The suicide rate was seven times higher among AIDS patients in the late 1980s than it was in the general population, but a statistical study published today found hopeful signs the problem may be lessening.
Scientists sifting through records of the National Center for Health Statistics found evidence of 165 people with AIDS who killed themselves from 1987 through 1989.
In a complex calculation, the epidemiologists found the suicide rate was 7.4 times higher among AIDS patients than it was among the U.S. adult population -- but the gap narrowed substantially during that period. In the first year, suicide was 10 times more common among patients with acquired immune deficiency syndrome; by 1989, it was six times higher.
"The message of hope is that the trend seems to be a decreasing rate of suicide among the three years we studied," said Dr. Andrew L. Dannenberg, an epidemiologist with the Johns Hopkins School of Hygiene and Public Health.
The study, also conducted by an epidemiologist at the National Cancer Institute, appears in today's Journal of the American Medical Association.
Studies of people with other kinds of terminal illnesses have found they also have a higher suicide rate than that of the general population.
While the study was purely statistical, the scientists speculated that improved treatments for AIDS, better psychiatric care and greater acceptance of people with the disease may account for the declining suicide rate.
Dr. Glenn Treismann, who runs a psychiatric service for AIDS patients at Johns Hopkins Hospital, said depression and other chronic mental illnesses are common among people who inject drugs or have unprotected sex with multiple partners including prostitutes -- both risk factors for AIDS.
That means that a person contracting the AIDS virus is more likely to be a suicide risk before getting infected. The disease, which carries the virtual certainty of death, poses stresses of its own.
The human immunodeficiency virus that causes AIDS can also cause psychiatric disease when it infects the brain. Dr. Treismann said brain diseases such as Parkinson's and Huntington's and blunt trauma to the head are also known to cause psychiatric illness.
"If you tell me the suicide rate is high, it's not a surprise because these people have a high rate of psychiatric disorders," Dr. Treismann said. "They need to be treated, and we under-provide treatment."
Despite these problems, Dr. Treismann said, clinics have become more attuned to the psychiatric problems of AIDS patients and have had success treating AIDS patients with anti-depressants. He said he knows of only one suicide among the several hundred people who have been treated at the Moore Clinic, the outpatient center for AIDS patients at Hopkins.
Indira Kotval, head social worker at Baltimore's Health Resource Education Organization, said she knows of two suicides among several hundred people who have sought help at HERO.
"We get a lot of people saying they want to kill themselves," she said. "Mostly, it's a cry for help and they need to get hooked into services."
The suicide study found that AIDS patients who killed themselves were more likely to have taken a drug overdose than to have used firearms, although it did not suggest an explanation. Across the general population, firearms account for more than half of all suicides.
Despite the heightened suicide risk, AIDS patients were much more likely to die of conditions associated with their disease than to kill themselves. Over the three-year period, the 165 suicides accounted for well under 1 percent of the 61,670 deaths among AIDS patients.