BackgroundPeople living with HIV/AIDS (PLWHA) must contend with a significant burden of disease. However, current studies of this demographic have yielded wide variations in the incidence of suicidality (defined as suicidal ideation, suicide attempt and suicide deaths).AimsThis systematic review and meta-analysis aimed to assess the lifetime incidence and prevalence of suicidality in PLWHA.MethodsPublications were identified from PubMed (MEDLINE), SCOPUS, OVID (MEDLINE), Joanna Briggs Institute EBP and Cochrane Library databases (from inception to before 1 February 2020). The search strategy included a combination of Medical Subject Headings associated with suicide and HIV. Researchers independently screened records, extracted outcome measures and assessed study quality. Data were pooled using a random-effects model. Subgroup and meta-regression analyses were conducted to explore the associated risk factors and to identify the sources of heterogeneity. Main outcomes were lifetime incidence of suicide completion and lifetime incidence and prevalence of suicidal ideation and suicide attempt.ResultsA total of 185 199 PLWHA were identified from 40 studies (12 cohorts, 27 cross-sectional and 1 nested case-control). The overall incidence of suicide completion in PLWHA was 10.2/1000 persons (95%CI: 4.5 to 23.1), translating to 100-fold higher suicide deaths than the global general population rate of 0.11/1000 persons. The lifetime prevalence of suicide attempts was 158.3/1000 persons (95%CI: 106.9 to 228.2) and of suicidal ideation was 228.3/1000 persons (95%CI: 150.8 to 330.1). Meta-regression revealed that for every 10-percentage point increase in the proportion of people living with HIV with advanced disease (AIDS), the risk of suicide completion increased by 34 per 1000 persons. The quality of evidence by Grading of Recommendations, Assessment, Development and Evaluations for the suicide deaths was graded as ‘moderate’ quality.ConclusionsThe risk of suicide death is 100-fold higher in people living with HIV than in the general population. Lifetime incidence of suicidal ideation and attempts are substantially high. Suicide risk assessments should be a priority in PLWHA, especially for those with more advanced disease.
IntroductionThe prevalence of HIV/AIDS is high and is associated with psychiatric morbidity and suicide risk. The objective of this study will be to assess the rates of suicidal ideation, suicide attempts and suicide deaths in people living with HIV/AIDS (PLWHA).Methods and analysisWe present a study protocol for a systematic review and meta-analysis of studies reporting the suicidality outcomes (suicidal ideation, suicide attempts and suicide deaths) in PLWHA. PubMed (MEDLINE), Scopus, EMBASE, Cochrane Library, OVID (HEALTH STAR), OVID (MEDLINE), Joanna Briggs Institute EBP Database, Web of Science and PsychINFO databases will be searched from their inception until 1 January 2020. The primary outcome of interest will be the incidence of suicidality in PLWHA. In addition, we will delineate risk factors associated with suicidality in PLWHA. Citations, full-text articles and abstracts will be screened by four reviewers independently. Disagreements will be resolved through discussion. The study methodological quality (or bias) will be appraised using an appropriate tool. Random-effects meta-analysis will be conducted if we find that the studies are very heterogenous. For the suicidality outcome, probability of suicide risk will be reported. Relative risk ratios (with 95% CIs) will be reported for the effects of the risk factors. Potential publication bias will be assessed by conducting Egger’s test and creating funnel plots. We will conduct additional analyses to explore the potential sources of heterogeneity (eg, age, sex and geographical location).Ethics and disseminationNo ethics clearance is required as no primary data will be collected. The results of this systematic review and meta-analysis will be presented at scientific conferences and published in a peer-reviewed journal. The results may inform clinical management of PLWHA and may guide future population-specific interventions.We will search PubMed (MEDLINE), Scopus, EMBASE, Cochrane Library, OVID (HEALTH STAR), OVID (MEDLINE), Joanna Briggs Institute EBP Database, Web of Science and PsychINFO from their inception until 1 January 2020.PROSPERO registration numberCRD42020161501.
Objectives Despite the universal iodization of salt in most parts of the world, iodine deficiency disorder remains a major public health problem, affecting over 2 billion people. Published literature on the association of over-consumption of cassava (a goitrogenic food) with lower urinary iodine concentration (UIC) and increased goiter prevalence are inconsistent. We aimed to examine the association of country-level cassava consumption with country-level median urinary iodine concentrations and goiter prevalence. Methods We analyzed data on cassava consumption (kcal/capita/day) from the food and agriculture organization (FAO), median UIC, and goiter prevalence from the World Health Organization for 176 countries. We adjusted for country-level salt iodization rates. Meta-regression analysis was used to estimate the association of cassava consumption with median UIC and goiter prevalence. Results The median UIC was: 171 μg/L; 25th and 75th percentile: 119–220). Median cassava consumption was 114 kcal/capita/day (25th and 75th percentile: 22–284). In the pooled multivariable-adjusted analysis, a 10-fold increase in salt iodization rate was significantly associated with a 157% increase in median UIC (β = 15.7, P = 0. 009. We found no association between cassava consumption and median UIC (β = −0.01, P = 0.90) or goiter prevalence (β = −0.005, P = 0.75). We consistently found no association between cassava consumption and the aforementioned outcomes in the subgroup of low and middle-income countries versus high-income countries and the lagged year of cassava consumption. Conclusions In this ecological study, the consumption of iodized salt was associated with higher median UIC. We found no association of cassava consumption with reduced median UIC or increased goiter prevalence. Funding Sources None.
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