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Determinants of suicide and accidental/violent death in the Australian HIV Observational Database

Determinants of suicide and accidental/violent death in the Australian HIV Observational Database

Suicide and accidental or violent death continues to occur in HIV-positive populations despite significantly improved prognosis since the introduction of cART. The combined effects of psychosocial factors and HIV-infection on risk are poorly understood. In this study we analysed predictors of confirmed cases of suicide as well as of accidental or violent death to develop adjusted models of risk associated with both psychosocial and HIV-related factors.

Methods: We conducted a retrospective nested case-control study of suicide and accidental or violent death in the Australian HIV Observational Database between January 1999 and March 2012. For each case, 2 controls were matched by clinic, age, sex, mode of exposure and HIV-positive diagnosis date. Psychosocial risk factors and HIV infection parameters were collected. Risk of suicide and accidental or violent death was estimated using conditional logistic regression.

Results: We included 27 cases (17 suicide and 10 accidental/violent death) and 54 controls. Increased risk was associated with unemployment (Odds Ratio (OR) 5.86, 95% CI:1.69-20.37), living alone (OR 3.26, 95% CI:1.06-10.07), suicidal ideation (OR 6.55, 95% CI:1.70-25.21), and >2 psychiatric/cognitive risk factors (OR 4.99, 95% CI:1.17-30.65). CD4 cell count of >500 cells/μL (OR 0.25, 95% CI:0.07-0.87) and later HIV-positive diagnosis date (p=0.04) were associated with decreased risk. Depression was not a significant predictor of risk (OR 1.87, 95% CI:0.67-5.25). CD4 cell count >500 cells/μL remained a significant predictor of reduced risk (OR 0.15, 95% CI:0.03-0.70) in a multivariate model adjusted for employment status, accommodation status and HIV-positive diagnosis date.

Conclusions: After adjustment for psychosocial factors, immunological status of HIV-positive patients contributed to the risk of suicide and accidental or violent death. The number of psychiatric/cognitive diagnoses contributed to the level of risk but many psychosocial factors were not individually significant. These findings indicate a complex interplay of factors associated with risk of suicide and accidental or violent death.

Conference: AIDS 2013, ASHM 2013, HIV

Australian Society for HIV 2015

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