Attempted Suicide And Mental Disorders Among Hiv-positive Drug Users In Guangdong

Objective: To explore the occurrence and related factors of suicide attempts among HIV-positive drug users in Guangdong, in order to provide scientific evidence for crisis intervention in HIV voluntary counseling and testing and services.Methods: Two hundred and eighty HIV-positive drug users completed a questionnaire by face-to-face interview that obtained information about demographic data, suicide and HIV infection related factors, including the time of onset of attempted suicide, drug use, first HIV-positive notification, AIDS diagnosis and suicide attempt and so on. Two psychiatric doctors diagnosed mental illness according to the standard of"Structured Clinical Interview for DSM-IV-TR Axis I Disorders-Patient Edition (SCID-I/P)". The time of attempted for each subject was divided into 5 stages, namely prior to drug use, after drug use but prior to HIV notification, in first 3 months after HIV notification, more than 3 months after HIV notification but prior to AIDS diagnosis, and after AIDS diagnosis. The rates of attempted suicide in each stage were compared. Logistic regression analysis was used to explore the risk of suicide attempts.Results: Among the 280 respondents, 258 (92.1%) were male, 22 (7.9%) were female, the mean (SD) age was 34.4 (6.3) years (range 19-54 years), 16.4% (46/280) had been diagnosed with AIDS, the median duration of heroin use was 12.3 years (IQR 8.1-16.1years), 12.5% (35/280) were currently using heroin. Lifetime prevalence of suicide ideation among HIV-positive drug users were 36.4% (102/280), the 12-month prevalence and the 1-month prevalence of suicidal ideation were 27.9% (78/280) and 14.3% (40/280) separately. Of the 280 Subjects, 16.1% (45/280) had a lifetime history of suicide attempt, and 4.3% (12/280) had attempted suicide in the prior year. Of the 45 who had attempted suicide, 21 had 1 attempt, 13 had 2 attempts, 8 had 3 attempts and 3 had 4 attempts. In the 45 cases of suicide attempt, 22.2% sought for help before suicide attempt, the time they had considered suicide before acting was 1.5 hours, the degree of intention to die was 100 points, the rate of 42.2% considered specific plans, less than half of them (40.0%) receive medical treatment. Their purpose of the self-harm was to relieve themselves (60.1%) and reduce the burden of others (26.7%). Drug use was the main reason for suicide prior to HIV-positive notification, but after HIV-positive notification was HIV/AIDS. The rates of attempt per 1000 person-years for the 5 stages were as follows: prior to drug use, 0.9 (2/2148.6); after drug use but prior to HIV notification, 9.0 (24/2680.0); in first 3 months after HIV notification but prior to AIDS diagnosis, 52.1(3/57.6); more than 3 months after HIV notification but prior to AIDS diagnosis, 92.3 (48/519.9) ; and after AIDS diagnosis, 168.6 (6/35.6) (Cochran-Armitage Test for Trend Z=15.842, P<0.0001). HIV-positive heroin drug users are at high risk of lifetime Major depressive disorder (21.5%) and lifetime Anxiety disorder not otherwise specified (16.1%). Higher the level of depressive symptoms, higher rates of suicide attempts (Z=2.561, P=0.010). Compared with HIV-positive drug users without attempted suicide, unconditional logistic regression model analysis identified aggression (OR=5.2, 95%CI 2.3~11.6), major depression(OR= 1.7, 95%CI 1.1~2.5) and negative life events(OR= 2.8, 95%CI 1.3~5.9) as related factors predicting attempted suicide among HIV-positive drug users.Conclusions: HIV-positive drug users have high risk for suicide attempts and Mental Disorders, Suicide crisis intervention should be carried out in HIV voluntary counseling and testing and services among HIV-positive drug users, especially in those who have history of major depression, aggression, and experienced more negative life events.