Psychological adjustment and suicidal ideation in patients with AIDS

This article assesses the psychosocial adjustment to illness and examines the relationship between adjustment and psychosocial and medical variables in 91 ambulatory HIV-infected patients. The 91 subjects were receiving ambulatory medical care in hospitals (Memorial Hospital, New York Hospital, and St. Vincent's Hospital) and in private medical consult (Gay Men's Health Crisis) in New York. The majority (74.5%) of subjects had AIDS. The sample was composed principally of white Roman Catholic homosexual men living alone. However, 49.5% were black or hispanic, 31.9% had intravenous drug use as their HIV risk behavior, 54.9% had past psychiatric history (including illegal drug use), and 22% had previous suicide attempts. Self-report measures of psychological adjustment (Psychological Adjustment to Illness Scale), mood (Brief Symptom Inventory), physical (PHYS) and psychological (PSYCH) symptoms from the Memorial Symptom Assessment Scale-Short Form (MSAS-SF), social support (Social Support Questionnaire-Short Report), suicidal ideation (Scale for Suicide Ideation Self-Report), and measures of disease status (Karnofsky Performance Rating Scale, HIV CDC Classification, and Absolute CD4+ Lymphocyte Count) were used in the study. The average age of subjects was 40 years (SD = 6.80). fifty-two (63.4%) subjects acknowledged some indication of suicidal ideation. Variables that correlated with poor medical adjustment (health-care posture) were current suicide ideation (0.32, p = 0.003), number of psychological symptoms (0.45, p = 0.0001), physical symptoms (0.31, p = 0.006), social support (-0.24, p = 0.03), and satisfaction with the social support received (-0.36, p = 0.001). Poor sexual adjustment was related to current suicide ideation (0.39, p = 0.0004), number of psychological symptoms (0.40, p = 0.0003), satisfaction with the social support received (-0.28, p = 0.01), and number of physical symptoms (0.35, p = 0.002). In patients with a diagnosis of AIDS, the number of psychological symptoms (Beta = 0.29, R2 = 0.07, p = 0.02) and the satisfaction with the social support received (Beta = -0.38, R2 = 0.14, p = 0.003) were clear predictors of poor medical adjustment (health-care posture). Likewise, the predictors of poor sexual adjustment were psychological symptoms (Beta = 0.33, R2 = 0.10, p = 0.003) and suicidal ideation (Beta = 0.40, R2 = 0.10, p = 0.002). The results suggest that suicide ideation is associated with poor adjustment, rather than serving as an adaptive function, as has been suggested by others.