Rates of suicidal ideation among HIV-infected patients in care in the HIV Outpatient Study 2000–2017, USA

Background: Suicidal ideation (SI) refers to an individual thinking about, considering or planning suicide. Identifying and characterizing persons with HIV (PWH) at greater risk for SI may lead to better suicide prevention strategies and quality of life improvement. Methods: Using clinical data gathered from medical chart abstraction for HIV Outpatient Study (HOPS) participants from 2000 to 2017, we assessed SI frequency among PWH in care and explored factors associated with the presence of SI diagnoses using linear mixed models analyses. Results: Among 6706 participants, 224 (3.3%) had a charted diagnosis of SI. Among those with SI, median age (interquartile range [IQR]) was 43.4 years [IQR: 38.7–50.3], median (IQR) CD4+ cell count was 439 cells/mm³ (IQR: 237–686), 71.4% were male, 54% were men who have sex with men (MSM), 25.4% heterosexual, and 13.4% persons who inject drugs. In multivariable analysis, persons at increased risk for SI were more likely to be: <50 years old (adjusted rate ratio [aRR] 1.86, 95% confidence interval [95%CI] 1.36–2.53), non-Hispanic/Latino black (aRR 1.75; 95%CI 1.29–2.38), have CD4+ cell count <350 cells/mm³ (aRR 1.32; 95%CI 1.05–1.65), have a viral load ≥50 copies/mL (aRR 1.49; 95%CI 1.12–1.98), have stopped antiretroviral therapy (aRR 1.46; 95%CI 1.10–1.95), have a history of: alcohol dependence (aRR 2.75; 95%CI 1.67–4.52), and drug overdose (aRR 4.09; 95%CI 2.16–7.71). Conclusion: Routine mental health assessment and monitoring are needed in HIV clinical practice to better understand factors associated with SI and to inform the development of preventive interventions.