Citation

Lawrence ST, Willig JH, Crane HM, Ye J, Aban IB, Lober W, Nevin CR, Batey DS, Mugavero MJ, McCullumsmith C, Wright C, Kitahata M, Raper JL, Saag MS, Schumacher JE. Clin. Infect. Dis. 2010; 50(8): 1165-1173.

Affiliation

Department of Internal Medicine, Division of Infectious Diseases, 2Department of Biostatistics, School of Public Health, 3Department of Psychiatry, and 4Department of Internal Medicine, Division of Preventive Medicine, University of Alabama at Birmingham, Birmingham; and 5Department of Medicine and 6School of Nursing, University of Washington, Seattle.

Copyright

(Copyright © 2010, University of Chicago Press)

DOI

10.1086/651420

PMID

20210646

PMCID

PMC2841210

Abstract

Background. Human immunodeficiency virus (HIV) and AIDS continue to be associated with an underrecognized risk for suicidal ideation, attempted suicide, and completed suicide. Suicidal ideation represents an important predictor for subsequent attempted and completed suicide. We sought to implement routine screening of suicidal ideation and associated conditions using computerized patient-reported outcome (PRO) assessments. Methods. Two geographically distinct academic HIV primary care clinics enrolled patients who attended scheduled visits from December 2005 through February 2009. Touch-screen, computer-based PRO assessments were implemented into routine clinical care. Substance abuse, alcohol consumption, depression, and anxiety were assessed. The 9-item Patient Health Questionnaire assesses the frequency of suicidal ideation in the preceding 2 weeks. A response of "nearly every day" triggered an automated page to predetermined clinic personnel, who completed more detailed self-harm assessments. Results. Overall, 1216 patients (740 from the University of Alabama at Birmingham and 476 from the University of Washington) completed the initial PRO assessment during the study period. Patients were predominantly white (646 [53%]) and male (959 [79%]), with a mean age (+/- standard deviation) of [Formula: see text] years. Among surveyed patients, 170 (14%) endorsed some level of suicidal ideation, whereas 33 (3%) admitted suicidal ideation nearly every day. In multivariable analysis, suicidal ideation risk was lower with advancing age (odds ratio [OR], 0.74 per 10 years; 95% confidence interval [CI], 0.58-0.96) and was increased with current substance abuse (OR, 1.88; 95% CI, 1.03-3.44) and more-severe depression (OR, 3.91 for moderate depression [95% CI, 2.12-7.22] and 25.55 for severe depression [95% CI, 12.73-51.30]). Discussion. Suicidal ideation was associated with current substance abuse and depression. The use of novel technologies to incorporate routine self-reported screening for suicidal ideation and other health domains allows for timely detection and intervention for this life-threatening condition.

Language: en