title: Suicidal Ideation Persists Among Individuals Engaged in HIV Care in the Era of Antiretroviral Therapy.
abstract: Little research has focused on suicidality in the era of successful antiretroviral therapy among those engaged in HIV care. We performed a study of 648 clinic patients who completed a psychological and behavioral annual assessment in 2012. Depressive symptoms were measured using the Patient Health Questionnaire-9 (PHQ-9), suicidal ideation was measured by the last item of the scale. Anxiety symptoms were measured using the Generalized Anxiety Disorder-7 questionnaire (GAD-7). HIV biomedical markers were abstracted from medical records. Suicidal ideation was reported among 13% (n = 81) of the sample. Individuals endorsing suicidality were more likely to have unsuppressed viral loads, moderate to severe anxiety symptoms and consider themselves to be homeless (p < 0.01 for all). After adjusting for confounders, homeless individuals and those endorsing moderate to severe anxiety symptoms had higher odds of reporting suicidality. Results suggest basic needs must be met to complement HIV management efforts. Furthermore, better understanding of how psychological distress symptoms are expressed and how to manage them may better inform barriers to HIV management.
authors.affiliation: Department of Behavioral Sciences and Health Education, College for Public Health and Social Justice, Saint Louis University, 3545 Lafayette Avenue, Saint Louis, MO, 63104, USA. lopezjd@slu.edu.
authors.forename: J D
authors.initials: JD
authors.lastname: López
authors.affiliation: Department of Behavioral Sciences and Health Education, College for Public Health and Social Justice, Saint Louis University, 3545 Lafayette Avenue, Saint Louis, MO, 63104, USA.
authors.forename: E
authors.initials: E
authors.lastname: Shacham
authors.affiliation: Infectious Diseases Clinic and Project ARK, Washington University School of Medicine, 620 South Taylor Avenue, Suite 100, Saint Louis, MO, 63110, USA.
authors.forename: T
authors.initials: T
authors.lastname: Brown
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001007:Anxiety / Q000175:diagnosis / Q000453:epidemiology* / Q000523:psychology; D003430:Cross-Sectional Studies; D003863:Depression / Q000175:diagnosis / Q000453:epidemiology* / Q000523:psychology; D005260:Female; D006678:HIV; D015658:HIV Infections / Q000188:drug therapy / Q000523:psychology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D000073222:Patient Health Questionnaire; D013315:Stress, Psychological; D059020:Suicidal Ideation; D011795:Surveys and Questionnaires; D014481:United States / Q000453:epidemiology; D019562:Viral Load; D055815:Young Adult
keywords: Depression; HIV; Psychological distress; Suicidal ideation