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Tsai YT, K. M. SP, Ku HC, Wu YL, Ko NY. Global overview of suicidal behavior and associated risk factors among people living with human immunodeficiency virus: A scoping review. PLoS One 2023; 18:e0269489. [PMID: 36940193 PMCID: PMC10029973 DOI: 10.1371/journal.pone.0269489] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2021] [Accepted: 05/22/2022] [Indexed: 03/21/2023] Open
Abstract
Death by suicide is a major public health problem. People living with human immunodeficiency virus (PLHIV) have higher risk of suicidal behavior than the general population. The aim of this review is to summarize suicidal behavior, associated risk factors, and risk populations among PLHIV. Research studies in six databases from January 1, 1988, to July 8, 2021, were searched using keywords that included "HIV," "suicide," and "risk factors." The study design, suicide measurement techniques, risk factors, and study findings were extracted. A total of 193 studies were included. We found that the Americas, Europe, and Asia have the highest rates of suicidal behavior. Suicide risk factors include demographic factors, mental illness, and physiological, psychological, and social support. Depression is the most common risk factor for PLHIV, with suicidal ideation and attempt risk. Drug overdosage is the main cause of suicide death. In conclusion, the current study found that PLHIV had experienced a high level of suicidal status. This review provides an overview of suicidal behavior and its risk factors in PLHIV with the goal of better managing these factors and thus preventing death due to suicide.
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Affiliation(s)
- Yi-Tseng Tsai
- Department of Nursing, An Nan Hospital, China Medical University, Tainan,
Taiwan
- Department of Nursing, College of Medicine, National Cheng Kung
University, Tainan, Taiwan
| | - Sriyani Padmalatha K. M.
- Department of Nursing, College of Medicine, National Cheng Kung
University, Tainan, Taiwan
- Operating Room Department, National Hospital of Sri Lanka, Colombo, Sri
Lanka
| | - Han-Chang Ku
- Department of Nursing, An Nan Hospital, China Medical University, Tainan,
Taiwan
- Department of Nursing, College of Medicine, National Cheng Kung
University, Tainan, Taiwan
| | - Yi-Lin Wu
- Department of Nursing, College of Medicine, National Cheng Kung
University, Tainan, Taiwan
| | - Nai-Ying Ko
- Department of Nursing, College of Medicine, National Cheng Kung
University, Tainan, Taiwan
- Department of Public Health, College of Medicine, National Cheng Kung
University, Tainan, Taiwan
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2
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Armoon B, Fleury MJ, Bayani A, Mohammadi R, Ahounbar E, Griffiths MD. Suicidal behaviors among intravenous drug users: a meta-analysis. JOURNAL OF SUBSTANCE USE 2022. [DOI: 10.1080/14659891.2022.2120435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Affiliation(s)
- Bahram Armoon
- Douglas Hospital Research Centre, Montreal, Quebec, Canada
- Department of Psychiatry, McGill University, Montreal, Quebec, Canada
| | - Marie-Josée Fleury
- Douglas Hospital Research Centre, Montreal, Quebec, Canada
- Department of Psychiatry, McGill University, Montreal, Quebec, Canada
| | - Azadeh Bayani
- Student Research Committee, School of Allied Medical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Rasool Mohammadi
- Department of Biostatistics and Epidemiology, School of Public Health and Nutrition, Lorestan University of Medical Sciences, Khorramabad, Iran
| | - Elaheh Ahounbar
- Orygen, the National Center of Excellence in Youth Mental Health, University of Melbourne, Parkville, Australia
- Center for Youth Mental Health, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Parkville, Australia
| | - Mark D. Griffiths
- International Gaming Research Unit, Psychology Department, Nottingham Trent University, Nottingham, UK
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Pelton M, Ciarletta M, Wisnousky H, Lazzara N, Manglani M, Ba DM, Chinchillli VM, Du P, Ssentongo AE, Ssentongo P. Rates and risk factors for suicidal ideation, suicide attempts and suicide deaths in persons with HIV: a systematic review and meta-analysis. Gen Psychiatr 2021; 34:e100247. [PMID: 33912798 PMCID: PMC8042999 DOI: 10.1136/gpsych-2020-100247] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 12/18/2020] [Accepted: 02/04/2021] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND People 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). AIMS This systematic review and meta-analysis aimed to assess the lifetime incidence and prevalence of suicidality in PLWHA. METHODS Publications 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. RESULTS A 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. CONCLUSIONS The 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.
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Affiliation(s)
- Matt Pelton
- Department of Public Health Sciences, The Pennsylvania State University College of Medicine, Hershey, Pennsylvania, USA
| | - Matt Ciarletta
- Department of Public Health Sciences, The Pennsylvania State University College of Medicine, Hershey, Pennsylvania, USA
| | - Holly Wisnousky
- Department of Public Health Sciences, The Pennsylvania State University College of Medicine, Hershey, Pennsylvania, USA
| | - Nicholas Lazzara
- Department of Public Health Sciences, The Pennsylvania State University College of Medicine, Hershey, Pennsylvania, USA
| | - Monica Manglani
- Department of Public Health Sciences, The Pennsylvania State University College of Medicine, Hershey, Pennsylvania, USA
| | - Djibril M Ba
- Department of Public Health Sciences, The Pennsylvania State University College of Medicine, Hershey, Pennsylvania, USA
| | - Vernon M Chinchillli
- Department of Public Health Sciences, The Pennsylvania State University College of Medicine, Hershey, Pennsylvania, USA
| | - Ping Du
- Department of Public Health Sciences, The Pennsylvania State University College of Medicine, Hershey, Pennsylvania, USA
| | - Anna E Ssentongo
- Department of Public Health Sciences, The Pennsylvania State University College of Medicine, Hershey, Pennsylvania, USA
- Department of Surgery, The Pennsylvania State University College of Medicine, Hershey, Pennsylvania, USA
| | - Paddy Ssentongo
- Department of Public Health Sciences, The Pennsylvania State University College of Medicine, Hershey, Pennsylvania, USA
- Center for Neural Engineering, Department of Engineering Science and Mechanics, The Pennsylvania State University, University Park, Pennsylvania, USA
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Artenie AA, Bruneau J, Roy É, Zang G, Lespérance F, Renaud J, Tremblay J, Jutras-Aswad D. Licit and illicit substance use among people who inject drugs and the association with subsequent suicidal attempt. Addiction 2015; 110:1636-43. [PMID: 26119212 DOI: 10.1111/add.13030] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2015] [Revised: 05/07/2015] [Accepted: 06/24/2015] [Indexed: 11/26/2022]
Abstract
AIM To estimate associations between recent licit and illicit substance use and subsequent suicide attempt among people who inject drugs (PWID). DESIGN Secondary analysis of longitudinal data from a prospective cohort study of PWID followed bi-annually between 2004 and 2011. SETTING Montréal, Canada. PARTICIPANTS Seven hundred and ninety-seven PWID who reported injection drug use in the previous 6 months, contributing to a total of 4460 study visits. The median number of visits per participant was five (interquartile range: 3-8). MEASUREMENTS An interviewer-administered questionnaire eliciting information on socio-demographic factors, detailed information on substance use patterns and related behaviours, mental health markers and suicide attempt. The primary exposure variables examined were past-month use of alcohol [heavy (≥ 60 drinks); moderate (one to 59 drinks); none], sedative-hypnotics, cannabis, cocaine, amphetamine and opioids [regular (≥ 4 days); occasional (1-3 days); none]. The outcome was a binary measure of suicide attempt assessed in reference to the previous 6 months. FINDINGS In multivariate analyses, a positive association was found among licit substances between heavy alcohol consumption [adjusted odds ratio (AOR) = 2.05; 95% confidence interval (CI) = 1.12-3.75], regular use of sedative-hypnotics (AOR = 1.89; 95% CI = 1.21-2.95) and subsequent attempted suicide. Among illicit substances, occasional use of cannabis (AOR = 1.84; 95% CI = 1.09-3.13) had a positive association with subsequent suicide attempt. No statistically significant association was found for the remaining substances. CONCLUSION Among people who inject drugs, use of alcohol, sedative-hypnotics and cannabis, but not cocaine, amphetamine or opioids, appears to be associated with an increased likelihood of later attempted suicide.
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Affiliation(s)
- Andreea Adelina Artenie
- Research Center, Centre Hospitalier de l'Université de Montréal (CHUM), Montréal, Canada.,Department of Epidemiology, School of Public Health, Université de Montréal, Montréal, Canada
| | - Julie Bruneau
- Research Center, Centre Hospitalier de l'Université de Montréal (CHUM), Montréal, Canada.,Department of Family and Emergency Medicine, Faculty of Medicine, Université de Montréal, Montréal, Canada
| | - Élise Roy
- Addiction Research and Study Program, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Longueuil, Canada.,Institut National de Santé Publique du Québec, Montréal, Canada
| | - Geng Zang
- Research Center, Centre Hospitalier de l'Université de Montréal (CHUM), Montréal, Canada
| | - François Lespérance
- Research Center, Centre Hospitalier de l'Université de Montréal (CHUM), Montréal, Canada.,Department of Psychiatry, Faculty of Medicine, Université de Montréal, Montréal, Canada
| | - Johanne Renaud
- Department of Psychiatry, Faculty of Medicine, McGill University, Montréal, Canada
| | - Joël Tremblay
- Department of Psychoeducation, Université du Québec à Trois-Rivières, Trois-Rivières, Canada
| | - Didier Jutras-Aswad
- Research Center, Centre Hospitalier de l'Université de Montréal (CHUM), Montréal, Canada.,Department of Psychiatry, Faculty of Medicine, Université de Montréal, Montréal, Canada
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Marshall BDL, Galea S, Wood E, Kerr T. Longitudinal associations between types of childhood trauma and suicidal behavior among substance users: a cohort study. Am J Public Health 2013; 103:e69-75. [PMID: 23865651 PMCID: PMC3966683 DOI: 10.2105/ajph.2013.301257] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/23/2013] [Indexed: 01/07/2023]
Abstract
OBJECTIVES We examined the longitudinal associations between different types and severities of childhood trauma and suicide attempts among illicit drug users. METHODS Data came from 2 prospective cohort studies of illicit drug users in Vancouver, Canada, in 2005 to 2010. We used recurrent event proportional means models to estimate adjusted and weighted associations between types and severities of childhood maltreatment and suicide attempts. RESULTS Of 1634 participants, 411 (25.2%) reported a history of suicidal behavior at baseline. Over 5 years, 80 (4.9%) participants reported 97 suicide attempts, a rate of 2.6 per 100 person-years. Severe to extreme levels of sexual abuse (adjusted hazard ratio [AHR] = 2.5; 95% confidence interval [CI] = 1.4, 4.4), physical abuse (AHR = 2.0; 95% CI = 1.1, 3.8), and emotional abuse (AHR = 3.5; 95% CI = 1.4, 8.7) predicted suicide attempts. Severe forms of physical and emotional neglect were not significantly associated with an increased risk of suicidal behavior. CONCLUSIONS Severe sexual, physical, and emotional childhood abuse confer substantial risk of repeated suicidal behavior in adulthood. Illicit drug users require intensive secondary suicide prevention efforts, particularly among those with a history of childhood trauma.
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Affiliation(s)
- Brandon D L Marshall
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA.
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Cepeda A, Kaplan C, Neaigus A, Cano MÁ, Villarreal Y, Valdez A. Injecting transition risk and depression among Mexican American non-injecting heroin users. Drug Alcohol Depend 2012; 125 Suppl 1:S12-7. [PMID: 22749681 PMCID: PMC4451197 DOI: 10.1016/j.drugalcdep.2012.05.035] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2011] [Revised: 05/10/2012] [Accepted: 05/30/2012] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Existing research has documented high comorbid rates for injecting drug use (IDU) and social and health consequences including HIV infection, a condition that disproportionately affects U.S. Hispanic populations. Few studies have examined the specific associations between injecting transition risk among non-injecting heroin using (NIU) populations and mental health conditions. This study hypothesizes that injecting transition risk will be strongly associated with depression symptomatology controlling for age and gender among Mexican American NIUs. METHODS Street-recruited NIUs (n=300) were administered structured interviews. The Mexican American sample was predominantly male (66%), unemployed (75%) with more than half experiencing incarceration in their lifetimes (58%). Depression was measured using the CES-D scale. Univariate and multivariate logistic regression analysis were employed to determine the associations between the dependent variable of heroin injecting transition risk and the key independent variables of depression symptomatology and other independent variables. RESULTS Depression symptomatology was the strongest independent correlate of injecting transition risk. Those NIUs with high levels of depression symptomatology had more than three times the heroin injecting transition risk than those NIUs with low levels. Heroin use network influence was also found to be a strong correlate. Acculturation level was significantly associated with injecting transition risk. CONCLUSION The comorbid condition of depression symptomatology and heroin use places Mexican American NIUs at elevated risk of contracting blood-borne pathogens such as HIV. Development of prevention and treatment strategies that target Hispanic non-injecting heroin users in socially disadvantaged communities should consider depression symptoms and develop interventions that build new social networks.
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Affiliation(s)
- Alice Cepeda
- School of Social Work, University of Southern California, Los Angeles, CA 90089-041, United States
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Warde M, Gragnani A, Gomes H, Hochman B, Ferreira LM. The impact of facial lipoatrophy treatment with polymethyl methacrylate in AIDS patients as measured by four quality-of-life questionnaires. Int J STD AIDS 2012; 22:596-9. [PMID: 21998182 DOI: 10.1258/ijsa.2009.009086] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Life-expectancy increased in patients infected with HIV/AIDS with the advent of highly active antiretroviral therapy (ART). Facial lipoatrophy is a common complication in these patients, eventually leading to stigma, segregation and a negative impact in quality of life (QOL). We measured the impact of the treatment of facial lipoatrophy with polymethyl methacrylate (PMMA) in the QOL of patients with HIV/AIDS by using four questionnaires that address QOL. Forty consecutive patients on ART referred for facial lipoatrophy treatment were enrolled in this study. The first 20 were allocated to the intervention group and were treated with tissue augmentation with PMMA. The other 20 were allocated to the control group, which received treatment only after six months. At baseline, four questionnaires were applied to all patients in both groups and again after six months. The variation in scores within the control group for all domains of all four instruments was significantly better when compared with that within the control group. We detected improvement in the QOL of patients with HIV/AIDS and facial lipoatrophy when they were treated with PMMA.
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Affiliation(s)
- M Warde
- Division of Plastic Surgery, Federal University of Sao Paulo, São Paulo, Brazil
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Catalan J, Harding R, Sibley E, Clucas C, Croome N, Sherr L. HIV infection and mental health: suicidal behaviour--systematic review. PSYCHOL HEALTH MED 2011; 16:588-611. [PMID: 21745024 DOI: 10.1080/13548506.2011.582125] [Citation(s) in RCA: 85] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Suicide has long been associated with serious illness generally and HIV specifically. New treatments have affected prognosis in HIV positively, but it is unclear how they impact on suicidal burden (thoughts, self-harm and completions). This review examines all published suicide and HIV data for a definitive account of (1) prevalence of HIV-related suicidality, (2) measurement within studies and (3) effectiveness of interventions. Standard systematic research methods were used to gather quality published papers on HIV and suicide, searching published databases according to quality inclusion criteria. From the search, 332 papers were generated and hand searched resulting in 66 studies for analysis. Of these, 75% were American/European, but there was representation from developing countries. The breakdown of papers provided 12, which measured completed suicides (death records), five reporting suicide as a cause of attrition. Deliberate self-harm was measured in 21, using 22 instruments; 16 studies measured suicidal ideation using 14 instruments, suicidal thoughts were measured in 17, using 15 instruments. Navigating the diverse range of studies clearly points to a high-suicidal burden among people with HIV. The overview shows that autopsy studies reveal 9.4% of deceased HIV+ individuals had committed suicide; 2.4% HIV+ study participants commit suicide; approximately 20% of HIV+ people studied had deliberately harmed themselves; 26.9% reported suicidal ideation, 28.5% during the past week and 6.5% reported ideation as a side effect to medication; 22.2% had a suicide plan; 19.7% were generally "suicidal" (11.7% of people with AIDS, 15.3% at other stages of HIV); 23.1% reported thoughts of ending their own life; and 14.4% expressed a desire for death. Only three studies recruited over 70% female participants (39 studies recruited over 70% men), and six focussed on injecting drug users. Only three studies looked at interventions - predominantly indirect. Our detailed data suggest that all aspects of suicide are elevated and urgently require routine monitoring and tracking as a standard component of clinical care. There is scant evidence of direct interventions to reduce any aspect of suicidality, which needs urgent redress.
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Affiliation(s)
- Jose Catalan
- Department of Psychological Medicine, CNWL Mental Health NHS Trust, Chelsea, London, UK.
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Lau J, Yu X, Mak W, Cheng Y, Lv Y, Zhang J. Suicidal ideation among HIV+ former blood and/or plasma donors in rural China. AIDS Care 2010; 22:946-54. [DOI: 10.1080/09540120903511016] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- J.T.F. Lau
- a Center for Health Behaviors Research, School of Public Health and Primary Care, Faculty of Medicine , The Chinese University of Hong Kong , Hong Kong , PRC
| | - X.N. Yu
- a Center for Health Behaviors Research, School of Public Health and Primary Care, Faculty of Medicine , The Chinese University of Hong Kong , Hong Kong , PRC
| | - W.W.S. Mak
- b Department of Psychology , The Chinese University of Hong Kong , Hong Kong , PRC
| | - Y.M. Cheng
- c National Research Institute for Family Planning , Beijing , PRC
| | - Y.H. Lv
- c National Research Institute for Family Planning , Beijing , PRC
| | - J.X. Zhang
- d Institute of Psychology , Chinese Academy of Sciences , Beijing , PRC
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Schönnesson LN, Williams M, Atkinson J, Timpson S. Factors associated with depressive symptoms in African American crack cocaine smokers. JOURNAL OF SUBSTANCE USE 2009; 14:161-174. [PMID: 20428319 PMCID: PMC2860323 DOI: 10.1080/14659890802695857] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Few studies have examined factors associated with depressive symptoms in crack cocaine smokers, although cocaine use has been linked to depression. The purpose of this study was to identify correlates of depressive symptoms in a sample of 799 HIV-positive and HIV-seronegative African-American crack cocaine smokers. Multiple regression modelling revealed that anxiety was strongly and positively associated with depressive symptoms. In addition, being female and more frequent crack smoking were also found to be associated. Higher self-esteem and decision-making confidence were found to be associated with less often experiencing depressive symptoms. The model accounted for 64% of the variance in the data. It was noteworthy that HIV infection, as such, was not associated with depressive symptoms. The study has important implication for mental health and health promotion interventions targeting crack cocaine smokers.
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Affiliation(s)
- L Nilsson Schönnesson
- Venhälsan (Gay Men's Clinic), South General Hospital Karolinska Institute, Stockholm, Sweden
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11
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Diehl A, Laranjeira R. Suicide attempts and substance use in an emergency room sample. JORNAL BRASILEIRO DE PSIQUIATRIA 2009. [DOI: 10.1590/s0047-20852009000200003] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
OBJECTIVE: Describe suicide attempts assisted in an emergency room (ER) and acute substance consumption or dependence on these individuals. METHODS: Descriptive epidemiologic study was carried out during one year, evaluating suicide attempts assisted at Embu das Artes ER, São Paulo, Brazil. Patients were scheduled to a non structured psychiatric interview. Main outcomes measures were: socio demographic data, suicide attempt method, drugs or alcohol acute use in the six hours prior to attempt, patients with ICD-10 substance dependence diagnosis. The descriptive analyses and chi-square test (p < 0.05) were used to verify associations between the variables studied. RESULTS: sample was formed of 80 patients, mean age of 26.9 years (SD = 8.91), predominantly female (72.5%) and 21.2% adolescents. Most suicide attempts were made through medicine ingestion (62.5%). Approximately 21.2% and 7.5% related to have used alcohol and an illicit drug respectively within 6 hours prior to attempt and 10% were found to be substance dependent. All substance dependents had attempted suicide previously (p-value = 0.4). There was a significant association between suicide attempt through medicine ingestion and psychiatric treatment history (p = 0.02). CONCLUSION: More national studies are necessary to consider the role of alcohol and drug in suicide attempts assisted in ER, especially in chemical dependents whose suicidal behavior is relevant.
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Berger-Greenstein JA, Cuevas CA, Brady SM, Trezza G, Richardson MA, Keane TM. Major depression in patients with HIV/AIDS and substance abuse. AIDS Patient Care STDS 2007; 21:942-55. [PMID: 18154491 DOI: 10.1089/apc.2006.0153] [Citation(s) in RCA: 70] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
Previous research has been inconsistent in documenting a strong relationship between depression and HIV/AIDS, although a recent meta-analysis of studies examining this issue indicates that rates of depression are modestly higher for this population. For the current study, conducted from 2001-2004, we sought to examine rates and types of depressive symptoms in a cohort of patients receiving HIV care at two urban medical centers. These patients were participants in an intervention study examining adherence and mental health in persons triply diagnosed with psychiatric disorders, substance use disorders, and HIV/AIDS. Nearly three quarters of these participants were people of color, two thirds described their sexual orientation as heterosexual, and the vast majority were unemployed. We sought to examine the relationship of depression to patients' adherence to antiretroviral medication regimens (highly active antiretroviral therapy [HAART]). Results obtained from structured clinical interviews and self-report questionnaires indicated that study participants experienced high rates of depressive symptoms, and that 72.9% of participants met criteria for major depressive disorder (MDD). The results of this study offer a detailed view of the incidence and nature of MDDs and depressive symptoms for an urban sample of substance-abusing adults with HIV/AIDS. Given the degree to which depressive symptoms and MDD appear to be prevalent for this group, as well as the observation that these symptoms are amenable to treatment, future research should focus on identifying helpful strategies and interventions for treating these symptoms, effective ways of providing linkages to care, and ways in which standardized assessment and treatment protocols might be adapted to better suit this population.
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Affiliation(s)
| | - Carlos A. Cuevas
- College of Criminal Justice, Northeastern University, Boston, Massachuetts
| | - Stephen M. Brady
- Department of Psychiatry, Boston University School of Medicine, Boston, Massachusetts
| | - Glenn Trezza
- Department of Psychiatry, Boston University School of Medicine, Boston, Massachusetts
| | - Mark A. Richardson
- Department of Psychiatry, Boston University School of Medicine, Boston, Massachusetts
| | - Terence M. Keane
- Department of Psychiatry, Boston University School of Medicine, Boston, Massachusetts
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Abstract
The prevalence, timing, and predictors of suicidal ideation and attempted suicide were evaluated in a sample of 207 HIV-positive women in New York City. Twenty-six percent of the women reported attempting suicide since their HIV diagnosis. Of those who made an attempt, 42% acted within the first month after diagnosis and 27% acted within the first week. AIDS diagnosis, psychiatric symptoms, and physical or sexual abuse were significant positive predictors of both suicidal ideation and attempts. Contrary to expectations, having children and being employed were also significant positive predictors. Spirituality was significantly negatively associated with suicidal ideation only. These results suggest that suicide prevention measures should be implemented for HIV-positive women immediately after diagnosis. Specifically, interventions should target those with an AIDS diagnosis, psychiatric symptoms, an abuse history, children, or employment. The encouragement of spiritual connection seems to be a deterrent to suicidal thoughts and is a possible avenue for intervention.
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Mehta SH, Thomas DL, Sulkowski MS, Safaein M, Vlahov D, Strathdee SA. A framework for understanding factors that affect access and utilization of treatment for hepatitis C virus infection among HCV-mono-infected and HIV/HCV-co-infected injection drug users. AIDS 2005; 19 Suppl 3:S179-89. [PMID: 16251816 DOI: 10.1097/01.aids.0000192088.72055.90] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Treatment for hepatitis C virus (HCV) is rarely received by injection drug users (IDU), particularly those co-infected with HIV. We propose a framework for understanding factors that affect utilization and adherence to HCV therapy among HCV mono-infected and HIV/HCV-co-infected IDU. Provision of treatment requires calculation of risks and benefits including evaluation of a number of time-varying factors that collectively determine a gradient of treatment eligibility, advisability and acceptability, the relative importance of which may differ in co-infected and mono-infected IDU. Treatment eligibility is determined by a number of non-modifiable and modifiable contraindications, the latter of which can change over time rendering patients who were once ineligible eligible. Among those eligible, treatment need can be assessed by liver biopsy and therapy may be deferred in those with no liver disease and started in those with significant liver disease. Among those with moderate disease, further consideration of treatment advisability (medical factors that affect treatment response) and acceptability (individual, provider and environmental barriers) is needed before treatment decisions are made. These factors are dynamic and thus should be continually evaluated even among those who may not initially appear to be ready for treatment. An evaluation of this framework is needed to determine applicability and feasibility. Until then, treatment decisions should be made on an individual basis after careful consideration of these issues by provider and patient and efforts to develop novel strategies for identifying IDU who need treatment most (alternatives to liver biopsy) and multidimensional approaches to deliver treatment for HCV while addressing other factors including HIV infection, depression and drug use should be continued.
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Affiliation(s)
- Shruti H Mehta
- Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD, USA.
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Dafoe ME, Stewart KE. Pain and psychiatric disorders contribute independently to suicidal ideation in HIV-positive persons. Arch Suicide Res 2004; 8:215-26. [PMID: 16081388 DOI: 10.1080/13811110490436819] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
The relationships between HIV-related pain, psychiatric disorders, and suicidal ideation (SI) are not well understood. The presented research investigated the ability of pain, psychiatric diagnoses, coping styles, and locus of control (LOC) to predict SI in 75 HIV-positive persons, using a sequential logistic regression. Reported psychiatric diagnoses included depression, anxiety, and substance abuse disorders. Variance accounted for by these analyses was approximated at 33%, with pain severity independently predicting SI after accounting for psychiatric diagnoses. Coping and LOC did not add significantly to the models. Given the prevalence of pain in this population, these results underscore the importance of assessing and treating pain and SI in persons with HIV.
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Marimoutou C, Carrieri P, Poizot-Martin I, Loundou A, Trémolières F, Rey D, Obadia Y. Hospitalization for depressive syndrome in a cohort of HIV-infected patients contaminated through injecting drug use: MANIF 2000 cohort, France, 1995-1999. AIDS Care 2003; 15:729-34. [PMID: 12959811 DOI: 10.1080/09540120310001595212] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
The objective of this study was to estimate the relative impact of hospitalization for depressive syndrome (DS) on all causes of hospitalization and characterize individuals more likely to experience hospitalization for DS in the French cohort study, Manif 2000, of patients HIV infected through injection drug use. We selected all patients followed-up to the 24-month visit (C24) who missed no more than one visit. Using medical records, dates and causes of hospitalizations, were collected retrospectively. A Poisson regression model based on generalized estimating equations was used to identify factors associated with hospitalization for DS. During the study period, 223 hospitalizations were recorded for 120 of the 335 selected patients. DS was the second reason for hospitalization after infections, accounting for 14.3% of the total number of hospitalizations. DS was reported in 32 hospitalizations and involved 24 patients, five of them being hospitalized more than once for the same cause. Factors independently associated with hospitalization for DS were history of multiple incarceration (RR = 2.1, 95% CI: 1.0-4.7), polydrug use (RR = 2.6, 95% CI: 1.1 -5.9) and lack of stable relationship (RR = 4.2, 95% CI: 1.6- 11. 1). In the HAART era, DS represents an important cause of hospitalization of HIV-infected injecting drug users, mainly concerning patients presenting no stable relationship and signs of social instability. Scheduled psychiatric consultations for these patients would permit us to identify those for whom major depression might lead to hospitalization and provide them with timely and appropriate care.
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Rogers G, Curry M, Oddy J, Pratt N, Beilby J, Wilkinson D. Depressive disorders and unprotected casual anal sex among Australian homosexually active men in primary care. HIV Med 2003; 4:271-5. [PMID: 12859327 DOI: 10.1046/j.1468-1293.2003.00155.x] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To examine the relationship between depressive disorders and unprotected anal intercourse with casual partners, among homosexually active men attending for primary care. METHODS The first 460 homosexually active men enrolling in an Australian integrated primary care programme were screened for current depressive disorders using the Primary Care Evaluation of Mental Disorders (PRIME-MD) and completed questionnaires on their sexual behaviour in the prior 6 months. One hundred and sixty-two (35%) were HIV positive, 283 (62%) were HIV negative and 15 (3%) were untested. RESULTS The prevalence of major depressive episode (MDE), as measured by the PRIME-MD, on enrollment was 28% (129/460), while the prevalence of dysthymic disorder (DD) was 26% (121/460). These include 84 men (18%) who met the criteria for both disorders ('double depression'). Neither disorder was associated with HIV status. Men with MDE were less likely to have been sexually active than the remainder of the cohort (90/129 [70%] vs. 291/331 [88%]; OR: 0.32 [95% CI: 0.19-0.52]; P<0.0001). Men with DD alone, however, were significantly more likely than men with neither disorder to report having had unprotected anal intercourse with a casual partner (11/38 [29%] vs. 43/292 [15%]; OR: 2.36 [95%CI: 1.09-5.10]; P=0.035). CONCLUSIONS Depressive disorders were highly prevalent in this cohort and independent of HIV status. MDE was associated with reduced sexual activity. Among men without MDE, the presence of DD was independently associated with an increased likelihood of reporting unsafe anal sex with a casual partner in the prior 6 months.
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Affiliation(s)
- G Rogers
- Health in Human Diversity Unit, Department of General Practice, University of Adelaide, 5005, Australia.
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Grassi L, Satriano J, Serra A, Biancosino B, Zotos S, Sighinolfi L, Ghinelli F. Emotional stress, psychosocial variables and coping associated with hepatitis C virus and human immunodeficiency virus infections in intravenous drug users. PSYCHOTHERAPY AND PSYCHOSOMATICS 2002; 71:342-9. [PMID: 12411769 DOI: 10.1159/000065993] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND The increasing health problem of hepatitis C virus (HCV) infection has only recently attracted the attention of psychosocial research, especially among subjects at higher risk (e.g. intravenous drug users; IDUs). The aim of the present study was to compare emotional stress symptoms, psychosocial variables (i.e. social support, external locus of control and emotional repression) and coping strategies in HCV-seropositive, human immunodeficiency virus (HIV)-seropositive and HCV/HIV-noninfected IDUs. METHODS IDUs followed by the Infectious Diseases Outpatient clinic were enrolled in the study over a period of 1 year. HCV-positive (n = 62) and HIV-positive (n = 76) IDUs and HCV/HIV-seronegative IDUs (n = 152) completed the Brief Symptom Inventory, the Social Provision Scale, the Locus of Control scale and the affective inhibition scale of the Illness Behavior Questionnaire. Coping with illness among HCV-positive and HIV-positive subjects was assessed through a modified version of the Mental Adjustment to Cancer Scale. RESULTS No significant differences were found between the samples with respect to individual and interpersonal variables. HCV-positive subjects showed higher scores on several psychological stress dimensions (i.e. obsessive-compulsive, phobic anxiety, paranoid ideation, psychoticism) and lower scores on fighting spirit, hopelessness and anxious preoccupation towards illness than HIV-positive patients. HCV-positive and HCV/HIV-seronegative IDUs reported comparable scores on most of the psychological measures. CONCLUSIONS The findings indicate that routine assessment of psychosocial variables and coping mechanisms should be integrated into all HCV and HIV services, especially those dedicated to treatment of patients with substance abuse, as a vulnerable segment of the population at risk for life-threatening physical illness such as HCV and HIV infections.
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Affiliation(s)
- Luigi Grassi
- Department of Medical Sciences of Communication and Behavior, Section of Psychiatry, University of Ferrara, Italy.
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Malbergier A, Schöffel AC. Tratamento de depressão em indivíduos infectados pelo HIV. BRAZILIAN JOURNAL OF PSYCHIATRY 2001. [DOI: 10.1590/s1516-44462001000300009] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
A infecção pelo HIV/Aids é freqüentemente associada a transtornos psiquiátricos. Dentre eles, a depressão é o mais comum. O diagnóstico e o tratamento dos transtornos depressivos são fundamentais para melhorar a qualidade de vida desses pacientes. Esta revisão tem como objetivo sintetizar e discutir os resultados mais importantes da literatura a respeito das particularidades do tratamento dos transtornos depressivos em indivíduos infectados pelo HIV. São discutidos a epidemiologia, o quadro clínico, a influência da depressão na evolução da infecção, o tratamento farmacológico com antidepressivos, testosterona e psicoestimulantes e a interação farmacológica entre os antidepressivos e benzodiazepínicos e as drogas antivirais. Conclui-se que o tratamento antidepressivo nessa população é eficaz, seguro e não promove imunossupressão nos indivíduos afetados.
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Affiliation(s)
- André Malbergier
- Universidade de São Paulo; Grupo Interdisciplinar de Estudos de Álcool e Drogas, Brasil
| | - Adriana C Schöffel
- Universidade Federal do Rio Grande do Sul; Hospital das Clínicas de Porto Alegre, Brasil
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