Suicide risk and mental health indicators: Do they differ by abuse and HIV status?

doi:10.1016/j.whi.2004.12.004

Women's Health Issues

Volume 15, Issue 2, March–April 2005, Pages 89-95

https://doi.org/10.1016/j.whi.2004.12.004 Get rights and content

Purpose

This study examines the association between women’s HIV serostatus, intimate partner violence (IPV) experience, and risk of suicide and other mental health indicators. Using data from Project WAVE (Women, AIDS, and the Violence Epidemic), we 1) describe the rates of suicidal thoughts and attempts, anxiety, and depression; 2) examine whether and to what extent these outcomes differ by women’s HIV and IPV status.

Methods

A one-time interview was conducted with a sample 611 women living in an urban area, one-half of whom were HIV-positive.

Results

Having thought about suicide was reported by 31% of the sample and 16% reported having attempted suicide. Among HIV-positive women, thoughts of suicide occurred more frequently among those who were recently diagnosed. One-half of the sample reported problems with depression, and 26% reported problems with anxiety; of women reporting these problems, 56% received mental health treatment. Rates varied significantly by HIV and IPV status, with women who were both HIV-positive and abused consistently faring worse. Relative to HIV-negative nonabused women, HIV-positive abused women were 7.0 times as likely to report problems with depression, 4.9 times as likely to report problems with anxiety, 3.6 times as likely to have thought about suicide, and 12.5 times as likely to have ever attempted suicide. Our findings that abused HIV-negative women were also at significantly elevated risk for all of these outcomes lends support to the conclusion that it is the experience of abuse that is associated with the negative outcomes.

Conclusions

Health care and service providers interacting with women who may be HIV-positive and/or in abusive relationships should routinely assess for mental health status, especially suicide risk, which may need crisis intervention.

Section snippets

Introduction and background

Women living in low-income, urban environments face a multitude of health concerns, not the least of which is HIV and intimate partner violence (IPV). Three mechanisms have been suggested through which violence may increase a woman’s risk for HIV infection, including forced sex with an infected individual, unprotected sex due to fear of abuse, and risk-taking behavior patterns subsequent to childhood abuse (Maman et al., 2000). Our own research and that of others suggest that women already

Sample and data collection

A cross-sectional design was used to interview a sample of HIV-positive women and a sample of demographically similar HIV-negative women, all of whom were living in low-income, urban neighborhoods in Baltimore. A total of 310 HIV-positive women were recruited, using a hospital-based HIV primary care clinic. To facilitate recruitment of a comparison group of HIV-negative women with a similar sociodemographic profile, we sampled from four Baltimore locations: 1) a hospital-based obstetrics and

Sample characteristics

The sample included predominantly African-American women (96%), over the age of 30 (74%), who earned $300 per month or less (64%), and who had a history of ever using drugs (81%) (see Table 1, Total column). Of the total sample, 16.7% of women were negative for both HIV and IPV, 18.8% were HIV-positive and negative for IPV, 32.6% were HIV-negative and positive for IPV, and 31.9% were positive for both HIV and IPV. Among the HIV-positive sample, 37% reported they had known they were HIV-positive

Conclusions and discussion

The relationship between IPV and depression that we found is consistent with the recent literature (Golding, 1999; Simoni & Ng, 2000), as is the significant associations between HIV seropositivity and mental health problems that we found (Kaslow et al., 2000; Morrison et al., 2002; Richardson et al., 2001). It is difficult to compare rates of mental health problems across studies because of differences in measurement instruments, definitions, and samples. Our overall rate of reported problems

Acknowledgments

The authors wish to acknowledge and thank the participating recruitment sites and women who gave us their time and insights, and Mary Garza, Elizabeth Tyler, Vivian Tyler, Molene Martin, Suzanne Maman, Pamela Fischer, Mary McCaul, and Jacqueline Campbell for their contributions to this research. Portions of this paper were presented at the XIV International AIDS Conference, Barcelona Spain, 2002. This study was supported by Grant #2RO1MH53821 from the National Institutes of Mental Health.

Dr. Andrea Carlson Gielen is Professor of social and behavioral sciences and Deputy Director of the Center for Injury Research and Policy at the Johns Hopkins Bloomberg School of Public Health. She is a health educator whose research is focused on behavior change interventions addressing injuries among women and children in low-income urban settings.

References (30)

J.E. Hathaway et al.
Health status and health care use of Massachusetts women reporting partner abuse
American Journal of Preventive Medicine
(2000)
R. Kessler et al.
Sex and depression in the national Comorbidity Survey. II
Journal of Affective Disorders
(1994)
S. Maman et al.
The intersections of HIV and violencedirections for future research and interventions
Social Science and Medicine
(2000)
G.M. Wingood et al.
Adverse consequence of intimate partner abuse among women in non-urban domestic violence shelters
American Journal of Preventive Medicine
(2000)
S. Zierler et al.
Sexual violence against women living with or at risk for HIV infection
American Journal of Preventive Medicine
(1996)
J.C. Campbell et al.
Depression in battered women
JAMWA
(1996)
M. Cohen et al.
Domestic violence and childhood abuse in HIV-infected women and women at risk for HIV
American Journal of Public Health
(2000)
A.C. Gielen et al.
Women living with HIVdisclosure, violence and social support
Journal of Urban Health
(2000)
A.C. Gielen et al.
Women’s lives after an HIV positive diagnosisdisclosure and violence
Maternal and Child Health Journal
(2000)
A.C. Gielen et al.
Intimate partner violence, HIV status and sexual risk reduction
AIDS and Behavior
(2002)

J.M. Golding

Intimate partner violence as a risk factor for mental disordersA meta-analysis

Journal of Family Violence

(1999)

N. Kaslow et al.

Risk factors for suicide attempts among African American women

Depression and Anxiety

(2000)

J.A. Kelly et al.

Factors associated with depression and high-risk sexual behavior among persons diagnoses with the human immunodeficiency virus (HIV) infection

Health Psychology

(1993)

C.A. Kennedy et al.

Gender differences in HIV-related psychological distress in heterosexual couples

AIDS Care

(1994)

M. Maj

Depressive syndromes and symptoms in subjects with HIV infection

British Journal of Psychiatry

(1996)

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Systematic review of interventions to address suicidal behavior among people with a history of intimate partner violence: Promises and gaps across the globe
2023, Aggression and Violent Behavior
Literature has shown a critical link between the experience of intimate partner violence (IPV) and suicidal behavior (i.e., suicidal ideation, plans, and attempts). Both epidemics are major contributors to morbidity and mortality worldwide; yet there remains a dearth in scientific understanding of how interventions can synergistically address IPV and suicidal behavior. Following PRISMA guidelines, we conducted a systematic review of intervention studies across the globe that reported suicidal behavior outcomes among people with a history of IPV. Articles were included if they reported quantitative findings related to suicidal behavior. We did not limit studies by age, location, study design, sexual orientation, or gender. Our search yielded 2924 abstracts for screening, resulting in six relevant articles from a total of five study interventions. Studies were conducted in the United States, Spain, South Africa, and Iran. Study populations primarily included cisgender women, however, one study additionally included cisgender men, and another included transgender women. Four were individual level interventions; the remaining study also targeted structural level factors. There were mixed findings on intervention effects on suicidal behaviors, although all studies indicated some statistically significant findings. Despite evidence linking IPV and suicidal behavior, we found very few intervention studies that address or measure suicidal behavior among populations with a history of IPV. Findings suggest the need for more robust designs, consistent use of measures, and work across more diverse populations and regions. Additionally, findings suggest an urgent need for more attention to suicidal behavior as part of mental health and risk focused interventions for survivors of IPV.
Intimate partner violence: Prevalence, health consequences, and intervention
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Citation Excerpt :
A study of formerly abused women experiencing chronic pain found that 31% had attempted suicide at some point in their lifetimes27 and a study of urban women found that abused women were nearly 8 times more likely to attempt suicide than nonabused women.48 In the latter study, women who were abused and HIV positive were nearly 13 times more likely to attempt suicide compared with nonabused, HIV-negative women.48 Among male veterans receiving Veterans Health Administration services, nearly 30% of men with a history of IPV had attempted suicide, which was twice the rate of men without a history of IPV.49
Depression and Social Support Among Women Living with the Substance Abuse, Violence, and HIV/AIDS Syndemic: AQualitative Exploration
2014, Women's Health Issues
Intimate partner violence (IPV), HIV/AIDS, and substance use are described as the SAVA “syndemic” among low-income urban women because of their intersecting and synergistic presence in these women's lives. Depressive symptoms are significantly associated with these SAVA factors and although social support is potentially protective for depression, little is understood about its impact on depression associated with the SAVA syndemic.
This paper investigates how women living with SAVA experience and describe depressive symptoms, and examines how the types of social support they access impact their experiences of SAVA and depressive symptoms. Qualitative, in-depth interviews were conducted with 24 HIV-positive, low-income, urban women who experienced IPV and used cocaine or heroin in their lifetime. Interviews were analyzed based on study aims, principles of thematic content analysis, and grounded theory.
Women identified multiple SAVA factors as catalysts for depression and noted their synergistic effect on depressive symptoms, which were both a trigger for and a result of drug use. Women accessed varying sources of social support to address their SAVA factors and associated symptoms of depression, relying on informal sources for instrumental support related to IPV and formal sources for support related to HIV, drug use, and depression.
These findings have important implications for health providers who serve SAVA-affected women, and suggest that comprehensively addressing all SAVA factors (and IPV in particular) and improving their access to quality social support at critical times is essential to improve their mental health.
A Systematic Review of the Frequency and Correlates of Partner Abuse in HIV-Infected Women and Men Who Partner With Men
2014, Journal of the Association of Nurses in AIDS Care
Citation Excerpt :
The studies have shown that women with HIV who reported a history of PA endorsed significantly more depression (Illangasekare et al., 2012; Jones, Beach, & Forehand, 2003; McDonnell, Gielen, O'Campo, & Burke, 2005; Newcomb & Carmona, 2004), anxiety (Galvan et al., 2004; Gielen et al., 2005), and posttraumatic stress disorder symptoms (Axelrod et al., 1999) compared to women with HIV who had not experienced PA. Gielen et al. (2005) reported that HIV-infected women who had been physically and sexually abused, compared to HIV-uninfected nonabused women, were 4.9 times as likely to report problems with anxiety, 7.0 times as likely to report problems with depression, and 12.5 times as likely to have ever attempted suicide. Only two studies, however, reported on significant associations between PA and mental health in HIV-infected MSM (physical & sexual PA, Galvan et al., 2004; physical PA or any PA, Pantalone et al., 2012).
Partner abuse (PA) is a highly prevalent and devastating social phenomenon, extracting an economic toll of more than $8 billion annually in the United States due to lost productivity alone. Many of the risk factors for PA increase vulnerability to acquiring HIV as well, yet little research has explored these overlapping epidemics. In this systematic review, we examine the frequency of PA victimization from male partners among persons living with HIV—both men who have sex with men (MSM) and women. We located 31 manuscripts reporting data from 24 unique samples, indicating a high lifetime frequency (but large range) of estimates for women/MSM, respectively, for physical (26–62%/15–39%), sexual (22–44%/8–33%), and psychological abuse (55%/22–73%). Data indicate strong and consistent associations of PA with poor mental health, engagement in health risk behaviors, and nonadherence to HIV medication for both groups. We discuss implications for clinical practice as well as future research directions.
Clinical and Mental Health Correlates and Risk Factors for Intimate Partner Violence among HIV-Positive Women in an Inner-City HIV Clinic
2012, Women's Health Issues
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Other literature indicates that psychiatric disorders are particularly prevalent among women with both HIV and IPV. One study indicated that women who were both HIV-positive and had ever experienced IPV as an adult were 7 times more likely to report having a problem with depression, 5 times more likely to report having a problem with anxiety, and 12.5 times more likely to report having ever attempted suicide compared with their HIV-negative counterparts who never experienced IPV (Gielen, McDonnell, O'Campo, & Burke, 2005). Such adverse mental health sequelae has been shown to be associated with increased morbidity among HIV-positive women, and faster progression to AIDS, as well as with decreased CD4 counts and immune functioning (Boarts, Sledjeski, Bogart, & Delahanty, 2006; Ickovics et al., 2001; Sledjeski, Delahanty, & Bogart, 2005).
Intimate partner violence (IPV) is a serious health concern for women in the United States, and HIV-positive women experience more frequent and severe abuse compared with HIV-negative women. The goals of this study were to determine the prevalence of IPV among HIV-infected women receiving care in an urban clinic and to determine the HIV clinical and mental health correlates of IPV among HIV-positive women.
We conducted a cross-sectional survey among 196 women visiting an inner-city HIV clinic. Women were eligible if they were 18 years of age or older, English speaking, and received both HIV primary and gynecologic care at the clinic. The survey queried demographics, drug and alcohol history, depressive symptoms, and IPV, using the Partner Violence Scale. Antiretroviral therapy (ART), CD4 cell count, HIV-1 RNA level, and appointment adherence were abstracted from clinical records.
Overall, 26.5% of women reported experiencing IPV in the past year. There were no differences in sociodemographics, substance use, ART prescription, CD4 count, or HIV-1 RNA level between women who experienced IPV and those who had not. Women with mild and severe depressive symptoms were significantly more likely to report IPV compared with those without, with adjusted odds ratios of 3.4 and 5.5, respectively. Women who missed gynecologic appointments were 1.9 times more likely to report experiencing IPV.
IPV is prevalent among women presenting for HIV care, and depressive symptoms or missed gynecologic appointments should prompt further screening for IPV.
Intimate partner violence against adult women and its association with major depressive disorder, depressive symptoms and postpartum depression: A systematic review and meta-analysis
2012, Social Science and Medicine
Citation Excerpt :
Results indicated that the odds of MDD were 3.26 times higher among women with an IPV history compared to those without an IPV history (Bonomi, Anderson, Reid et al., 2009). EDS was the outcome related to IPV in 25 out of 37 studies (Al-Modallal et al., 2010; Bauer, Rodriguez, & Perez-Stable, 2000; Bonomi, Anderson, Cannon, Slesnick, & Rodriguez, 2009; Bonomi, Anderson, Rivara, & Thompson, 2007; Bonomi et al., 2006; Caetano & Cunradi, 2003; Coker, Pope, Smith, Sanderson, & Hussey, 2001; Coker, Smith et al., 2002; Davis, Coker, & Sanderson, 2002; Dunn & Oths, 2004; Gielen, McDonnell, O'Campo, & Burke, 2005; Hathaway et al., 2000; Hegarty, Gunn, Chondros, & Small, 2004; Hegarty, Gunn, Chondros, & Taft, 2008; Hillemeier, Weisman, Chase, & Dyer, 2008; Houry, Kemball, Rhodes, & Kaslow, 2006; Hurwitz, Gupta, Liu, Silverman, & Raj, 2006; Lehrer, Buka, Gortmaker, & Shrier, 2006; Rodriguez et al., 2008; Romito & Grassi, 2007; Schneider, Burnette, Ilgen, & Timko, 2009; Vaeth, Ramisetty-Mikler, & Caetano, 2010; Vung, Ostergren, & Krantz, 2009; Wong, Huang, DiGangi, Thompson, & Smith, 2008; Yang, Yang, Chang, Chen, & Ko, 2006). Several of the large population-based cross-sectional studies used BRFSS data (Bonomi, Anderson, Cannon et al., 2009; Bonomi et al., 2007, 2006; Hathaway et al., 2000; Hurwitz et al., 2006), and the majority of studies provided evidence for a positive association between IPV and EDS.
To date, few systematic reviews of observational studies have been conducted to comprehensively evaluate the co-morbidity of intimate partner violence (IPV) and specific depression outcomes in women. In this systematic review and meta-analysis, we summarize the extant literature and estimate the magnitude of the association between IPV and key depressive outcomes (elevated depressive symptoms, diagnosed major depressive disorder and postpartum depression). PubMed (January 1, 1980–December 31, 2010) searches of English-language observational studies were conducted. Most of the selected 37 studies had cross-sectional population-based designs, focused on elevated depressive symptoms and were conducted in the United States. Most studies suggested moderate or strong positive associations between IPV and depression. Our meta-analysis suggested two to three-fold increased risk of major depressive disorder and 1.5–2-fold increased risk of elevated depressive symptoms and postpartum depression among women exposed to intimate partner violence relative to non-exposed women. A sizable proportion (9%–28%) of major depressive disorder, elevated depressive symptoms, and postpartum depression can be attributed to lifetime exposure to IPV. In an effort to reduce the burden of depression, continued research is recommended for evaluating IPV preventive strategies.

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Dr. Karen A McDonnell is Assistant Professor of maternal and child health at the George Washington University, School of Public Health and Health Sciences. She is a health psychologist who studies quality of life and psychosocial adjustment among women and children, with an emphasis on injury problems affecting low-income families and the development and evaluation of interventions.

Dr. Jessica Griffin Burke is a research associate in the department of Population and Family Health Sciences at the Johns Hopkins Bloomberg School of Public Health. She is a social scientist whose research examines the multiple levels of risk and protective factors influencing women’s health, including the relationship between neighborhood context and intimate partner violence.

Dr. Patricia O’Campo is Alma and Baxter Ricard Endowed Chair in Inner City Health and Director of the Centre for Research on Inner City Health. She is a social epidemiologist whose research is focused on social inequalities in health.

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Suicide risk and mental health indicators: Do they differ by abuse and HIV status?

Purpose

Methods

Results

Conclusions

Section snippets

Introduction and background

Sample and data collection

Sample characteristics

Conclusions and discussion

Acknowledgments

American Journal of Preventive Medicine

Journal of Affective Disorders

Social Science and Medicine

American Journal of Preventive Medicine

American Journal of Preventive Medicine

Depression in battered women

JAMWA

Domestic violence and childhood abuse in HIV-infected women and women at risk for HIV

American Journal of Public Health

Women living with HIVdisclosure, violence and social support

Journal of Urban Health

Women’s lives after an HIV positive diagnosisdisclosure and violence

Maternal and Child Health Journal

Intimate partner violence, HIV status and sexual risk reduction

AIDS and Behavior

Intimate partner violence as a risk factor for mental disordersA meta-analysis

Journal of Family Violence

Risk factors for suicide attempts among African American women

Depression and Anxiety

Factors associated with depression and high-risk sexual behavior among persons diagnoses with the human immunodeficiency virus (HIV) infection

Health Psychology

Gender differences in HIV-related psychological distress in heterosexual couples

AIDS Care

Depressive syndromes and symptoms in subjects with HIV infection

British Journal of Psychiatry