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Risk factors for suicide among veterans living with and without HIV: a nested case-control study

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Abstract

The rate of suicide among people with HIV (PWH) remains elevated compared to the general population. The aim of the study was to examine the association between a broad range of risk factors, HIV-specific risk factors, and suicide. We conducted a nested case-control study using data from the Veterans Aging Cohort Study (VACS) between 2006 and 2015. The risk of suicide was estimated using conditional logistic regression and models were stratified by HIV status. Most risk factors associated with suicide were similar between PWH and people without HIV; these included affective disorders, use of benzodiazepines, and mental health treatment. Among PWH, HIV-specific risk factors were not associated with suicide. A multiplicative interaction was observed between a diagnosis of HIV and a previous suicide attempt. Among PWH, a high prevalence of psychiatric, substance use disorders and multimorbidity contribute to the risk of suicide.

Resumen

La tasa de suicidio entre las personas con VIH (PWH) sigue siendo elevada en comparación con la población general. El objetivo del estudio fue examinar la asociación entre un amplio rango de factores de riesgo, los riesgos específicos del VIH y el suicidio. Realizamos un estudio anidado de casos y controles usando datos del Veterans Aging Cohort Study (VACS) entre 2006–2015. El riesgo de suicidio fue estimado mediante regresión logística condicional y los modelos se estratificaron por estado serológico. La mayoría de los factores de riesgo asociados con el suicidio fueron similares entre las PWH y las personas sin VIH; estos incluyeron trastornos afectivos, uso de benzodiazepinas y tratamiento de salud mental. Entre las PWH, los factores de riesgo específicos del VIH no se asociaron con el suicidio. Se observó una interacción multiplicativa entre un diagnóstico de VIH y un intento de suicidio previo. Entre las PWH, una alta prevalencia de trastornos psiquiátricos, por consumo de sustancias y multimorbilidad contribuyen al riesgo de suicidio.

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Data Availability (data transparency)

While data are not publicly available, reasonable requests will be considered by the corresponding author.

Code Availability (software application or custom code)

All programing was conducted in SAS 9.4 and will be made available by the corresponding author if requested.

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Acknowledgements

This work was supported by the Robert Wood Johnson, Future of Nursing Scholars program; Yale Center for Clinical Investigation Multidisciplinary Pre-Doctoral Training Program in Translational Research; and NIH National Institute on Alcohol Abuse and Alcoholism U24 AA020794, U01 AA020790, U24 AA022001, U10 AA013566.

Funding

Robert Wood Johnson, Future of Nursing Scholars; Yale Center for Clinical Investigation Multidisciplinary Pre-Doctoral Training Program in Translational Research; NIH National Institute on Alcohol Abuse and Alcoholism U24 AA020794, U01 AA020790, U24 AA022001, U10 AA013566-completed and in kind by the US Department of Veterans Affairs.

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Authors and Affiliations

  1. Yale School of Nursing, 400 West Campus Drive, Orange, CT, 06477, USA

    Alexandria Smith, David Vlahov & Julie A Womack

  2. Yale School of Public Health, Orange, USA

    Alexandria Smith

  3. VA Connecticut Healthcare System, West Haven, CT, USA

    Joseph L Goulet & Amy C. Justice

  4. Yale School of Medicine, New Haven, CT, USA

    Joseph L Goulet & Amy C. Justice

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  1. Alexandria Smith
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  2. Joseph L Goulet
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  3. David Vlahov
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Contributions

Conception or design of the work. AS, JW, JG, AJ, DV. Data collection: AS, AJ. Data analysis and interpretation: AS, JW, JG. Drafting the article: AS, JW. Critical revision of the article: AS, JW, JG, AJ, DV. Final approval of the version to be published: AS, JW, JG, AJ, DV.

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Correspondence to Alexandria Smith.

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No conflicts of interest.

Ethics Approval

This study was performed in line with the principles of the Declaration of Helsinki. IRB approval was granted from the institutional review boards of the coordinating center at Yale University, New Haven, CT, the Veterans Affairs (VA) Connecticut Healthcare System, West Haven, CT, and from the participating clinical sites. (Yale HIC 0309025943; VA IRB AJ0001; IRBNet 1583210)

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Smith, A., Goulet, J.L., Vlahov, D. et al. Risk factors for suicide among veterans living with and without HIV: a nested case-control study. AIDS Behav 28, 115–124 (2024). https://doi.org/10.1007/s10461-023-04164-3

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