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Suicide

Many reviews have report a higher incidence of suicidal ideation, suicide attempts, and actual suicide in the HIV-infected than the general population. People infected by the HIV virus are at higher risk for suicide. Suicide is reported to be the second most common cause of death in HIV-infected gay men in San Francisco, second only to death from AIDS itself. Two of the populations most likely

Suicidal Ideation, Intent, Attempts, and Successes

Before describing how to proceed with an assessment, it is important for providers to understand the range of suicidal presentations. Suicidal thinking or ideation is very common and usually is fleeting, without a clear plan or strong intent. Suicidal intent presents often with a plan and, at times, a questionable ability to control the impulse to act on the plan. Rational suicides usually present this way, with a time frame or set of conditions that would need to occur before acting on the plan. Suicide attempts are less frequent, and

Every person with HIV infection probably thinks about suicide at some point. One review reported a greater incidence of suicidal ideation in HIV-infected people not diagnosed with AIDS than those with AIDS. The thoughts are more frequent in people who have

A study of suicide attempts in military personnel who are HIV infected (a population that may not be comparable to the general HIV-infected population) reported 1,790 attempts per 100,000, or 16 to 24 times greater than the general population. Two-thirds of the attempts occurred within the first year of learning serostatus, and one-half within the first three months, and were often

A national assessment reported a suicide rate among people with AIDS of 165 per 100,000, 7.4 times greater than

Office Assessment

Providers in the office setting may see a patient who has just made an attempt, reports suicidal thinking spontaneously, or answers positively to an inquiry about suicidal ideation during a review of suicide, HIV, AIDS, physician assisted suicide, physician-assisted, sucide, suicide

• Current symptoms of depression such as hopelessness, helplessness, insomnia, loss of appetite or loss of sexual and other interests

• A psychiatric history of depression, anxiety, alcohol or substance abuse, or organic mental disorders

• A family history of any of the above

• An experience with someone who committed suicide that could be seen as positive or "for the best"

• A history of several losses due to AIDS

• A limited or non-existent social support system

• The inability to work c Financial worries

• Guilt or shame in being HIV infected, being gay (if the patient is), or being an IDU (if the patient is)

• Progression in HIV illness c A large drop in CD4 count

• Limited future medical treatment options

• Pain that is increasing or difficult to treat

• Mild neuro-cognitive impairment

• Or a hopelessness about feeling better.

• The development of denial, acceptance, and even a mild dementia may all contribute to a reduced incidence of suicidal ideation in someone diagnosed with AIDS.

Responses to Suicidal Thinking

If the provider believes the patient is open and honest about the suicidal thinking and has no immediate plan to act on