Clinical Guide > Neuropsychiatric Disorders > Suicide Risk

Suicide Risk

January 2011

Chapter Contents

Background

Transient suicidal thoughts are common for some people throughout the course of HIV disease and often do not indicate significant risk of suicide. However, persistent suicidal thoughts with associated feelings of hopelessness and intent to die are very serious and must be assessed promptly and carefully. Compared with people at high risk of suicide who are not HIV infected, people living with HIV have significantly increased frequency and severity of both suicidal ideation and thoughts of death. The risk of suicide is especially high for patients who are depressed and for those at pivotal points in the course of HIV infection. Stigma, quality of life concerns, and issues regarding disclosure may be contributing factors.

Suicidality may be the direct physiological result of HIV (e.g., owing to the impact of HIV in the brain), a reaction to chronic pain, an emotional reaction to having a chronic and life-threatening illness (e.g., major depression as a result of physical illness or psychiatric side effects caused by medications used to treat HIV infection and associated comorbidities). Many events may trigger suicidal thoughts among people with HIV. Such events include learning of their positive HIV status, disclosing to family and friends, starting antiretroviral therapy (ART), noticing the first symptoms of infection, having a decrease in CD4 cell count, undergoing a major illness or hospitalization, receiving an AIDS diagnosis, losing a job, experiencing major changes in lifestyle, requiring evaluation for dementia, and losing a significant relationship.

Evaluation of suicide risk must be included as part of a comprehensive mental health evaluation for HIV-infected patients. Note that asking patients about suicidal thoughts does not increase their risk of suicide.

Risk factors for suicide attempts include the following:

Protective factors include the following:

S: Subjective

The patient expresses or exhibits, or a personal care giver discloses, the following:

Inquire about the following during the history (again, note that asking patients about suicidal thoughts does not increase their risk of suicide):

Probe for other depressive symptoms and the immediacy of potential suicidal intent. Sample questions may include the following:

O: Objective

A: Assessment

See chapter Major Depression and Other Depressive Disorders for differential diagnosis of possible causes of depression and suicidality.

P: Plan

Evaluation

Evaluate the patient for depression, risk factors for suicide, and contributing psychiatric illnesses or situational stressors. Determine the immediacy of potential suicidal intent. If a mental health professional is available on site or can be summoned, an urgent consultation often is helpful in making these determinations.

Treatment

Patient Education

References

HRSA HAB Core Clinical Performance Measures