title: Ongoing life stressors and suicidal ideation among HIV-infected adults with depression.
abstract: BACKGROUND
  Suicidal ideation is the most proximal risk factor for suicide and can indicate extreme psychological distress; identification of its predictors is important for possible intervention. Depression and stressful or traumatic life events (STLEs), which are more common among HIV-infected individuals than the general population, may serve as triggers for suicidal thoughts.
  
  
  METHODS
  A randomized controlled trial testing the effect of evidence-based decision support for depression treatment on antiretroviral adherence (the SLAM DUNC study) included monthly assessments of incident STLEs, and quarterly assessments of suicidal ideation (SI). We examined the association between STLEs and SI during up to one year of follow-up among 289 Southeastern US-based participants active in the study between 7/1/2011 and 4/1/2014, accounting for time-varying confounding by depressive severity with the use of marginal structural models.
  
  
  RESULTS
  Participants were mostly male (70%) and black (62%), with a median age of 45 years, and experienced a mean of 2.36 total STLEs (range: 0-12) and 0.48 severe STLEs (range: 0-3) per month. Every additional STLE was associated with an increase in SI prevalence of 7% (prevalence ratio (PR) (95% confidence interval (CI)): 1.07 (1.00, 1.14)), and every additional severe STLE with an increase in SI prevalence of 19% (RR (95% CI): 1.19 (1.00, 1.42)).
  
  
  CONCLUSIONS
  There was a substantial amount of missing data and the exposures and outcomes were obtained via self-report; methods were tailored to address these potential limitations.
  
  
  CONCLUSIONS
  STLEs were associated with increased SI prevalence, which is an important risk factor for suicide attempts and completions.
authors.affiliation: University of North Carolina at Chapel Hill, Department of Epidemiology, United States. Electronic address: julie.k.odonnell@gmail.com.
authors.forename: Julie K
authors.initials: JK
authors.lastname: O'Donnell
authors.affiliation: University of North Carolina at Chapel Hill School of Medicine, Department of Psychiatry, United States.
authors.forename: Bradley N
authors.initials: BN
authors.lastname: Gaynes
authors.affiliation: University of North Carolina at Chapel Hill, Department of Epidemiology, United States.
authors.forename: Stephen R
authors.initials: SR
authors.lastname: Cole
authors.affiliation: University of North Carolina at Chapel Hill, Department of Epidemiology, United States.
authors.forename: Andrew
authors.initials: A
authors.lastname: Edmonds
authors.affiliation: Duke University, Center for Health Policy, Duke Global Health Institute, United States.
authors.forename: Nathan M
authors.initials: NM
authors.lastname: Thielman
authors.affiliation: University of North Carolina at Chapel Hill, Institute for Global Health, Infectious Diseases and Center for AIDS Research, United States.
authors.forename: E Byrd
authors.initials: EB
authors.lastname: Quinlivan
authors.affiliation: Duke University School of Medicine, Department of Psychiatry, United States.
authors.forename: Kristen
authors.initials: K
authors.lastname: Shirey
authors.affiliation: University of North Carolina at Chapel Hill, Institute for Global Health and Infectious Diseases, United States.
authors.forename: Amy D
authors.initials: AD
authors.lastname: Heine
authors.affiliation: University of Alabama at Birmingham, Division of Infectious Diseases, United States.
authors.forename: Riddhi
authors.initials: R
authors.lastname: Modi
authors.affiliation: University of North Carolina at Chapel Hill, Department of Epidemiology, United States.
authors.forename: Brian W
authors.initials: BW
authors.lastname: Pence
mesh_terms: D000328:Adult; D001294:Attitude to Health; D003863:Depression / Q000453:epidemiology / Q000523:psychology*; D005260:Female; D015658:HIV Infections / Q000453:epidemiology / Q000523:psychology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012307:Risk Factors; D013315:Stress, Psychological / Q000453:epidemiology / Q000523:psychology*; D059020:Suicidal Ideation; D013405:Suicide / Q000523:psychology; D013406:Suicide, Attempted / Q000523:psychology* / Q000706:statistics & numerical data; D014481:United States / Q000453:epidemiology
keywords: Depression; HIV; Stress; Suicidal ideation; Trauma