HIV testing in the healthcare setting is an opportunity for targeted suicide prevention interventions in a high-risk group, suggested a study in AIDS Care that examined peri-urban areas of Cape Town, South Africa.1
Conducted by the department of psychology at Stellenbosch University in Matieland, South Africa, this cross-sectional study sought to document the prevalence and correlates of suicidal ideation and behavior (SIB) among people seeking HIV testing in the Western Cape Province of South Africa. The study results were in keeping with global findings suggesting high rates of SIB among people living with HIV/AIDS (PLWHA).2 Suicide rates among PLWHA in Switzerland are 3 times that of the general population, 1 in 5 HIV-positive US patients report suicidal ideation in the previous week, and a study of HIV-positive patients attending a Ugandan clinic reported prevalence rates of 13% for current SIB.3
A total of 500 individuals seeking HIV testing were recruited at 3 testing sites in close proximity to residential areas in the greater Cape Town area. Of the study participants, 51.6% were women, and the mean participant age was 36 years. Trained postgraduate psychology students supervised by registered psychologists collected self-report data in the following categories: sociodemographic information, food insecurity, socioeconomic status, common mental disorder (CMD), suicidal ideation, and suicidal behavior.
Of the study participants, 24% reported suicidal ideation in the previous 2 weeks: 18.05% reported suicidal thoughts, 2.07% reported a desire to kill themselves, and 4.15% stated that they would kill themselves if they had the opportunity. While 5.20% of the participants reported a lifetime prevalence of suicide attempts, 2.8% reported a 2-week prevalence of suicide attempt or planning. Depressive disorders were the most common form of psychopathology (22.41%), and no significant gender differences were observed with respect to a lifetime prevalence of suicide attempt.
Suicidal ideation was significantly associated with past suicide attempt and depressive disorders, generalized anxiety disorder, trauma and stress-related disorders, and alcohol use disorder. These results support previous findings that also found strong associations between psychiatric symptoms and suicidal ideation in PLWHA. However, the study found no association between suicidal ideation and age, gender, unemployment, family income, or food insecurity.
“Our findings may be in part a result of the relative homogeneity of our sample in terms of socioeconomic status,” explained Jason Bantjes, PhD, lead researcher of the study. “Future studies [that] draw from a broader cross-section of individuals may help to identify the socioeconomic and contextual factors that contribute to SIB in this population.”
These data imply that individuals who seek HIV testing could potentially constitute a group at higher risk for suicide than the general population; this situation could therefore qualify as a serious public health problem. Dr Bantjes suggests the need for integration of mental health services, especially screening for mental disorders and referral of patients who need such services, as part of a national suicide prevention strategy. “In an effort to provide greater access to HIV testing in South Africa, a large number of nonmedical HIV testing sites have been established.”
- Bantjes J, Ashraf Kagee A, Saal W. Suicidal ideation and behaviour among persons seeking HIV testing in peri-urban areas of Cape Town, South Africa: a lost opportunity for suicide prevention [published online December 28, 2016]. AIDS Care. doi.org/10.1080/09540121.2016.1274716
- Shirey, K G. Suicide and HIV. In: Mental Health Practitioner’s Guide to HIV/AIDS. New York, NY: Springer Publishing Company:2013; 405-407.
- Petrushkin A, Boardman J, Ovuga E. Psychiatric disorders in HIV-positive individuals in urban Uganda. Psychiatr Bull. 2005;29:455-458.