HIV and suicide in adolescence and young adulthood

The suicide rate worldwide has increased by 60% in the last 45 years. A significant increase can be seen in the group of adolescents and young adults with HIV.

Suicide: a socio-demographic and structural problem?

In the US, a number of social determinants, such as ethnicity and income status, contribute to differences in suicidality. Statistically, a large proportion of Black and People of Color (BPoc) live in poverty. In 2019, the poverty rate for BPoc (18.8%) was twice that of the white population (7.3%)¹.

A large proportion of BPoc live in low-income neighbourhoods where stressful life events, such as the death of a family member or gang-related crime, are more common. These stressful life events are associated with suicide attempts. Other negative influences such as mental illness and substance dependence are also associated with an increased risk of suicide.

Data and statistical method

The present study investigates the concurrent structural, socio-demographic as well as psychosocial factors influencing suicide attempts among a cohort of adolescents and young adults living with perinatally acquired HIV infection and who were perinatally exposed but not infected.

The data used for this are derived from Mellin's CASAH study,² a prospective cohort study conducted between 2003 to 2008 that evaluated adolescents and young adults with an average age of 12 years from New York City living with HIV infection and HIV stigma.

The primary outcome of the study is suicide attempt. The evaluation used the following baseline question:

Have you ever tried to kill yourself or attempted suicide in your life?

The first step was to collect data from the total sample, followed by only adolescents and young adults living with perinatally acquired HIV and stigma (PHIV) and then only those who were perinatally HIV exposed uninfected (PHEU).

The study group is composed as follows:

49% Male (50% PHIV, 49% PHEU).
51% Female (50% PHIV, 51% PHEU)
57% Black/African-American (60% PHIV, 51%)
50% Latinx (48% PHIV, 53% PHEU)

To evaluate the relationship between risk factors and suicide attempt, the following factors were considered:

Sociodemographic & Structural: gender, sexuality, "race", ethnicity, age, pregnancy (self or partner), arrest or time spent in jail, metropolitan-related stress³, stressful life events and HIV status.
Psychosocial: spirituality, social problem inventory score⁴, Tennessee self-concept score⁵ (concept of awareness of self, family, social and school), any form of DISG-listed psychiatric illness and substance use disorders.

General estimating equations were used to individually estimate the odds ratio (OR) value for the association between each sociodemographic, contextual and psychosocial factor and the first report of a suicide attempt, adjusting for age at each round of the survey.

Results and analysis

The study results show that adolescents and young adults living with HIV have a higher risk of committing a suicide attempt (OR = 1.74). To this end, adolescents who identify as heterosexual have a lower risk (OR = 0.30) compared to adolescents who identify as homosexual or genderminority.

A known pregnancy (self or partner) is associated with a high risk of suicide attempt (OR = 1.48), especially in the PHIV subgroup (OR = 2.28). Adolescents who have been arrested or spent time in prison also have a significantly high risk of suicide (OR = 2.56), mainly in the subgroup PHIV (OR = 3.05). In addition, there are stressful life events (OR = 1.23), city-related stress (OR = 2.07) and HIV stigma (OR = 2.46).

In the connection between suicide attempt and the psychosocial factors, it can be seen that a high self-esteem and a healthy family concept can be considered protective factors for suicide (OR = 0.51; OR = 0.41).

In addition, adolescents with mental illness have a significantly high risk for suicide attempts (OR = 3.32), especially in the PHEU subgroup (OR = 4.60). Equally important, is the risk ratio of adolescents with substance dependence, especially in the PHEU subgroup (OR = 5.83; compared to overall OR = 2.60).

Summary:

Adolescents and young adults with HIV who identify as homosexual or genderminority are at high risk of suicide.
Pregnant young women living with perinatally acquired HIV infection have an increased risk of committing a suicide attempt.
HIV-infected young people who have been arrested or spent time in prison have a high risk of suicide.
Mental illness and substance dependence are significant risk factors for a suicide attempt.
High self- and/or family well-being reduces suicide risk.

Conclusions:

This investigation of sociodemographic and psychosocial risk factors for suicide attempt among adolescents living with HIV is one of the first studies on the topic. The results are consistent with evaluations of other studies, especially in relation to HIV status in the context of sexuality and mental illness. Further research in the area is needed.
Arrest, urban-life stress and the above-mentioned stressful life events are significant key variables in capturing suicide risk scores and are also factors associated with structural racism.
Further research on intersectional identities and the impact of structural racism on suicidality is needed.
Close collaboration with medical institutions could offer adolescents and young adults living with perinatal-acquired HIV the opportunity to intervene in a timely manner and address suicidality directly.

This article is based on the presentation "Social support attenuates the syndemic of poor HIV care and stigma on suicidal tendencies among South African young women living with HIV" by Wylene Saal at this year's AIDS conference. esanum covered the 24th International AIDS Conference in Montreal, Canada, from 29 July to 2 August 2022. For more articles, please visit our dedicated AIDS 2022 congress page

References & Notes:

US Census Bureau, 2019.
Access to the study at: https://www.hivcenternyc.org/casah
For more information: https://vaay.com/pages/stressful-cities-index
For more information: https://dataverse.unc.edu/CAPS-TSBI - only in English
For more information: https://dataverse.unc.edu/dataset/CAPS-TSC - only in English