Suicide Prevention in HIV Treatment Centres: Population Attributable Risk Analysis of Treating Common Mental Disorders

Bantjes, Jason; Kagee, Ashraf

doi:10.1007/s10461-020-03116-5

Cited by 7 publications

(6 citation statements)

References 41 publications

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“…18 However, the size of the cohort with a history of HIV/AIDS problems who attempted suicide in that study was small (2% of 688 participants) and resulted in insufficient statistical power to determine associations. 18 Although we also had a small cohort (n = 90) of people with a history of HIV/AIDS problems who reattempted suicide within 30 days of ASI-MV assessment, we were able to determine in our adjusted models that no significant association existed between having a history of HIV/AIDS problems and a suicide reattempt within 30 days of ASI-MV assessment. Similar to other studies, 28 however, our study found that a history of HIV/AIDS problems was associated with suicide reattempt when our logistic regression model was unadjusted for other known risk factors for suicide reattempt.…”

Section: Discussionmentioning

confidence: 93%

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Psychiatric Treatment and Repeat Suicide Attempts Among Adults With Substance Use, by HIV Status, United States, 2014-2020

2022

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Objectives: The association among psychiatric treatment history, HIV, and suicide reattempts among people starting treatment for substance use is not well understood. The objective of this study was to describe, by HIV status, the risk and protective factors associated with suicide reattempts among adults seeking treatment for substance use. Methods: The study included 340 390 US adult residents aged ≥18 years in the Addiction Severity Index–Multimedia Version network from January 1, 2014, through December 31, 2020. We used adjusted logistic regression models to estimate strength of association between prior psychiatric treatment, HIV status, and sociodemographic factors and suicide reattempts within 30 days of treatment evaluation. Results: Adults who had been prescribed psychiatric medication were less likely to have a recent suicide reattempt (adjusted odds ratio [aOR] = 0.8; 95% CI, 0.7-0.8) than adults with no prescription history. Adjusted models found similar protective effects between psychiatric treatment and suicide reattempts among adults reporting abuse, mental illness, injection drug use, and limited activity because of a medical condition. Conversely, the following were associated with recent suicide reattempts: being male (aOR = 1.4; 95% CI, 1.3-1.5), having a high school education/GED (General Educational Development) or less (aOR = 1.2; 95% CI, 1.1-1.2), being single (aOR = 1.2; 95% CI, 1.1-1.3), experiencing a pain problem (aOR = 1.2; 95% CI, 1.2-1.3), and not being referred to substance use treatment by court (aOR = 3.4; 95% CI, 3.2-3.7). Conclusions: A history of prescribed psychiatric medication is significantly associated with a reduced risk for suicide reattempts among adults seeking substance use treatment. Clinicians should consider incorporating mental health and suicide assessments into substance use treatment plans.

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Section: Discussionmentioning

confidence: 93%

“…17 Bantjes and Kagee found that treatment for common mental disorders was associated with a reduction in suicidal ideation and planning, but not suicide attempts, among people living with HIV/AIDS. 18 The effect of psychiatric treatment on future suicide attempts among people with HIV/AIDS and substance use disorder is not well known.…”

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confidence: 99%

Psychiatric Treatment and Repeat Suicide Attempts Among Adults With Substance Use, by HIV Status, United States, 2014-2020

2022

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“…To maximize the benefits of task-shifting, governments should universally integrate suicide screening and prevention efforts in HIV care. 29 Future studies should first assess the adequacy of safety planning for suicide prevention and the additional human resource capacity needed to effectively reduce suicide attempts and deaths by suicide. For higher acuity cases, including patients at immediate risk for suicide, it may be necessary to integrate other innovative strategies for implementation.…”

Section: Discussionmentioning

confidence: 99%

“…To maximize the benefits of task-shifting, governments should universally integrate suicide screening and prevention efforts in HIV care. 29…”

Section: Discussionmentioning

confidence: 99%

Brief Report: Task-Shifting “Gold Standard” Clinical Assessment and Safety Planning for Suicide Risk Among People Living With HIV: A Feasibility and Fidelity Evaluation in Tanzania

Knettel

Amiri

Minja

et al. 2023

JAIDS Journal of Acquired Immune Deficiency Syndromes

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Background: Suicide is a leading cause of death among people living with HIV (PLWH) worldwide, with suicide deaths occurring twice as frequently among PLWH than among the general public. In Tanzania, resources for mental health care are sorely lacking, with 55 psychiatrists and psychologists providing treatment for 60 million people. In light of this shortage, nonspecialists play a crucial role. The objective of this study was to assess feasibility of implementing task-shifted screening, assessment, and safety planning for suicide risk among PLWH. Setting: Two adult HIV clinics in Kilimanjaro, Tanzania. Methods: Registered professional nurses in the HIV clinics were trained to administer brief screening of suicidal ideation in the past month. Patients experiencing suicidal ideation were referred to bachelor's-level counselors for further assessment and safety planning, supervised by specialist providers who reviewed audio recordings for quality assurance. Results: During 180 days of implementation, nurses screened patients attending 2745 HIV appointments. Sixty-one (2.2%) endorsed suicidal ideation and were linked to further assessment and safety planning. We cross-checked screening with clinic attendance logs on 7 random days and found high fidelity to screening (206 of 228 screened, 90%). Quality assurance ratings demonstrated key assessment pieces were consistently completed (mean = 9.3/10 possible), with “Good” to “Excellent” counseling skills (mean = 23.7/28) and “Good” to “Excellent” quality (mean = 17.1/20), including appropriate referral for higher levels of care. Conclusions: Brief screening can be implemented and paired with task-shifted counseling to facilitate high-quality assessment of suicide risk. This model shows excellent potential to extend mental health services for PLWH in low-resource settings.

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“…In addition, a cross‐sectional study reported that males had a higher risk than females for suicidal ideation (OR 0.92; p > 0.5) and suicide attempts (OR 0.81; p > 0.5), albeit the results were not statistically significant [20]. Nevertheless, several other studies have reported that female gender was a risk factor for suicidal ideation and suicide attempts [5, 21–24]. Additionally, a previous meta‐analysis of gender distribution suggested that the prevalence of suicidal ideation was 2.7% for females and 2.9% for males, whereas the pooled estimates of suicide attempts indicated that females were 1.19 times more likely to have a higher risk of suicide attempts than males; these results were not statistically significant [25].…”

Section: Introductionmentioning

confidence: 99%

Gender differences in suicidal ideation, suicide attempts, and suicide death among people living with HIV: A systematic review and meta‐analysis

Zhao

et al. 2022

HIV Medicine

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Objective: Although excess mortality, especially suicide, is a critical trait in people living with HIV, consensus about gender differences in these areas is lacking. We conducted meta-analyses to examine gender differences in suicidal ideation, suicide attempts, and suicide death among people living with HIV.Methods: We systematically searched PubMed and Web of Science for studies written in English. In this review, suicide among people living with HIV includes suicide death, suicidal ideation, and suicide attempts. Studies reporting the suicide prevalence among males and females living with HIV were eligible for inclusion in our review. Odds ratios (ORs) and 95% confidence intervals (CIs) served as the effect size index. Fixed-effects or random-effects meta-analyses were chosen based on the size of the heterogeneity. Results: A total of 27 studies comprising 801 017 participants from 11 countries were included in the meta-analysis. The overall prevalence of suicidal ideation was 18.0% (95% CI 13.3%-22.8%) in males and 20.8% (95% CI 16.4%-25.1%) in females, and there was a statistically significant higher risk of suicidal ideation in females living with HIV (OR 1.30; 95% CI 1.09-1.56; p < 0.05). The overall prevalence of suicide attempts was 16.8% (95% CI 9.0%-24.5%) in males and 24.7% (95% CI 12.4%-37.1%) in females, and there was a statistically significant higher risk of suicide attempts in females living with HIV (OR 1.34; 95% CI 1.02-1.75; p < 0.05).The pooled prevalence of suicide death was 1.2% (95% CI 0.5%-1.9%) among males and 0.2% (95% CI 0.1%-0.3%) among females, and the risk of suicide death between genders was not statistically significant (OR 0.78; 95% CI 0.50-1.24; p = 0.298).Conclusions: There were gender differences in suicidal ideation and suicide attempts among people living with HIV. Females living with HIV were more likely to experience suicidal ideation and make suicide attempts, but there were no statistically significant gender differences in suicide death. Appropriate initiatives to optimize the recognition, treatment, and management suicide behaviours of males and females living with HIV may narrow this gender gap.

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Suicide Prevention in HIV Treatment Centres: Population Attributable Risk Analysis of Treating Common Mental Disorders

Cited by 7 publications

References 41 publications

Psychiatric Treatment and Repeat Suicide Attempts Among Adults With Substance Use, by HIV Status, United States, 2014-2020

Psychiatric Treatment and Repeat Suicide Attempts Among Adults With Substance Use, by HIV Status, United States, 2014-2020

Brief Report: Task-Shifting “Gold Standard” Clinical Assessment and Safety Planning for Suicide Risk Among People Living With HIV: A Feasibility and Fidelity Evaluation in Tanzania

Gender differences in suicidal ideation, suicide attempts, and suicide death among people living with HIV: A systematic review and meta‐analysis

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