Annals of Behavioral Medicine

, Volume 24, Issue 2, pp 141–148 | Cite as

Thoughts of suicide among HIV-infected rural persons enrolled in a telephone-delivered mental health intervention

  • Timothy G. Heckman
  • Jeffrey Miller
  • Arlene Kochman
  • Seth C. Kalichman
  • Bruce Carlson
  • Monica Silverthorn


This study characterized rates and predictors of suicidal thoughts among HIV-infected persons living in rural communities of eight U.S. states. Self-administered surveys were completed by 201 HIV-infected persons living in communities of 50,000 or fewer that were located at least 20 miles from a city of 100,000 or more. All participants were clients of rural AIDS service organizations and had recently enrolled into a randomized clinical trial of a telephone-delivered, coping improvement-group intervention designed specifically for HIV-infected rural persons. At baseline, participants reported on thoughts of suicide, psychological symptomatology, life-stressor burden, ways of coping, coping self-efficacy, social support, and barriers to health care and social services. Thirty-eight percent of HIV-infected rural persons had engaged in thoughts of suicide during the past week. A logistic regression analysis revealed that participants who endorsed thoughts of suicide also reported more depressive symptoms(odds ratio [OR] = 2.19; 95% confidence interval [CI] = 1.32-3.63, p < .002), less coping self-efficacy (OR = 0.70; 95% CI = 0.56-0.88, p < .002), more frequently worried about transmitting their HIV infection to others (OR = 1.66, 95% CI = 1.14-2.40, p < .008), and experienced more stress associated with AIDS-related stigma (OR = 1.58, 95% CI = 1.07-2.35, p < .03). As AIDS prevalence rates increase in rural areas, interventions that successfully identify and treat geographically isolated HIV-infected persons who experience more frequent or serious thoughts of suicide are urgently needed.


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  1. (1).
    Centers for Disease Control and Prevention:HIV/AIDS Surveillance Supplemental Report. 1999, 5:8.Google Scholar
  2. (2).
    Sullivan PS, Chu SY, Fleming PL, Ward JW: Changes in AIDS incidence for men who have sex with men, United States 1990–1995.AIDS. 1997,11:1641–1646.PubMedCrossRefGoogle Scholar
  3. (3).
    Pergami A, Gala C, Burgess A, et al.: The psychosocial impact of HIV infection in women.Journal of Psychosomatic Research. 1993,37:687–696.PubMedCrossRefGoogle Scholar
  4. (4).
    Alfonso CA, Cohen MA, Aldajem AD, Morrison F: HIV seropositivity as a major risk factor for suicide in the general hospital.Psychosomatics. 1994,35:368–373.PubMedGoogle Scholar
  5. (5).
    Goggins K, Sewell M, Ferrando S, et al.: Plans to hasten death among gay men with HIV/AIDS: Relationship to psychological adjustment.AIDS Care. 2000,12:125–136.CrossRefGoogle Scholar
  6. (6).
    Green G: AIDS and euthanasia.AIDS Care. 1995,7(Suppl.2): 169–173.CrossRefGoogle Scholar
  7. (7).
    Van den Boom FM: AIDS, euthanasia, and grief.AIDS Care 1995,7(Suppl. 2):175–185.Google Scholar
  8. (8).
    Dannenberg AL, McNeil JG, Brundage JF, Brookmeyer R: Suicide and HIV infection: Mortality follow-up of 4147 HIV-sero-positive military service applicants.Journal of the American Medical Association. 1996,276:1743–1746.PubMedCrossRefGoogle Scholar
  9. (9).
    Kalichman SC:Understanding AIDS: A Guide for Mental Health Professionals (2nd Ed.). Washington, DC: American Psychological Association, 1998.Google Scholar
  10. (10).
    Millard J: Suicide and suicide attempts in the lesbian and gay community.Australian and New Zealand Journal of Mental Health Nursing. 1995,4:181–189.PubMedGoogle Scholar
  11. (11).
    Rossow I, Lauritzen G: Balancing on the edge of death: Suicide attempts and life-threatening overdoses among drug addicts.Addiction. 1999,94:209–219.PubMedCrossRefGoogle Scholar
  12. (12).
    Kalichman SC, Heckman TG, Kochman AR, Sikkema KJ, Berg-holte J: Suicidal ideation among midlife and older adults living with HIV/AIDS.Psychiatric Services. 2000,51: 903–907.PubMedCrossRefGoogle Scholar
  13. (13).
    Rosenfeld B, Breitbart W, Stein K, et al.: Measuring desire for deaths among patients with HIV/AIDS: The schedule of attitudes towards hastening death.American Journal of Psychiatry. 1999,156:94–100.PubMedGoogle Scholar
  14. (14).
    Berry DE, McKinney MM, McClain M: Rural HIV service networks: Patterns of care and policy issues.AIDS & Public Policy Journal. 1996,11:36–46.Google Scholar
  15. (15).
    Heckman TG, Somlai AM, Otto-Salaj L, Davantes B: Health-related quality of life among people living with HIV/AIDS in small communities and rural areas.Psychology and Health. 1998,13:859–871.CrossRefGoogle Scholar
  16. (16).
    Heckman TG, Somlai AM, Kalichman SC, Franzoi S, Kelly JA: Psychosocial differences between urban and rural persons living with HIV/AIDS.The Journal of Rural Health. 1998,14:138–146.PubMedGoogle Scholar
  17. (17).
    Graham RP, Forrester ML, Wysong JA, Rosenthal TC, James PA: HIV/AIDS in the rural United States: Epidemiology and Health Services Delivery.Medical Care Research and Review. 1995,52:435–452.PubMedCrossRefGoogle Scholar
  18. (18).
    Lansky A, Nakashima AK, Diaz T, et al.: Human immunodeficiency virus infection in rural areas and small cities of the Southeast: Contributions of migration and behavior.The Journal of Rural Health. 2000,16:20–30.PubMedGoogle Scholar
  19. (19).
    Heckman TG, Somlai AM, Otto-Salaj L, et al.: Barriers to care among persons living with HIV/AIDS in urban and rural areas.AIDS Care. 1998,10:365–375.PubMedCrossRefGoogle Scholar
  20. (20).
    Beck AT:Depression: Clinical, Experimental, and Theoretical Aspects. New York: Harper & Row, 1967.Google Scholar
  21. (21).
    Beck AA, Brown G, Berchick RJ, Stewart BL, Steer RA: Relationship between hopelessness and ultimate suicide: A replication with psychiatric outpatients.American Journal of Psychiatry. 1990,147:190–195.PubMedGoogle Scholar
  22. (22).
    Minkoff K, Bergman E, Beck AT, Beck R: Hopelessness, depression, and attempted suicide.American Journal of Psychiatry. 1973,130:455–459.PubMedGoogle Scholar
  23. (23).
    McNaught A, Spicer J: Theoretical perspectives on suicide in gay men with AIDS.Social Science andMedicine. 2000,51:65–72.CrossRefGoogle Scholar
  24. (24).
    Heckman TG, Kalichman SC, Roffman R, et al.: A telephone-delivered coping improvement intervention for persons living with HIV/AIDS in rural areas.Social Work with Groups. 1999,21:49–62.CrossRefGoogle Scholar
  25. (25).
    Beck AT, Steer RA:Beck Depression Inventory. New York: Psychological Corporation, 1993.Google Scholar
  26. (26).
    Derogatis LR:SCL-90-R, Administration, Scoring & Procedures Manual-II. Towson, MD: ClinicalPsychometric Research, 1983.Google Scholar
  27. (27).
    Sikkema KJ, Kalichman SC, Hoffmann R, et al.: Coping strategies and emotional well-being among HIV-infected men and women experiencing AIDS-related bereavement.AIDS Care. 2000,12:613–624.PubMedCrossRefGoogle Scholar
  28. (28).
    Folkman S, Lazarus RS:The Ways of Coping Questionnaire. Palo Alto: Consulting Psychologists Press, 1988.Google Scholar
  29. (29).
    Chesney M, Folkman S, Chambers D: Coping effectivenesstraining for men living with HIV: Preliminary findings.International Journal of STDs & AIDS. 1996,7(Suppl. 2):75–82.CrossRefGoogle Scholar
  30. (30).
    Turner TJ, Frankel BG, Levin DM: Social support: Conceptualization, measurement, and implications for mental health.Research in Community and Mental Health, 1983,3:67–111.Google Scholar
  31. (31).
    Marzuk P, Tierney H, Gross EM, et al.: Increased risk for suicide in persons with AIDS.Journal of the American Medical Association. 1988,259:1333–1337.PubMedCrossRefGoogle Scholar
  32. (32).
    McKegney FP, O’Dowd MA: Suicidality and HIV status.American Journal of Psychiatry. 1992,49:396–398.Google Scholar
  33. (33).
    Kessler RC, Borges G, Walters EE: Prevalence of and risk factors for lifetime suicide attempts in the National Co-morbidity Survey.Archives of General Psychiatry. 1999,56:617–626.PubMedCrossRefGoogle Scholar
  34. (34).
    Ramberg I, Wasserman D: Prevalence of reported suicidal behaviour in the general population and mental health-care staff.Psychological Medicine. 2000,30:1189–1196.PubMedCrossRefGoogle Scholar
  35. (35).
    Vilhjalmsson R, Kristansdottir G, Sveinbjarndottir E:Social Psychiatry and Psychiatric Epidemiology. 1998,33:97–103.PubMedCrossRefGoogle Scholar
  36. (36).
    Kissinger P, Fuller C, Clark RA, Abdalian SE: Psychosocial characteristics of HIV-infected adolescents in New Orleans.Journal of Adolescent Health. 1997,20:258.PubMedCrossRefGoogle Scholar
  37. (37).
    Beck AT: Cognitive therapy: Past, present, and future.Journal of Consulting and Clinical Psychology. 1993,61:194–198.PubMedCrossRefGoogle Scholar
  38. (38).
    Rush AJ, Beck AT, Kovacs M, et al.: Comparison of the effects of cognitive therapy and pharmacotherapy on hopelessness and self-concept.American Journal of Psychiatry. 1982,139:862–866.PubMedGoogle Scholar
  39. (39).
    Antoni MH, Baggett L, Ironson G, et al.: Cognitive-behavioral stress management intervention buffers distress responses and immunologic changes following notification of HIV-1 ser- opositivity.Journal of Consulting and Clinical Psychology. 1991,59:906–915.PubMedCrossRefGoogle Scholar
  40. (40).
    Lutgendorf SK, Antoni MH, Ironson G, et al.: Cognitive-behavioral stress management decreases dysphoric mood and herpes simplex virus-type 2 antibody titers in symptomatic HIV-seropositive gay men.Journal of Clinical and Consulting Psychology. 1997,65:31–43.CrossRefGoogle Scholar
  41. (41).
    Rounds KA: AIDS in rural areas: Challenges to providing care.Social Work. 1988,33:257–261.PubMedGoogle Scholar

Copyright information

© The Society of Behavioral Medicine 2002

Authors and Affiliations

  • Timothy G. Heckman
    • 1
    • 2
  • Jeffrey Miller
    • 2
  • Arlene Kochman
    • 2
    • 3
  • Seth C. Kalichman
    • 2
  • Bruce Carlson
    • 3
  • Monica Silverthorn
    • 3
  1. 1.Department of PsychologyOhio UniversityAthens
  2. 2.Medical College of WisconsinUSA
  3. 3.Yale University School of MedicineUSA

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