Suicide Ideation and Attempt Among People With HIV: A Statewide Population-level Cohort Analysis Between 2005 and 2020

Abstract

Background: Risk factors for suicidality among people with HIV (PWH) may evolve over their disease course, particularly as they develop comorbidities such as mental health disorders over time. Setting: This study compared the leading risk factors of suicide ideation/attempt among PWH in South Carolina across different combination antiretroviral therapy (cART) eras. Methods: A statewide cohort of PWH who were diagnosed between 2005 and 2016, with a follow-up record until 2020, was involved in the study. A Cox proportional hazards model was employed to examine the association of suicide ideation/attempt and predictors including demographics, HIV-related characteristics, and mental health conditions. Results: Among 8,567 PWH, the incidence of suicide ideation/attempt increased from 537.7 per 100,000 person-years (95% Confidence Interval [CI] 460.2-615.1) in the early cART cohort (2005-2008) to 782.5 (95% CI 697.6-867.4) in the late cART cohort (2009-2016). Leading risk factors of suicide ideation/attempt changed across cART cohort. In the early cART cohort, PWH with suicide ideation/attempt were more likely to be White and diagnosed with bipolar disorder (Ps<.05). In the late cART cohort, suicide ideation/attempt was positively associated with transmission through injection drug use, anxiety, post-traumatic stress disorder, schizophrenia, and personality disorder (Ps<.05). Conclusions: Mental health conditions have emerged as more prominent risk factors for suicide ideation/attempt in the late cART cohort. Enhanced access to psychiatric care could facilitate the early identification of mental health conditions, enabling timely counseling or psychosocial interventions that may mitigate mental health issues and, consequently, reduce the likelihood of suicide ideation/attempts among PWH.