Assessment of Suicidality in a Group of HIV Positive Individuals attending a Tertiary Care Hospital Prior to Initiation of Antiretroviral Therapy.

Introduction: Acquired Immuno Deficiency Syndrome (AIDS) is caused by Human Immuno Deficiency Virus (HIV). Infection with HIV-1 virus type can have a significant impact on immune system as well as on central nervous system. The HIV/AIDS global epidemic has greatly exceeded earlier predictions and it is now clear that it has the potential to affect all countries and all population groups. About 95% of all HIV/AIDS infected people are living in developing countries. These countries have to cope with the huge burden of suffering and death. Globally, nearly 42 million people are now living with HIV/AIDS, about one-third are in between 15&24 years of age, 3 million people are newly infected in every year, young women are especially vulnerable, most people do not know that they are infected. India accounts for 10% of global HIV burden. In India, every day 1500 people are newly infected with HIV (50% below 25 years of age group). Currently India has an estimated prevalence of 0.23 – 0.33%. Prior to anti retroviral therapy (ART), viable long-term treatment options for HIV infection were unavailable and advanced HIV disease was a terminal illness. Because HIV-positive persons were acutely aware of the progressive nature of their illness, perceived risk for developing AIDS and AIDS-related life events were important determinants of suicide intent. The burden of coping with insidious onset of functional limitations related to advanced HIV disease and the ever-present threat of death may partially explain the markedly elevated suicide rate among HIV-positive persons during this period. Eventhough the rates of suicide decreases after the introduction of HAART, still it remains high compared to general population. Suicide is a significant public health problem worldwide. Suicide has apparently existed for as long as human existence . Based on available data, globally suicide is believed to account for an average of 10– 15 deaths for every 100000 persons each year and for each completed suicide there are up to 20 failed suicide attempts. Over one million people commit suicide ever year the world over. Approximately 0.9 % of all deaths are results from suicide. And suicide continues to be one of the three leading causes of death in young people between the ages 15 & 24 years. Suicide is the result of a complex interaction of biological, genetic, psychological, cultural and environmental factors. Studies indicate that the majority (up to two-thirds) of those who commit suicide have had contact with a health-care professional for various physical and emotional complaints in the month before their death. Unfortunately, many suicidal individuals may not spontaneously voice suicidal thoughts or plans of self-harm to their health-care provider, and the majority of those at risk may never be asked about Suicidality during clinical assessments. Suicidal ideation (having thoughts of wanting to die or killing oneself) is more common (up to six times more common than suicidal attempts and up to 100 times more common than completed suicides!). Mental illness is most commonly encountered in people with HIV / AIDS. Physicians should routinely screen HIV positive patients for psychiatric co-morbidity and explicitly assess suicidal ideation, plan and intent. A mood disorder, especially Depression is a risk factor for suicide. And suicide is the most lethal outcome of untreated Depression. Stress of living with stigmatizing illness further increases suicidal risk. Cognitive-behavioral disengagement leads to increased substance abuse, hopelessness and pessimism which in turn increases the suicidal risk. Suicidal ideation is more likely to occur in those with a history of psychiatric illness and immediately following the diagnosis of HIV . So assessment and management of mental disorders is an integral part of effective HIV /AIDS intervention programme