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Home >> Publications >> Determinants of Suicide and Accidental or Violent Death in the Australian HIV Observational Database.

Publication

Author(s):

McManus H, Petoumenos K, Franic T, Kelly MD, Watson J, O'Connor CC, Jeanes M, Hoy J, Cooper DA, Law MG; Australian HIV Observational Database.

Pub Title:

Determinants of Suicide and Accidental or Violent Death in the Australian HIV Observational Database.

Pub Date:

Feb 19 2014

Pub Region(s):

Asia-Pacific

Journal:

Title: 
PLoS One
Link: 
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3929688/

PubMed: 24586519
Pub PDF: PDF icon 24586519.pdf

Abstract

BACKGROUND:
Rates of suicide and accidental or violent death remain high in HIV-positive populations despite significantly improved prognosis since the introduction of cART.

METHODS: We conducted a nested case-control study of suicide and accidental or violent death in the Australian HIV Observational Database (AHOD) between January 1999 and March 2012. For each case, 2 controls were matched by clinic, age, sex, mode of exposure and HIV-positive date to adjust for potential confounding by these covariates. Risk of suicide and accidental or violent death was estimated using conditional logistic regression.

RESULTS: We included 27 cases (17 suicide and 10 violent/accidental death) and 54 controls. All cases were men who have sex with men (MSM) or MSM/ injecting drug use (IDU) mode of exposure. 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 HIV-positive date ≥1990 (1990-1999 (OR 0.31, 95% CI: 0.11-0.89), post-2000 (OR 0.08, 95% CI: 0.01-0.84)) were associated with decreased risk. 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 date.

CONCLUSIONS: After adjustment for psychosocial factors, the 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.

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Citation:

McManus H, Petoumenos K, Franic T, Kelly MD, Watson J, O'Connor CC, Jeanes M, Hoy J, Cooper DA, Law MG; Australian HIV Observational Database. Determinants of Suicide and Accidental or Violent Death in the Australian HIV Observational Database. PLoS One. 2014;9(2):e89089. doi: 10.1371/journal.pone.0089089. PubMed PMID: 24586519; PubMed Central PMCID: PMC3929688.