Mortality from suicide among people living with HIV and the general Swiss population: 1988‐2017

Abstract

Introduction In many countries, mortality due to suicide is higher among people living with HIV than in the general population. We aimed to analyse trends in suicide mortality before and after the introduction of triple combination antiretroviral therapy (cART), and to identify risk factors associated with death from suicide in Switzerland. Methods We analysed data from the Swiss HIV Cohort Study from the pre‐cART (1988‐1995), earlier cART (1996‐2008) and later cART (2009‐2017) eras. We used multivariable Cox regression to assess risk factors for death due to suicide in the ART era and computed standardized mortality ratios (SMRs) to compare mortality rates due to suicide among persons living with HIV with the general population living in Switzerland, using data from the Swiss National Cohort. Results and Discussion We included 20,136 persons living with HIV, of whom 204 (1.0%) died by suicide. In men, SMRs for suicide declined from 12.9 (95% CI 10.4‐16.0) in the pre‐cART era to 2.4 (95% CI 1.2‐5.1) in the earlier cART and 3.1 (95% CI 2.3‐4.3) in the later cART era. In women, the corresponding ratios declined from 14.2 (95% CI 7.9‐25.7) to 10.2 (3.8‐27.1) and to 3.3 (95% CI 1.5‐7.4). Factors associated with death due to suicide included gender (adjusted hazard ratio 0.58 (95% CI 0.38‐0.87) comparing women with men), nationality (1.95 (95% CI 1.34‐2.83) comparing Swiss with other), Centers for Disease Control and Prevention clinical stage (0.33 (95% CI 0.24‐0.46) comparing stage A with C), transmission group (2.64 (95% CI 1.71‐4.09) for injection drug use and 2.10 (95% CI 1.36‐3.24) for sex between men compared to other), and mental health (2.32 (95% CI 1.71‐3.14) for a history of psychiatric treatment vs. no history). There was no association with age. Conclusions Suicide rates have decreased substantially among people living with HIV in the last three decades but have remained about three times higher than in the general population since the introduction of cART. Continued emphasis on suicide prevention among men and women living with HIV is important.

Compassion-Focused Therapy (Cft) As An Intervention Against Suicidal Ideation In Newly Diagnosed People Living With Hiv/Aids (Plwha) Attending A Nigerian Maternity Teaching Hospital

“…Interestingly, depression, family history of suicide and perceived stigma from living with HIV were found to be associated with suicidal risks in that same study. In a different study, Ruffieux et al (2019) found that high mortality rate because of suicide is often reported amongst PLWHA, especially the very recently diagnosed (HIV-positive diagnosis less than 1 month old) when compared to the general population. Zarei and Joulaei (2018) identified that suicidal ideation was common in both recently and non-recently diagnosed patients with HIV/ AIDS.…”

Short-term mortality from HIV-infected persons diagnosed from 2012 to 2016

“…Despite the availability of ART, suicide rates remained significantly higher in PLHIV than in the general population. [ 35 ] PLHIV facing high levels of HIV-related stigma were more likely to delay enrollment into care than those who did not perceive HIV-related stigma. [ 36 ] To reduce rates of suicide, there is a need to reduce HIV-related stigma and discrimination, provide routine screening and close monitoring for depression and drug and alcohol misuse, and expand the network of psychosocial support.…”

Predicting Emotional Valence of People Living with the Human Immunodeficiency Virus Using Daily Voice Clips: A Preliminary Study

“…Studies have found that people living with the human immunodeficiency virus (PLHIV) are more likely to be depressed than ordinary people due to negative emotions to initial diagnosis, the stress of living with chronic illness, perceived and internalized stigma, and the side effects of HIV drugs [ 1 , 2 , 3 , 4 , 5 ]. The prevalence of depression among PLHIV was between 18% and 81% [ 3 , 6 , 7 , 8 ].…”