Suicide and HIV infection. Mortality follow-up of 4147 HIV-seropositive military service applicants.
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.


METHODS
Prospective cohort study.


METHODS
Military service applicants from throughout the United States.


METHODS
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.
Dannenberg
A L
AL
Center for Injury Research and Policy, Johns Hopkins University School of Hygiene and Public Health, Baltimore, Md, USA.
McNeil
J G
JG
Brundage
J F
JF
Brookmeyer
R
R
D015492:AIDS Serodiagnosis; D000293:Adolescent; D000328:Adult; D015331:Cohort Studies; D005260:Female; D015658:HIV Infections / Q000401:mortality / Q000517:prevention & control / Q000523:psychology*; D006801:Humans; D015994:Incidence; D008297:Male; D008403:Mass Screening; D008875:Middle Aged; D011446:Prospective Studies; D012306:Risk; D013405:Suicide / Q000706:statistics & numerical data*; D014481:United States