HIV-related factors not associated with increased risk of suicide (France)

[Jim Allen]

Active or substitute drug use was noted in 25% of cases and 76% had a history of a psychiatric disorder

The study seems to indicate that continuing high rate of death from suicide seen among people with HIV are linked to mental well-being challenges

I'm not surprised, as higher rates of mental health concerns for various reasons is well documented under the population living with hiv. Taking home as example last year HIV Ireland studies showed 17% of the people living with HIV in Ireland had suicidal thoughts in 12 months previous

Keep saying that HIV care needs to be far more holistic including mental health support and harm reduction services.

Jim


Full story:
http://www.aidsmap.com/HIV-related-factors-not-associated-with-increased-risk-of-suicide-among-people-with-HIV-in-France/page/3297944/

In Short:

Approximately 4% of deaths among people with HIV in France are due to suicide, investigators report in HIV Medicine. Suicide incidence remained stable over 13 years of follow-up, but HIV-related factors were not associated with an increased risk of suicide.

“We found that most factors associated with suicide mortality among PLHIV [people living with HIV] were similar to those in the general population,” comment the authors. “Suicide prevention measures should target PLHIV with the psychological morbidities identified in our cohort.”

European studies have shown that the suicide rate fell among HIV-positive individuals after the introduction of effective antiretroviral therapy. Nevertheless, it still remains between three- and five-fold higher than that seen in the general population.

In France, suicide is the sixth most common cause of death among people with HIV, accounting for 5% of deaths in 2010, compared to 1.7% in the general French population.

But factors associated with increased suicide risk in HIV-positive people in the era of modern HIV therapy are poorly understood.

Hentzein M et al. Factors associated with death from suicide in a French nationwide HIV-infected cohort. HIV Medicine, doi:10.1111/hiv.12633, 2018.

[MarkintheDark]

Honestly @JimDublin, I'd take that French study with a grain of salt, particularly taking issue with their statement, "But factors associated with increased suicide risk in HIV-positive people in the era of modern HIV therapy are poorly understood."

Even the England/Wales 1997-2012 study establishes, imo, some direction (https://www.aidsmap.com/Suicide-accounts-for-2-of-deaths-in-people-with-HIV-twice-the-rate-of-the-general-population/page/3130052/), especially among the newly-diagnosed.  Those factors include stigma, difficulty adjusting to diagnosis, etc.

I suppose I could really dig and cite myriad other studies - just not in the mood today - that, as the French study touched on in passing, factors include previous drug use.  I'm surprised those factors were almost reduced to a footnote.  Consistently, too, a lack of mental health resources is a significant factor, as you pointed out.

If getting population-specific, the risk factors for the MSM population, for example, I believe have already been identified in multiple studies in the U.S. and elsewhere, such as lack of familial support, social ostracism, etc.

You may read the French study differently than I do.  But to me it's rife with doublespeak ("...HIV-related factors were not associated with an increased risk of suicide") and sounds like sloppy research.

[Jim Allen]

Honestly @JimDublin, I'd take that French study with a grain of salt, particularly taking issue with their statement, "But factors associated with increased suicide risk in HIV-positive people in the era of modern HIV therapy are poorly understood."

That's fine 

I don't take issue with them calling that out myself in this case, i think the driving factors are too easily labeled at times without further understanding, but i'm glad to hear you are critical. Personally I take everything posted, published including studies with a grain of salt, its one of the reason its shared here for discussion.

Here is the full version BTW https://onlinelibrary.wiley.com/doi/full/10.1111/hiv.12633

This study has the context of being up to 2013, specific to PLHIV in France. The study was not limited to the MSM community, the study discussion indicates that similar factors we have seen before and also seen in the HIV negative population played a role. The main call out seems to be that more suicide prevention measures is needed under PLHIV in France. That much I think is fair, and its what I got out of the report and reading the report I would have come to similar conclusions.

I would add that I would not expect data or studies always to line up particularly when comparing results from different nations like France, England and the USA, as  they each have cultural, healthcare and treatment differences, sample size etc and  I am sure such things play a role and why results may vary.

("...HIV-related factors were not associated with an increased risk of suicide") and sounds like sloppy research.

Medically its highly manageable in this era of HIV treatment (In France). So i take it from that point of view.

Consistently, too, a lack of mental health resources is a significant factor, as you pointed out.

Indeed, I agree and there are plenty of examples that far better mental health care and far more resources are desperately needed. I know that half the people living with HIV still do not have access to HIV treatment but under that half that do have access the mental aspect needs to be addressed. 

HIV treatment plans must also nourish individuals’ mental well-being
https://forums.poz.com/index.php?topic=68869.0

http://www.aidsmap.com/Nearly-one-in-three-UK-HIV-patients-has-considered-suicide-in-the-previous-week-revised/page/1431848/

https://www.poz.com/article/british-men-hiv-commit-suicide-double-national-rate

17% of people living with HIV in Ireland surveyed felt suicidal or had suicidal thoughts in the year previous this compared to 4% of the national average
http://www.hivireland.ie/wp-content/uploads/Summary_Report_HIV_Survey_2017.pdf & https://forums.poz.com/index.php?topic=67660.0

Study Depression & HIV - missed clinic visits, VL and a greater risk of death
https://forums.poz.com/index.php?topic=69077.0

https://www.poz.com/article/time-spent-depressed-linked-poorer-engagement-hiv-care

https://www.poz.com/article/interested-much-lately-clinically-depressed

Jim