# Effect of Substance Abuse on Suicidal Behaviors Among People Living With HIV: 11-Year Cohort Study

## TL;DR

People with HIV who abuse substances are at much higher risk of suicide, with sleep issues playing a key role in this link.

## Contribution

This study identifies sleep disturbances as a key mediator between substance abuse and suicide risk among people living with HIV.

## Key findings

- Substance abuse nearly doubles the suicide risk for people living with HIV.
- Sleep disturbances mediate 19.1% of the effect between substance abuse and suicide.
- Low income significantly increases suicide risk among people living with HIV.

## Abstract

The suicide rate among individuals with substance abuse disorders is three times higher than in the general population, with nearly half of people living with human immunodeficiency virus (PLHIV) experiencing substance abuse.

This study was implemented using 11 years of official data to identify the risk factors of suicide and their association with substance abuse among PLHIV.

A nationwide cohort study was conducted in Taiwan using statistics from the national HIV database dating from January 1, 2005, to December 31, 2016. PLHIV aged 15 and older were identified using recorded diagnoses; medical treatments were identified using unique identification codes (ICD). Cox proportional hazard models and mediation analysis were used to estimate the association between substance abuse and suicide risk.

Fifty-nine suicide events were reported among the 4,016 PLHIV tracked in the study data, correlating with a suicide incidence rate of 743.91 per 100,000 person-years among substance abusers (n=1,287). Two factors, including substance abuse and low income, were found to significantly increase the hazard ratio (HR) of suicide (HR=1.93, 95% CI=[1.12, 3.33], p=.0174 and HR=5.15, 95% CI=[1.58, 16.86], p=.0067, respectively). Also, sleep disturbances were shown to mediate 19.1% of the effect between substance abuse and suicide. Conversely, depression did not exhibit a significant mediating role.

The findings indicate that substance abusers face a nearly twofold higher risk of suicide than nonusers, with significant socioeconomic disparities evident. Moreover, sleep disturbances was identified as a critical mediator in the relationship between substance abuse and suicide. These findings provide valuable insights to help improve clinical practices and policy development efforts aimed at preventing suicidal behaviors and improving the well-being of PLHIV struggling with substance abuse globally.