title: Suicidal ideation in UK HIV clinic attenders.
abstract: BACKGROUND
  HIV has been associated with elevated suicidal ideation. Although new treatments have changed prognosis, they also bring new challenges. This study measured suicidal ideation in HIV clinic attenders in the United Kingdom (London/Southeast) and explored associated factors.
  
  
  METHODS
  All 1006 attenders at five HIV clinics were approached, of which 903 met inclusion criteria and 778 participated (86% response). Participants provided detailed information on suicidal ideation, demographics, treatment, adherence, symptoms (psychological and physical on Memorial Symptom Assessment Schedule), quality of life (EuroQol) information, HIV disclosure, clinical variables, sexual risk behaviour and treatment optimism.
  
  
  RESULTS
  There was a 31% prevalence of suicidal ideation. Factors associated with suicidal ideation were being a heterosexual man, black ethnicity, unemployment, lack of disclosure of HIV status, having stopped antiretroviral treatment (compared to treatment or treatment naive), physical symptoms, psychological symptoms and poorer quality of life. There was no association with sexual risk behaviour. Sex/sexuality and ethnicity were independently associated with suicidal ideation: the odds of suicidal ideation increased almost two-fold for heterosexual men compared with gay men or women and for black respondents compared with White or Asian respondents. Lack of disclosure was independently associated with a two-fold increase in odds of suicidal ideation. Elevated physical and psychological symptoms were strong independent predictors of suicidal ideation. Independent predictors of suicidal ideation were very similar among the subgroup of 492 patients on antiretroviral treatment.
  
  
  CONCLUSIONS
  Despite advances in treatment, suicidal ideation rates among HIV-positive clinic attenders are high. Emotional support and attention to mental health provision and social context are strongly endorsed.
authors.affiliation: Royal Free and University College Medical School, London, UK. l.sherr@pcps.ucl.ac.uk
authors.forename: Lorraine
authors.initials: L
authors.lastname: Sherr
authors.forename: Fiona
authors.initials: F
authors.lastname: Lampe
authors.forename: Martin
authors.initials: M
authors.lastname: Fisher
authors.forename: Gilly
authors.initials: G
authors.lastname: Arthur
authors.forename: Jane
authors.initials: J
authors.lastname: Anderson
authors.forename: Sarah
authors.initials: S
authors.lastname: Zetler
authors.forename: Margaret
authors.initials: M
authors.lastname: Johnson
authors.forename: Simon
authors.initials: S
authors.lastname: Edwards
authors.forename: Richard
authors.initials: R
authors.lastname: Harding
mesh_terms: D044383:Black People; D016009:Chi-Square Distribution; D003376:Counseling; D004739:England; D005260:Female; D006679:HIV Seropositivity / Q000208:ethnology / Q000523:psychology*; D006716:Homosexuality; D006801:Humans; D008297:Male; D015999:Multivariate Analysis; D012944:Social Support; D013406:Suicide, Attempted / Q000208:ethnology / Q000523:psychology*; D014478:Unemployment