Suicide and Trauma in Persons living with HIV

Rates of posttraumatic stress disorder (PTSD), substance use, sleep disorders and suicide are disproportionately higher in persons living with HIV (PLWH). The Syndemic Model of Substance Abuse, Intimate Partner Violence, and HIV (SAVA Syndemic), refers to the frequent co-occurrence and mutual influence between these conditions. The SAVA Syndemic has not been directly associated with suicide risk. The pathway to developing suicidal ideation and to transitioning from thinking about suicide to engaging in suicidal behaviors in PLWH is unclear. An analysis of demographic and clinical variables associated with increased risk for suicide in PLWH is essential to formulate testable hypotheses and elucidate pathways to suicide within the context of the SAVA Syndemic. We have identified the following specific aims: Aim 1: To determine variables associated with the presence of suicidal ideation in PLWH. Aim 2: To determine variables associated with the emergence of suicidal ideation. Aim 3: To variables associated with the transition from suicidal ideation to suicidal behavior in PLWH. In Phase I, we will conduct a comprehensive chart review of PLWH within the CFAR longitudinal database and link this database with medical records to determine the associations among PTSD, substance use, sleep disorders, and suicide risk. We will repeat these analyses with the larger electronic medical record system using a de-identified database of all HIV+ individuals, generated in collaboration with the Clinical Research Computing Unit (CRCU) at Penn. In Phase II, we will follow a small sample (n = 10-20) of participants who have HIV for one month. We will use ecological momentary assessment, FitBit®, and sleep diaries to inform the associations among PTSD, substance use, sleep disorders, and suicide risk.