印度尼西亚 HIV 感染者的自杀意念、精神病理学和相关因素。
Suicidal ideation, psychopathology and associated factors among HIV-infected adults in Indonesia.
机构信息
Department of Pathology, Graduate School of Medicine, Kobe University, Kobe, Japan.
Department of Psychiatry, Faculty of Medicine, Universitas Indonesia, 71 Diponegoro, Central Jakarta, DKI, Jakarta, Indonesia.
出版信息
BMC Psychiatry. 2020 May 24;20(1):255. doi: 10.1186/s12888-020-02666-1.
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/μl. 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/μl, 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.
背景
自杀行为是 HIV 感染成人中普遍存在的精神科急症。检测自杀意念对于计划早期精神科干预和优化 HIV/AIDS 管理非常重要。了解 HIV 感染成人的自杀意念特征至关重要；然而，在亚洲 HIV/AIDS 流行负担第二大的国家印度尼西亚，实际上没有相关数据。本研究旨在确定自杀意念，并分析印度尼西亚 HIV 感染成人的相关精神病理学和决定因素。
方法
对接受抗逆转录病毒治疗（ART）的 18-65 岁 HIV 感染成人进行了一项观察性横断面研究。使用症状清单 90（SCL-90）进行测量，以评估现有的精神病理学。采用 Firth 罚 logistic 回归分析识别与自杀意念相关的因素。
结果
共纳入 86 名受试者。大多数受试者为男性（65.1%），中位年龄为 35 岁，中位最新 CD4 计数为 463 个/μl。20 名受试者（23.3%）有过自杀意念。有自杀意念的受试者的 SCL-90 总分均值（M=60.75，SD=12.0，p=0.000）和抑郁症状的 SCL-90 总分均值（M=57.9，SD=2.8，p=0.001）均显著高于无自杀意念的受试者。单变量分析显示，自杀意念与抑郁和焦虑症状、非婚姻状况、CD4 计数<500 个/μl 和使用依非韦伦有关。多变量分析确定 SCL-90 抑郁症状评分增加一个点（AOR 1.16，95%CI 4.5-123.6，p=0.000）和使用依非韦伦（AOR 5.00，95%CI 1.02-24.6，p=0.048）是与自杀意念相关的独立显著因素。
结论
在接受 ART 的印度尼西亚 HIV 感染成人中，自杀意念很常见。抑郁症状和依非韦伦的使用是与自杀意念相关的独立因素。因此，建议早期筛查精神病理学，并将依非韦伦替换为其他 ART 方案，以预防自杀和改善 HIV/AIDS 管理结果。
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