Journal Article Annotations
2022, 1st Quarter

Suicide

Annotations by Liliya Gershengoren, MD MPH
January, 2022

HIV related stigma associated with social support, alcohol use disorders, depression, anxiety, and suicidal ideation among people living with HIV: a systematic review and meta-analysis.

PUBLICATION #1 — Suicide

HIV related stigma associated with social support, alcohol use disorders, depression, anxiety, and suicidal ideation among people living with HIV: a systematic review and meta-analysis.

Bahram Armoon, Marie-Josée Fleury, Amir-Hossein Bayat, Yadollah Fakhri, Peter Higgs, Ladan Fattah Moghaddam , Leila Gonabadi-Nezhad

Abstract: Int J Ment Health Syst. 2022 Mar 4;16(1):17. doi: 10.1186/s13033-022-00527-w.

Background:
Stigma is a social phenomenon known to have a negative impact on the lives of people living with HIV (PLWH). However, defining HIV-related stigma (HRS) is difficult because of the intersection it has with structural inequalities, and cultural differences, discrimination by health care providers that measure stigma among PLWH. HIV/AIDS has been characterized as a traumatic experience and PLWH may experience stigma which can cause negative mental health disorders and experiences, including emotional distress, shame, depression, anxiety, suicidal ideation. A systematic review of the evidence on the mental disorders of PLWH is currently lacking. This study aimed to analyze the association between HRS and social support, alcohol use disorders and mental health disorders and experiences (depression, anxiety, and suicidal ideation) among PLWH.

Methods:
In accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) this study searched PubMed, Scopus, Web of sciences, PsycInfo, SciELO and Cochrane library electronic databases to identify publications between January 1992 and August 2020 that discussed social support, alcohol use disorders, mental health disorders and experiences (i.e., depression and anxiety and suicidal ideation) associated with HRS. Pooled Odds Ratios (ORs) were utilized at a 95% confidence level, and as sampling methods differed between articles pooled estimates used a random effects model.

Results:
Twenty-two studies with 9548 participants met the eligibility criteria. No association was observed between HRS and alcohol use disorders. PLWH who had higher levels of social supports were less likely to report HRS. Participants who had been diagnosed with anxiety were 1.89 times more likely to report HRS, while those diagnosed with depression were 1.61 times more. Respondents who reported suicidal ideation also were 1.83 times more likely to report HRS.

Conclusions:
This meta-analysis supports that HRS has a detrimental asociation with anxiety, depression and suicidal ideation, but social support protects again HRS in PLWH. Applying interventions which focus on the mental health disorders of PLWH may decrease HRS. Provision of social support by practitioners, combined with mental health treatment and assessments, and designing methods to identify stigma at different stages of illness are warranted.

Annotation

The finding:
This is the first systematic review and meta-analysis investigating the connection between experienced HIV-related stigma and social support, alcohol use disorders, and mental health disorders such as depression, anxiety, and suicidal ideation. The authors report a positive association between HIV-related stigma and increased levels of depression, anxiety, suicidal ideation. There was a negative association between social support and reported stigma. Interestingly, there was no association between alcohol use disorders and HIV-related stigma.

Strength and weaknesses:
One particular area of strength in this study is its examination of different variables (eg, social support, alcohol use, mental health disorders) with HIV-related stigma. It is also the first meta-analysis to examine these relationships. Additionally, the inclusion of studies from different geographic locations and publication eras render the results more generalizable. The limitations of the study include relying on self-report to characterize HIV-related stigma. The majority of the studies were cross-sectional; thus, establishing causal and temporal associations were not possible.

Relevance:
C-L psychiatrists often work with patients living with HIV and must be aware of the impact of HIV-related stigma which many patients experience. This study highlights the association between depression, anxiety, and suicidal ideation with HIV-related stigma. Furthermore, the study demonstrates the benefits of social supports for patients diagnosed with HIV. This study highlights that social support, experienced stigma, anxiety, depression, and SI are important factors to consider when evaluating patients living with HIV.