SUICIDE AND HIV-INFECTION - MORTALITY FOLLOW-UP OF 4147 HIV-SEROPOSITIVE MILITARY SERVICE APPLICANTS

Objective.-To examine the risk of suicide among individuals positive f or the human immunodeficiency virus (HIV) following screening for evid ence of HIV infection. Prior studies have reported a 7- to 36-fold inc reased risk of suicide for persons with the acquired immunodeficiency syndrome. Design.-Prospective cohort study. Setting.-Military service applicants from throughout the United States. Main Outcome Measure.-De ath from suicide. Methods.-The National Death Index was searched for m ortality among 4147 HIV-positive military service applicants and 12437 HIV-negative applicants disqualified from military service due to oth er medical conditions (matched 1:3 on age, race, sex, and screening da te and location) identified by the US Department of Defense between Oc tober 1985 and December 1993. Death certificates were obtained from in dividual states. Identifiers and HIV status of living applicants were known only by the Department of Defense. Results.-The HIV-positive app licants were 92% male, 37% white, and 56% black. Median age was 24 yea rs (range, 17-57 years). Median follow-up time was 70 months (range, 0 -99 months). Ten HIV-positive (49 per 100 000 person-years) and 24 HIV -negative applicants (36 per 100 000 person-years) died of suicide (ra te ratio [RR], 1.35; 95% confidence interval [CI]= 0.58-2.93). Suicide rates among both HIV-positive (RR, 2.08; 95% CI, 1.00-3.82) and HIV-n egative (RR, 1.67; 95% CI, 1.07-2.48) applicants are marginally higher than those for the US general population, after adjustment for age, r ace, and sex. Time from screening to death was less than 3 months for 3 of 10 HIV-positive and 2 of 24 HIV-negative applicants who died of s uicide. Conclusions.-The HIV-positive individuals do not appear to hav e a significantly increased risk of death from suicide in the months f ollowing HIV screening in this study population. Because suicide risk is reported to be greatly increased after symptomatic HIV disease is p resent, clinicians should consider asking persons with HIV infection a bout suicide risk factors during both initial counseling and subsequen t medical care.