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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, second only to death from AIDS itself.

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.

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.

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.

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

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 physician assisted suicide.

Responses to Suicidal Thinking

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