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S004-2

HIV and Suicide- an Update for the General Psychiatrist'

Cesar A Alfonso

WPA Psychoanalysis in Psychiatry Section and of the HIV Psychiatry Section, USA

Background/Objective: HIV continues to be a risk factor for suicide. Even after more effective
antiretroviral treatments were developed and the mortality of HIV was significantly reduced in
countries and regions with access to HIV medical care and antiretroviral therapy, psychological and
medical multimorbidities continue to create great distress.

Method: The presenter will review of the literature on HIV and suicide including case reports,
clinical and autopsy studies. He will describe the epidemiology of suicide in persons with HIV
throughout the world. He will discuss in detail the known predisposing factors for suicidal behavior
and protective factors against suicide in HIV-positive persons.

Result: Predisposing factors for suicide in persons with HIV include gender (female), course of
illness with a bimodal distribution (at the time of diagnosis with HIV and at end-stage illness),
symptomatic medical and psychiatric multimorbidities, physical incapacity causing distress, history
of childhood trauma, past suicide attempts, hopelessness, family history of suicide, bereavement,
anniversary reactions, poor social support, decreased social integration, poor family relations,
unemployment, unstable housing, a detectable viral load, stressful life events, and access to means.
Protective factors include positive-reappraisal coping skills, treatment adherence, increasing social
support, feelings of responsibility toward family, reporting reasons for living, religious
considerations, higher emotional expression and depth processing, experiential involvement,
self-esteem enhancement, and secure attachments.

Conclusion: With support, networking, establishing a therapeutic alliance, opportunities for
reparative emotional experiences and earned secure attachments, conflict resolution, palliative care,
adequate medical treatment, and alleviation of psychological distress, persons with HIV may be open
to resolution of a suicidal crisis and reconstruction of new relational and coping strategies. By
identifying protective and risk factors for suicide, clinicians will be better equipped and cognizant of
those who are at risk. Timely application of psychotherapeutic, pharmacologic and psychosocial
interventions can treat suicidality and may prevent death by suicide.