- Email: [email protected]
Sounding the Alarm: Perinatally HIV-Infected Youth More Likely to Attempt Suicide Than Their Uninfected Cohort Peers
Journal of Adolescent Health xxx (2019) 1e4
www.jahonline.org Adolescent health brief
Sounding the Alarm: Perinatally HIV-Infected Youth More Likely to Attempt Suicide Than Their Uninfected Cohort Peers Philip Kreniske, Ph.D. a, *, Claude Ann Mellins, Ph.D. a, Curtis Dolezal, Ph.D. a, Rehema Korich, M.P.H. a, Cheng-Shiun Leu, Ph.D. a, Andrew Wiznia, M.D. b, and Elaine J. Abrams, M.D. c a
HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute, Columbia University, New York, New York Jacobi Medical Center, Albert Einstein College of Medicine, The Bronx, New York c ICAP at Columbia University, Mailman School of Public Health, Vagelos College of Physicians & Surgeons, Columbia University, New York, New York b
Article history: Received January 18, 2019; Accepted June 19, 2019 Keywords: Suicide; HIV; Adolescence; Continuum of care
A B S T R A C T
Purpose: Suicide is the second leading cause of death among youth in the U.S., yet there are few studies on suicide among youth with perinatally acquired HIV infection (YPHIV). Our aim was to determine if suicide attempts differed for YPHIV compared with perinatally HIV-exposed but uninfected peers (YPHEU). Methods: Data come from a longitudinal behavioral health cohort (N ¼ 340) of YPHIV (n ¼ 206) and YPHEU (n ¼ 134) recruited between ages 9 and 16 years and interviewed with psychosocial batteries every 12e18 months. Logistic regression analyses were conducted to assess the association between reported suicide attempt and participants’ HIV status. We assessed whether baseline demographic characteristics and sexual orientation were potential confounding factors. Fisher’s exact tests were used to evaluate the association between first attempted suicide and HIV status within age groups. Results: YPHIV were more likely to make a suicide attempt than YPHEU (odds ratio ¼ 2.35, 95% confidence interval ¼ 1.28e4.34). Youth most often reported their first attempt between the ages of 14e18 years. Demographic characteristics and sexual orientation were not associated with attempted suicide. Conclusions: YPHIV compared with YPHEU were more likely to report a suicide attempt, and this difference emerged during late adolescence and persisted through young adulthood. Ó 2019 Society for Adolescent Health and Medicine. All rights reserved.
Suicide is a global crisis, with suicide rates increasing 60% in the last 45 years, and adolescent and young adult (herein referred to as youth) suicide rates increasing most rapidly. In Conflicts of interest: The authors have no conflicts of interest to disclose. Disclaimer: The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health, The New York State Psychiatric Institute, or Columbia University. * Address correspondence to: Philip Kreniske, Ph.D., HIV Center for Clinical and Behavioral Studies, the New York State Psychiatric Institute, Columbia University, 1051 Riverside Drive, R 347, New York, NY 10032. E-mail address: [email protected] (P. Kreniske). 1054-139X/Ó 2019 Society for Adolescent Health and Medicine. All rights reserved. https://doi.org/10.1016/j.jadohealth.2019.06.006
IMPLICATIONS AND CONTRIBUTION
Youth with perinatally acquired HIV infection were more likely than HIV-exposed uninfected peers to report a suicide attempt. This difference emerged during adolescence, suggesting an urgent need for routine clinical care to assess for suicide risk and consider mental health treatment an important component of HIV care.
the U.S., suicide is the second leading cause of death among youth [1]. Furthermore, youth with chronic health conditions have 3.5 times the odds of attempting suicide compared with healthy peers [2]. Given advances in antiretroviral treatment, HIV infection is now considered a chronic disease, and globally, 1.8 million children living with HIV are likely to survive into adolescence and adulthood [3]. Despite mental health concerns for youth with perinatally acquired HIV infection (YPHIV), a recent systematic review showed few studies on suicide behavior in this population [4]. To address this gap, we examined reports of attempted suicide in YPHIV compared
2
P. Kreniske et al. / Journal of Adolescent Health xxx (2019) 1e4
Table 1 Demographic characteristics of CASAH participants at enrollment and follow-up 5
Enrollment Age (y), mean (SD) Annual household income, mean (SD) Annual household income range, mean (SD) Female, n (%) African American/Black, n (%) Latino, n (%) Caregiver type, n (%) Biological parent Relative Nonrelative Caregiver gender (% female) Caregiver HIV status (% positive)
Total (N ¼ 340)a
YPHIV (N ¼ 206)
YPHEU (N ¼ 134)
p valueb
12.58 (2.25) $27,718 ($20,761) $0e$126,000 172 (51) 221 (65) 142 (42)
12.70 (2.16) $30,111 ($21,687) $0e$121,200 104 (51) 135 (66) 79 (38)
12.40 (2.37) $24,090 ($18,783) $0e$126,000 68 (51) 86 (64) 63 (47)
.218 .009
167 80 93 298 150
73 59 74 179 61
94 21 19 119 89
(49) (24) (27) (88) (46)
(35) (29) (36) (87) (31)
(70) (16) (14) (89) (69)
.963 .798 .113 <.001
.600 <.001
Follow-up 5
Total (N ¼ 248)
YPHIV (N ¼ 151)
YPHEU (N ¼ 97)
p value
Age (y), mean (SD) Female, n (%a) African American/Black, n (%a) Latino, n (%a)
22.38 133 170 124
22.79 83 106 73
21.72 50 64 51
.002 .598 .485 .515
(2.68) (54) (69) (50)
(2.63) (55) (70) (48)
(2.65) (52) (66) (53)
CASAH ¼ Child and Adolescent Self-Awareness and Health; SD ¼ standard deviation. a Some variables had missing data; only Household Income was missing for >15 (15 YPHIV and eight YPHEU participants). Percent values are based on those with nonmissing data. b p values are from t-tests (continuous variables) or chi-square tests (dichotomous/categorical variables).
with youth who were perinatally HIV-exposed but uninfected (YPHEU) in the U.S. In this cohort, YPHEU serve as a comparison group for the YPHIV and share almost all sociodemographic characteristics, including maternal HIV, allowing us to examine the impact of growing up with HIV infection on suicidality. Methods Data come from the Child and Adolescent Self-Awareness and Health (CASAH) study, an ongoing longitudinal behavioral health cohort (N ¼ 340) study of YPHIV (n ¼ 206) and YPHEU (n ¼ 134). Youth (aged 9e16-years) were recruited from 2003 to 2008, from four medical centers in New York City that provided primary and specialty care to HIV-infected children and families. Providers identified all eligible patients in their clinic and informed them about the study. All interested caregivers and youth were referred to the study team. All those who provided consent (caregivers for themselves and for youth aged <18 years, youth assent <18 years, and consent >18 years) were subsequently interviewed with psychosocial batteries every 12e18 months. Analyses were based on data from enrollment and four follow-up (FU) interviews when psychiatric disorder was assessed (up to FU5). We examined the earliest age at which a participant reported a suicide attempt using the Diagnostic Interview Schedule for Children, Version IV, Young Adult, a well-validated psychiatric interview [5]. The specific suicide question asks: “Have you ever in your whole life tried to kill yourself or make a suicide attempt?” Previous research with adolescents suggests that retrospective measures of attempted suicide are a valid measure of assessment [6]. A dichotomous variable was calculated that identified participants who reported at least one suicide attempt at any of the five study visits. All those with a reported history of suicidality were evaluated for active risk at the time of the interview. CASAH has an emergency protocol for assessing risk
and making referrals as needed. No participants needed to be taken to the emergency room at the time of the interview for active suicidal ideations. Table 1 describes the demographic characteristics of the sample at baseline. T-tests and chi-square tests were used to compare these characteristics by HIV status for continuous and categorical variables respectively. Logistic regression analyses were conducted to assess the association between reported suicide attempt at any visit and participant HIV status. We assessed whether baseline sociodemographic characteristics (age, gender, race, ethnicity, and household income) and sexual orientation were potential confounding factors when examining the previously mentioned association. We found no evidence of confounding and therefore conducted an unadjusted analysis. Fisher’s exact tests were used to evaluate the association between first attempted suicide and HIV status within age groups. This study was approved by the local institutional review board. Results Most participants identified as African American/Black (69%), and at FU5, the mean age was 22.38 years (range: 18e28; Table 1). Overall, 67 participants (20%) reported ever attempting suicide, and YPHIV were more likely to report a suicide attempt than YPHEU (24% YPHIV vs. 13% YPHEU; odds ratio ¼ 2.35; 95% confidence interval ¼ 1.28e4.34; p ¼ .006). Youth most often reported their first suicide attempt between ages 14 and 18 years, with significantly higher prevalence of suicide attempts for YPHIV (12%), than YPHEU (4%) in this age range (p ¼ .019; Figure 1). Discussion As compared with YPHEU, YPHIV were significantly more likely to attempt suicide. The difference between YPHIV and YPHEU suicide attempts emerged during adolescence and persisted through young adulthood. The frequency of YPHIV
P. Kreniske et al. / Journal of Adolescent Health xxx (2019) 1e4
14.0%
p = 0.344
3
p = 0.170
p = 0.019
Percent of First Suicide Attemptsb
12.0%
10.0%
8.0% YPHEU
6.0%
4.0%
p = 0.601
a
YPHIV
c
2.0%
0.0% 9-13 (n=229)
14-18 (n=293)
19-22 (n=197)
23-28 (n=88)
Age Group Figure 1. Age at First Reported Suicide Attempt by HIV Status. aYouth who were perinatally HIV-exposed but uninfected (YPHEU) and youth with perinatally acquired HIV infection (YPHIV). bPercentage of reported first attempts was calculated from the total number of participant observations per age category. Once a participant reported a suicide attempt, all subsequent reports were censored from the analysis. cAll p values were calculated using Fisher’s exact test.
attempted suicide was higher than healthy youth in national studies, whereas the frequency of attempted suicide for YPHEU was similar to that of healthy youth [7]. In previous CASAH analyses, we found few differences between the YPHIV and YPHEU participants in psychosocial functioning: both groups exhibited similar rates of psychiatric disorders (e.g., depression, anxiety, and substance use), sexual behaviors (e.g., ever had sex, condomless sex, and number of sex partners), and achievement of young adult milestones (e.g., education, employment, and starting families) [8]. In the context of rising suicide rates and an aging population of people living with HIV, the current finding has important implications for medical providers, including the need for ongoing screening of suicidal behavior, especially during high school years and young adulthood. Furthermore, this work has clear relevance to the transition from pediatric to adult HIV care. The developmental transition from adolescence to adulthood is complex for all youth, and it is especially challenging for many YPHIV who are coping with a chronic and transmittable health condition, serious health risks, and significant stigma [9]. Our findings indicate that the increase in attempted suicide corresponds with the period when YPHIV frequently transition to new HIV health care environments [10] although future studies are needed to examine this association. A limitation of this study is that our findings may not be broadly generalizable to participants outside New York City. However, New York City is an epicenter of the U.S. epidemic, and demographics from CASAH participants are similar to national studies, with YPHIV and YPHEU largely from inner-city, low-income, ethnic minority families [8]. Another limitation is that we do not have additional information about how these youth attempted suicide. Continued research is needed to examine risk and protective factors associated with attempted suicide among YPHIV. Potential factors include stigma, side effects of HIV medication, life
adversity, HIV-related biological factors, and, conversely, family and social support and resilience characteristics. Our findings show an urgent need to assess for suicide risk routinely in this population and suggest that special attention should be devoted to suicide risk as YPHIV transition to adult care. For YPHIV, mental health treatment should be considered an integral component of HIV care.
Funding Sources This project was supported by an award from the National Institute of Mental Health (NIMH) (R01MH069133, principal investigator [PI]: Claude Ann Mellins, Ph.D.). In addition, Philip Kreniske’s contribution was supported by T32MH019139 award (PI: Theodorus Sandfort, Ph.D.), and a center grant from NIMH to the HIV Center for Clinical and Behavioral Studies at NY State Psychiatric Institute and Columbia University (P30MH43520; PI: Robert H. Remien, Ph.D.).
References [1] National Center for Injury Prevention and Control. 10 leading causes of death by age group, United States. Centers for Disease Control and Prevention Website. 2016. Available at: https://www.cdc.gov/injury/wisqars/ LeadingCauses.html. Accessed November 1, 2018. [2] Barnes A, Eisenberg M, Resnick M. Suicide and self-injury among children and youth with chronic health conditions. Pediatrics 2010;125:889e95. [3] Joint United Nations Programme on HIV/AIDS (UNAIDS). UNAIDS data 2018. Available at: http://www.unaids.org/en/resources/fact-sheet. Accessed November 1, 2018. [4] Vreeman RC, McCoy BM, Lee S. Mental health challenges among adolescents living with HIV. J Int AIDS Soc 2017;20(Suppl. 3):21497. [5] Shaffer D, Fisher P, Lucas CP, et al. NIMH Diagnostic Interview Schedule for Children version IV (NIMH DISC-IV): Description, differences from previous versions, and reliability of some common diagnoses. J Am Acad Child Adolesc Psychiatry 2000;39:28e38.
4
P. Kreniske et al. / Journal of Adolescent Health xxx (2019) 1e4
[6] Mazza JJ, Catalano RF, Abbott RD, Haggerty KP. An examination of the validity of retrospective measures of suicide attempts in youth. J Adolesc Health 2011;49:532. [7] Piscopo K, Lipari RN, Cooney J, et al. Suicidal thoughts and behavior among adults: Results from the 2015 National Survey on Drug Use and Health. NSDUH Data Review. SAMHSA, Center for Behavioral Health Statistics and Quality; 2016. Available at: https://www.samhsa.gov/data/sites/ default/files/NSDUH-DR-FFR3-2015/NSDUH-DR-FFR3-2015.pdf. Accessed November 20, 2018.
[8] Abrams E, Mellins CA, Bucek A, et al. Behavioral health and adult milestones in young adults with perinatal HIV infection or exposure. Pediatrics 2018;142:e20180938. [9] Tepper V, Zaner S, Ryscavage P. HIV healthcare transition outcomes among youth in North America and Europe: A review. J Int AIDS Soc 2017;20(Suppl. 3):21490. [10] Lam PK, Fidler S, Foster C. A review of transition experiences in perinatally and behaviourally acquired HIV-1 infection; same, same but different? J Int AIDS Soc 2017;20(Suppl. 3):21506.
www.jahonline.org Adolescent health brief
Sounding the Alarm: Perinatally HIV-Infected Youth More Likely to Attempt Suicide Than Their Uninfected Cohort Peers Philip Kreniske, Ph.D. a, *, Claude Ann Mellins, Ph.D. a, Curtis Dolezal, Ph.D. a, Rehema Korich, M.P.H. a, Cheng-Shiun Leu, Ph.D. a, Andrew Wiznia, M.D. b, and Elaine J. Abrams, M.D. c a
HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute, Columbia University, New York, New York Jacobi Medical Center, Albert Einstein College of Medicine, The Bronx, New York c ICAP at Columbia University, Mailman School of Public Health, Vagelos College of Physicians & Surgeons, Columbia University, New York, New York b
Article history: Received January 18, 2019; Accepted June 19, 2019 Keywords: Suicide; HIV; Adolescence; Continuum of care
A B S T R A C T
Purpose: Suicide is the second leading cause of death among youth in the U.S., yet there are few studies on suicide among youth with perinatally acquired HIV infection (YPHIV). Our aim was to determine if suicide attempts differed for YPHIV compared with perinatally HIV-exposed but uninfected peers (YPHEU). Methods: Data come from a longitudinal behavioral health cohort (N ¼ 340) of YPHIV (n ¼ 206) and YPHEU (n ¼ 134) recruited between ages 9 and 16 years and interviewed with psychosocial batteries every 12e18 months. Logistic regression analyses were conducted to assess the association between reported suicide attempt and participants’ HIV status. We assessed whether baseline demographic characteristics and sexual orientation were potential confounding factors. Fisher’s exact tests were used to evaluate the association between first attempted suicide and HIV status within age groups. Results: YPHIV were more likely to make a suicide attempt than YPHEU (odds ratio ¼ 2.35, 95% confidence interval ¼ 1.28e4.34). Youth most often reported their first attempt between the ages of 14e18 years. Demographic characteristics and sexual orientation were not associated with attempted suicide. Conclusions: YPHIV compared with YPHEU were more likely to report a suicide attempt, and this difference emerged during late adolescence and persisted through young adulthood. Ó 2019 Society for Adolescent Health and Medicine. All rights reserved.
Suicide is a global crisis, with suicide rates increasing 60% in the last 45 years, and adolescent and young adult (herein referred to as youth) suicide rates increasing most rapidly. In Conflicts of interest: The authors have no conflicts of interest to disclose. Disclaimer: The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health, The New York State Psychiatric Institute, or Columbia University. * Address correspondence to: Philip Kreniske, Ph.D., HIV Center for Clinical and Behavioral Studies, the New York State Psychiatric Institute, Columbia University, 1051 Riverside Drive, R 347, New York, NY 10032. E-mail address: [email protected] (P. Kreniske). 1054-139X/Ó 2019 Society for Adolescent Health and Medicine. All rights reserved. https://doi.org/10.1016/j.jadohealth.2019.06.006
IMPLICATIONS AND CONTRIBUTION
Youth with perinatally acquired HIV infection were more likely than HIV-exposed uninfected peers to report a suicide attempt. This difference emerged during adolescence, suggesting an urgent need for routine clinical care to assess for suicide risk and consider mental health treatment an important component of HIV care.
the U.S., suicide is the second leading cause of death among youth [1]. Furthermore, youth with chronic health conditions have 3.5 times the odds of attempting suicide compared with healthy peers [2]. Given advances in antiretroviral treatment, HIV infection is now considered a chronic disease, and globally, 1.8 million children living with HIV are likely to survive into adolescence and adulthood [3]. Despite mental health concerns for youth with perinatally acquired HIV infection (YPHIV), a recent systematic review showed few studies on suicide behavior in this population [4]. To address this gap, we examined reports of attempted suicide in YPHIV compared
2
P. Kreniske et al. / Journal of Adolescent Health xxx (2019) 1e4
Table 1 Demographic characteristics of CASAH participants at enrollment and follow-up 5
Enrollment Age (y), mean (SD) Annual household income, mean (SD) Annual household income range, mean (SD) Female, n (%) African American/Black, n (%) Latino, n (%) Caregiver type, n (%) Biological parent Relative Nonrelative Caregiver gender (% female) Caregiver HIV status (% positive)
Total (N ¼ 340)a
YPHIV (N ¼ 206)
YPHEU (N ¼ 134)
p valueb
12.58 (2.25) $27,718 ($20,761) $0e$126,000 172 (51) 221 (65) 142 (42)
12.70 (2.16) $30,111 ($21,687) $0e$121,200 104 (51) 135 (66) 79 (38)
12.40 (2.37) $24,090 ($18,783) $0e$126,000 68 (51) 86 (64) 63 (47)
.218 .009
167 80 93 298 150
73 59 74 179 61
94 21 19 119 89
(49) (24) (27) (88) (46)
(35) (29) (36) (87) (31)
(70) (16) (14) (89) (69)
.963 .798 .113 <.001
.600 <.001
Follow-up 5
Total (N ¼ 248)
YPHIV (N ¼ 151)
YPHEU (N ¼ 97)
p value
Age (y), mean (SD) Female, n (%a) African American/Black, n (%a) Latino, n (%a)
22.38 133 170 124
22.79 83 106 73
21.72 50 64 51
.002 .598 .485 .515
(2.68) (54) (69) (50)
(2.63) (55) (70) (48)
(2.65) (52) (66) (53)
CASAH ¼ Child and Adolescent Self-Awareness and Health; SD ¼ standard deviation. a Some variables had missing data; only Household Income was missing for >15 (15 YPHIV and eight YPHEU participants). Percent values are based on those with nonmissing data. b p values are from t-tests (continuous variables) or chi-square tests (dichotomous/categorical variables).
with youth who were perinatally HIV-exposed but uninfected (YPHEU) in the U.S. In this cohort, YPHEU serve as a comparison group for the YPHIV and share almost all sociodemographic characteristics, including maternal HIV, allowing us to examine the impact of growing up with HIV infection on suicidality. Methods Data come from the Child and Adolescent Self-Awareness and Health (CASAH) study, an ongoing longitudinal behavioral health cohort (N ¼ 340) study of YPHIV (n ¼ 206) and YPHEU (n ¼ 134). Youth (aged 9e16-years) were recruited from 2003 to 2008, from four medical centers in New York City that provided primary and specialty care to HIV-infected children and families. Providers identified all eligible patients in their clinic and informed them about the study. All interested caregivers and youth were referred to the study team. All those who provided consent (caregivers for themselves and for youth aged <18 years, youth assent <18 years, and consent >18 years) were subsequently interviewed with psychosocial batteries every 12e18 months. Analyses were based on data from enrollment and four follow-up (FU) interviews when psychiatric disorder was assessed (up to FU5). We examined the earliest age at which a participant reported a suicide attempt using the Diagnostic Interview Schedule for Children, Version IV, Young Adult, a well-validated psychiatric interview [5]. The specific suicide question asks: “Have you ever in your whole life tried to kill yourself or make a suicide attempt?” Previous research with adolescents suggests that retrospective measures of attempted suicide are a valid measure of assessment [6]. A dichotomous variable was calculated that identified participants who reported at least one suicide attempt at any of the five study visits. All those with a reported history of suicidality were evaluated for active risk at the time of the interview. CASAH has an emergency protocol for assessing risk
and making referrals as needed. No participants needed to be taken to the emergency room at the time of the interview for active suicidal ideations. Table 1 describes the demographic characteristics of the sample at baseline. T-tests and chi-square tests were used to compare these characteristics by HIV status for continuous and categorical variables respectively. Logistic regression analyses were conducted to assess the association between reported suicide attempt at any visit and participant HIV status. We assessed whether baseline sociodemographic characteristics (age, gender, race, ethnicity, and household income) and sexual orientation were potential confounding factors when examining the previously mentioned association. We found no evidence of confounding and therefore conducted an unadjusted analysis. Fisher’s exact tests were used to evaluate the association between first attempted suicide and HIV status within age groups. This study was approved by the local institutional review board. Results Most participants identified as African American/Black (69%), and at FU5, the mean age was 22.38 years (range: 18e28; Table 1). Overall, 67 participants (20%) reported ever attempting suicide, and YPHIV were more likely to report a suicide attempt than YPHEU (24% YPHIV vs. 13% YPHEU; odds ratio ¼ 2.35; 95% confidence interval ¼ 1.28e4.34; p ¼ .006). Youth most often reported their first suicide attempt between ages 14 and 18 years, with significantly higher prevalence of suicide attempts for YPHIV (12%), than YPHEU (4%) in this age range (p ¼ .019; Figure 1). Discussion As compared with YPHEU, YPHIV were significantly more likely to attempt suicide. The difference between YPHIV and YPHEU suicide attempts emerged during adolescence and persisted through young adulthood. The frequency of YPHIV
P. Kreniske et al. / Journal of Adolescent Health xxx (2019) 1e4
14.0%
p = 0.344
3
p = 0.170
p = 0.019
Percent of First Suicide Attemptsb
12.0%
10.0%
8.0% YPHEU
6.0%
4.0%
p = 0.601
a
YPHIV
c
2.0%
0.0% 9-13 (n=229)
14-18 (n=293)
19-22 (n=197)
23-28 (n=88)
Age Group Figure 1. Age at First Reported Suicide Attempt by HIV Status. aYouth who were perinatally HIV-exposed but uninfected (YPHEU) and youth with perinatally acquired HIV infection (YPHIV). bPercentage of reported first attempts was calculated from the total number of participant observations per age category. Once a participant reported a suicide attempt, all subsequent reports were censored from the analysis. cAll p values were calculated using Fisher’s exact test.
attempted suicide was higher than healthy youth in national studies, whereas the frequency of attempted suicide for YPHEU was similar to that of healthy youth [7]. In previous CASAH analyses, we found few differences between the YPHIV and YPHEU participants in psychosocial functioning: both groups exhibited similar rates of psychiatric disorders (e.g., depression, anxiety, and substance use), sexual behaviors (e.g., ever had sex, condomless sex, and number of sex partners), and achievement of young adult milestones (e.g., education, employment, and starting families) [8]. In the context of rising suicide rates and an aging population of people living with HIV, the current finding has important implications for medical providers, including the need for ongoing screening of suicidal behavior, especially during high school years and young adulthood. Furthermore, this work has clear relevance to the transition from pediatric to adult HIV care. The developmental transition from adolescence to adulthood is complex for all youth, and it is especially challenging for many YPHIV who are coping with a chronic and transmittable health condition, serious health risks, and significant stigma [9]. Our findings indicate that the increase in attempted suicide corresponds with the period when YPHIV frequently transition to new HIV health care environments [10] although future studies are needed to examine this association. A limitation of this study is that our findings may not be broadly generalizable to participants outside New York City. However, New York City is an epicenter of the U.S. epidemic, and demographics from CASAH participants are similar to national studies, with YPHIV and YPHEU largely from inner-city, low-income, ethnic minority families [8]. Another limitation is that we do not have additional information about how these youth attempted suicide. Continued research is needed to examine risk and protective factors associated with attempted suicide among YPHIV. Potential factors include stigma, side effects of HIV medication, life
adversity, HIV-related biological factors, and, conversely, family and social support and resilience characteristics. Our findings show an urgent need to assess for suicide risk routinely in this population and suggest that special attention should be devoted to suicide risk as YPHIV transition to adult care. For YPHIV, mental health treatment should be considered an integral component of HIV care.
Funding Sources This project was supported by an award from the National Institute of Mental Health (NIMH) (R01MH069133, principal investigator [PI]: Claude Ann Mellins, Ph.D.). In addition, Philip Kreniske’s contribution was supported by T32MH019139 award (PI: Theodorus Sandfort, Ph.D.), and a center grant from NIMH to the HIV Center for Clinical and Behavioral Studies at NY State Psychiatric Institute and Columbia University (P30MH43520; PI: Robert H. Remien, Ph.D.).
References [1] National Center for Injury Prevention and Control. 10 leading causes of death by age group, United States. Centers for Disease Control and Prevention Website. 2016. Available at: https://www.cdc.gov/injury/wisqars/ LeadingCauses.html. Accessed November 1, 2018. [2] Barnes A, Eisenberg M, Resnick M. Suicide and self-injury among children and youth with chronic health conditions. Pediatrics 2010;125:889e95. [3] Joint United Nations Programme on HIV/AIDS (UNAIDS). UNAIDS data 2018. Available at: http://www.unaids.org/en/resources/fact-sheet. Accessed November 1, 2018. [4] Vreeman RC, McCoy BM, Lee S. Mental health challenges among adolescents living with HIV. J Int AIDS Soc 2017;20(Suppl. 3):21497. [5] Shaffer D, Fisher P, Lucas CP, et al. NIMH Diagnostic Interview Schedule for Children version IV (NIMH DISC-IV): Description, differences from previous versions, and reliability of some common diagnoses. J Am Acad Child Adolesc Psychiatry 2000;39:28e38.
4
P. Kreniske et al. / Journal of Adolescent Health xxx (2019) 1e4
[6] Mazza JJ, Catalano RF, Abbott RD, Haggerty KP. An examination of the validity of retrospective measures of suicide attempts in youth. J Adolesc Health 2011;49:532. [7] Piscopo K, Lipari RN, Cooney J, et al. Suicidal thoughts and behavior among adults: Results from the 2015 National Survey on Drug Use and Health. NSDUH Data Review. SAMHSA, Center for Behavioral Health Statistics and Quality; 2016. Available at: https://www.samhsa.gov/data/sites/ default/files/NSDUH-DR-FFR3-2015/NSDUH-DR-FFR3-2015.pdf. Accessed November 20, 2018.
[8] Abrams E, Mellins CA, Bucek A, et al. Behavioral health and adult milestones in young adults with perinatal HIV infection or exposure. Pediatrics 2018;142:e20180938. [9] Tepper V, Zaner S, Ryscavage P. HIV healthcare transition outcomes among youth in North America and Europe: A review. J Int AIDS Soc 2017;20(Suppl. 3):21490. [10] Lam PK, Fidler S, Foster C. A review of transition experiences in perinatally and behaviourally acquired HIV-1 infection; same, same but different? J Int AIDS Soc 2017;20(Suppl. 3):21506.