title: Thoughts of suicide among HIV-infected rural persons enrolled in a telephone-delivered mental health intervention.
abstract: This study characterized rates and predictors of suicidal thoughts among HIV-infected persons living in rural communities of eight U.S. states. Self-administered surveys were completed by 201 HIV-infected persons living in communities of 50,000 or fewer that were located at least 20 miles from a city of 100,000 or more. All participants were clients of rural AIDS service organizations and had recently enrolled into a randomized clinical trial of a telephone-delivered, coping improvement-group intervention designed specifically for HIV-infected rural persons. At baseline, participants reported on thoughts of suicide, psychological symptomatology, life-stressor burden, ways of coping, coping self-efficacy, social support, and barriers to health care and social services. Thirty-eight percent of HIV-infected rural persons had engaged in thoughts of suicide during the past week. A logistic regression analysis revealed that participants who endorsed thoughts of suicide also reported more depressive symptoms (odds ratio [OR] = 2.19; 95% confidence interval [CI] = 1.32-3.63, p < .002), less coping self-efficacy (OR = 0.70; 95% CI = 0.56-0.88, p < .002), more frequently worried about transmitting their HIV infection to others (OR = 1.66, 95% CI = 1.14-2.40, p < .008), and experienced more stress associated with AIDS-related stigma (OR = 1.58, 95% CI = 1.07-2.35, p < .03). As AIDS prevalence rates increase in rural areas, interventions that successfully identify and treat geographically isolated HIV-infected persons who experience more frequent or serious thoughts of suicide are urgently needed.
authors.affiliation: Department of Psychology, Ohio University, Athens 45701, USA. heckmant@ohiou.edu
authors.forename: Timothy G
authors.initials: TG
authors.lastname: Heckman
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Miller
authors.forename: Arlene
authors.initials: A
authors.lastname: Kochman
authors.forename: Seth C
authors.initials: SC
authors.lastname: Kalichman
authors.forename: Bruce
authors.initials: B
authors.lastname: Carlson
authors.forename: Monica
authors.initials: M
authors.lastname: Silverthorn
mesh_terms: D000223:Adaptation, Psychological; D000293:Adolescent; D000328:Adult; D003419:Crisis Intervention; D005260:Female; D006679:HIV Seropositivity / Q000175:diagnosis / Q000453:epidemiology / Q000523:psychology*; D015277:Hotlines; D006801:Humans; D007398:Interpersonal Relations; D008297:Male; D008605:Mental Health Services; D008875:Middle Aged; D012424:Rural Population / Q000706:statistics & numerical data*; D012720:Severity of Illness Index; D019966:Substance-Related Disorders / Q000453:epidemiology; D013850:Thinking; D000092864:Suicide Prevention