HIV-infection as a self-reported risk factor for attempted suicide in South Africa

The aim of this study was to examine variables associated with recently diagnosed HIV-infection as a self-reported attempted suicide risk factor.

The study cohort consisted of 112 general hospital in-patients who attempted suicide because of HIV-infection. All the patients were subject to a comprehensive mental state examination and administration of a semi-structured questionnaire to obtain biographical, sociodemographic and other relevant information. Pearson uncorrected Chi-square (X(2)) or Fisher's Exact Probability Test were used to analyze data utilising Epicalc 2000, version 1.02.

Most patients expressed a heterosexual preference. The average age was 34.9 years. Females predominated and in both genders depression and substance abuse (mainly alcohol-related) accounted for the most common psychiatric diagnoses. Less than half of the patients were married. Partner relational problems was a statistically significant variable. The most prevalent co-morbid stressors were poor social support, fear of disclosure/stigmatization and socio-economic pressures. Cognitive deficits included problems with cognitive flexibility, concentration and memory. Based on estimated national suicidal behaviour prevalence rates, a descriptive HIV-related attempted suicide rate of 67.2 per 100 000 and an increased risk for attempted suicide of 13.33% to 18.87% were calculated.

HIV-infection can be an underestimated suicide risk factor. Effective management and prevention programmes should include as imperatives early diagnosis of HIV-related suicidal behaviour, recognition of underlying psychopathology, neurocognitive deficits, associated stressors, the dynamics of partner relationship problems, as well as cultural awareness and sensitivity. Potential neurocognitive complications that can act as additional risk factors require further research.