Ongoing life stressors and suicidal ideation among HIV-infected adults with depression

JOURNAL OF AFFECTIVE DISORDERS

卷:190

Article

O'Donnell, Julie K.¹  Gaynes, Bradley N.²  Cole, Stephen R.¹  Edmonds, Andrew¹  Thielman, Nathan M.³  Quinlivan, E. Byrd^4,5  Shirey, Kristen⁶  Heine, Amy D.⁷  Modi, Riddhi⁸  Pence, Brian W.¹ 

[1] Univ N Carolina, Dept Epidemiol, Chapel Hill, NC USA

[2] Univ N Carolina, Sch Med, Dept Psychiat, Chapel Hill, NC USA

[3] Duke Univ, Duke Global Hlth Inst, Ctr Hlth Policy, Durham, NC 27706 USA

[4] Univ N Carolina, Inst Global Hlth, Infect Dis, Chapel Hill, NC USA

[5] Univ N Carolina, Ctr AIDS Res, Chapel Hill, NC USA

[6] Duke Univ, Sch Med, Dept Psychiat, Durham, NC 27706 USA

[7] Univ N Carolina, Inst Global Hlth & Infect Dis, Chapel Hill, NC USA

[8] Univ Alabama Birmingham, Div Infect Dis, Birmingham, AL USA

关键词: Stress;    Trauma;    Suicidal ideation;    Depression;    HIV;   

DOI  :  10.1016/j.jad.2015.09.054

来源: Elsevier

【 摘 要 】

Background: Suicidal ideation is the most proximal risk factor for suicide and can indicate extreme psychological distress; identification of its predictors is important for possible intervention. Depression and stressful or traumatic life events (STLEs), which are more common among HIV-infected individuals than the general population, may serve as triggers for suicidal thoughts. Methods: A randomized controlled trial testing the effect of evidence-based decision support for depression treatment on antiretroviral adherence (the SLAM DUNC study) included monthly assessments of incident STLEs, and quarterly assessments of suicidal ideation (SI). We examined the association between STLEs and SI during up to one year of follow-up among 289 Southeastern US-based participants active in the study between 71112011 and 41112014, accounting for time-varying confounding by depressive severity with the use of marginal structural models. Results: Participants were mostly male (70%) and black (62%), with a median age of 45 years, and experienced a mean of 2.36 total STLEs (range: 0-12) and 0.48 severe STLEs (range: 0-3) per month. Every additional STLE was associated with an increase in SI prevalence of 7% (prevalence ratio (PR) (95% confidence interval (CI)): 1.07 (1.00, 1.14)), and every additional severe STLE with an increase in SI prevalence of 19% (RR (95% CI): 1.19 (1.00, 1.42)). Limitations: There was a substantial amount of missing data and the exposures and outcomes were obtained via self-report; methods were tailored to address these potential limitations. Conclusions: STLEs were associated with increased SI prevalence, which is an important risk factor for suicide attempts and completions. (C) 2015 Elsevier BY. All rights reserved.

【 授权许可】

Free