Objective: Suicide is an important public health problem in China. Elsewhere, injection drug use and HIV infection have independently been associated with suicidality, but research has often overlooked these high-risk groups in China. We determined the frequency and predictors of suicidal ideas in Chinese HIV-infected (HIV+) and HIV-uninfected (HIV−) heroin injection drug users (IDUs) in treatment and a control sample. We hypothesized that rates of suicidal ideas would be significantly higher among IDUs compared with controls and highest among HIV+ IDUs.
Method: We assessed suicidal ideas within the past 2 weeks in HIV+ (n = 204) and HIV− (n = 202) heroin IDUs in methadone treatment in Yunnan, a province at the intersection of the heroin and HIV epidemics, and in demographically matched HIV− non–drug-using controls (n = 201).
Results: Rates of suicidality were higher in IDUs than controls, but there was no additive effect of HIV infection (HIV+ IDU: 43.1%; HIV− IDU: 37.1%; controls: 8.5%). Among HIV+ IDUs, suicidality was associated most strongly with a combination of prior history of major depression, low perceived social support, and experience of HIV-relevant stress, but not with AIDS diagnosis. Among HIV− IDUs, suicidality was associated with prior history of major depressive or alcohol use disorder. Less than 25% of IDUs with suicidality had histories of mood or alcohol use diagnoses.
Conclusion: Because suicidal ideation is frequent in IDUs in China, regardless of HIV status, and is not fully accounted for by past psychiatric history, additional research may be warranted.