of suicide are elevated and urgently require routine monitoring and tracking as a standard component of clinical care. There is scant evidence of direct interventions to reduce any aspect of suicidality, which needs urgent redress.

Keywords:

• suicidal behaviour
• HIV
• mental health

Notes

1. Full search strategy and keywords from authors on request.

2. Papers from 2009 were used only to reduce the number of results because the term AIDS also refers to other things such as hearing aids. Also added the keyword in 2009 because articles are not always indexed with subject terms in the last year.

3. The asterisk instructs OVID to search for all words that include “suicid” in order to capture “suicide”, “suicidal” and any other derivatives.

4. Whilst the inclusion criteria did not specify that the study had to include a trial or intervention, this step was necessary in order to reduce the number of hits so that screening would be manageable within the time available for this review.

5. The DES was designed to accommodate intervention studies; therefore, some sections are redundant for the purposes of this review.

6. Two additional papers were retrieved, but excluded due to being based on the same datasets or samples as two other papers in the review.

7. One North American and one Western European study were coded according to the country of author affiliation; two North American, one Western European, one Indian and one Eastern European study were coded according to the note in the abstract record.