AIDS/HIV infection, comorbid psychiatric illness, and risk for subsequent suicide: a nationwide register linkage study

Objective: To explore socioeconomic and psychiatric characteristics of persons with acquired immunodeficiency syndrome (AIDS) or human immunodeficiency virus (HIV) infection and to assess the effect of AIDS/HIV infection on risk for subsequent suicide in the context of psychiatric comorbidity and socioeconomic status.

Method: In this study based on the entire population of Denmark, we interlinked 5 national registers to retrieve personal data on AIDS/HIV infection and covariates for 9,900 men who died of suicide during 1986-2006 and 189,037 controls matched for sex and date of birth. Suicide risk associated with AIDS/HIV infection was assessed using a conditional logistic regression model.

Results: People with AIDS/HIV infection, especially those who died of suicide, mostly lived as single people, had low income, and were dwellers of the Capital area of Denmark (Copenhagen and Frederiksberg). While presence of other physical illness was common in these patients, 38.6% of suicide and 29.0% of control patients developed psychiatric illness after being diagnosed with AIDS or HIV infection. Meanwhile, AIDS/HIV infection constituted a significant risk factor for subsequent suicide (adjusted incidence rate ratio [IRR] = 3.84; 95% confidence interval, 2.53-5.81); the risk was substantially higher for persons who were diagnosed for the first time recently, were treated as inpatients, had a recent hospital contact, or had multiple hospital contacts because of the illness. The increased suicide risk associated with AIDS/HIV infection was slightly stronger before the introduction in 1997 of highly active antiretroviral therapy (HAART) (adjusted IRR = 5.55; 95% CI, 3.07-10.06), but remained highly significant in the HAART era (adjusted IRR = 2.77; 95% CI, 1.55-4.94). Moreover, AIDS/HIV infection significantly interacted with psychiatric illness (P < .0001), and their comorbidity increased the risk of suicide substantially.

Conclusions: Suicide risk is increased in individuals with AIDS/HIV infection, particularly those with a recent diagnosis, more intensive and frequent hospital care, or comorbid psychiatric illness. The findings call for improvement of clinical capacities to address psychosocial and existential needs in the treatment of patients with AIDS/HIV infection.