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Am Fam Physician. 2023;108(4):413-414

Author disclosure: No relevant financial relationships.

Clinical Question

What association exists between people living with HIV/AIDS and suicide attempts?

Evidence-Based Answer

People living with HIV/AIDS should be screened regularly for suicidal thoughts because suicide attempts are significantly higher in this cohort compared with the general population. (Strength of Recommendation: A, systematic review of cross-sectional and cohort studies.) In people living with HIV/AIDS, depression and a family history of suicide increase the risk of future attempts.

Evidence Summary

A 2022 systematic review and meta-regression of 43 studies (10 cohort and 33 cross-sectional studies) from 16 countries examined the suicidality rates and risk factors among people living with HIV/AIDS (n = 170,234).1 Patients had a mean age of 56 years and 67% were male. Primary outcomes were the prevalence of suicidal ideation, suicide attempts, and suicide completions. The studies included self-identified risk factors of sex, age, sexual orientation, marital status, education level, and other contributing factors. Among people living with HIV/AIDS, the prevalence of suicidal ideation was 22% (33 studies; n = 24,939; 95% CI, 17% to 28%). The prevalence of suicide attempts was 9.6% (17 studies; n = 9,149; 95% CI, 6.3% to 15%), and the prevalence of suicide completions was 1.7% (eight studies; n = 144,723; 95% CI, 1% to 2.8%). The rate of suicide completion was higher in people living with HIV/AIDS than in the general population (0.3 vs. 0.1 per 100 person-years). The most significant risk factors for suicide attempts in people living with HIV/AIDS were a diagnosis of depression (four studies; n = 1,783; relative risk [RR] = 1.7; 95% CI, 0.7 to 2.7) and family history of suicide (two studies; n = 738; RR = 1.1; 95% CI, 0.16 to 2.06). Suicidality was more common in people living with HIV/AIDS who were not receiving HIV treatment (nine studies; n = 95,575; RR = 2.9; 95% CI, 0.69 to 5.15) vs. patients who were on highly active antiretroviral therapy (seven studies; n = 14,610; RR = 2.6; 95% CI, 0.28 to 4.86). Limitations were mostly cross-sectional design studies and heterogeneity, including diverse samples and effect sizes.

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Help Desk Answers provides answers to questions submitted by practicing family physicians to the Family Physicians Inquiries Network (FPIN). Members of the network select questions based on their relevance to family medicine. Answers are drawn from an approved set of evidence-based resources and undergo peer review. The strength of recommendations and the level of evidence for individual studies are rated using criteria developed by the Evidence-Based Medicine Working Group (

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