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Unique Identifier 97094235
Authors: Dannenberg AL. McNeil JG. Brundage JF. Brookmeyer R.
Institution: Center for Injury Research and Policy, Johns Hopkins University School of Hygiene and Public Health, Baltimore, Md, USA.
Title: Suicide and HIV infection. Mortality follow-up of 4147 HIV-seropositive military service applicants.
Source: JAMA. 276(21)1743-6, 1996 Dec 4.
Abstract: OBJECTIVE: To examine the risk of suicide among individuals positive for the human immunodeficiency virus (HIV) following screening for evidence of HIV infection. Prior studies have reported a 7- to 36-fold increased risk of suicide for persons with the acquired immunodeficiency syndrome. DESIGN: Prospective cohort study. SETTING: Military service applicants from throughout the United States. MAIN OUTCOME MEASURE: Death from suicide. METHODS: The National Death Index was searched for mortality among 4147 HIV-positive military service applicants and 12437 HIV-negative applicants disqualified from military service due to other medical conditions (matched 1:3 on age, race, sex, and screening date and location) identified by the US Department of Defense between October 1985 and December 1993. Death certificates were obtained from individual states. Identifiers and HIV status of living applicants were known only by the Department of Defense. RESULTS: The HIV-positive applicants were 92% male, 37% white, and 56% black. Median age was 24 years (range, 17-57 years). Median follow-up time was 70 months (range, 0-99 months). Ten HIV-positive (49 per 100 000 person-years) and 24 HIV-negative applicants (36 per 100 000 person-years) died of suicide (rate ratio [RR], 1.35; 95% confidence interval [CI]= 0.58-2.93). Suicide rates among both HIV-positive (RR, 2.08; 95% CI, 1.00-3.82) and HIV-negative (RR, 1.67; 95% CI, 1.07-2.48) applicants are marginally higher than those for the US general population, after adjustment for age, race, and sex. Time from screening to death was less than 3 months for 3 of 10 HIV-positive and 2 of 24 HIV-negative applicants who died of suicide. CONCLUSIONS: The HIV-positive individuals do not appear to have a significantly increased risk of death from suicide in the months following HIV screening in this study population. Because suicide risk is reported to be greatly increased after symptomatic HIV disease is present, clinicians should consider asking persons with HIV infection about suicide risk factors during both initial counseling and subsequent medical care.

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Unique Identifier 93021565
Authors: Cote TR. Biggar RJ. Dannenberg AL.
Institution: National Cancer Institute, Viral Epidemiology Section, Rockville, Md 20852.
Title: Risk of suicide among persons with AIDS. A national assessment
Source: JAMA. 268(15)2066-8, 1992 Oct 21. [see comments]
Abstract: OBJECTIVE--We sought to describe the rate, risk, trends, methods, and distribution of suicide among persons with the acquired immunodeficiency syndrome (AIDS) in the United States. DESIGN--We used National Center for Health Statistics multiple-cause mortality data from 1987 through 1989 to identify suicides among persons with AIDS (PWAs) and public-access AIDS surveillance data to determine person-years of observation of PWAs. PATIENTS--Residents of the United States with death certificates indicating suicide. MAIN OUTCOME MEASURE--Death certificates indicating both AIDS and suicide. RESULTS--In 1987 through 1989, a total of 165 suicides among PWAs occurred in 45 states and the District of Columbia. All but one case were male. Among males the rate was 165 per 100,000 person-years of observation, 7.4-fold higher than among demographically similar men in the general population. Self-poisoning with drugs was both the most common method (35%) and the method with the highest standardized mortality ratio (35). Suicide risk for PWAs decreased significantly (P < .05) from 1987 to 1989. CONCLUSION--Persons with AIDS have an increased risk of suicide, and assessment of such risk should be a standard practice in their care. These assessments should be carefully considered when potentially lethal medications are prescribed. The declining trend in suicide rates between 1987 and 1989 is encouraging; possible causes include emerging therapies for human immunodeficiency virus/AIDS, better psychiatric care for these patients, and lessened social stigma against PWAs.

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