Social Support, Depression, and Anxiety as Predictors of Suicidal Ideation in People Living with HIV/AIDS: A Meta-Analysis
DOI:
https://doi.org/10.26911/thejhpb.2025.10.04.04Abstract
Background: Acquired Immune Deficiency Syndrome (AIDS) is a disease caused by the Human Immunodeficiency Virus (HIV). People living with HIV/AIDS (PLWHA) are 7 to 36 times more likely to experience suicidal ideation compared to the general population. Suicidal ideation among PLWHA is closely correlated with depression and anxiety. Social support plays a crucial role in helping individuals cope with HIV, serving as a direct protective factor for psychosocial health. This meta-analysis aims to examine the relationship between social support, depression, and anxiety with suicidal ideation among people living with HIV/AIDS (PLWHA)
Subjects and Method: The meta-analysis was conducted using the PICO framework. Population: people living with HIV/AIDS (PLWHA). Intervention: high social support, presence of depression, and anxiety. Comparison: low social support, absence of depression, and absence of anxiety. Outcome: suicidal ideation. Research data were obtained from the Google Scholar, PubMed, and ScienceDirect databases. The keywords used were “social support” OR “depression” OR “anxiety” AND “suicidal ideation” AND “HIV/AIDS” OR “PLWHA.” The inclusion criteria included cross-sectional studies published between 2014 and 2024. Data analysis was performed using RevMan version 5.4.
Results: The meta-analysis included 19 primary studies conducted in Indonesia, South Korea, China, Ethiopia, Uganda, Nigeria, South Africa, and the United States, with a total sample size of 11,166 participants. PLWHA residing in communities with high social support had 0.65 times lower odds of suicidal ideation compared to those with low social support (aOR= 0.65; 95% CI= 0.57 to 0.74; p<0.001). PLWHA experiencing depression had a 3.21 times higher risk of suicidal ideation compared to those without depression (aOR= 3.21; 95% CI= 2.07 to 4.99; p <0.001). PLWHA with anxiety were 1.67 times more likely to experience suicidal ideation than those without anxiety (aOR= 1.67; 95% CI= 1.29 to 2.18; p= 0.001).
Conclusion: Depression and anxiety increase the risk of suicidal ideation, whereas high social support reduces the risk of suicidal ideation among people living with HIV/AIDS.
Keywords:
social support, depression, anxiety, people living with HIV/AIDS, suicidal ideationHow to Cite
References
Ahmed A, Saqlain M, Umair, MM, Hashmi FK, Saeed H, Amer M, Blebil AQ, Dujaili JA. (2021). Stigma, social support, illicit drug use, and other predictors of anxiety and depression among HIV/AIDS patients in Pakistan: a cross-sectional study. Front Public Health. 9: 745545. doi: 10.3389/fpubh.2021.745545.
Armoon B, Fleury MJ, Bayat AH. et al. (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. Int J Ment Health Syst. https://doi.org/10.1186/s13033-022-00527-w.
Bagheri Z, Noorshargh P, Shahsavar Z, Jafari P (2021). Assessing the mea-surement invariance of the 10-item Centre for Epidemiological Studies Depression Scale and Beck Anxiety Inventory questionnaires across people living with HIV/AIDS and healthy people. BMC Psychol, 9(1): 1–11. https://doi.org/10.1186/s40359-021-00546-1.
Bamidele OT, Agada D, Afolayan E, et al. (2024). Pattern and risk factors for suicidal behaviors of people accessing HIV care in Ogun State, Nigeria: a cross-sectional survey. HIV AIDS Rev. 23(2):141-151. doi:10.5114/hivar/171-613.
Bantjes J, Kagee A (2021). Suicide Preven-tion in HIV Treatment Centres: Popu-lation Attributable Risk Analysis of Treating Common Mental Disorders. AIDS Behav. 25:1864-1872. doi:10.10-07/s10461-020-03116-5.
Bitew H, Andargie G, Tadesse A, Belete A, Fekadu W, Mekonen T (2016). Suicidal Ideation, Attempt, and Determining Factors among HIV/AIDS Patients, Ethiopia. Depress Res Treat. 2016(1): 1-6. doi:10.1155/2016/8913160.
Brandt C, Zvolensky MJ, Woods SP, Gonzalez A, Safren SA, O’Cleirigh CM. (2017). Anxiety symptoms and dis-orders among adults living with hiv and aids: A critical review and integrative synthesis of the empirical literature. Clin Psychol Rev. 51: 164–84. doi: 10.1016/j.cpr.2016.11.005.
Casale M, Boyes M, Pantelic M, Toska E, Cluver L. (2019). Suicidal thoughts and behaviour among South African adolescents living with HIV: Can social support buffer the impact of stigma?. J Affect Disord, 245: 82–90. https://-doi.org/10.1016/j.jad.2018.10.102.
Degroote S, Vogelaers D, Vandijck DM. (2014). What determines health-related quality of life among people living with HIV: an updated review of the literature. Arch Public Health, 72: 1– 10.
Fredericksen RJ, Gibbons LE, Fitzsimmons E, et al. (2021) Impact and correlates of sub-optimal social support among patients in HIV care. AIDS Care. 33(9): 1178-1188.
Fu J, Chen X, Dai Z, et al. (2023). HIV-related stigma, depression and suicidal ideation among HIV-positive MSM in China: a moderated mediation model. BMC Public Health. 23:1-12. doi:10.11-86/s12889-023-17047-y.
Gariepy G, Honkaniemi H, Quesnel-Vallee A (2016). Social support and protection from depression: systematic review of current findings in Western countries. Br J Psychiatry. 209(4): 284-293.
Gebremariam EH, Reta MM, Nasir Z, Amdie FZ (2017). Prevalence and associated factors of suicidal ideation and attempt among people living with HIV/AIDS at Zewditu Memorial Hospital, Addis Ababa, Ethiopia: A Cross-Sectional Study. Psychiatry J. 2017(1):2301524. doi:10.1155/2017/-2301524.
Gizachew KD, Chekol YA, Basha EA, Mamuye SA, Wubetu AD (2021). Suicidal ideation and attempt among people living with HIV/AIDS in selected public hospitals: Central Ethiopia. Ann Gen Psychiatry. 20:1-18. doi:10.1186/s12991-021-00335-5.
Ji J, Zhang Y, Ma Y, et al. (2024). People who living with HIV/AIDS also have a high prevalence of anxiety disorders: a systematic review and meta-analysis. Front Psychiatry. 15: 1259290.
Kang CR, Bang JH, Cho S Il, et al. (2016). Suicidal ideation and suicide attempts among human immunodeficiency virus-infected adults: Differences in risk factors and their implications. AIDS Care. 28(3):306-313. doi:10.108-0/09540121.2015.1093593.
Kindaya GG, Demoze CK (2020). Lifetime prevalence and determinants of suicidal ideation and attempt among all patients living with hiv/aids in hiwot fana specialized hospital, harar, ethiopia, 2020. HIV/AIDS - Res Palliat Care. 12:331-339. doi:10.2147/HIV.-S257502.
Liu Y, Niu L, Wang M, Chen X, Xiao S, Luo D (2017). Suicidal behaviors among newly diagnosed people living with HIV in Changsha, China. AIDS Care. 29(11):1359-1363. doi:10.1080/09540121.2017.1338653.
Luo R., Silenzio VMB, Huang, Y, Chen X, Luo D. (2022). The changes and the predictors of suicidal ideation among HIV-positive sexual minority men: a five-year Longitudinal Study from China. AIDS Behav. 1–11.
López JD, Shacham E, Brown T (2018). Suicidal Ideation Persists Among Individuals Engaged in HIV Care in the Era of Antiretroviral Therapy. AIDS Behav. 22:800-805. doi:10.10-07/s10461-016-1666-5.
Machado AV, Mukamutara J, Lora RMS, Gonza lez RME. (2021). Depression, Suicidal Ideation and Social Support in Patients with HIV/AIDS. SVOA Neurology 2:5 (2021) Pages 140-147.
Mugisha J, Muyinda H, Kagee A, et al. (2016). Prevalence of suicidal ideation and attempt: Associations with psychiatric disorders and HIV/AIDS in post-conflict northern Uganda. Afri Heal Sci. 16(4):1027-1035. doi:10.431-4/ahs.v16i4.20.
Ophinni Y, Adrian, Siste K, et al. (2020). Suicidal ideation, psychopathology and associated factors among HIV-infected adults in Indonesia. BMC Psychiatry. 20:1-10. doi:10.1186/s128-88-020-02666-1.
Passos SMK, Souza LD de M, Spessato BC. (2014). High prevalence of suicide risk in people living with HIV: who is at higher risk? AIDS Care. 26(11): 1379-1382.
Pei JH, Pei YX, Ma T, Du YH, Wang XL, Zhong JP, Xie Q, Zhang LH, Yan LX, Dou XM. (2021). Prevalence of suicidal ideation, suicide attempt, and suicide plan among HIV/AIDS: A systematic review and meta-analysis. J Affect Disord, 292(82): 295–304. https://-doi.org/10.1016/j.jad.2021.05.064.
Pelton M, Ciarletta M, Wisnousky H, Lazzara N, Manglani M, Ba DM, Chinchillli VM, Du PS, Ssentongo P. (2021). Rates and risk factors for suicidal ideation, suicide attempts and suicide deaths in persons with HIV: A systematic review and meta-analysis. General Psychiatry, 34(2): 1–9. https:-//doi.org/10.1136/gpsych-2020-100-247.
Remien RH, Stirratt MJ, Nguyen N, Robbins RN, Pala AN, Mellins CA. (2019). Mental health and HIV/AIDS: The need for an integrated response. Aids, 33(9): 1411–1420. https://doi.org/10.-1097/QAD.0000000000002227.
Rukundo GZ, Mishara BL, Kinyanda E (2016). Burden of Suicidal Ideation and Attempt among Persons Living with HIV and AIDS in Semiurban Uganda. AIDS Res Treat. 2016(1):1-9. doi:10.1155/2016/3015468.
Supriyatni N, Salim LA, Hargono A, Febri-yanti (2023). Antiretroviral medication adherence for people with HIV/ AIDS. J Public Health in Afr, 14(7). https://doi.org/10.4081/jphia.2023.-2434.
Tamirat KS, Tesema GA, Tessema ZT (2021). Psychosocial factors associated with suicidal ideation among hiv/aids patients on follow-up at dessie referral hospital, northeast ethiopia: A cross-sectional study. HIV/AIDS - Res Palliat Care. 13:415-423. doi:10.2147/-HIV.S299538.
Wang W, Xiao C, Yao X, Yang Y, Yan H, Li S (2018). Psychosocial health and suicidal ideation among people living with HIV/AIDS: A cross-sectional study in Nanjing, China. PLoS One. 13(2):1-17. doi:10.1371/journal.pone.-0192940.
Wang X, Yan C, Tong Y, et al. (2022). Comparison of psycho-social factors associated with suicidal ideation and suicide attempts among people living with HIV in Central West China. Front Public Heal. 10:1-10. doi:10.3389/fp-ubh.2022.832624.
Wonde M, Mulat H, Birhanu A, Biru A, Kassew T, Shumet S (2019). The magnitude of suicidal ideation, attempts and associated factors of HIV positive youth attending ART follow ups at St. Paul’s hospital Millennium Medical College and St. Peter’s specia-lized hospital, Addis Ababa, Ethiopia, 2018. PLoS One. 14(11):1-15. doi:10.-1371/journal.pone.0224371.
Wu Y Le, Yang HY, Wang J, et al. (2015). Prevalence of suicidal ideation and associated factors among HIV-positive MSM in Anhui, China. Int J STD AIDS. 26(7):496-503. doi:10.1177/0956462414544722.
Yu Y, Luo B, Qin L, Gong H, Chen Y (2023). Suicidal ideation of people living with HIV and its relations to depression, anxiety and social support. BMC Psychol. 11:1-9. doi:10.1186/s40359-023-01177-4.


