Determinants of suicide and accidental or violent death in the Australian HIV Observational Database

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dc.contributor.authorMcManus, H.
dc.contributor.authorPetoumenos, K.
dc.contributor.authorFranic, T.
dc.contributor.authorKelly, M.
dc.contributor.authorWatson, J.
dc.contributor.authorO’Connor, C.
dc.contributor.authorJeanes, M.
dc.contributor.authorHoy, J.
dc.contributor.authorCooper, D.
dc.contributor.authorLaw, M.
dc.contributor.editorPendyala, G.
dc.date.issued2014
dc.description.abstractBackground: 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.
dc.description.statementofresponsibilityHamish 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
dc.identifier.citationPLoS ONE, 2014; 9(2):e89089-1-e89089-8
dc.identifier.doi10.1371/journal.pone.0089089
dc.identifier.issn1932-6203
dc.identifier.issn1932-6203
dc.identifier.urihttp://hdl.handle.net/2440/116330
dc.language.isoen
dc.publisherPublic Library of Science (PLoS)
dc.rights© 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.
dc.source.urihttps://doi.org/10.1371/journal.pone.0089089
dc.subjectAustralian HIV Observational Database
dc.subjectHumans
dc.subjectHIV-1
dc.subjectHIV Infections
dc.subjectCause of Death
dc.subjectCase-Control Studies
dc.subjectSuicide
dc.subjectHomosexuality, Male
dc.subjectAccidents
dc.subjectHomicide
dc.subjectViolence
dc.subjectDatabases, Factual
dc.subjectAdult
dc.subjectMiddle Aged
dc.subjectAustralia
dc.subjectMale
dc.subjectYoung Adult
dc.titleDeterminants of suicide and accidental or violent death in the Australian HIV Observational Database
dc.typeJournal article
pubs.publication-statusPublished

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