Determinants of suicide and accidental or violent death in the Australian HIV Observational Database
Date
2014
Authors
McManus, H.
Petoumenos, K.
Franic, T.
Kelly, M.
Watson, J.
O’Connor, C.
Jeanes, M.
Hoy, J.
Cooper, D.
Law, M.
Editors
Pendyala, G.
Advisors
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Volume Title
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Journal article
Citation
PLoS ONE, 2014; 9(2):e89089-1-e89089-8
Statement of Responsibility
Hamish McManus, Kathy Petoumenos, Teo Franic, Mark D. Kelly, Jo Watson, Catherine C. O’Connor, Mark Jeanes, Jennifer Hoy, David A. Cooper, Matthew G. Law, M. Boyd on behalf of the Australian HIV Observational Database
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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/mL (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/mL 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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© 2014 McManus et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.