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Mi T, Zhang J, Yang X, Chen S, Weissman S, Olatosi B, Li X. Suicide Ideation and Attempt Among People With HIV: A Statewide Population-level Cohort Analysis Between 2005 and 2020. J Acquir Immune Defic Syndr 2024; 95:117-125. [PMID: 37977196 DOI: 10.1097/qai.0000000000003342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 10/19/2023] [Indexed: 11/19/2023]
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 used to examine the association of suicide ideation/attempt and predictors, including demographics, HIV-related characteristics, and mental health conditions. RESULTS Among 8567 PWH, the incidence of suicide ideation/attempt increased from 537.7 per 100,000 person-years [95% confidence interval (CI): 460.2 to 615.1] in the early cART cohort (2005-2008) to 782.5 (95% CI: 697.6 to 867.4) in the late cART cohort (2009-2016). Leading risk factors of suicide ideation/attempt changed across the cART cohort. In the early cART cohort, PWH with suicide ideation/attempt were more likely to be White and diagnosed with bipolar disorder ( P' s < 0.05). In the late cART cohort, suicide ideation/attempt was positively associated with transmission through injection drug use, anxiety, posttraumatic stress disorder, schizophrenia, and personality disorder ( P' s < 0.05). 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.
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Affiliation(s)
- Tianyue Mi
- Department of Health Promotion, Education, and Behavior & South Carolina SmartState Center for Healthcare Quality (CHQ), University of South Carolina, Arnold School of Public Health, Columbia, SC
| | - Jiajia Zhang
- Department of Epidemiology and Biostatistics, University of South Carolina, Arnold School of Public Health, Columbia, SC
| | - Xueying Yang
- Department of Health Promotion, Education, and Behavior & South Carolina SmartState Center for Healthcare Quality (CHQ), University of South Carolina, Arnold School of Public Health, Columbia, SC
| | - Shujie Chen
- Department of Epidemiology and Biostatistics, University of South Carolina, Arnold School of Public Health, Columbia, SC
| | - Sharon Weissman
- Department of Internal Medicine, School of Medicine, University of South Carolina, Columbia, SC; and
| | - Bankole Olatosi
- Department of Health Services Policy and Management, University of South Carolina, Arnold School of Public Health, Columbia, SC
| | - Xiaoming Li
- Department of Health Promotion, Education, and Behavior & South Carolina SmartState Center for Healthcare Quality (CHQ), University of South Carolina, Arnold School of Public Health, Columbia, SC
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2
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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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3
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Mitra P, Jain A, Kim K. HIV and AIDS in Older Adults: Neuropsychiatric Changes. Curr Psychiatry Rep 2022; 24:463-468. [PMID: 35809165 DOI: 10.1007/s11920-022-01354-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/08/2022] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Patients diagnosed with HIV can now survive well into their old age. Aging with HIV is not only associated with comorbid medical illnesses but also with neuropsychiatric conditions that can range from cognitive changes to severe behavioral manifestations. This paper reviews mood, anxiety, and cognitive changes in older patients with HIV, as well as some of the treatment challenges in this population. RECENT FINDINGS Most recent findings show that untreated HIV illness over a long period of time may further worsen both preexisting neuropsychiatric illness and may cause new onset behavioral and cognitive symptoms. HIV induces immune phenotypic changes that have been compared to accelerated aging Low CD 4 counts and high viral counts are indicative of poor prognosis. Evaluation for potential HIV infections may be overlooked in older adults and require screening. Older adults experience accelerated CD4 cell loss. Older adults endorsing new onset mood or cognitive changes must be screened for HIV infection. New onset neurobehavioral symptoms should be carefully screened for and treated simultaneously in patients with HIV infection.
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Affiliation(s)
- Paroma Mitra
- New York University Grossman School of Medicine, New York City, NY, USA.
- Bellevue Hospital Center, New York City, NY, USA.
| | - Ankit Jain
- Penn State College of Medicine, Hershey, USA
| | - Katherine Kim
- New York University Grossman School of Medicine, New York City, NY, USA
- Bellevue Hospital Center, New York City, NY, USA
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4
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Qrareya AN, Mahdi F, Kaufman MJ, Ashpole NM, Paris JJ. Age-related neuroendocrine, cognitive, and behavioral co-morbidities are promoted by HIV-1 Tat expression in male mice. Aging (Albany NY) 2022; 14:5345-5365. [PMID: 35830469 PMCID: PMC9320553 DOI: 10.18632/aging.204166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Accepted: 06/23/2022] [Indexed: 11/25/2022]
Abstract
In the U.S. about half of the HIV-infected individuals are aged 50 and older. In men living with HIV, secondary hypogonadism is common and occurs earlier than in seronegative men, and its prevalence increases with age. While the mechanisms(s) are unknown, the HIV-1 trans-activator of transcription (Tat) protein disrupts neuroendocrine function in mice partly by dysregulating mitochondria and neurosteroidogenesis. We hypothesized that conditional Tat expression in middle-aged male transgenic mice [Tat(+)] would promote age-related comorbidities compared to age-matched controls [Tat(−)]. We expected Tat to alter steroid hormone milieu consistent with behavioral deficits. Middle-aged Tat(+) mice had lower circulating testosterone and progesterone than age-matched controls and greater circulating corticosterone and central allopregnanolone than other groups. Young Tat(+) mice had greater circulating progesterone and estradiol-to-testosterone ratios. Older age or Tat exposure increased anxiety-like behavior (open field; elevated plus-maze), increased cognitive errors (radial arm water maze), and reduced grip strength. Young Tat(+), or middle-aged Tat(−), males had higher mechanical nociceptive thresholds than age-matched counterparts. Steroid levels correlated with behaviors. Thus, Tat may contribute to HIV-accelerated aging.
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Affiliation(s)
- Alaa N Qrareya
- Department of BioMolecular Sciences, School of Pharmacy, University of Mississippi, University, MS 38677, USA
| | - Fakhri Mahdi
- Department of BioMolecular Sciences, School of Pharmacy, University of Mississippi, University, MS 38677, USA
| | - Marc J Kaufman
- Department of Psychiatry, McLean Imaging Center, McLean Hospital/Harvard Medical School, Belmont, MA 02478, USA
| | - Nicole M Ashpole
- Department of BioMolecular Sciences, School of Pharmacy, University of Mississippi, University, MS 38677, USA.,Research Institute of Pharmaceutical Sciences, University of Mississippi, University, MS 38677, USA
| | - Jason J Paris
- Department of BioMolecular Sciences, School of Pharmacy, University of Mississippi, University, MS 38677, USA.,Research Institute of Pharmaceutical Sciences, University of Mississippi, University, MS 38677, USA
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5
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Psaros C, Stanton AM, Goodman GR, Raggio G, Briggs ES, Lin N, Robbins GK, Park ER. Adapting, testing, and refining a resilience intervention for older women with HIV: An open pilot study. J Women Aging 2022:1-21. [PMID: 35787146 PMCID: PMC9879572 DOI: 10.1080/08952841.2022.2094163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Half of persons with HIV in the United States (US), many of whom are women, are over age 50. Aging women with HIV (WWH) face unique biopsychosocial challenges, including stigma, the physiological effects of aging, and illness-associated stressors. Resilience interventions can build awareness of such stressors and aid in facilitating the relaxation response; however, no existing interventions specifically cater to the needs of older WWH. The content of the Relaxation Response Resiliency Program, which teaches positive psychology strategies, relaxation techniques, and cognitive behavioral skills, was adapted for older WWH. Thirteen WWH over 50 participated in an open pilot of the adapted intervention to iteratively refine the program and its procedures. Participants attended either 8 or 10 weekly group sessions; three groups were conducted in total. Pre- and post-intervention assessments and qualitative exit interviews were conducted. Among completers, an increase in resilience was observed. Though significance testing was not conducted, social support also increased, and depression, anxiety, and HIV stigma decreased from pre- to post-intervention. Over half of eligible women enrolled; completers reported high satisfaction with the program. However, retention was difficult; six participants withdrew or were lost to follow-up. Mean number of sessions attended was 3.5 in the 8-session group and 5 in the 10-session groups. In this small sample, the adapted intervention led to a clinically meaningful increase in resilience, though recruitment and retention were challenging. Further refinements to the intervention are needed to minimize attrition and increase acceptability before additional testing is initiated.
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Affiliation(s)
- Christina Psaros
- Department of Psychiatry, Massachusetts General Hospital/Harvard Medical School, Boston MA
| | - Amelia M. Stanton
- Department of Psychiatry, Massachusetts General Hospital/Harvard Medical School, Boston MA,The Fenway Institute, Fenway Health, Boston MA
| | - Georgia R. Goodman
- Department of Psychiatry, Massachusetts General Hospital/Harvard Medical School, Boston MA,The Fenway Institute, Fenway Health, Boston MA
| | - Greer Raggio
- Department of Psychiatry, Massachusetts General Hospital/Harvard Medical School, Boston MA
| | - Elsa S. Briggs
- Department of Psychiatry, Massachusetts General Hospital/Harvard Medical School, Boston MA
| | - Nina Lin
- Boston Medical Center, Boston MA
| | - Gregory K. Robbins
- Division of Infectious Diseases, Massachusetts General Hospital/Harvard Medical School, Boston MA
| | - Elyse R. Park
- Department of Psychiatry, Massachusetts General Hospital/Harvard Medical School, Boston MA,Benson-Henry Institute for Mind Body Medicine, Massachusetts General Hospital, Boston MA,Mongan Institute for Health Policy, Massachusetts General Hospital, Boston MA
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6
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Abstract
OBJECTIVES African Americans experience relatively low rates of mental disorder despite being disproportionately exposed to psychosocial stressors. Coping is an understudied area that may help explain the mental health resilience among this population. METHODS Using data from the National Survey of American Life, I use negative binomial logistic regression to investigate the relationships between stress exposure/appraisal, ten coping responses, and mental health among older African American adults. RESULTS Seven of 10 coping responses were predictive of psychological distress. I also found evidence of moderation for six responses. Active coping, instrumental social support, looking for something good in what has happened, and two measures of acceptance were protective against psychological distress associated with high levels of stress. Substance use generally exacerbated the association between stress and psychological distress. DISCUSSION Problem-focused coping and acceptance responses were effective coping strategies for older African Americans under high levels of stress exposure/appraisal.
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Affiliation(s)
- Dawne M Mouzon
- Department of Sociology Rutgers, The State University of New Jersey, New Brunswick, NJ, USA
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7
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Layrón Folgado JE, Conchado Peiró A, Marco JH, Barrigón ML, Baca-García E, Pérez Rodríguez S. Trajectory Analysis of Suicidal Ideation in Spanish College Students Using Ecological Momentary Assessment. Front Psychiatry 2022; 13:853464. [PMID: 35432031 PMCID: PMC9008881 DOI: 10.3389/fpsyt.2022.853464] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 02/14/2022] [Indexed: 12/14/2022] Open
Abstract
Introduction Suicide is a preventable death in young people. It is well known that suicide behavior is a multicausal phenomenon. However, suicidal ideation (SI) commonly underlies suicide, and Ecological Momentary Assessment (EMA) can help us to better characterize it and its risk and protective factors in the short term. We aimed, first, to investigate the estimated prevalence and trajectories of SI in a community sample of Spanish college students using an EMA methodology and, second, explore the associations between risk and protective factors and SI categorized as moderate or low. Materials and Methods A total of 737 participants followed the EMA during a period of 6 months. We estimated the prevalence and trajectories of SI and the associations between depressive symptoms, positive and negative affect, thwarted belongingness, perceived burdensomeness, cognitive reappraisal, emotional suppression, and purpose in life with the MEmind smartphone App. SI was assessed 14 times during this period. Results Twenty-eight participants referred to SI at least once in longitudinal assessments. We found a lack of curvature and, thus, a relatively stable trajectory of SI. Two groups of latent dimensions were observed related to risk and protective factors of SI. One latent dimension of the risk factors (higher levels of thwarted belongingness, perceived burdensomeness, depressive symptoms, negative affect, and emotional suppression) best represented the group with moderate levels of SI, and a second latent dimension of protective variables (positive affect, cognitive reappraisal, and purpose in life) best represented the group with lower levels of SI. Discussion These findings may indicate that students with a sense of having a life worth living, in addition to having the ability to reevaluate their negative beliefs, are less likely to experience high levels of SI. Therefore, purpose in life would be a protective factor against the presence of SI.
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Affiliation(s)
| | - Andrea Conchado Peiró
- Department of Statistics and Applied Operations Research and Quality, Polytechnic University of Valencia, Valencia, Spain
| | - José H. Marco
- Department of Personality, Evaluation and Psychological Treatment, University of Valencia, Valencia, Spain
- CIBER Fisiopatología Obesidad y Nutrición (CIBEROBN), Madrid, Spain
| | - María Luisa Barrigón
- Department of Psychiatry, Jiménez Díaz Foundation Hospital, Madrid, Spain
- Department of Psychiatry, University Hospital Virgen del Rocio, Seville, Spain
| | - Enrique Baca-García
- Department of Psychiatry, Jiménez Díaz Foundation Hospital, Madrid, Spain
- Department of Psychiatry, University Hospital Rey Juan Carlos, Mostoles, Spain
- Department of Psychiatry, General Hospital of Villalba, Madrid, Spain
- Department of Psychiatry, University Hospital Infanta Elena, Valdemoro, Spain
- Department of Psychiatry, Madrid Autonomous University, Madrid, Spain
- CIBERSAM (Centro de Investigacion en Salud Mental), Carlos III Institute of Health, Madrid, Spain
- Departamento de Psicología, Universidad Catolica del Maule, Talca, Chile
- Department of Psychiatry, Centre Hospitalier Universitaire de Nîmes, Nîmes, France
| | - Sandra Pérez Rodríguez
- Department of Personality, Evaluation and Psychological Treatment, University of Valencia, Valencia, Spain
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8
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Armoon B, Fleury MJ, Bayat AH, Fakhri Y, Higgs P, Moghaddam LF, Gonabadi-Nezhad L. HIV related stigma associated with social support, alcohol use disorders, depression, anxiety, and suicidal ideation among people living with HIV: a systematic review and meta-analysis. Int J Ment Health Syst 2022; 16:17. [PMID: 35246211 PMCID: PMC8896327 DOI: 10.1186/s13033-022-00527-w] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2021] [Accepted: 02/17/2022] [Indexed: 12/16/2022] Open
Abstract
Background Stigma is a social phenomenon known to have a negative impact on the lives of people living with HIV (PLWH). However, defining HIV-related stigma (HRS) is difficult because of the intersection it has with structural inequalities, and cultural differences, discrimination by health care providers that measure stigma among PLWH. HIV/AIDS has been characterized as a traumatic experience and PLWH may experience stigma which can cause negative mental health disorders and experiences, including emotional distress, shame, depression, anxiety, suicidal ideation. A systematic review of the evidence on the mental disorders of PLWH is currently lacking. This study aimed to analyze the association between HRS and social support, alcohol use disorders and mental health disorders and experiences (depression, anxiety, and suicidal ideation) among PLWH. Methods In accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) this study searched PubMed, Scopus, Web of sciences, PsycInfo, SciELO and Cochrane library electronic databases to identify publications between January 1992 and August 2020 that discussed social support, alcohol use disorders, mental health disorders and experiences (i.e., depression and anxiety and suicidal ideation) associated with HRS. Pooled Odds Ratios (ORs) were utilized at a 95% confidence level, and as sampling methods differed between articles pooled estimates used a random effects model. Results Twenty-two studies with 9548 participants met the eligibility criteria. No association was observed between HRS and alcohol use disorders. PLWH who had higher levels of social supports were less likely to report HRS. Participants who had been diagnosed with anxiety were 1.89 times more likely to report HRS, while those diagnosed with depression were 1.61 times more. Respondents who reported suicidal ideation also were 1.83 times more likely to report HRS. Conclusions This meta-analysis supports that HRS has a detrimental association with anxiety, depression and suicidal ideation, but social support protects again HRS in PLWH. Applying interventions which focus on the mental health disorders of PLWH may decrease HRS. Provision of social support by practitioners, combined with mental health treatment and assessments, and designing methods to identify stigma at different stages of illness are warranted.
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Affiliation(s)
- Bahram Armoon
- Douglas Mental Health University Institute, Research Centre, 6875 LaSalle Boulevard, Montreal, QC, H4H 1R3, Canada. .,Department of Psychiatry, McGill University, 33 Pine Avenue West, Montreal, QC, H3A 1A1, Canada.
| | - Marie-Josée Fleury
- Douglas Mental Health University Institute, Research Centre, 6875 LaSalle Boulevard, Montreal, QC, H4H 1R3, Canada.,Department of Psychiatry, McGill University, 33 Pine Avenue West, Montreal, QC, H3A 1A1, Canada
| | - Amir-Hossein Bayat
- Social Determinants of Health Research Center, Saveh University of Medical Sciences, Saveh, Iran
| | - Yadollah Fakhri
- Food Health Research Center, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
| | - Peter Higgs
- Department of Public Health, La Trobe University, Melbourne, Australia.,Burnet Institute, Melbourne, Victoria, Australia
| | - Ladan Fattah Moghaddam
- Department of Nursing, Faculty of Nursing and Midwifery, Tehran Medical Sciences, Islamic Azad University, Tehran, Iran
| | - Leila Gonabadi-Nezhad
- Department of Psychiatry, Faculty of Medicine, Aja University of Medical Sciences, Tehran, Iran
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9
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Ogunnubi OP, Aina FO, Busari CO, Fatiregun O, Fadipe B, Adegbohun AA, Oni OD. From ideation to attempt: A study of suicidality and its correlates amongst patients with schizophrenia in a resource-poor country. S Afr J Psychiatr 2022; 28:1547. [PMID: 35169504 PMCID: PMC8831998 DOI: 10.4102/sajpsychiatry.v28i0.1547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Accepted: 07/08/2021] [Indexed: 11/01/2022] Open
Affiliation(s)
- Oluseun P Ogunnubi
- Department of Psychiatry, Faculty of Clinical Sciences, College of Medicine, University of Lagos, Lagos, Nigeria
| | - Francis O Aina
- Department of Psychiatry, Faculty of Clinical Sciences, College of Medicine, University of Lagos, Lagos, Nigeria
| | - Cecilia O Busari
- Department of Psychiatry, Faculty of Clinical Sciences, College of Medicine, University of Lagos, Lagos, Nigeria
| | - Olamijulo Fatiregun
- Department of Psychiatry, Faculty of Clinical Services, Lagos University Teaching Hospital, Lagos, Nigeria
| | - Babatunde Fadipe
- Department of Psychiatry, Faculty of Clinical Services, Lagos University Teaching Hospital, Lagos, Nigeria
| | - Abosede A Adegbohun
- Department of Psychiatry, Faculty of Clinical Services, Federal Neuropsychiatric Hospital, Lagos, Nigeria
| | - Osunwale D Oni
- Department of Psychiatry, Faculty of Clinical Services, Lagos University Teaching Hospital, Lagos, Nigeria
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10
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Dangerfield DT, Ober AJ, Li MJ, Allen S, Bluthenthal RN. HIV Treatment Adherence Strategies Among Virally Suppressed Black Sexual Minority Men in Baltimore, Maryland, and Los Angeles, California: A Theory-Based Qualitative Study. J Assoc Nurses AIDS Care 2022; 33:54-62. [PMID: 34939988 PMCID: PMC8718261 DOI: 10.1097/jnc.0000000000000304] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Indexed: 01/03/2023]
Abstract
ABSTRACT The goals and strategies of Black sexual minority men living with HIV (BSMMLWH) who achieve viral suppression require further investigation. This study explored treatment adherence strategies among BSMMLWH with sustained viral suppression. We conducted 27 in-depth qualitative interviews with BSMMLWH in Baltimore, Maryland, and Los Angeles, California, between December 2018 and May 2019. Interviews included questions guided by Positive Deviance and Life Course theoretical frameworks regarding multilevel factors and explicit strategies for antiretroviral therapy adherence. Themes regarding intentional, age group-specific strategies such as using technology (among younger men) and taking HIV medications with other daily pills (among older men) were identified. Participants also reported symbiotic goals and values that encouraged adherence, such as having a desire to live, strong familial relationships with clinicians, and support networks. Identifying personal goals and having supportive clinical and social relationships could be key to improving treatment adherence and viral suppression among BSMMLWH.
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Affiliation(s)
| | | | - Michael J. Li
- Department of Family Medicine, University of California Los Angeles, Los Angeles, California, USA
| | - Sophia Allen
- Johns Hopkins University School of Nursing, Baltimore, Maryland, USA
| | - Ricky N. Bluthenthal
- Department of Preventive Medicine, Keck School of Medicine of University of Southern California, Los Angeles, California, USA
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11
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Gianella S, Saloner R, Curtin G, Little SJ, Heaton A, Montoya JL, Letendre SL, Marquine MJ, Jeste DV, Moore DJ. A Cross-Sectional Study to Evaluate the Effects of Age and Duration of HIV Infection on Anxiety and Depression in Cisgender Men. AIDS Behav 2022; 26:196-203. [PMID: 34287757 PMCID: PMC8294268 DOI: 10.1007/s10461-021-03373-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/03/2021] [Indexed: 11/27/2022]
Abstract
This observational cross-sectional study of 152 people with HIV (PWH) examined the effects of age and estimated duration of HIV infection (EDI) on depressive and anxiety symptoms. All participants were cisgender men and completed the Profile of Moods State (POMS), a self-report inventory of current (i.e., past week) mood states. Overall, study results confirmed higher levels of anxiety and depression in PWH compared to individuals without HIV. Age group (< 50 or ≥ 50 years) moderated the effect of EDI (< 3 or ≥ 3 years) on mood disturbance. Specifically, younger PWH with early diagnosed infection exhibited the highest levels of depression and anxiety, whereas depression and anxiety were attenuated in older PWH with early infection such that their POMS scores did not significantly differ from the HIV-negative and chronically HIV-infected groups. Despite the small sample size and other important limitations in our study design, our preliminary findings confirm previous observations that older people may have some adaptive ability to better handle the acute psychological stressors associated with recent HIV infection.
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Affiliation(s)
- Sara Gianella
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego, 9500 Gilman Drive MC 0679, La Jolla, CA, 92093-0679, USA.
| | - Rowan Saloner
- Department of Psychiatry, University of California San Diego, La Jolla, USA
| | - Genevieve Curtin
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego, 9500 Gilman Drive MC 0679, La Jolla, CA, 92093-0679, USA
| | - Susan J Little
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego, 9500 Gilman Drive MC 0679, La Jolla, CA, 92093-0679, USA
| | - Anne Heaton
- Department of Psychiatry, University of California San Diego, La Jolla, USA
| | - Jessica L Montoya
- Department of Psychiatry, University of California San Diego, La Jolla, USA
| | - Scott L Letendre
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego, 9500 Gilman Drive MC 0679, La Jolla, CA, 92093-0679, USA
- Department of Psychiatry, University of California San Diego, La Jolla, USA
| | - María J Marquine
- Division of Geriatrics, Gerontology and Palliative Care, University of California, La Jolla, USA
| | - Dilip V Jeste
- Department of Psychiatry, University of California San Diego, La Jolla, USA
- Sam and Rose Stein Institute for Research on Aging, University of California San Diego, La Jolla, USA
- Department of Neurosciences, University of California San Diego, La Jolla, USA
| | - David J Moore
- Department of Psychiatry, University of California San Diego, La Jolla, USA
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12
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Kreniske P, Mellins CA, Dolezal C, Morrison C, Shea E, Fisher PW, Kluisza L, Robbins RN, Nguyen N, Leu CS, Wiznia A, Abrams EJ. Predictors of Attempted Suicide Among Youth Living With Perinatal HIV Infection and Perinatal HIV-Exposed Uninfected Counterparts. J Acquir Immune Defic Syndr 2021; 88:348-355. [PMID: 34406984 PMCID: PMC8693508 DOI: 10.1097/qai.0000000000002784] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 07/22/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Suicide is a leading cause of death among adolescents and young adults (AYA). AYA living with perinatally acquired HIV infection (AYALPHIV) are at higher risk of attempted suicide when compared with AYA who were perinatally HIV-exposed but uninfected (AYAPHEU). To inform interventions, we identified risk and protective factors of attempted suicide among AYALPHIV and AYAPHEU. SETTING Data were obtained from a longitudinal New York City-based study of AYALPHIV and AYAPHEU (n = 339; enrollment age 9-16 years) interviewed approximately every 12-18 months. METHOD Our main outcome was suicide attempt at any follow-up. The DISC was used to assess psychiatric disorder diagnoses and attempted suicide and the Child Depression Inventory to assess depressive symptoms. Psychosocial and sociodemographic risk factors were also measured. Analyses used backward stepwise logistic regression modeling. RESULTS At enrollment, 51% was female individuals, 49% Black, 40% Latinx, and 11% both Black and Latinx. Attempted suicide prevalence was significantly higher among AYALPHIV compared with AYAPHEU (27% vs 16%, P = 0.019), with AYALPHIV having 2.21 times the odds of making an attempt [95% confidence interval: (1.18 to 4.12), P = 0.013]. Higher Child Depression Inventory scores were associated with an increased risk of attempted suicide in both groups and the total sample. The presence of DISC-defined behavior disorder increased the risk of attempted suicide in the total sample and the AYALPHIV subgroup. Religiosity was protective of attempted suicide in AYALPHIV. CONCLUSIONS AYALPHIV had increased suicide attempts compared with AYAPHEU. Religiosity was protective in AYALPHIV. Highlighting a need for prevention of early mental health challenges was associated with risk.
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Affiliation(s)
- Philip Kreniske
- HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute and Columbia University, New York, NY
| | - Claude Ann Mellins
- HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute and Columbia University, New York, NY
| | - Curtis Dolezal
- HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute and Columbia University, New York, NY
| | - Corey Morrison
- HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute and Columbia University, New York, NY
| | - Eileen Shea
- Department of Psychiatry, Mental Health Data Science, Columbia University Medical Center, New York, NY
| | - Prudence W Fisher
- Child and Adolescent Psychiatry, New York State Psychiatric Institute and Columbia University, New York, NY
| | - Luke Kluisza
- HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute and Columbia University, New York, NY
| | - Reuben N Robbins
- HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute and Columbia University, New York, NY
| | - Nadia Nguyen
- HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute and Columbia University, New York, NY
| | - Cheng-Shiun Leu
- HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute and Columbia University, New York, NY
- Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, NY
| | - Andrew Wiznia
- Jacobi Medical Center, Albert Einstein College of Medicine, New York, NY; and
| | - Elaine J Abrams
- ICAP at Columbia University, Mailman School of Public Health and Vagelos College of Physicians & Surgeons, Columbia University, New York, NY
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Pei JH, Pei YX, Ma T, Du YH, Wang XL, Zhong JP, Xie Q, Zhang LH, Yan LX, Dou XM. Prevalence of suicidal ideation, suicide attempt, and suicide plan among HIV/AIDS: A systematic review and meta-analysis. J Affect Disord 2021; 292:295-304. [PMID: 34134028 DOI: 10.1016/j.jad.2021.05.064] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2020] [Revised: 05/09/2021] [Accepted: 05/30/2021] [Indexed: 02/06/2023]
Abstract
BACKGROUND Suicidality is common in people living with HIV/AIDS. However, the prevalence estimates of the suicidality vary between studies. Here, we performed a systematic review and estimated the prevalence of suicidal behavior in this population. METHODS Systematic search of PubMed, Embase, Web of Science, CINAHL, Scopus and PsycINFO for relevant studies published before August 29, 2020. A random-effects model was used to pool the estimates of the prevalence of suicidal ideation, attempts and plans, which were also stratified by continent or region and screening instrument from the studies included in this meta-analysis. RESULTS Suicide prevalence data were extracted from 36 studies(n=32,818) from 15 countries. The overall pooled crude prevalence estimates of suicidal ideation, plans, and attempts were 20.9% [95% confidence interval (CI) 16.5-21.6%],8.1% (95% CI 5.4-11.3%), and 7.5% (95% CI 5.7-9.5%), respectively. For lifetime suicidal ideation and attempts prevalence, this was 22.4% (95% CI 15.9-29.8%), and 12.0% (95% CI 6.9- 18.1%), respectively. Summary prevalence estimates ranged across assessment modalities from 6.5% to 33.7%. Pooled estimates were generally higher for females, as compared with males (risk ratios in the range 1.48-1.85). The leave-one-out analysis showed that no single study significantly affected the final pooled results.
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Affiliation(s)
- Ju-Hong Pei
- School of Nursing, Lanzhou university, Lanzhou, Gansu, People's Republic of China
| | - Yi-Xuan Pei
- Performance Operation Office, The Second People's Hospital of Gansu Province, Lanzhou, Gansu, People's Republic of China
| | - Tong Ma
- Department of Spine Minimally Invasive Orthopedics, Gansu Provincial Hospital of Traditional Chinese Medicine, Gansu, People's Republic of China
| | - Ye-Hui Du
- School of Nursing, Lanzhou university, Lanzhou, Gansu, People's Republic of China
| | - Xing-Lei Wang
- Department of liver diseases branch, Lanzhou University Second Hospital, Lanzhou, Gansu, People's Republic of China
| | - Juan-Ping Zhong
- School of Nursing, Lanzhou university, Lanzhou, Gansu, People's Republic of China
| | - Qi Xie
- School of Nursing, Lanzhou university, Lanzhou, Gansu, People's Republic of China
| | - Li-Hong Zhang
- School of Nursing, Lanzhou university, Lanzhou, Gansu, People's Republic of China
| | - Li-Xin Yan
- Second Department of Mental Health, Lanzhou University Second Hospital, Lanzhou, Gansu
| | - Xin-Man Dou
- School of Nursing, Lanzhou university, Lanzhou, Gansu, People's Republic of China;; Department of Nursing, Lanzhou University Second Hospital, Lanzhou, Gansu, People's Republic of China
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14
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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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15
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Yuan NY, Kaul M. Beneficial and Adverse Effects of cART Affect Neurocognitive Function in HIV-1 Infection: Balancing Viral Suppression against Neuronal Stress and Injury. J Neuroimmune Pharmacol 2021; 16:90-112. [PMID: 31385157 PMCID: PMC7233291 DOI: 10.1007/s11481-019-09868-9] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Accepted: 07/23/2019] [Indexed: 02/07/2023]
Abstract
HIV-associated neurocognitive disorders (HAND) persist despite the successful introduction of combination antiretroviral therapy (cART). While insufficient concentration of certain antiretrovirals (ARV) may lead to incomplete viral suppression in the brain, many ARVs are found to cause neuropsychiatric adverse effects, indicating their penetration into the central nervous system (CNS). Several lines of evidence suggest shared critical roles of oxidative and endoplasmic reticulum stress, compromised neuronal energy homeostasis, and autophagy in the promotion of neuronal dysfunction associated with both HIV-1 infection and long-term cART or ARV use. As the lifespans of HIV patients are increased, unique challenges have surfaced. Longer lives convey prolonged exposure of the CNS to viral toxins, neurotoxic ARVs, polypharmacy with prescribed or illicit drug use, and age-related diseases. All of these factors can contribute to increased risks for the development of neuropsychiatric conditions and cognitive impairment, which can significantly impact patient well-being, cART adherence, and overall health outcome. Strategies to increase the penetration of cART into the brain to lower viral toxicity may detrimentally increase ARV neurotoxicity and neuropsychiatric adverse effects. As clinicians attempt to control peripheral viremia in an aging population of HIV-infected patients, they must navigate an increasingly complex myriad of comorbidities, pharmacogenetics, drug-drug interactions, and psychiatric and cognitive dysfunction. Here we review in comparison to the neuropathological effects of HIV-1 the available information on neuropsychiatric adverse effects and neurotoxicity of clinically used ARV and cART. It appears altogether that future cART aiming at controlling HIV-1 in the CNS and preventing HAND will require an intricate balancing act of suppressing viral replication while minimizing neurotoxicity, impairment of neurocognition, and neuropsychiatric adverse effects. Graphical abstract Schematic summary of the effects exerted on the brain and neurocognitive function by HIV-1 infection, comorbidities, psychostimulatory, illicit drugs, therapeutic drugs, such as antiretrovirals, the resulting polypharmacy and aging, as well as the potential interactions of all these factors.
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Affiliation(s)
- Nina Y Yuan
- School of Medicine, Division of Biomedical Sciences, University of California Riverside, 900 University Ave, Riverside, CA, 92521, USA
| | - Marcus Kaul
- School of Medicine, Division of Biomedical Sciences, University of California Riverside, 900 University Ave, Riverside, CA, 92521, USA.
- Sanford Burnham Prebys Medical Discovery Institute, Infectious and Inflammatory Disease Center, 10901 North Torrey Pines Road, La Jolla, CA, 92037, USA.
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16
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Wang W, Chen X, Yan H, Yu B, Li S. Association between social capital and suicide ideation, plan and attempt among men living with HIV in China. J Affect Disord 2021; 280:173-179. [PMID: 33212409 DOI: 10.1016/j.jad.2020.11.088] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Revised: 10/05/2020] [Accepted: 11/08/2020] [Indexed: 11/17/2022]
Abstract
BACKGROUND Better understanding of the relationship between social capital and risk of suicide is essential for suicide prevention and control among people living with HIV (PLWH). METHODS Participants were 494 male PLWH recruited with a venue-based method from Wuhan in China. Data were collected using a self-reported questionnaire during November 2015 and January 2016. Social capital was measured using the short-version Personal Social Capital Scale. Multivariate logistic regression was used to assess the association between social capital and suicidal ideations post HIV+ diagnosis and in the past month, as well as suicide plan and attempt. RESULTS Scatter plots showed a nonlinear trend in the prevalence of the three suicide measures along with social capital. Logistic regression analyses stratified by quartiles of social capital indicated a significant nonlinear association between social capital and the risk of suicide. The estimated odds ratio [95% CI] of suicidal ideation was 0.87 [0.51.1.42], 0.68 [0.40, 1.14] and 0.24 [0.12, 0.46] for the second, third and fourth quartile of social capital scores respectively with the first quartile as the reference. Similar results were observed for suicidal ideation in the past month and suicidal plan/attempt. CONCLUSIONS Findings of this study suggest that social capital is only associated with lower suicidal ideation at very high levels of social capital. If verified with longitudinal data, this finding suggests an effective suicide prevention intervention among male PLWH must foster social capital to a level greater than average.
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Affiliation(s)
- Wei Wang
- School of Public Health, Xuzhou Medical University, Xuzhou, Jiangsu, China; School of Health Sciences, Wuhan University, Wuhan, Hubei, China.
| | - Xinguang Chen
- Department of Epidemiology, University of Florida, Gainesville, FL, USA
| | - Hong Yan
- School of Health Sciences, Wuhan University, Wuhan, Hubei, China.
| | - Bin Yu
- Department of Epidemiology, University of Florida, Gainesville, FL, USA
| | - Shiyue Li
- School of Health Sciences, Wuhan University, Wuhan, Hubei, China
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17
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Zewdu LB, Reta MM, Yigzaw N, Tamirat KS. Prevalence of suicidal ideation and associated factors among HIV positive perinatal women on follow-up at Gondar town health institutions, Northwest Ethiopia: a cross-sectional study. BMC Pregnancy Childbirth 2021; 21:42. [PMID: 33422024 PMCID: PMC7797091 DOI: 10.1186/s12884-020-03529-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Accepted: 12/26/2020] [Indexed: 11/24/2022] Open
Abstract
Background Suicidal behaviors cover a range or continuum of acts from suicidal ideations to a series of actions, commonly known as suicidal attempts or deliberate self-harms. Though different mental disorders related studies were conducted among HIV/AIDS patients, there is a scarcity of information about the magnitude and determinants of suicidal thoughts among perinatal women. Therefore, this study aimed to determine the prevalence of suicidal ideation and associated factors among HIV positive perinatal women in the study setting. Methods An institution-based cross-sectional study was conducted among perinatal women on treatment to the prevention of mother to child transmission of HIV/AIDS at Gondar town health facilities. A total of 422 HIV-positive perinatal women were selected systematically and the data collected through medical record review and interview using a Composite International Diagnostic Interview (CIDI) toolkit. A binary and multivariable logistic regression model was employed to identify factors associated with suicidal ideation. An Adjusted Odds Ratio (AOR) with 95% Confidence Interval (CI) was computed to see the strength of association between outcome and independent variables. Characteristics having less than 0.05 p-value had been taken as significant factors associated with the outcome of interest. Result The prevalence of suicidal ideation was found to be 8.2% (95% CI; 5.7 to 11.3) and with a standard error of 0.013. Perinatal depression (AOR=4.40, 95%CI: 1.63 11.85), not disclosed HIV status (AOR=3.73, 95%CI: 1.44 9.65), and unplanned pregnancy (AOR=2.75, 95%CI: 1.21 6.21) were significant factors associated with suicidal ideation. Conclusion The magnitude of suicidal ideation among HIV positive perinatal women was found to be low. Perinatal depression, non-disclosed HIV status, and unplanned pregnancy were factors significantly associated with suicidal ideation. This finding suggests the integration of mental health services with maternal and HIV support programs. Supplementary Information The online version contains supplementary material available at 10.1186/s12884-020-03529-z.
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Affiliation(s)
| | - Mebratu Mitiku Reta
- Department of Internal Medicine, School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Niguse Yigzaw
- Department of Psychiatry, School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Koku Sisay Tamirat
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia.
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18
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Gelaw MM, Zeleke EG, Asres MS, Reta MM. One-Third of Perinatal Women Living with HIV Had Perinatal Depression in Gondar Town Health Facilities, Northwest Ethiopia. HIV AIDS-RESEARCH AND PALLIATIVE CARE 2020; 12:887-895. [PMID: 33324114 PMCID: PMC7733382 DOI: 10.2147/hiv.s268686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Accepted: 11/06/2020] [Indexed: 11/30/2022]
Abstract
Background Depression is the most common co-morbidity among perinatal women living with HIV. It affects client’s adherence to care and treatment, which results in increased viral load; further exposing women to opportunistic infections that reduce quality-of-life. A cumulative effect of these may increase mother-to-child transmission of HIV. Methods An institution-based cross-sectional study was conducted among perinatal women living with HIV in Gondar town health facilities, Northwest Ethiopia from October 1–30, 2018. A single population proportion formula was used to calculate the sample size. The sample was stratified and proportionally allocated to each health facility. Participants were chosen from each stratum independently using a simple random sampling technique. A total of 422 study participants were selected. The World Health Organization (WHO) 20-item self-reported questionnaire (SRQ-20) was used to measure perinatal depression among women living with HIV. Perceived stigma was measured using HIV stigma scale. Women were interviewed at the PMTCT clinic during follow-up care, and clinical variables were extracted from client chart. Bi-variable and multivariable logistic regression models were used to identify factors associated with perinatal depression. Variables having an odds ratio with 95% confidence interval and a P-value less than 0.05 were taken as significant variables associated with perinatal depression. Results The prevalence of perinatal depression among women living with HIV was found to be 38.4% (95% CI=34.1–43.1%). Fair and poor ART drug adherence (AOR=5.44; 95% CI= 2.81–10.56%), the presence of comorbid illness (AOR=3.24; 95% CI: 1.83–5.75), being on second line ART (AOR=2.97; 95% CI=1.08–8.17), perceived stigma (AOR=3.61; 95% CI=2.11–6.17), and suicidal ideation (AOR=3.89; 95% CI=1.28–11.81) were factors associated with perinatal depression. Conclusion The prevalence of perinatal depression among women living with HIV was found to be high. Adherence counseling needs to be strengthened; preventing first line treatment failure has to be encouraged; greater emphasis has to be given for those women on second line ART. Early identification and management of co-morbidity has to be considered. HIV positive perinatal women need counseling to reduce HIV-related perceived stigma.
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Affiliation(s)
| | - Ejigu Gebeye Zeleke
- Department of Epidemiology and Biostatistics, Institution of Public Health, University of Gondar, Gondar, Ethiopia
| | - Mezgebu Silamsaw Asres
- Department of Internal Medicine, School of Medicine, University of Gondar, Gondar, Ethiopia
| | - Mebratu Mitiku Reta
- Department of Internal Medicine, School of Medicine, University of Gondar, Gondar, Ethiopia
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19
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Exploring HIV-Related Stigma and Discrimination at the Workplace in Southwestern Uganda: Challenges and Solutions. ADVANCES IN PUBLIC HEALTH 2020. [DOI: 10.1155/2020/8833166] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Globally, the HIV/AIDS pandemic continues to have an enormous impact on affected societies. Despite several health promotion interventions being carried out, HIV/AIDS remains a major cause of deaths in low and middle income countries. At the workplace, the pandemic has brought about reduction in productivity, increased staff turnover, increased production costs, high levels of stigma, etc. HIV stigma is one of the main reasons why the pandemic has continued to devastate a number of societies around the world. HIV stigma presents barriers to HIV prevention in different settings including the workplace. Unlike large enterprises, small-scale enterprises have received less attention in the fight against HIV/AIDS. This study’s purpose was to explore how employers and employees can overcome challenges of HIV-related stigma at the workplace. This study employed a qualitative case study design. Data were collected from eighteen participants in three small-scale enterprises in Kabale. Findings indicate that small-scale enterprises are faced with the fear of HIV testing, status disclosure, staff turnover, suicidal thoughts, gossip, etc. Implementing operative national HIV workplace policies may enable small-scale enterprises to overcome challenges of HIV-related stigma at the workplace.
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20
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Gebreegziabhier Kindaya G, Kassaw Demoze C. Lifetime Prevalence and Determinants of Suicidal Ideation and Attempt Among All Patients Living with HIV/AIDS in Hiwot Fana Specialized Hospital, Harar, Ethiopia, 2020. HIV AIDS-RESEARCH AND PALLIATIVE CARE 2020; 12:331-339. [PMID: 32821172 PMCID: PMC7418163 DOI: 10.2147/hiv.s257502] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Accepted: 07/31/2020] [Indexed: 11/23/2022]
Abstract
Background Suicide is a psychiatric emergency and the second leading cause of death among youths. Suicide risk is 7 to 36 times greater among PLWHA as compared to the general population. This study was aimed at determining the prevalence of suicide and its associated factors among PLWHA and attendings at Hiwot Fana Specialized University Hospital, Ethiopia, 2020. Patients and Methods We conducted a cross-sectional study on 412 randomly selected respondent PLWHA and attendingz at Hiwot Fana Specialized University Hospital from February 1–March 1, 2020. The interviewers administered a structured questionnaire consisting of the World Health Organization Composite International Diagnostic Interview (CIDI) tool to measure suicidality. We used the clinical records to collect clinical variables of the respondents. We used simple logistic regression ≤ 0.25 at p-value ≤ 0.25 and multiple logistic regression at p-value ≤ 0.05 to identify the predictor variables of the outcome. Results A total of 412 participants have completed the questionnaire, with a response rate of 97.4%. The majority, 252 (61.2) of the participants were female, while 112 (27.2%) of the respondents were in the age group of 28–37. The prevalence of suicidal ideation and attempt among PLWHA was 24.3% (CI; 20.4, 28.4) and 12.6% (9.5–15.8), respectively. Predictors for suicidal ideation were being in extreme poverty, living alone, widowed, CD4 level less than 250, and current alcohol use, and for suicidal attempt were an urban residence, stage IV HIV, family history of suicide, and depression. Conclusion Nearly one-fourth of the respondents reported suicidal ideation. So, early screening and working on those identified predictors of suicidality is vital to prevent the mortality of it in PLWHA.
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Affiliation(s)
| | - Chalachew Kassaw Demoze
- Department of Psychiatry, College of Medicine and Health Science, Dilla University, Dilla, Ethiopia
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21
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Cecchini D, Alcaide ML, Rodriguez VDJ, Mandell LN, Abbamonte JM, Cassetti I, Cahn P, Sued O, Weiss SM, Jones DL. Women of Reproductive Age Living with HIV in Argentina: Unique Challenges for Reengagement in Care. J Int Assoc Provid AIDS Care 2020; 18:2325958219883250. [PMID: 31623511 PMCID: PMC6900676 DOI: 10.1177/2325958219883250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
This study evaluated the reasons for not taking antiretroviral treatment (ART) among
women of reproductive age who are disengaged from HIV care (have missed pharmacy pickups
and physician visits), with the goal of identifying strategies for reengagement in HIV
care. Participants were cisgender women (n = 162), 18 to 49 years of age, and who
completed sociodemographic, medical history, reasons why they were not taking ART, mental
health, motivation, and self-efficacy assessments. Latent class analysis was used for
analysis. Women who reported avoidance-based coping (avoid thinking about HIV) had higher
depression (U = 608.5, z = −2.7, P =
.007), lower motivation (U = 601, z = −2.8,
P = .006), and lower self-efficacy (U = 644.5,
z = −2.4, P = .017) than those not using this
maladaptive strategy. As women living with HIV experience a disproportionate burden of
poor health outcomes, interventions focused on the management of depression may improve
HIV outcomes and prevent HIV transmission.
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Affiliation(s)
| | - Maria Luisa Alcaide
- Department of Medicine, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Violeta de Jesus Rodriguez
- Department of Psychology, University of Georgia, Athens, GA, USA.,Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Lissa Nicole Mandell
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | - John Michael Abbamonte
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | | | - Pedro Cahn
- Fundacion Huesped, Buenos Aires, Argentina
| | - Omar Sued
- Fundacion Huesped, Buenos Aires, Argentina
| | - Stephen Marshall Weiss
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Deborah Lynne Jones
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
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Mandell LN, Rodriguez VJ, De La Rosa A, Abbamonte JM, Sued O, Cecchini D, Cassetti I, Cahn P, Weiss SM, Jones DL. Suicidal Ideation Among Adults Re-engaging in HIV Care in Argentina. AIDS Behav 2019; 23:3427-3434. [PMID: 31049810 DOI: 10.1007/s10461-019-02526-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Argentina has one of the highest suicide rates in Latin America and the Caribbean. Though people living with HIV are at increased risk for suicidal behavior, little research on suicide risk has been conducted among HIV-positive people in this region. This study examined risk factors for suicidal ideation among HIV-infected adults (N = 360) re-engaging in care in Argentina. Overall, 21% of participants reported suicidal ideation in the past week. In adjusted logistic regression models, younger age, increased depressive symptomatology, and drug abuse were associated with suicidal ideation (p < 0.05); decreased motivation for adherence and fewer months since initiating antiretroviral therapy approached significance (p = 0.07). Suicidal ideation was common in this sample of HIV-positive patients in Argentina. Findings highlight the need for routine risk assessment and interventions integrated into the HIV care continuum, addressing depression, substance use, and suicidal behavior.
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Affiliation(s)
- Lissa N Mandell
- Department of Psychiatry & Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Violeta J Rodriguez
- Department of Psychiatry & Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
- Department of Psychology, University of Georgia, Athens, GA, USA
| | - Aileen De La Rosa
- Department of Psychiatry & Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | - John M Abbamonte
- Department of Psychiatry & Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Omar Sued
- Fundación Huésped, Buenos Aires, Argentina
| | | | | | - Pedro Cahn
- Fundación Huésped, Buenos Aires, Argentina
| | - Stephen M Weiss
- Department of Psychiatry & Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Deborah L Jones
- Department of Psychiatry & Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL, USA.
- University of Miami Miller School of Medicine, 1400 NW 10th Ave., Suite 404A, Miami, FL, 33136, USA.
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Wonde M, Mulat H, Birhanu A, Biru A, Kassew T, Shumet S. The magnitude of suicidal ideation, attempts and associated factors of HIV positive youth attending ART follow ups at St. Paul's hospital Millennium Medical College and St. Peter's specialized hospital, Addis Ababa, Ethiopia, 2018. PLoS One 2019; 14:e0224371. [PMID: 31689299 PMCID: PMC6830816 DOI: 10.1371/journal.pone.0224371] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Accepted: 10/12/2019] [Indexed: 11/26/2022] Open
Abstract
Background Suicide which is considered a psychiatric emergency, is a serious cause of mortality worldwide. Youth living with HIV/AIDS (YLWHA) have higher rates of suicidal behavior than the general public. This study aimed to assess the magnitude and associated factors of suicide ideation and attempt among the Human Immune deficiency Virus (HIV) positive youth attending anti-retroviral therapy (ART) follow up at St. Paul`s hospital Millennium Medical College and St. Peter`s specialized hospital, Addis Ababa, Ethiopia. Methods In this cross-sectional study, 413 HIV positive youth were recruited for interviews, using the systematic random sampling technique. The Composite International Diagnostic Interview (CIDI) was used to assess suicide. PHQ-9, the Oslo social support and HIV perceived stigma scale instruments were used to assess the factors. We computed bivariate and multivariable binary logistic regressions to assess factors associated with suicidal ideation and attempt. Statistical significance was declared at P-value <0.05. Result The magnitude of suicidal ideation and attempts were found to be 27.1% and 16.9%, respectively. In the multivariate analysis, female sex (adjusted odd ratio(AOR) = 3.1, 95% CI, 1.6–6.0), family death (AOR = 2.1, 95%CI 1.15–3.85), WHO clinical stage III of HIV (AOR = 3.1 95% CI 1.3–7.35), WHO clinical stage IV of HIV (AOR = 4.76, 95%CI, 1.3–7.35), co-morbid depression (AOR = 7.14, 95%CI, 3.9–12.9), and perceived HIV stigma (AOR = 4.2, 95%CI, 2.27–8.2) were significantly associated with suicidal ideation, whereas female sex (AOR = 4.12, 95%CI, 1.82–9.78), opportunistic infections (AOR = 3.1, 95%CI, 1.6–6.04), WHO clinical stage III of HIV (AOR = 3.1 95%CI 1.24–7.81), co-morbid depression (AOR = 5.6 95% CI, 2.8–11.1), and poor social support (AOR = 3.4, 95%CI, 1.2–9.4) were statistically significant with suicidal attempt. The result suggests that the magnitude of suicidal ideation and attempts among HIV positive youth were high. We recommend that clinicians consider youth with comorbid depression, perceived HIV stigma and poor social support.
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Affiliation(s)
- Mesele Wonde
- Department of Psychiatry, University of Gondar, Gondar, Ethiopia
| | - Haregewoin Mulat
- Department of Psychiatry, University of Gondar, Gondar, Ethiopia
| | - Addis Birhanu
- Amanuel Mental Specialized Hospital, Addis Ababa, Ethiopia
| | - Aynalem Biru
- Amanuel Mental Specialized Hospital, Addis Ababa, Ethiopia
| | - Tilahun Kassew
- Department of Psychiatry, University of Gondar, Gondar, Ethiopia
| | - Shegaye Shumet
- Department of Psychiatry, University of Gondar, Gondar, Ethiopia
- * E-mail:
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Stanton AM, Goodman G, Looby SE, Robbins GK, Psaros C. Sexuality and Intimacy Among Older Women Living with HIV: a Systematic Review. CURRENT SEXUAL HEALTH REPORTS 2019; 11:320-330. [PMID: 34045930 DOI: 10.1007/s11930-019-00227-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Purpose of Review Sexual well-being and intimacy are critical to overall quality of life and retain a high degree of significance for aging individuals, even though these considerations are often overlooked in older populations. Sexual health may be particularly impacted in older individuals living with HIV, especially women, as a result of both physical and psychosocial disease-specific factors. Despite this, sexuality research related to HIV has traditionally focused on risk reduction, rather than on other elements of sexual wellness. In this review, we examine several aspects of sexual well-being that may be important to older women living with HIV (OWLH). Recent Findings This review summarizes existing literature on sexuality in OWLH over the age of 50 and explores five themes related to sexual health: physical and emotional intimacy, desire/interest, satisfaction/pleasure, frequency of sexual activity, and abstinence. Reduced intimacy among OWLH was reported across most studies, due to stigma and disclosure concerns, lack of opportunity for relationships, and difficulty communicating sexual preferences. Data on sexual desire/interest and satisfaction/pleasure among OWLH were mixed. Frequency of sexual activity varied widely across studies, and abstinence emerged as both an intentional and inadvertent decision for OWLH. Factors related to menopause as it relates to sexuality and HIV are also discussed. Summary Sexual health and well-being are important to women living with HIV over 50, though key components such as intimacy, desire, and pleasure remain poorly understood. As this population continues to grow, comprehensive and age-specific interventions are needed to examine positive aspects of sexuality and promote sexual wellness among OWLH.
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Affiliation(s)
- Amelia M Stanton
- Department of Psychiatry, Massachusetts General Hospital/Harvard Medical School, Boston, MA, USA.,The Fenway Institute, Fenway Health, Boston, MA, USA
| | - Georgia Goodman
- Department of Psychiatry, Massachusetts General Hospital/Harvard Medical School, Boston, MA, USA.,The Fenway Institute, Fenway Health, Boston, MA, USA
| | - Sara E Looby
- Program in Nutritional Metabolism, Massachusetts General Hospital, Boston, MA, USA.,Yvonne L. Munn Center for Nursing Research, Massachusetts General Hospital, Boston, MA, USA
| | - Gregory K Robbins
- Division of Infectious Diseases, Massachusetts General Hospital/Harvard Medical School, Boston, MA, USA
| | - Christina Psaros
- Department of Psychiatry, Massachusetts General Hospital/Harvard Medical School, Boston, MA, USA
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Tyree GA, Vaida F, Zisook S, Mathews WC, Grelotti DJ. Clinical correlates of depression chronicity among people living with HIV: What is the role of suicidal ideation? J Affect Disord 2019; 258:163-171. [PMID: 31426014 PMCID: PMC6909554 DOI: 10.1016/j.jad.2019.07.081] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Revised: 07/16/2019] [Accepted: 07/29/2019] [Indexed: 12/25/2022]
Abstract
BACKGROUND Chronicity of depression among people living with HIV (PLWH) is associated with poorer viral suppression and mortality risk. The extent to which suicidal ideation (SI) and other baseline characteristics predict a prolonged duration of depressive illness among PLWH is not known but could help identify PLWH most at risk. METHODS Data were drawn from a sample of 1002 depressed PLWH engaged in primary care at a metropolitan HIV clinic from 2007-2018, representing 2,569 person-years. Depression characteristics were derived from the Patient Health Questionnaire 9 (PHQ-9), administered during routine screening. Other characteristics were derived from clinic data. Unadjusted and covariate-adjusted survival analyses compared the time to depression remission between depressed participants with and without SI at their initial screening. RESULTS At baseline, 38.4% of depressed PLWH endorsed SI. Depressed PLWH with SI took significantly longer to achieve remission from depression than those without SI. The association appeared to be mediated by depression symptom severity. When adjusted for age, depression diagnosis, any recent drug use, and depression symptom severity, baseline SI no longer predicted remission hazard. LIMITATIONS Participants were assessed for depression with variable frequency. The analysis assumed all patients received comparable treatment for their depression. Some variables were based on clinic measurements that may be subject to misclassification bias. CONCLUSIONS These data suggest that depressed PLWH with SI are at risk for greater chronicity of depression because their depression is more severe. Accordingly, PLWH should be urgently engaged in psychiatric care in the event of SI or severe depressive symptoms.
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Affiliation(s)
- Griffin A Tyree
- School of Medicine, University of California San Diego, La Jolla, CA, USA
| | - Florin Vaida
- Department of Family Medicine and Public Health, University of California San Diego, La Jolla, CA, USA; HIV Neurobehavioral Research Program, University of California San Diego, San Diego, CA, USA
| | - Sidney Zisook
- Department of Psychiatry, University of California San Diego, La Jolla, CA, USA
| | - William C Mathews
- Center for AIDS Research, University of California San Diego, La Jolla, CA, USA
| | - David J Grelotti
- HIV Neurobehavioral Research Program, University of California San Diego, San Diego, CA, USA; Department of Psychiatry, University of California San Diego, La Jolla, CA, USA; Center for AIDS Research, University of California San Diego, La Jolla, CA, USA.
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Erlandson KM, Karris MY. HIV and Aging: Reconsidering the Approach to Management of Comorbidities. Infect Dis Clin North Am 2019; 33:769-786. [PMID: 31395144 PMCID: PMC6690376 DOI: 10.1016/j.idc.2019.04.005] [Citation(s) in RCA: 61] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Health care for older adults with human immunodeficiency virus can be highly complex, resource intensive, and carry a high administrative burden. Data from aging longitudinal cohorts and feedback from the human immunodeficiency virus community suggest that the current model is not meeting the needs of these older adults. We introduce the 6 Ms approach, which acknowledges the multicomplexity of older adults with human immunodeficiency virus, simplifies geriatric principles for non-geriatrics-trained providers, and minimizes extensive training and specialized screening tests or tools. Implementing novel approaches to care requires support at local/national levels.
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Affiliation(s)
- Kristine M Erlandson
- University of Colorado, Anschutz Medical Campus, 12700 East 19th Avenue, Mail Stop B168, Aurora, CO 80045, USA.
| | - Maile Y Karris
- University of California San Diego, 200 West Arbor Drive #8208, San Diego, CA 92103-8208, USA
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27
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Depressive symptoms, physical symptoms, and health-related quality of life among older adults with HIV. Qual Life Res 2019; 28:3313-3322. [PMID: 31446515 DOI: 10.1007/s11136-019-02271-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/09/2019] [Indexed: 12/13/2022]
Abstract
PURPOSE In the United States, approximately 45% of persons living with HIV (PLHIV) are ≥ 50 years of age. Many older PLHIV have multi-morbidities that complicate HIV infection and/or interfere with, or are exacerbated by, antiretroviral treatment. Physical health symptoms and psychiatric disorders, particularly depression, can worsen life quality in older PLHIV. METHODS This study assessed associations among physical symptoms, indicators of HIV-related health status (i.e., time since diagnosis; ever diagnosed with AIDS; having attained viral suppression), depressive symptoms, and health-related quality of life (HRQoL) in older PLHIV. Regression analyses examined data from 296 PLHIV ≥ 50 years of age living in Cincinnati, OH, Columbus, OH, and New York City. RESULTS Depressive symptoms and physical symptoms, particularly those related to appearance and sexual functioning, most strongly predicted HRQoL. Indicators of HIV health status did not significantly predict HRQoL. Depressive symptoms were a particularly robust predictor of HRQoL, even when accounting for physical health symptoms. CONCLUSION Findings suggest that symptom management is critical to HRQoL in older PLHIV, and symptoms related to physical appearance and sexual functioning should not be overlooked in this growing population.
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28
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Finkelstein-Fox L, Park CL, Kalichman SC. Health benefits of positive reappraisal coping among people living with HIV/AIDS: A systematic review. Health Psychol Rev 2019; 14:394-426. [PMID: 31284849 DOI: 10.1080/17437199.2019.1641424] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
People living with HIV/AIDS (PLWHA) often face significant stress, ranging from perceiving identity changes to encountering barriers to daily health behavior engagement. To manage these experiences, many people use positive reappraisal coping (including benefit finding and perceiving growth). Effective coping is highly important for PLWHA; stress reduction has salutary effects on multiple indicators of health. The present systematic review, conducted in PubMed, PsycINFO, and CINAHL, synthesises findings from 33 studies of PLWHA, addressing effects of positive reappraisal on health-related outcomes for adults living with HIV as a chronic illness. Studies were evaluated based on methodological considerations, measurement of key variables, and implications for specific aspects of health. Results suggest that positive reappraisal is often beneficial when dealing with the implications of a potentially traumatic HIV diagnosis on one's identity, although effects may be contextually bound. Implications of these findings are reviewed, emphasizing the importance of positive reappraisal for enhancing health promotion and self-management of HIV. Although the present review is limited by inclusion of multiple disparate outcomes and exclusion of non-English-language articles, these findings inform a comprehensive model of direct and indirect effects of positive reappraisal on emotional, functional, physiological, and behavioural aspects of health useful for guiding future research.
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Affiliation(s)
| | - Crystal L Park
- Department of Psychological Sciences, University of Connecticut, Storrs, CT
| | - Seth C Kalichman
- Department of Psychological Sciences, University of Connecticut, Storrs, CT
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29
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Hunter-Jones JJ, Gilliam SM, Carswell AL, Hansen NB. Assessing the Acceptability of a Mindfulness-Based Cognitive Therapy Intervention for African-American Women Living with HIV/AIDS. J Racial Ethn Health Disparities 2019; 6:1157-1166. [PMID: 31332688 DOI: 10.1007/s40615-019-00617-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Revised: 07/01/2019] [Accepted: 07/11/2019] [Indexed: 11/24/2022]
Abstract
African-American HIV-seropositive women are at elevated risk for depressive symptoms compared to their seropositive counterparts. Depressive symptoms have been linked to HIV/AIDS-related health predictors and outcomes such as medication and care adherence, and viral load. Project UPLIFT, a mindfulness-based cognitive therapy intervention originally designed for persons with epilepsy has been shown effective to reduce depressive and anxiety symptoms. Focus groups were conducted to assess the appropriateness and acceptability of UPLIFT for African-American HIV-seropositive women and to obtain feedback on needed modifications. The focus groups, including cisgender and transgender African-American HIV-seropositive women, revealed, while well received, modifications should include lowering the reading level of content and altering specific mindfulness-based exercises to make them relevant and acceptable to the target population. This qualitative work demonstrates UPLIFT could be a promising avenue to improve the mental health of African-American HIV-seropositive women, a group for which mindfulness interventions had not been previously considered. SIGNIFICANCE: Mindfulness-based interventions have been found effective in reducing depression, anxiety, and chronic pain. Further, it has been used for groups living with chronic illness, particularly HIV/AIDS. It has helped to improve mental and behavioral health, as well as increase CD4 count and reduce viral load for some samples of people living with HIV/AIDS. African-American women living with HIV/AIDS are especially vulnerable to poor mental and behavioral health given their experience of mental illness and hesitancy to engage mental healthcare. Though used for other groups of people living with HIV/AIDS, mindfulness-based cognitive therapy has not previously been considered for this population. This study explored the acceptability and feasibility of an MBCT intervention for this group. The data suggests that this intervention could be potentially useful in improving the mental health of this population, and includes suggestions for making the intervention culturally relevant.
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Affiliation(s)
- Josalin J Hunter-Jones
- SSchool of Social Work, College of Health and Human Sciences, University of North Carolina Wilmington, Wilmington, NC, USA.
| | - Shantesica M Gilliam
- Department of Health Promotion and Behavior, College of Public Health, University of Georgia, Athens, GA, USA
| | | | - Nathan B Hansen
- Department of Health Promotion and Behavior, College of Public Health, University of Georgia, Athens, GA, USA
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30
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Mannes ZL, Bryant VE, Burrell LE, Lu H, Ferguson EG, Zhou Z, Cook RL, Ennis N. The prevalence and patterns of substance use by birth cohort among HIV-positive adults in Florida. Aging Ment Health 2019; 23:515-523. [PMID: 29436844 PMCID: PMC6286223 DOI: 10.1080/13607863.2018.1430740] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
OBJECTIVES Antiretroviral therapy is affording longer lifespans for people living with HIV (PLWH), yet factors such as substance use play an increasing role in morbidity and mortality in this population. Though previous studies have examined substance use differences between age cohorts of PLWH, no study has examined the influence of birth cohort on current substance use patterns. Thus, this study investigated the prevalence of past 12-month self-reported substance use between four birth cohorts, <1970 (M age = 54.1), 1970s (M age = 41.5), 1980s (M age = 31.3 years old), and 1990s (M age = 23.2 years old) of PLWH in Florida. METHODS PLWH (N = 934) recruited from community health clinics in Florida completed a questionnaire assessing sociodemographics, health status, and substance use. Multivariate logistic regressions utilizing the <1970 cohort as the referent group examined the relationship between birth cohort and substance use. RESULTS The 1980s cohort had significantly greater odds of marijuana use compared to the oldest cohort (<1970s), while the three younger cohorts (1970s, 1980s, and 1990s) evidenced a significantly greater odds of ecstasy use compared to the oldest group. Contrastingly, the three younger birth cohorts reported significantly less crack use than the oldest cohort, while the youngest group (1990s) also demonstrated an 80% reduction in injection drug use compared to the oldest group. CONCLUSION The older cohort evidenced significantly greater crack and injection drug use, while the younger cohorts evidenced greater marijuana and ecstasy use. Therefore, it is important to develop age-specific substance use interventions among PLWH.
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Affiliation(s)
- Zachary L. Mannes
- Corresponding Author: Zachary L. Mannes, NIDA Predoctoral Fellow, Department of Clinical & Health Psychology College of Public Health and Health Professions, University of Florida, P.O. Box 100165, 1225 Center Drive, Room 3146, Gainesville, FL 32610-0165, Phone: +1-(352)-273-6617,
| | - Vaughn E. Bryant
- Department of Clinical and Health Psychology, College of Public Health and Health Professions, University of Florida, P.O. Box 100165, 1225 Center Drive, Room 3146 Gainesville, FL, 32610-0165, United States, ,+1-(352)-273-6617
| | - Larry E. Burrell
- Department of Clinical and Health Psychology, College of Public Health and Health Professions, University of Florida, P.O. Box 100165, 1225 Center Drive, Room 3146 Gainesville, FL, 32610-0165, United States, ,+1-(352)-273-6617
| | - Huiyin Lu
- Department of Biostatistics, College of Public Health and Health Professions & College of Medicine, University of Florida, P.O. Box 117450, 2004 Mowry Road, 5th Floor CTRB, Gainesville, Florida, 32611-7450, United States, , (352)-294-5770
| | - Erin G. Ferguson
- Department of Clinical and Health Psychology, College of Public Health and Health Professions, University of Florida, P.O. Box 100165, 1225 Center Drive, Room 3146 Gainesville, FL, 32610-0165, United States, ,+1-(352)-273-6617
| | - Zhi Zhou
- Department of Epidemiology, College of Public Health and Health Professions & College of Medicine, University of Florida, P.O. Box 100231, 2004 Mowry Road, Gainesville, FL 32610, United States, , (352) 294-5949
| | - Robert L. Cook
- Department of Epidemiology, College of Public Health and Health Professions & College of Medicine, University of Florida, P.O. Box 100231, 2004 Mowry Road, Gainesville, FL 32610, United States, , (352) 273-5869
| | - Nicole Ennis
- Department of Clinical and Health Psychology, College of Public Health and Health Professions, University of Florida, P.O. Box 100165, 1225 Center Drive, Room 3146 Gainesville, FL, 32610-0165, United States, , +1-(352)-273-6617
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Cysique LA, Brew BJ. Comorbid depression and apathy in HIV-associated neurocognitive disorders in the era of chronic HIV infection. HANDBOOK OF CLINICAL NEUROLOGY 2019; 165:71-82. [PMID: 31727231 DOI: 10.1016/b978-0-444-64012-3.00006-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
This chapter provides an overview of the current research on the question of depression and apathy in HIV-associated neurocognitive disorders (HAND) in the era of chronic HIV infection. After presenting the epidemiology of each condition showing that depression and apathy are the two most frequent psychiatric comorbidities of HAND, we review the current research, particularly in relation to the milder forms of HAND that characterize treated HIV cohorts. Doing so, we include findings on depression and apathy in non-HIV aging population and the risk of dementia, findings that are relevant to the aging HIV cohorts carrying a high burden of psychiatric comorbidities. We then present a review of the research pertaining to the differentiation between depression and apathy. A section is dedicated to the question of suicidality in chronic HIV infection, which is underappreciated. An overview of the pharmacologic and psychosocial interventions relevant to depression and apathy in HIV cohorts treated with antiretroviral treatment is provided. The chapter concludes with future directions for the research on apathy and depression with emphasis on the question of aging and the need for longitudinal studies.
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Affiliation(s)
- Lucette A Cysique
- Neuroscience Research Australia, Randwick, NSW, Australia; Peter Duncan Neurosciences Unit, St. Vincent's Centre for Applied Medical Research, Sydney, NSW, Australia
| | - Bruce J Brew
- Neurology and HIV Departments, St. Vincent's Hospital, Sydney, NSW, Australia; Peter Duncan Neurosciences Unit, St. Vincent's Centre for Applied Medical Research, Sydney, NSW, Australia.
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Vitale A, Ryde J. Exploring Risk Factors Affecting the Mental Health of Refugee Women Living with HIV. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15102326. [PMID: 30360458 PMCID: PMC6209869 DOI: 10.3390/ijerph15102326] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Revised: 10/15/2018] [Accepted: 10/16/2018] [Indexed: 12/21/2022]
Abstract
Little is known about how the intersection of being a forced migrant and living with HIV can contribute to the development or exacerbation of pre-existing mental conditions. This study is set in this context and it aims to explore specific risk factors affecting the mental health of refugee women living with HIV. A total of eight refugee women living with HIV took part in the study; they were individually interviewed, and their transcripts were thematically analyzed. The overall findings indicated that participants’ mental health was impaired by multiple stressors associated with their conditions, such as racial discrimination, HIV-related stigma, including from health professionals, loneliness, and resettlement adversities. These all represent threats to public health, as they discourage individuals from engaging with adequate health/mental health services. Despite their situation, participants had not received psychological interventions and their healthcare was reduced to managing the physical symptoms of HIV. Participants indicated their need to take part in group interventions that could promote their mental health and social recovery. These findings are relevant to raising awareness about the specific risk factors affecting refugee women living with HIV and to provide evidence for public health interventions based on this specific population’s need.
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Affiliation(s)
- Agata Vitale
- College of Liberal Arts (CoLA), Bath Spa University, Newton Park, Bath BA29BN, UK.
| | - Judy Ryde
- Trauma Foundation South West, Barrow Castle, Rush Hill, Bath BA22QR, UK.
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Rodriguez VJ, Mandell LN, Babayigit S, Manohar RR, Weiss SM, Jones DL. Correlates of Suicidal Ideation During Pregnancy and Postpartum Among Women Living with HIV in Rural South Africa. AIDS Behav 2018; 22:3188-3197. [PMID: 29752621 DOI: 10.1007/s10461-018-2153-y] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
In developing countries, up to 20% of maternal deaths during pregnancy are due to suicide, and being HIV-infected confers additional risk. This manuscript sought to identify perinatal correlates of suicidal ideation among women living with HIV (WLHIV) in rural South Africa. Pregnant WLHIV (N = 681) were recruited and re-assessed at 12-months postpartum. Mean age was 28.3 (SD = 5.7) years and 68% were below the poverty line. Prenatal suicidal ideation was 39%; suicidal ideation continued for 7% at 12 months, 13% experienced incident suicidal ideation, and for 19% suicidal ideation had stopped postnatally. Intimate partner violence (AOR = 1.17) and depression (AOR = 1.14) predicted sustained suicidal ideation. Increased income (AOR = 2.25) and greater stigma (AOR = 1.33) predicted incident suicidal ideation. Younger age (AOR = 0.94), disclosure of HIV status to partner (AOR = 0.60), and greater stigma (AOR = 1.24) predicted postnatal cessation of suicidal ideation. Perinatal care may provide windows of opportunity for identification and treatment of suicidal ideation.
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Rodriguez VJ, Sued O, Cecchini D, Mandell LN, Bofill LM, Weiss SM, Cassetti I, Cahn P, Jones DL. Suicidality among nonadherent patients living with HIV in Buenos Aires, Argentina: prevalence and correlates. AIDS Care 2018; 30:1380-1387. [PMID: 29607661 DOI: 10.1080/09540121.2018.1458974] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Of those in the general population hospitalized for suicidal ideation and suicide attempts in Argentina, many reattempt suicide and are readmitted. However, few studies in Argentina have examined suicidal ideation and suicide-related behaviors among people living with HIV (PLHIV) and none have examined these factors among nonadherent PLHIV, though the prevalence of suicidal ideation in this group may be higher than in the general population and also than in other groups of PLHIV. This study of PLHIV in Buenos Aires, Argentina, examined the correlates of suicidal ideation in nonadherent PLHIV. Nonadherent patients with HIV (N = 118) were recruited from two clinics providing outpatient healthcare services to PLHIV in Buenos Aires, Argentina. Participants completed assessments on demographic characteristics, depression and suicidality, stigma, and self-efficacy. Participants were HIV-infected men (51%) and women (49%) with a median age of 40 years (IQR = 11). About half had completed high school or more, two-thirds were employed, and had a mean monthly income of 4196.79 (SD = 3179.64) Argentine pesos (USD$221). Thirty-three (28% [95% CI 20.3, 37.3]) participants reported suicidal ideation in the past two weeks, and one-third (35.6% [27.1, 44.9]) reported lifetime suicidal ideation. In bivariate analyses, attending a public clinic, being female, younger, unemployed, and experiencing greater stigma and depression were associated with suicidal ideation. In multivariable logistic regression, stigma interacted with the number of years since HIV diagnosis to predict suicidal ideation. The impact of stigma on suicidal ideation decreased with time since HIV diagnosis, suggesting that suicidal ideation may arise following HIV diagnosis due to perception of HIV-related stigma. Interventions to reduce perceived stigma during the period following HIV diagnosis may reduce suicidal ideation in this population. Organizational initiatives that explore HIV stigma microagressions in the healthcare setting may be needed to optimize health outcomes.
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Affiliation(s)
- Violeta J Rodriguez
- a Department of Psychiatry and Behavioral Sciences , University of Miami Miller School of Medicine , Miami , FL , USA.,d Department of Psychology , University of Georgia
| | - Omar Sued
- b Fundación Huésped , Buenos Aires , Argentina
| | | | - Lissa N Mandell
- a Department of Psychiatry and Behavioral Sciences , University of Miami Miller School of Medicine , Miami , FL , USA
| | - Lina M Bofill
- a Department of Psychiatry and Behavioral Sciences , University of Miami Miller School of Medicine , Miami , FL , USA
| | - Stephen M Weiss
- a Department of Psychiatry and Behavioral Sciences , University of Miami Miller School of Medicine , Miami , FL , USA
| | | | - Pedro Cahn
- b Fundación Huésped , Buenos Aires , Argentina
| | - Deborah L Jones
- a Department of Psychiatry and Behavioral Sciences , University of Miami Miller School of Medicine , Miami , FL , USA
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Kiosses DN, Alexopoulos GS, Hajcak G, Apfeldorf W, Duberstein PR, Putrino D, Gross JJ. Cognitive Reappraisal Intervention for Suicide Prevention (CRISP) for Middle-Aged and Older Adults Hospitalized for Suicidality. Am J Geriatr Psychiatry 2018; 26:494-503. [PMID: 29395858 PMCID: PMC5860974 DOI: 10.1016/j.jagp.2017.11.009] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Revised: 10/31/2017] [Accepted: 11/12/2017] [Indexed: 11/25/2022]
Abstract
Middle-aged and older adults constitute a high suicide-risk group. Among adults aged 50 years old and older, suicide rates increased and suicide deaths almost doubled during the period from 2000 to 2015. Suicide rates are elevated for patients hospitalized for suicidality (i.e., active suicidal ideation or suicide attempt) and the 3 months post-hospitalization is the time of the highest suicide risk. Psychosocial interventions for middle-aged and older adults hospitalized for suicidality are sparse. In this article, we present the main aspects, stages, techniques and a clinical case study of Cognitive Reappraisal Intervention for Suicide Prevention (CRISP), a psychosocial intervention targeting cognitive reappraisal to reduce suicide risk in middle-aged and older adults who have been recently hospitalized for suicidal ideation or a suicide attempt. CRISP is based on the theory that hospitalization for suicidality is preceded by an emotional crisis ("perfect storm"); this emotional crisis is related to personalized (patient- and situation-specific) triggers; and identifying these personalized triggers and the associated negative emotions and providing strategies for an adaptive response to these triggers and negative emotions will reduce suicidal ideation and improve suicide prevention. CRISP therapists identify these triggers of negative emotions and use cognitive reappraisal techniques to reduce these negative emotions. The cognitive reappraisal techniques have been selected from different psychosocial interventions and the affective neuroscience literature and have been simplified for use with middle-aged and older adults. CRISP may fill a treatment need for the post-discharge high-risk period for middle-aged and older adults hospitalized for suicidality.
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Affiliation(s)
- Dimitris N. Kiosses
- Psychology in Clinical Psychiatry, Weill-Cornell Institute of Geriatric Psychiatry, Weill Cornell Medical College
| | | | - Greg Hajcak
- Biomedical Sciences and Psychology, Florida State University
| | - William Apfeldorf
- Clinical Psychiatry, Weill-Cornell Institute of Geriatric Psychiatry, Weill Cornell Medicine
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Lutz J, Fiske A. Functional disability and suicidal behavior in middle-aged and older adults: A systematic critical review. J Affect Disord 2018; 227:260-271. [PMID: 29107819 DOI: 10.1016/j.jad.2017.10.043] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2017] [Revised: 10/23/2017] [Accepted: 10/27/2017] [Indexed: 11/17/2022]
Abstract
BACKGROUND Middle-aged and older adults have elevated rates of suicide around the globe, but there is a paucity of knowledge about risk factors for suicide in these age groups. One possible risk factor may be functional disability, which is more common at later ages. METHODS The current systematic critical review examined findings regarding the associations between functional disability and suicidal behavior (suicidal ideation, suicide attempts, and death by suicide) in middle-aged and older adults (i.e. age 50 and older). RESULTS Forty-five studies were found that examined these associations. The majority of studies supported a significant association between functional disability and suicidal ideation. In addition, findings to date strongly suggest that depression serves as a mediator of the association between functional disability and suicidal ideation, though most studies did not directly test for mediation. LIMITATIONS Firm conclusions regarding suicide attempts and death by suicide, as well as mediation, cannot be drawn due to a relative lack of research in these areas. CONCLUSIONS The association between functional disability and suicidal behavior suggests an important area for prevention and intervention among middle-aged and older adults, but additional research is necessary to clarify the specifics of these associations and examine appropriate intervention strategies. Important future directions for research in this area include the direct comparison of associations of risk factors with different types of suicidal behavior, greater use of longitudinal data with multiple time points, and further examination of potential mediators and moderators of the association between functional disability and suicidal behavior.
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Affiliation(s)
- Julie Lutz
- West Virginia University, Department of Psychology, Morgantown, WV, United States.
| | - Amy Fiske
- West Virginia University, Department of Psychology, Morgantown, WV, United States; West Virginia University Injury Control Research Center, Morgantown, WV, United States
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Ambrus L, Sunnqvist C, Asp M, Westling S, Westrin Å. Coping and suicide risk in high risk psychiatric patients. J Ment Health 2017; 29:27-32. [PMID: 29260914 DOI: 10.1080/09638237.2017.1417547] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Background: A dysfunctional use of coping strategies has repeatedly been linked to suicidal behaviour in non-psychiatric populations. However, data regarding association between coping strategies and suicidal behaviour in psychiatric populations are limited.Aims: The aim of the study was to investigate the possible relationship between self-reported suicide risk, suicidal ideation and coping strategies in three psychiatric cohorts.Method: Three cohorts of psychiatric patients were involved in the study; recent suicide attempters (n = 55), suicide attempters at follow-up 12 years after a suicide attempt (n = 38) and patients with ongoing depression without attempted suicide (n = 72). Patients filled in the self-rating version of The Suicide Assessment Scale (SUAS-S) from which items no. 17-20 addressing current suicidal ideation were extracted. To investigate coping strategies, the Coping Orientation of Problem Experience Inventory (COPE) was used.Results: In all cohorts, regression analyses showed that only avoidant coping was significantly correlated with the scores of SUAS-S adjusted for covariates. The items no. 17-20 correlated significantly to avoidant coping but not with other coping strategies in all cohorts.Conclusion: The results of this study indicate that among coping strategies only avoidant coping may be associated with suicide risk in psychiatric patients independently of history of attempted suicide.
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Affiliation(s)
- Livia Ambrus
- Department of Clinical Sciences, Section for Psychiatry, Lund University, Lund, Sweden, and
| | | | - Marie Asp
- Department of Clinical Sciences, Section for Psychiatry, Lund University, Lund, Sweden, and
| | - Sofie Westling
- Department of Clinical Sciences, Section for Psychiatry, Lund University, Lund, Sweden, and
| | - Åsa Westrin
- Department of Clinical Sciences, Section for Psychiatry, Lund University, Lund, Sweden, and
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Wyczechowska D, Lin HY, LaPlante A, Jeansonne D, Lassak A, Parsons CH, Molina PE, Peruzzi F. A miRNA Signature for Cognitive Deficits and Alcohol Use Disorder in Persons Living with HIV/AIDS. Front Mol Neurosci 2017; 10:385. [PMID: 29187813 PMCID: PMC5694774 DOI: 10.3389/fnmol.2017.00385] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2017] [Accepted: 11/06/2017] [Indexed: 01/23/2023] Open
Abstract
HIV-associated neurocognitive disorders (HAND) affects more than half of persons living with HIV-1/AIDS (PLWHA). Identification of biomarkers representing the cognitive status of PLWHA is a critical step for implementation of successful cognitive, behavioral and pharmacological strategies to prevent onset and progression of HAND. However, the presence of co-morbidity factors in PLWHA, the most common being substance abuse, can prevent the identification of such biomarkers. We have optimized a protocol to profile plasma miRNAs using quantitative RT-qPCR and found a miRNA signature with very good discriminatory ability to distinguish PLWHA with cognitive impairment from those without cognitive impairment. Here, we have evaluated this miRNA signature in PLWHA with alcohol use disorder (AUD) at LSU Health Sciences Center (LSUHSC). The results show that AUD is a potential confounding factor for the miRNAs associated with cognitive impairment in PLWHA. Furthermore, we have investigated the miRNA signature associated with cognitive impairment in an independent cohort of PLWHA using plasma samples from the CNS HIV Antiretroviral Therapy Effects Research (CHARTER) program. Despite differences between the two cohorts in socioeconomic status, AUD, and likely misuse of illicit or prescription drugs, we validated a miRNA signature for cognitive deficits found at LSUHSC in the CHARTER samples.
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Affiliation(s)
- Dorota Wyczechowska
- Stanley S. Scott Cancer Center, Louisiana State University, New Orleans, LA, United States
| | - Hui-Yi Lin
- Biostatistics Program, School of Public Health, Louisiana State University, New Orleans, LA, United States
| | - Andrea LaPlante
- Department of Psychiatry, University Medical Center, Louisiana State University, New Orleans, LA, United States
| | - Duane Jeansonne
- Stanley S. Scott Cancer Center, Louisiana State University, New Orleans, LA, United States
| | - Adam Lassak
- Stanley S. Scott Cancer Center, Louisiana State University, New Orleans, LA, United States
| | - Christopher H Parsons
- Stanley S. Scott Cancer Center, Department of Medicine, School of Medicine, Louisiana State University, New Orleans, LA, United States
| | - Patricia E Molina
- Alcohol and Drug Abuse Center of Excellence, Department of Physiology, School of Medicine, Louisiana State University, New Orleans, LA, United States
| | - Francesca Peruzzi
- Stanley S. Scott Cancer Center, Alcohol and Drug Abuse Center of Excellence, Department of Medicine, School of Medicine, Louisiana State University, New Orleans, LA, United States
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Bahall M. Prevalence, patterns, and perceived value of complementary and alternative medicine among HIV patients: a descriptive study. BMC COMPLEMENTARY AND ALTERNATIVE MEDICINE 2017; 17:422. [PMID: 28830419 PMCID: PMC5567497 DOI: 10.1186/s12906-017-1928-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/09/2016] [Accepted: 08/15/2017] [Indexed: 01/23/2023]
Abstract
BACKGROUND Use of complementary and alternative medicine (CAM) is widespread among different patient populations despite the availability of evidence-based conventional medicine and lack of supporting evidence for the claims of most CAM types. This study explored the prevalence, patterns, and perceived value of CAM among human immunodeficiency virus (HIV) patients. METHODS This quantitative descriptive study was conducted between November 1, 2014 and March 31, 2015 among a cross-sectional, convenience sample of attendees of the HIV clinic of a public tertiary health care institution. Face-to-face interviews using a 34-item questionnaire were conducted. Data analysis included descriptive statistics, chi-square tests, and binary logistic regression analysis. RESULTS CAM was used by 113 (32.8%) of a total of 343 HIV patients, but <1% informed their health care providers of CAM usage. Medicinal herbs were the most common type of CAM used (n = 110, 97.3%) followed by spiritual therapy (n = 56, 49.6%), including faith healing/prayer and meditation. The most used medicinal herbs were Aloe vera (n = 54, 49.1%), ginger (n = 33, 30.0%), and garlic (n = 23, 20.9%). The most used vitamins were complex B vitamins (n = 70, 61.9%), followed by vitamin A (n = 58, 51.3%), vitamin E (n = 51, 45.1%), and vitamin D (n = 42, 37.1%). Most CAM users continued using conventional medicine in addition to CAM and were willing to use CAM without supervision and without informing their health care provider. Patients were generally satisfied with CAM therapy (n = 91, 80.5%). The main reasons for CAM use were the desire to take control of their treatment (8.8%) or just trying anything that could help (18.8%). Main influences were the mass media (32.7%) and non-hospital health personnel (19.5%). Predictors of CAM use were being 30-50 years, married and having a secondary school education. CONCLUSION About one-third of HIV patients used CAM, but virtually none informed their healthcare provider. Medicinal herbs were the most common type of CAM, followed by spiritual therapy and vitamins. A patient's decision to use CAM was influenced for the most part by the mass media and non- hospital health care personnel.
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Affiliation(s)
- Mandreker Bahall
- School of Medicine and Arthur Lok Jack Graduate School of Business, University of the West Indies, St. Augustine, Trinidad and Tobago.
- Department of Medicine, San Fernando General Hospital, Chancery Lane, San Fernando, Trinidad and Tobago.
- , House #57 LP 62, Calcutta Road Number 3, McBean, Couva, Trinidad, Trinidad and Tobago.
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40
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Egbe CO, Dakum PS, Ekong E, Kohrt BA, Minto JG, Ticao CJ. Depression, suicidality, and alcohol use disorder among people living with HIV/AIDS in Nigeria. BMC Public Health 2017; 17:542. [PMID: 28577548 PMCID: PMC5457576 DOI: 10.1186/s12889-017-4467-5] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Accepted: 05/25/2017] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND People Living with HIV/AIDS (PLHIV) face various day-to-day and long-term personal, interpersonal, social, physical and psychological challenges as a result of, and in addition to the health conditions they are susceptible to due to their HIV status. There is a dearth of large-scale research to provide robust prevalence estimates of mental health problems among PLHIV, especially in Nigeria. This study aimed to ascertain the prevalence and factors associated with major depressive episodes, suicidality, and alcohol use disorder among people living with HIV/AIDS in Nigeria. METHODS A survey of 1187 participants aged 18 years and above was conducted within three HIV treatment centres in Abuja, Nigeria. Depression, suicidality, and alcohol use disorder modules of the WHO World Mental Health Composite International Diagnostic Interview questionnaire were used for this study. A socio-demographic questionnaire was also used to collect other health and demographic data. Descriptive statistics (frequency distribution, percentage, mean, median, mode, and standard deviation) and regression analyses were conducted to explore associations between mental health problems and demographic and other health-related factors. RESULTS Twelve-month prevalence rates were 28.2% for major depressive episodes, 2.9% for suicidal ideation, 2.3% for suicide attempts, 7.8% for harmful alcohol use, 7.0% for alcohol abuse, and 2.2% for alcohol dependence. Major depressive episodes were significantly associated with having planned suicide and marital status. Suicidal ideation was significantly associated with major depressive episodes, marital status, and religion. Females were less likely to be diagnosed with alcohol disorders. CONCLUSIONS Some people living with HIV/AIDS also tend to suffer from depression, suicidality, and alcohol use disorders. These findings highlight the need for the integration of mental health services into HIV/AIDS care in Nigeria.
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Affiliation(s)
- Catherine O Egbe
- Center for Tobacco Control Research and Education, University of California San Francisco, 530 Parnassus Avenue, Suite 366, San Francisco, CA, 94143, USA.
| | - Patrick S Dakum
- Institute of Human Virology, Nigeria, 252 Herbert Macaulay Way, Central Business District, Abuja, Nigeria
| | - Ernest Ekong
- Institute of Human Virology, Nigeria, 252 Herbert Macaulay Way, Central Business District, Abuja, Nigeria
| | - Brandon A Kohrt
- Duke Global Health Institute & Department of Psychiatry, Duke University, Box 90519, Durham, NC, 27708, USA
| | - John G Minto
- Gede Foundation Nigeria, 13 Danube Street, Abuja, Nigeria
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Quinlivan EB, Gaynes BN, Lee JS, Heine AD, Shirey K, Edwards M, Modi R, Willig J, Pence BW. Suicidal Ideation is Associated with Limited Engagement in HIV Care. AIDS Behav 2017; 21:1699-1708. [PMID: 27380390 DOI: 10.1007/s10461-016-1469-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PHQ-9 data from persons living with HIV (PLWH, n = 4099) being screened for depression in three clinics in the southeastern USA were used to determine the prevalence of suicidal ideation (SI). SI was reported by 352 (8.6 %); associated with <3 years since HIV diagnosis (1.69; 95 %CI 1.35, 2.13), and HIV RNA >50 copies/ml (1.70, 95 %CI 1.35, 2.14). Data from PLWH enrolled in a depression treatment study were used to determine the association between moderate-to-high risk SI (severity) and SI frequency reported on PHQ-9 screening. Over forty percent of persons reporting that SI occurred on "more than half the days" (by the PHQ-9) were assessed as having a moderate-to-high risk for suicide completion during the Mini International Neuropsychiatric Interview. SI, including moderate-to-high risk SI, remains a significant comorbid problem for PLWH who are not fully stabilized in care (as indicated by detectable HIV RNA or HIV diagnosis for less than 3 years).
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Affiliation(s)
- E Byrd Quinlivan
- Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, 103 Wild Turkey Trail, Chapel Hill, NC, 27516-9041, USA.
- Center for AIDS Research, University of North Carolina at Chapel Hill, 103 Wild Turkey Trail, Chapel Hill, NC, 27516-9041, USA.
| | - Bradley N Gaynes
- Center for AIDS Research, University of North Carolina at Chapel Hill, 103 Wild Turkey Trail, Chapel Hill, NC, 27516-9041, USA
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Jennifer S Lee
- Department of Epidemiology, Gillings School of Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Amy D Heine
- Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, 103 Wild Turkey Trail, Chapel Hill, NC, 27516-9041, USA
| | - Kristen Shirey
- Departments of Psychiatry and Behavioral Sciences and Medicine, Duke University, Durham, NC, USA
| | - Malaika Edwards
- Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, 103 Wild Turkey Trail, Chapel Hill, NC, 27516-9041, USA
| | - Riddhi Modi
- Department of Medicine, University of Alabama - Birmingham, Birmingham, AL, USA
| | - James Willig
- Department of Medicine, University of Alabama - Birmingham, Birmingham, AL, USA
| | - Brian W Pence
- Center for AIDS Research, University of North Carolina at Chapel Hill, 103 Wild Turkey Trail, Chapel Hill, NC, 27516-9041, USA
- Department of Epidemiology, Gillings School of Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Suicidal Behavior Among People Living with HIV (PLHIV) in Medical Care in Estonia and Factors Associated with Receiving Psychological Treatment. AIDS Behav 2017; 21:1709-1716. [PMID: 27664013 DOI: 10.1007/s10461-016-1561-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
People living with HIV (PLHIV) have higher rates of suicidal behavior than the general population. This study assessed suicidal behavior (ideation and/or attempts, ever and in the past 12 months) among PLHIV receiving outpatient HIV medical care in Estonia and associations between suicidal behavior and psychological treatment. The cross-sectional study collected data from January to November 2013 using a self-report questionnaire. Eight hundred PLHIV participated, 39 % (n = 306) of whom had been suicidal. Lifetime prevalence was 36 % for suicidal ideation and 20 % for attempts. Younger age, incarceration, having ever abused alcohol and also injected drugs, having lived with HIV for more than 10 years, and being depressed were associated with lifetime suicidal behavior. Suicidal behavior within the past 12 months was reported by 20 % (n = 156) of respondents. Of these, 27 % received psychological treatment (counseling and/or psychotherapy), 20 % had taken antidepressants, and 49 % sedatives. Individuals perceiving a need for treatment were significantly more likely to receive psychological treatment when experiencing suicidal behavior (OR 25.65, 95 % CI 2.92-225.47). In conclusion, suicidal behavior is frequent among PLHIV but psychological treatment is not often received. One of the barriers to treatment is patients' lack of perceived need for help.
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Abstract
: HIV infection, in many circumstances, can now be managed as a chronic disease due to the marked increase in life expectancy since the introduction of combination antiretroviral therapy (ART). As the patients who first had access to combination ART age into their 50s and 60s, the effects of chronic HIV infection on health have become an important research focus in HIV infection. People living with HIV appear to exhibit an earlier occurrence of some aging-related conditions compared to people without HIV, in part due to higher rates of comorbidities, high-risk behaviors (e.g. smoking, substance use), chronic immune activation, inflammation, and ART-specific factors. Some studies have even suggested an earlier-than-expected appearance of the 'geriatric syndromes,' which are complex medical syndromes of older adults that are associated with morbidity and mortality. The geriatric syndromes include a wide variety of disease processes ranging from incontinence and dementia to impairments in physical function. This review will focus on one geriatric syndrome, sarcopenia, in older HIV-infected populations, and its relation to other aging syndromes, including frailty and falls. The contribution of HIV itself, ART exposure, and specific comorbidities, and the importance of early recognition and prevention of these aging syndromes will be highlighted.
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Affiliation(s)
- Kellie L Hawkins
- aUniversity of Colorado, Aurora, Colorado bJohns Hopkins School of Medicine cJohns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
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Taylor TN, Munoz-Plaza CE, Goparaju L, Martinez O, Holman S, Minkoff HL, Karpiak SE, Gandhi M, Cohen MH, Golub ET, Levine AM, Adedimeji AA, Gonsalves R, Bryan T, Connors N, Schechter G, Wilson TE. "The Pleasure Is Better as I've Gotten Older": Sexual Health, Sexuality, and Sexual Risk Behaviors Among Older Women Living With HIV. ARCHIVES OF SEXUAL BEHAVIOR 2017; 46:1137-1150. [PMID: 27220311 PMCID: PMC5122465 DOI: 10.1007/s10508-016-0751-1] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/30/2015] [Revised: 02/26/2016] [Accepted: 03/29/2016] [Indexed: 05/16/2023]
Abstract
There is limited research examining the sexual health and well-being of older women living with HIV (OWLH). Most studies focus on sexual dysfunction, leaving aside the richer context of sexuality and sexual health, including the effect of age-related psychosocial and interpersonal changes on sexual health behaviors. Guided by the integrative biopsychosocial model and the sexual health model, this study explored the importance of sex and sexuality among OWLH to identify their sexual health and HIV prevention needs for program planning. A purposive sample (n = 50) of OWLH was selected from a parent study (n = 2052). We conducted 8 focus groups and 41 in-depth interviews with 50 African American and Latina OWLH aged 50-69 years old in three U.S. cities. The triangulation approach was used to synthesize the data. Six salient themes emerged: sexual pleasure changes due to age, sexual freedom as women age, the role of relationships in sexual pleasure, changes in sexual ability and sexual health needs, sexual risk behaviors, and ageist assumptions about older women's sexuality. We found that sexual pleasure and the need for intimacy continue to be important for OWLH, but that changing sexual abilities and sexual health needs, such as the reduction of sexual desire, as well as increased painful intercourse due to menopause-associated vaginal drying, were persistent barriers to sexual fulfillment and satisfaction. Particular interpersonal dynamics, including low perceptions of the risk of HIV transmission as related to gender, viral suppression, and habitual condomless sex with long-term partners without HIV transmission have resulted in abandoning safer sex practices with serodiscordant partners. These findings suggest that HIV prevention for OWLH should focus on how sexual function and satisfaction intersect with sexual risk. HIV prevention for OWLH should promote ways to maintain satisfying and safe sex lives among aging women.
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Affiliation(s)
- Tonya N Taylor
- College of Medicine, Division of Infectious Disease and the Special Treatment and Research Program, SUNY Downstate Medical Center, 450 Clarkson Avenue, Box 1240, Brooklyn, NY, 11203, USA.
| | | | - Lakshmi Goparaju
- Department of Medicine, Georgetown University Medical Center, Washington, DC, USA
| | - Omar Martinez
- College of Public Health, Temple University, Philadelphia, PA, USA
| | - Susan Holman
- College of Medicine, Division of Infectious Disease and the Special Treatment and Research Program, SUNY Downstate Medical Center, 450 Clarkson Avenue, Box 1240, Brooklyn, NY, 11203, USA
| | - Howard L Minkoff
- Department of Obstetrics and Gynecology, Maimonides Medical Center, Brooklyn, NY, USA
| | - Stephen E Karpiak
- AIDS Community Research Initiative of America, New York, NY, USA
- School of Nursing, New York University, New York, NY, USA
| | - Monica Gandhi
- School of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Mardge H Cohen
- Department of Medicine, Cook County Health and Hospital System and Rush University, Chicago, IL, USA
| | - Elizabeth T Golub
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | - Adebola A Adedimeji
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Rebecca Gonsalves
- College of Medicine, Division of Infectious Disease and the Special Treatment and Research Program, SUNY Downstate Medical Center, 450 Clarkson Avenue, Box 1240, Brooklyn, NY, 11203, USA
| | - Tiffany Bryan
- College of Medicine, Division of Infectious Disease and the Special Treatment and Research Program, SUNY Downstate Medical Center, 450 Clarkson Avenue, Box 1240, Brooklyn, NY, 11203, USA
| | - Nina Connors
- College of Medicine, Division of Infectious Disease and the Special Treatment and Research Program, SUNY Downstate Medical Center, 450 Clarkson Avenue, Box 1240, Brooklyn, NY, 11203, USA
| | - Gabrielle Schechter
- College of Medicine, Division of Infectious Disease and the Special Treatment and Research Program, SUNY Downstate Medical Center, 450 Clarkson Avenue, Box 1240, Brooklyn, NY, 11203, USA
| | - Tracey E Wilson
- School of Public Health, SUNY Downstate Medical Center, Brooklyn, NY, USA
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Lin CC, Lee YT, Yang HJ. Risky Sexual Behaviors as Correlates of Depression and Suicidal Ideation Among Male HIV Test-Seekers at a Voluntary Counseling and Testing Facility in Taiwan. Asia Pac J Public Health 2017; 29:219-228. [PMID: 28434253 DOI: 10.1177/1010539517697790] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This study aims at determining the level of depression and suicidal status of adult HIV test-seekers. Of the total enrolled 850 males, almost 50% reported some risk behaviors, 38.9% experienced depression, and 7.2% had suicidal ideation. Subjects with risky sexual behaviors in terms of repeated HIV test, had a history of sexually transmitted disease, engaged in one-night stands, or did not use condoms all the time with causal sexual partners were more likely to have depression. Furthermore, subjects who were bisexual/homosexual, engaged in Internet sex, engaged in one-night stands, or used addictive drugs within the past 6 months were more likely to experience suicidal ideation. The HIV testers are at risk of experiencing depression and suicidal ideation; each is associated with different types of risky sexual behaviors. It is essential for the health authority to further provide mental health services for HIV testers and to draw up an effective strategy in reducing unprotected sexual behaviors.
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Affiliation(s)
- Chia-Chun Lin
- 1 Department of Public Health, Chung Shan Medical University, Taichung, Taiwan.,2 Department of Infection Diseases, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Yuan-Ti Lee
- 2 Department of Infection Diseases, Chung Shan Medical University Hospital, Taichung, Taiwan.,3 School of Medicine, College of Medicine, Chung Shan Medical University, Taichung, Taiwan
| | - Hao-Jan Yang
- 1 Department of Public Health, Chung Shan Medical University, Taichung, Taiwan.,4 Department of Family and Community Medicine, Chung Shan Medical University Hospital, Taichung, Taiwan
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Carrieri MP, Marcellin F, Fressard L, Préau M, Sagaon-Teyssier L, Suzan-Monti M, Guagliardo V, Mora M, Roux P, Dray-Spira R, Spire B. Suicide risk in a representative sample of people receiving HIV care: Time to target most-at-risk populations (ANRS VESPA2 French national survey). PLoS One 2017; 12:e0171645. [PMID: 28192455 PMCID: PMC5305195 DOI: 10.1371/journal.pone.0171645] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2016] [Accepted: 01/24/2017] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Suicide risk is high among people living with HIV (PLHIV). This study aimed to identify major correlates of suicide risk in a representative sample of PLHIV in France, in order to help target individuals who would benefit from suicide risk screening and psychiatric care. METHODS The ANRS VESPA2 cross-sectional survey (April 2011-January 2012) collected socio-demographic, medical and behavioral data from 3,022 PLHIV recruited in 73 French HIV hospital departments. The study sample comprised the 2,973 participants with available self-reported data on suicide risk (defined as having either thought about and planned to commit suicide during the previous 12 months or attempted suicide during the same period of time) and medical data on comorbidities. Weighted Poisson models adjusted for HCV co-infection and significant clinical variables were used to estimate the relationship between suicide risk and HIV transmission groups, experience with HIV disease and other psychosocial factors. RESULTS Suicide risk was reported by 6.3% of PLHIV in the study sample. After adjustment for HIV immunological status and HCV co-infection, women (IRR [95%CI]:1.93 [1.17; 3.19]) and men who have sex with men (MSM) (1.97 [1.22; 3.19]) had a higher suicide risk than the rest of the sample. Moreover, the number of discrimination-related social contexts reported (1.39 [1.19; 1.61]), homelessness (4.87 [1.82; 13.02]), and reporting a feeling of loneliness (4.62 [3.06; 6.97]) were major predictors of suicide risk. CONCLUSIONS Reducing the burden of precarious social conditions and discrimination is an important lever for preventing suicide risk among PLHIV in France. Comprehensive care models involving peer/community social interventions targeted at women and MSM need to be implemented to lower the risk of suicide in these specific subgroups of PLHIV.
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Affiliation(s)
- Maria Patrizia Carrieri
- Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l’Information Médicale, Marseille, France
- ORS PACA, Observatoire régional de la santé Provence-Alpes-Côte d’Azur, Marseille, France
| | - Fabienne Marcellin
- Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l’Information Médicale, Marseille, France
- ORS PACA, Observatoire régional de la santé Provence-Alpes-Côte d’Azur, Marseille, France
- * E-mail: (FM); (LF)
| | - Lisa Fressard
- Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l’Information Médicale, Marseille, France
- ORS PACA, Observatoire régional de la santé Provence-Alpes-Côte d’Azur, Marseille, France
- * E-mail: (FM); (LF)
| | - Marie Préau
- Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l’Information Médicale, Marseille, France
- GREPS, Psychology Institute, Lyon 2 University, 5 avenue Pierre Mendes-France, Bron, France
| | - Luis Sagaon-Teyssier
- Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l’Information Médicale, Marseille, France
- ORS PACA, Observatoire régional de la santé Provence-Alpes-Côte d’Azur, Marseille, France
| | - Marie Suzan-Monti
- Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l’Information Médicale, Marseille, France
- ORS PACA, Observatoire régional de la santé Provence-Alpes-Côte d’Azur, Marseille, France
| | - Valérie Guagliardo
- Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l’Information Médicale, Marseille, France
- ORS PACA, Observatoire régional de la santé Provence-Alpes-Côte d’Azur, Marseille, France
| | - Marion Mora
- Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l’Information Médicale, Marseille, France
- ORS PACA, Observatoire régional de la santé Provence-Alpes-Côte d’Azur, Marseille, France
| | - Perrine Roux
- Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l’Information Médicale, Marseille, France
- ORS PACA, Observatoire régional de la santé Provence-Alpes-Côte d’Azur, Marseille, France
| | - Rosemary Dray-Spira
- INSERM, UMR_S1136, Pierre Louis Institute of Epidemiology and Public Health, Team Research in social epidemiology, Paris, France
- Sorbonne Universités, UPMC Univ Paris 06, UMR_S1136, Pierre Louis Institute of Epidemiology and Public Health, Team Research in social epidemiology, Paris, France
| | - Bruno Spire
- Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l’Information Médicale, Marseille, France
- ORS PACA, Observatoire régional de la santé Provence-Alpes-Côte d’Azur, Marseille, France
| | - ANRS-VESPA2 Study Group
- Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l’Information Médicale, Marseille, France
- ORS PACA, Observatoire régional de la santé Provence-Alpes-Côte d’Azur, Marseille, France
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Subramaniam S, Camacho LM, Carolan MT, López-Zerón G. Resilience in low-income African American women living and aging with HIV. J Women Aging 2016; 29:543-550. [PMID: 28027018 DOI: 10.1080/08952841.2016.1256735] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Women are living with HIV into middle and older age and are likely to face multiple comorbidities and stressors as they age. This study focused on understanding how women who experience multiple forms of oppression and ongoing adversity are still able to adapt and stand strong. Using a theoretical framework of resilience and a feminist research ideology, interviews of eight middle-aged and older African American women living with HIV were analyzed. Despite experiences of HIV-related discrimination, trauma, and violence, these women demonstrated a remarkable ability to adapt and maintain support. Implications for research and practice are discussed.
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Affiliation(s)
- Sailaja Subramaniam
- a Department of Human Development and Family Studies , Michigan State University , East Lansing , Michigan , USA
| | - Lizeth M Camacho
- a Department of Human Development and Family Studies , Michigan State University , East Lansing , Michigan , USA
| | - Marsha T Carolan
- a Department of Human Development and Family Studies , Michigan State University , East Lansing , Michigan , USA
| | - Gabriela López-Zerón
- a Department of Human Development and Family Studies , Michigan State University , East Lansing , Michigan , USA
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Mannes ZL, Burrell LE, Dunne EM, Hearn LE, Whitehead NE. Contextualizing Psychosocial Determinants of Alcohol Use by Age Cohorts of Adults Living With HIV, Ages 50 and Older. J Assoc Nurses AIDS Care 2016; 28:279-288. [PMID: 28003102 DOI: 10.1016/j.jana.2016.11.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2016] [Accepted: 11/21/2016] [Indexed: 11/25/2022]
Abstract
We examined the influence of age on associations between affective states, social support, and alcohol use by age cohorts. We recruited 96 older Black adults living with HIV from the southeastern United States in 2013 and 2014. Participants completed questionnaires assessing demographics, psychological function, and substance use. Hierarchical regression analyses assessed the relationship between psychosocial factors and alcohol use in a 50- to 59-year-old group, and a 60-years-and-older age group. After controlling for covariates, trait anger, state anger, and life stress were positively associated with alcohol consumption in the younger group, while social support was negatively associated with alcohol consumption in the older group. Interventions should target negative affective states in 50- to 59-year-old adults with HIV, and preserve social support for adults with HIV as they age, as such interventions will likely have an impact on these individuals' alcohol consumption and longstanding quality of life.
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Abstract
Social support becomes an increasingly significant resource for people as they age, particularly those living with chronic illnesses. Previous research has shown that older adults with HIV do not receive adequate emotional and instrumental assistance from their informal support networks. This study examined what factors contribute to older HIV-positive adults'perceptions of inadequate emotional and instrumental support. Regression analyses showed that physical strain and the number of comorbid illnesses were significant predictors of instrumental and emotional support adequacy. Specifically, participants who reported greater numbers of comorbid illnesses and higher levels of physical strain were more likely to report that they received adequate support. Curiously, those with fewer health complaints reported greater need for emotional and instrumental support. The aging HIV-positive population, largely disconnected from traditional informal support networks, relies on formal care providers. This dependence on an increasingly overburdened health care system may be a result of isolation and stigma.
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50
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Elsheikha HM, Büsselberg D, Zhu XQ. The known and missing links between Toxoplasma gondii and schizophrenia. Metab Brain Dis 2016; 31:749-59. [PMID: 27041387 DOI: 10.1007/s11011-016-9822-1] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2015] [Accepted: 03/20/2016] [Indexed: 12/14/2022]
Abstract
Toxoplasma gondii, an intracellular protozoan parasite, has a striking predilection for infecting the Central Nervous System and has been linked to an increased incidence of a number of psychiatric diseases. Several in vitro and in vivo studies have shown that T. gondii infection can affect the structure, bioenergetics and function of brain cells, and alters several host cell processes, including dopaminergic, tryptophan-kynurenine, GABAergic, AKT1, Jak/STAT, and vasopressinergic pathways. These mechanisms underlying the neuropathology of latent toxoplasmosis seem to operate also in schizophrenia, supporting the link between the two disorders. Better understanding of the intricate parasite-neuroglial communications holds the key to unlocking the mystery of T. gondii-mediated schizophrenia and offers substantial prospects for the development of disease-modifying therapies.
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Affiliation(s)
- Hany M Elsheikha
- Faculty of Medicine and Health Sciences, School of Veterinary Medicine and Science, University of Nottingham, Sutton Bonington, Leicestershire, LE12 5RD, UK.
| | - Dietrich Büsselberg
- Weill Cornell Medical College in Qatar, Qatar Foundation - Education City, P.O. Box: 24144, Doha, Qatar
| | - Xing-Quan Zhu
- State Key Laboratory of Veterinary Etiological Biology, Key Laboratory of Veterinary Parasitology of Gansu Province, Lanzhou Veterinary Research Institute, Chinese Academy of Agricultural Sciences, Lanzhou, Gansu Province, 730046, People's Republic of China
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