Suicidal ideation, psychopathology and associated factors among HIV-infected adults in Indonesia
Suicidal ideation, psychopathology and associated factors among HIV-infected adults in Indonesia
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DOI：
10.1186/s12888-020-02666-1
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发表时间：
2020-05-24
期刊：
影响因子：
4.4
通讯作者：
Hayashi, Yoshitake
中科院分区：
文献类型：
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作者：
Ophinni, Youdiil;Adrian;Hayashi, Yoshitake
背景自杀行为是HIV感染成人中普遍存在的一种精神突发事件。自杀意念的发现对于计划早期精神干预和优化艾滋病毒/艾滋病管理非常重要。确定感染艾滋病毒的成年人的自杀意念是至关重要的；然而，在亚洲艾滋病毒/艾滋病疫情负担第二大的国家印度尼西亚，几乎没有数据。这项研究旨在识别印度尼西亚HIV感染者的自杀意念，并分析与之相关的精神病理和决定因素。方法对接受抗逆转录病毒治疗(ART)的18~65岁HIV感染者进行横断面观察性研究。采用症状自评量表(SCL-90)对现有的精神病理学进行评定。采用Firth惩罚Logistic回归分析确定与自杀意念相关的因素。结果共招募86名受试者。大多数受试者为男性(65.1%)，中位年龄为35岁，最新CD4细胞计数中位数为463个/亩L。有20名受试者(23.3%)有终生自杀意念。有自杀意念(M=60.75，SD=12.0，p=0.000)和无自杀意念(M=57.9，SD=2.8，P=0.001)者抑郁和焦虑症状T分均显著高于无自杀意念者(P<0.05)。双因素分析显示，终生自杀意念与抑郁和焦虑症状、未婚状况、CD4500细胞/亩L和使用依法韦仑有关。多因素分析显示，SCL-90抑郁症状评分增加一分(AOR1.16，95%CI4.5~123.6，p=0.000)和使用依法韦仑(AOR5.00，95%CI1.02~24.6，p=0.048)是自杀意念的显著独立影响因素。结论印度尼西亚艾滋病病毒感染者在接受抗逆转录病毒治疗的成人中存在自杀意念。抑郁症状和依法韦仑的使用是与自杀意念的存在有关的独立因素。因此，建议及早进行精神病理学筛查，并用其他抗逆转录病毒药物替代法韦伦兹，以防止自杀和改善艾滋病毒/艾滋病的治疗结果。
Background Suicidal behavior is a prevalent psychiatric emergency in HIV-infected adults. Detection of suicidal ideation is important in planning early psychiatric intervention and optimizing HIV/AIDS management. Characterization of suicidal ideation among HIV-infected adults is crucial; however, practically there is no data in Indonesia, the country with the second largest burden of HIV/AIDS epidemic in Asia. This study aims to identify suicidal ideation and analyze the associated psychopathology and determining factors among HIV-infected adults in Indonesia. Methods An observational cross-sectional study was conducted among HIV-infected adults aged 18-65 years old receiving antiretroviral therapy (ART). Measurement using Symptom Checklist-90 (SCL-90) was performed to assess the existing psychopathology. Firth's penalized logistic regression analysis was performed to identify factors associated with suicidal ideation. Results A total of 86 subjects were recruited. Most subjects were male (65.1%), median age was 35 years, and median latest CD4 count was 463 cells/mu l. Lifetime suicidal ideation was identified in 20 subjects (23.3%). Mean SCL-90 T-score for depressive and anxiety symptoms were both significantly higher among subjects with suicidal ideation (M = 60.75, SD = 12.0, p = 0.000 and M = 57.9, SD = 2.8, p = 0.001, respectively) compared to those without. Bivariate analyses showed that lifetime suicidal ideation was associated with depressive and anxiety symptoms, non-marital status, CD4 count < 500 cells/mu l, and efavirenz use. Multivariate analysis identified that a single-point increase in SCL-90 depression symptoms score (AOR 1.16, 95% CI 4.5-123.6, p = 0.000) and efavirenz use (AOR 5.00, 95% CI 1.02-24.6, p = 0.048) were significant independent factors related to suicidal ideation. Conclusion Suicidal ideation is commonly found among Indonesian HIV-infected adults on ART. Depressive symptoms and efavirenz use are independent factors related to the presence of suicidal ideation. Thus, early screening of psychopathology as well as substitution of efavirenz with other ART regiment are recommended to prevent suicide and improve HIV/AIDS management outcome.