Psychological adjustment and suicidal ideation in patients with AIDS

This article assesses the psychosocial adjustment to illness and examines t he relationship between adjustment and psychosocial and medical variables i n 91 ambulatory HIV-infected patients. The 91 subjects were receiving ambul atory medical care in hospitals (Memorial Hospital, New York Hospital, and St. Vincent's Hospital) and in private medical consult (Gay Men's Health Cr isis) in New York. The majority (74.5%) of subjects had AIDS. The sample wa s composed principally of white Roman Catholic homosexual men living alone. However, 49.5% were black or hispanic, 31.9% had intravenous drug use as t heir HIV risk behavior, 54.9% had past psychiatric history (including illeg al drug use), and 22% had previous suicide attempts. Self-report measures o f psychological adjustment (Psychological Adjustment to Illness Scale), moo d (Brief Symptom Inventory), physical (PHYS) and psychological (PSYCH) symp toms from the Memorial Symptom Assessment Scale-Short Form (MSAS-SF), socia l support (Social Support Questionnaire-Short Report), suicidal ideation (S cale for Suicide Ideation Self-Report), and measures of disease status (Kar nofsky Performance Rating Scale, HIV CDC Classification, and Absolute CD4() Lymphocyte Count) were used in the study. The average age of subjects was 40 years (SD = 6.80). Fifty-two (63.4%) subjects acknowledged some indicat ion of suicidal ideation. Variables that correlated with poor medical adjus tment (health-care posture) were current suicide ideation (0.32, p = 0.003) , number of psychological symptoms (0.45, p = 0.0001), physical symptoms (0 .31, p = 0.006), social support (-0.24, p = 0.03), and satisfaction with th e social support received (-0.36, p = 0.001). Poor sexual adjustment was re lated to current suicide ideation (0.39, p = 0.0004), number of psychologic al symptoms (0.40, p = 0.0003), satisfaction with the social support receiv ed (-0.28, p = 0.01), and number of physical symptoms (0.35, p = 0.002). In patients with a diagnosis of AIDS, the number of psychological symptoms (B eta = 0.29, R-2 = 0.07, p = 0.02) and the satisfaction with the social supp ort received (Beta = -0.38, R-2 = 0.14, p = 0.003) were clear predictors of poor medical adjustment (health-care posture). Likewise, the predictors of poor sexual adjustment were psychological symptoms (Beta = 0.33, R-2 = 0.1 0, p = 0.003) and suicidal ideation (Beta = 0.40, R-2 = 0.10, p = 0.002). T he results suggest that suicide ideation is associated with poor adjustment , rather than serving as an adaptive function, as has been suggested by oth ers.