Risks and predictors of current suicidality in HIV-infected heroin users in treatment in Yunnan, China: a controlled study.

OBJECTIVE

Suicide is an important public health problem in China. Elsewhere, injection drug use and HIV infection have independently been associated with suicidality, but research has often overlooked these high-risk groups in China. We determined the frequency and predictors of suicidal ideas in Chinese HIV-infected (HIV(+)) and HIV-uninfected (HIV(-)) heroin injection drug users (IDUs) in treatment and a control sample. We hypothesized that rates of suicidal ideas would be significantly higher among IDUs compared with controls and highest among HIV IDUs.

METHOD: We assessed suicidal ideas within the past 2 weeks in HIV(+) (n = 204) and HIV(-) (n = 202) heroin IDUs in methadone treatment in Yunnan, a province at the intersection of the heroin and HIV epidemics, and in demographically matched HIV non-drug-using controls (n = 201).

RESULTS

Rates of suicidality were higher in IDUs than controls, but there was no additive effect of HIV infection (HIV(+) IDU: 43.1%; HIV(-) IDU: 37.1%; controls: 8.5%). Among HIV(+) IDUs, suicidality was associated most strongly with a combination of prior history of major depression, low perceived social support, and experience of HIV-relevant stress, but not with AIDS diagnosis. Among HIV(-) IDUs, suicidality was associated with prior history of major depressive or alcohol use disorder. Less than 25% of IDUs with suicidality had histories of mood or alcohol use diagnoses.

CONCLUSION

Because suicidal ideation is frequent in IDUs in China, regardless of HIV status, and is not fully accounted for by past psychiatric history, additional research may be warranted.