The occurrence of suicidal ideation over the course of HIV infection in gay men: A cross-sectional study

Previous research has demonstrated an elevation in emotional distress and suicidality in persons infected with HIV. However, no study had previously reported having systematically analyzed the modulation of suicidal ideation or the qualitative changes associated with ideation which likely occur with the progression of HIV illness. This study utilized a controlled, cross-sectional model and self-report questionnaire instruments to assess the level of suicidal ideation and factors related to ideation, as well as depression, hopelessness, social support, and disease-related health factors in gay men at different points of HIV illness progression. As expected, the seropositive group evidenced significantly greater levels of suicidal ideation, depression, and hopelessness than the seronegative controls. Among the disease-related factors, only time since diagnosis of seropositivity predicted level of suicidal ideation: ideation increased linearly with the passage of time, suggesting that suicidality is mediated by psychological processes. A discriminant analysis revealed that time since diagnosis correctly distinguished ideators from nonideators only 61.2% of the time. This function lacks the accuracy necessary to be useful as a diagnostic tool, but suggests the importance of assessing this factor. Seropositive ideators who had survived HIV for more than five years, compared to those who had been diagnosed within two years, reported a higher incidence of persons in their environment who would lend at least emotional support for committing suicide, and among reasons for not committing suicide rated fear of social disapproval and moral objections as less important. These two groups were not significantly different on other measures, suggesting that the long-term survivors had sought out support for their suicidal intentions and disposed of reasons which might prevent them from enacting them. Finally, significant interactions were found between time since diagnosis and presence or absence of suicidal ideation on the factors of support network size, helpers for suicide, and fear of suicide and moral objections as suicide deterrents. These results suggest that long-term HIV survivors develop support networks that are more similar in size but different in composition than those newly diagnosed, and that they tend to dispose of reasons that would prevent them from acting on suicidal thoughts.