# A Syndemic Clustering of Adversities on Suicide Risk among YMSM Living with HIV in Bangkok: A Causal Latent Class Analysis

## TL;DR

This study explores how multiple adversities and depression together increase suicide risk among young men who have sex with men living with HIV in Bangkok.

## Contribution

The study introduces a causal latent class analysis to identify how adversity clusters synergistically with depression to elevate suicidality.

## Key findings

- Subgroups of YMSM with distinct adversity clusters were identified using latent class analysis.
- Moderate and high adversity clusters synergistically interact with depression to increase suicidality.
- Effective depression treatment could significantly reduce suicide risk despite existing adversities.

## Abstract

This study investigated the clustering of psychosocial adversities and their synergistic effect with depression on suicidality in a 12-month prospective cohort (N = 214) of YMSM living with HIV in Bangkok, Thailand. Latent class analysis identified subgroups with distinct combinations of adversities, including bullying, intimate partner violence, substance use, HIV stigma, low social support, histories of sex work, and below-income status. Significant interactive synergism were found as hypothesized, supporting a syndemic effect with qualitatively increasing levels of adversities on suicidality (score range: 3–17) over the 12 months. The interaction between moderate adversity clustering and depression (βow = 2.50, 95% CI: 1.12–3.88) and high adversity clustering and depression (βow = 3.61, 95% CI: 1.12–6.09) indicated that the impact of depression on suicidality was modified by pre-existing adversities. The findings suggest that, while a multi-component intervention addressing psychosocial problems is ideal, effective depression treatment alone could significantly reduce suicidality among YMSM living with HIV.

The online version contains supplementary material available at 10.1007/s10461-024-04516-7.