HIV, Depression, and Suicide

By: Ranier Simons, ADAP Blog Guest Contributor

In the early years of the HIV epidemic, a diagnosis was effectively a death sentence. There were no robust treatment regimens, and life expectancy was low. People suffered a great deal being overcome by opportunistic infections and lived in a great deal of isolation, whether in a hospital setting or at home. This resulted in a high prevalence of depression. Over the past few decades, medical advances in HIV treatment have transformed an HIV diagnosis into a manageable chronic health issue with people living long, healthy lives on antiretroviral therapy. But has mental health advances kept pace?

Photo Source: HIV.gov

Despite the advances, a high rate of depression and suicide remains among people living with HIV (PLWHA). Depression in PLWHA results in worsened disease states and poorer health outcomes. Data shows that depression can hasten the progression of AIDS, resulting in higher viral loads and lower CD4 counts.[1] Many PLWHA also have mental comorbidities that exacerbate their risk of suicide.[2] A recent study being presented at this year’s European Congress of Clinical Microbiology & Infectious Diseases (ECCMID) in Copenhagen, Denmark (15–18 April), further examines depression and suicide in PLWHA.

The observational study utilized data from Denmark’s national health registers from 1995 -2021. The study compared 5,943 PLWHA with 59,430 sex and date-of-birth-matched controls from the general population. Researchers also investigated 5,807 siblings of PLWHA and 82,411 siblings of controls.[3,4] Overall, PLWHA had twice the risk of depression and treatment with electroconvulsive therapy, 1.5 times the risk of using antidepressants, and 3.5 times the risk for suicide.[3,4] These numbers were higher for the first two years after diagnosis. During this period, PLWHA had a threefold higher risk of depression and antidepressant use and a tenfold risk of suicide.[3,4] The study data also showed an increased risk of depression and suicide for the siblings of PLWHA compared to the general population, but it was not as high as the risk for PLWHA.

Photo Source: AIDSmap

This study was specific to Denmark. Other studies in the past, encompassing a global perspective, indicate that globally PLWHA have a 100 times higher risk of suicide than the general population.[5] Researchers agree that many more studies need to be conducted. The main weakness in the data from present and past studies is the variance. These observational studies try to normalize the data by comparing subjects to general population controls. However, past studies contain many differences in subject selection criteria. There are differences in cultural norms of the subjects, variance in types and availability of antiretroviral therapies or lack of them, and even societal factors that vary between continents.

What does not vary is the urgency of the need to address the mental health of PLWHA. Medical science has a focused, concerted effort to develop medications to treat and prevent. The same energy is needed to address psychological needs. Mental health screening of PLWHA must go hand in hand with treatment. PLWHA often have poor social support, face stigma, and don’t have access to trained mental health professionals.[2] Additional research also needs to thoroughly investigate issues such as long-term antiretroviral treatment's biological and cognitive effects or identifying pre-HIV infection mental comorbidities that may cause a higher incidence of depression and suicide once infected. 

Going forward, the mental health assessment and support of PLWHA must be on a continuum. It should start with psychological counseling and support when someone is about to be tested all the way through positive diagnosis, treatment, and long-term survival. Standardizing evidence-based mental health protocols for PLWHA will prevent suicides and improve the lives of PLWHA and their families and friends.

[1] Tran, B. X., Ho, R. C. M., Ho, C. S. H., Latkin, C. A., Phan, H. T., Ha, G. H., Vu, G. T., Ying, J., & Zhang, M. W. B. (2019). Depression among Patients with HIV/AIDS: Research Development and Effective Interventions (GAPRESEARCH). International journal of environmental research and public health, 16(10), 1772. https://doi.org/10.3390/ijerph16101772

[2] Liu, Y., Songtaweesin, W., Tucker, J., Sohn, A., Latkin, C., Hall, B. (2022). Suicide prevention research is crucial to achieving health equity for people with HIV. The Lancet HIV, 9(11),E745-E746, https://doi.org/10.1016/S2352-3018(22)00296-X

[3] American Association for the Advancement of Science. (2023, April 3). People living with HIV at substantially higher risk of depression and suicide, especially in first 2 years after diagnosis. Retrieved from https://www.eurekalert.org/news-releases/984677#.ZC75j2xKVyk.twitter

4) Medical Express. (2023, April 3). People living with HIV at substantially higher risk of depression and suicide. Retrieved from https://medicalxpress.com/news/2023-04-people-hiv-substantially-higher-depression.html

5) Pelton, M., Ciarletta, M., Wisnousky, H., et al. Rates and risk factors for suicidal ideation, suicide attempts and suicide deaths in persons with HIV: a systematic review and meta-analysis. General Psychiatry 2021;34:e100247. doi: 10.1136/gpsych-2020-100247

Disclaimer: Guest blogs do not necessarily reflect the views of the ADAP Advocacy Association, but rather they provide a neutral platform whereby the author serves to promote open, honest discussion about public health-related issues and updates.