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Mortality Follow-up of 4147 HIV-Seropositive Military Service Applicants

Andrew L. Dannenberg, MD, MPH; John G. McNeil, MD, MPH; John F. Brundage, MD, MPH; Ronald Brookmeyer, PhD

JAMA. 1996;276(21):1743-1746.

Abstract
Objective.
—To examine the risk of suicide among individuals positive for the human immunodeficiency virus (HIV) following screening for evidence of HIV infection. Prior studies have reported a 7- to 36-fold increased risk of suicide for persons with the acquired immunodeficiency syndrome.

Design.
—Prospective cohort study.

Setting.
—Military service applicants from throughout the United States.

Main Outcome Measure.
—Death from suicide.

Methods.
—The National Death Index was searched for mortality among 4147 HIV-positive military service applicants and 12437 HIV-negative applicants disqualified from military service due to other medical conditions (matched 1:3 on age, race, sex, and screening date and location) identified by the US Department of Defense between October 1985 and December 1993. Death certificates were obtained from individual states. Identifiers and HIV status of living applicants were known only by the Department of Defense.

Results.
—The HIV-positive applicants were 92% male, 37% white, and 56% black. Median age was 24 years (range, 17-57 years). Median follow-up time was 70 months (range, 0-99 months). Ten HIV-positive (49 per 100000 person-years) and 24 HIV-negative applicants (36 per 100000 person-years) died of suicide (rate ratio [RR], 1.35; 95% confidence interval [Cl]=0.58-2.93). Suicide rates among both HIV-positive (RR, 2.08; 95% CI, 1.00-3.82) and HIV-negative (RR, 1.67; 95% CI, 1.07-2.48) applicants are marginally higher than those for the US general population, after adjustment for age, race, and sex. Time from screening to death was less than 3 months for 3 of 10 HIV-positive and 2 of 24 HIV-negative applicants who died of suicide.

Conclusions.
—The HIV-positive individuals do not appear to have a significantly increased risk of death from suicide in the months following HIV screening in this study population. Because suicide risk is reported to be greatly increased after symptomatic HIV disease is present, clinicians should consider asking persons with HIV infection about suicide risk factors during both initial counseling and subsequent medical care.

Author Affiliations
From the Center for Injury Research and Policy (Dr Dannenberg) and the Department of Biostatistics (Dr Brookmeyer), Johns Hopkins University School of Hygiene and Public Health, Baltimore, Md; the Division of Preventive Medicine, Walter Reed Army Institute of Research, Washington, DC (Dr McNeil); and the Henry M. Jackson Foundation for the Advancement of Military Medicine, Rockville, Md (Dr Brundage). Dr Dannen-; berg is now with the Division of Applied Public Health Training, Epidemiology Program Office, Centers for Disease Control and Prevention, Atlanta, Ga.

Footnotes
Reprints: Andrew L. Dannenberg, MD, MPH, Division of Applied Public Health Training, Epidemiology Program Office, Centers for Disease Control and Prevention, Mailstop D-18, 1600 Clifton Rd NE, Atlanta, GA 30333.

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