丹麥的一項長期研究顯示，愛滋病毒感染者自殺和抑鬱的風險增加
資料來源：Roger Pebody / 2023 年 4 月 13 日 / Aidsmap
圖片來源：多米齊亞·薩盧斯特 | www.domiziasalusest.com
一項對丹麥 HIV 感染者長達 20 年的追踪研究顯示，自殺風險是普通人群的三倍，罹患抑鬱症的風險是普通人群的兩倍。 然而，抑鬱症（大約每 25 名愛滋病毒感染者中就有一人）比自殺（每 140 名愛滋病毒感染者中有一名）更為常見。 這些數據已於本週在歐洲臨床微生物學和傳染病大會上公佈。
先前關於愛滋病毒感染者自殺的研究得出了範圍廣泛的估計，但並非所有這些都可靠。 例如，一些研究側重於特定的 HIV 感染者亞群，或者無法與 HIV 陰性人群進行直接比較。
最艱難的結果：愛滋病毒和自殺
丹麥研究人員可以訪問該國幾乎所有人的匿名健康記錄，從而可以對 HIV 陽性和 HIV 陰性人群進行比較。 儘管如此，這些記錄不包括許多其他可能相關的因素的信息，例如社會階層、就業、性和藥物使用。
該分析包括 5,943 名在 1995 年至 2021 年間被診斷出感染愛滋病毒的人。根據丹麥的愛滋病毒流行病學，四分之三是男性。 每個愛滋病毒感染者都與十名未被診斷出感染愛滋病毒的同齡同性別的人配對。
在診斷後的頭兩年，愛滋病毒感染者罹患抑鬱症的風險是其三倍多，儘管在隨後幾年中風險降低到兩倍。 十年後，3.9% 的 HIV 感染者和 1.8% 的非 HIV 感染者至少接受過一次抑鬱症住院治療。 在整個 20 年的追蹤期間，抑鬱症的發病率和抗抑鬱藥物的處方都存在明顯差異。
在確診後的頭兩年，自殺風險尤其高，是普通人群的十倍以上。 在這個特別脆弱的時期過去後，愛滋病毒感染者的自殺風險仍然是其三倍多（風險比 3.6，95% 信賴區間 2.3-5.6）。 雖然這些數字可能給人一種自殺非常普遍的印象，但自殺的絕對數量很低——十年後，0.7% 的愛滋病毒感染者自殺，而沒有感染愛滋病毒的人自殺率為 0.2%。 在整個 20 年的追蹤期間，風險持續增加。
為了嘗試考慮可能影響這些風險的環境和遺傳因素，研究人員還收集了有關兄弟姐妹的數據。這顯示愛滋病毒感染者的自殺率和抑鬱率高於他們的兄弟姐妹，而愛滋病毒感染者的兄弟姐妹和對照組的兄弟姐妹之間的比率相似。 這顯示家庭因素並不那麼重要。
哥本哈根大學的主要作者 Lars Omland 博士評論說：「我們的研究結果清楚地強調了被診斷為 HIV 的嚴重心理健康影響以及臨床醫生在這一高危人群中尋找抑鬱症狀的重要性」。「傳統上關注 HIV 感染者的身體健康，應該更加重視他們的心理健康」。
如果您受到本文中問題的影響，可以在英國撥打 116 123 聯繫 Samaritans，在美國撥打國家自殺預防生命線 1-800-273-8255。 可以在 www.befrienders.org 或透過此維基百科頁面找到其他國際求助熱線。
參考文獻：
Vollmond CV et al. HIV 感染者罹患抑鬱症的風險，一項全國性的基於人群的匹配世代研究。 歐洲臨床微生物學和傳染病大會 (ECCMID)，哥本哈根，摘要 MAK0806，2023 年 4 月。
People with HIV have increased risk of suicide and depression in long-term Danish study
Roger Pebody / 13 April 2023 Aidsmap
Domizia Salusest | www.domiziasalusest.com
A study following people living with HIV in Denmark for up to 20 years shows a three-times greater risk of suicide than in the general population, and a doubling of the risk of depression. However, depression was far more common (around one in 25 people living with HIV) than suicide (one in 140 people with HIV). These data were presented at the European Congress of Clinical Microbiology & Infectious Diseases this week.
Previous studies on suicide in people with HIV have produced a wide range of estimates, not all of them reliable. For example, some studies have focused on particular sub-groups of people living with HIV or have not been able to make a direct comparison with HIV-negative people.
The hardest outcome of all: HIV and suicide
Danish researchers have access to anonymised health records for almost all people in the country, allowing comparisons to be made between HIV-positive and HIV-negative people. Nonetheless, these records do not include information on a number of other factors that may be relevant, such as social class, employment, sexuality and substance use.
The analysis included 5,943 individuals diagnosed with HIV between 1995 and 2021. In line with the epidemiology of HIV in Denmark, three quarters were men. Each person with HIV was matched with ten people of the same age and sex who had not been diagnosed with HIV.
In the first two years after diagnosis, people with HIV had over three times the risk of depression, although this reduced to twice the risk in subsequent years. After ten years, 3.9% of those living with HIV and 1.8% of those without HIV had received hospital treatment for depression at least once. Differences were apparent throughout the 20 years of follow-up both in the incidence of depression and in prescription of anti-depressant medications.
The risk of suicide was especially elevated in the first two years after diagnosis, with a rate over ten times that of people in the general population. After this particularly vulnerable period had passed, people with HIV still had over three times the risk of suicide (hazard ratio 3.6, 95% confidence interval 2.3-5.6). While those figures may give the impression that suicide is very common, the absolute number of suicides was low – after ten years, 0.7% of people with HIV had committed suicide, compared to 0.2% of people without HIV. The increased risk continued throughout the 20-year follow up.
In order to try to take some account of environmental and genetic factors that might influence these risks, the researchers also collected data on siblings. This showed higher rates of suicide and depression in people living with HIV than in their brothers and sisters, while rates were similar between siblings of people with HIV and siblings of the comparator group. This suggests that familial factors are not that important.
“Our findings clearly highlight the serious mental health implications of being given a diagnosis of HIV and the importance of clinicians looking out for of symptoms of depression in this high-risk population,” commented lead author Dr Lars Omland of Copenhagen University. “Caring for people with HIV, which has traditionally focused on their physical health, should place more emphasis on their mental health.”
If you’ve been affected by the issues in this article, Samaritans can be contacted in the UK on 116 123, and in the US, the National Suicide Prevention Lifeline is 1-800-273-8255. Other international helplines can be found at www.befrienders.org or via this Wikipedia page.
References
Vollmond CV et al. Risk of depression in people living with HIV, a nationwide population-based matched cohort study. European Congress of Clinical Microbiology and Infectious Diseases (ECCMID), Copenhagen, abstract MAK0806, April 2023.