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Section 5
Mental Health in HIV Care

Question 5 | Test | Table of Contents

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In the last section, we discussed AIDS dementia Complex.  We examined four steps for caregivers providing care to a relative or friend who has AIDS dementia Complex.  These four steps are providing a calm, stable environment, helping to cope with a failing memory, maintaining a safe environment, and setting up advance directives.   

In this section... we will discuss suicidal tendencies.  As you know, caregivers can take a break from care-giving when they begin to feel overwhelmed.  However, the HIV positive friend or family member has no such options.  Often, their only escape seems to be suicide.  Therefore, the purpose of this section is to address suicide as preventable from the perspective of the caregiver.  We’ll discuss the two types of suicide and steps caregivers can take to prevent suicide.

♦ Two Types of Suicide
First, let’s discuss two types of suicide.  Clearly, suicides do not fall neatly into precise categories, but HIV related suicides typically come in two different types.  The two types of suicide are irrational and rational suicide.  As you know, irrational suicide is generally crisis-oriented.  The death of a friend, a feared diagnosis, or feelings of insecurity may result in irrational suicide.  For clients who have recently tested positive for HIV, occasional suicidal fantasies may even be a way to cope.  Recently diagnosed HIV positive clients may feel that by considering suicide, they can at least take back some control that they feel the virus has stolen.  When these thoughts lead to plans, however, suicidal tendencies may begin to surface.

Rational suicide is more carefully planned and may even seem understandable to some people in the person’s ssocial group or community.  Rational suicide is based on a person’s realistic assessment of a situation.  An example of rational suicide would be a client who wanted to end their life because of unendurable pain.  Rational suicide may lead to assisted suicide as end-stage AIDS clients seek a way to escape pain and die with dignity. 

♦ Steps Caregivers Can Take To Prevent Suicide
Let’s examine steps caregivers can take to preventing suicide.  In most cases, I have found that thoughts of suicide are usually only temporary.  For example, when Samantha’s HIV positive husband Luke, age 42, said he was considering suicide, Samantha asked him to first talk to a therapist.  Samantha also told Luke that she thought he owed it to her not to act without talking to her first.  Luke agreed and made those promises.  Eventually, Luke decided against suicide.  Have you found that, like Luke, most clients find their interest in life is stronger than their desire to die?

However, if thoughts about suicide persist, and if thoughts about taking pills become plans to collect specific pills, intervention is necessary. 

Todd, age 34, was concerned about his HIV positive partner, Brett.  After a session with Brett, Todd privately stated to me, "Brett has started talking about suicide.  I’m worried.  Please call me."  I called Todd and set up a time to see him as soon as possible.  After talking to Todd, I felt that Brett’s suicidal thoughts may have been a frustrated expression of fear.  What might be the cause of your HIV positive client’s suicidal thoughts? 

To provide Todd  with steps he could take to prevent a possible suicide, I stated, "One of the best things you can do might be to listen to Brett’s feelings right now.  It sounds like he might be afraid of the future."  Todd asked, "How is listening going to help?" 

How might you have responded to Todd?  I stated, "First, you’ll have the opportunity to ‘read between the lines’ to discover the basis for Brett’s suicidal thoughts.  Once you can possibly identify the basis for Brett’s suicidal thoughts, you can begin to help resolve them.  And don’t be afraid to talk about suicide with Brett. Asking him some straightforward questions will not plant suicidal thoughts in his mind.  Those thoughts are already there.  Your questions can give Brett the permission to talk about his thoughts and feelings." 

Assessing the Suicide Risk by Asking Questions
Todd wanted to know what might be some good questions to ask, so I gave him some sample questions with which he and I did some role playing.  Could role playing sensitive conversations with the caregiver of your HIV positive client be productive? 

1. First, I stated to Todd, "Don’t be afraid to ask Brett if he’s thinking about suicide.  Perhaps you could say ‘You sound so depressed and resigned.  Are you thinking about killing yourself?"  Todd answered as he believed Brett would. "Yes."  I then asked, "How are you planning to kill yourself?"  Todd looked puzzled and stated, "I don’t think Brett would have a definite plan.  But what if he told me that he had a plan?"  How would you have responded? 

2. I stated, "If Brett indicates that he might have a definite plan for suicide, weigh the possibilities of suicide.  For example, you might ask yourself if the method sounds plausible. Are the means available for Brett to carry out the threat?  How specific are the details of his plan?  If you find out that Brett has a plan or if you have any reason to believe that he might have suicidal tendencies, do not leave him alone until he agrees not to carry out his plan without fair warning.  Then call a suicide crisis line."  Think of your Brett.  Is he suicidal or does your HIV positive client consider suicide mostly as a means of regaining a feeling of control?  How can you help the caregiver of your client evaluate him or her for suicidal tendencies?  Would this information be helpful to your caregiver?

In this section... we discussed suicidal tendencies.  We discussed the two types of suicide and steps caregivers can take to prevent suicide.

In the next section, we will discuss overcoming substance abuse.  Four steps you might encourage your client to take if their HIV positive friend or family member has a substance abuse problem are avoiding nagging and preaching, encouraging honesty and positive thinking, promoting self affirmation, and supporting the process of change. 

Peer-Reviewed Journal Article References:
Chesin, M. S., Brodsky, B. S., Beeler, B., Benjamin-Phillips, C. A., Taghavi, I., & Stanley, B. (2018). Perceptions of adjunctive mindfulness-based cognitive therapy to prevent suicidal behavior among high suicide-risk outpatient participants. Crisis: The Journal of Crisis Intervention and Suicide Prevention, 39(6), 451–460. 

Rooks-Peck, C. R., Adegbite, A. H., Wichser, M. E., Ramshaw, R., Mullins, M. M., Higa, D., Sipe, T. A., & The Prevention Research Synthesis Project, Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention. (2018). Mental health and retention in HIV care: A systematic review and meta-analysis. Health Psychology, 37(6), 574–585. 

Sauceda, J. A., Lisha, N. E., Dilworth, S. E., Johnson, M. O., Christopoulos, K. A., Wood, T., Koester, K. A., Mathews, W. C., Moore, R. D., Napravnik, S., Mayer, K. H., Crane, H. M., Fredericksen, R. J., Mugavero, M. J., & Neilands, T. B. (2020). Measuring engagement in HIV care: Measurement invariance in three racial/ethnic patient groups. Health Psychology, 39(7), 622–631.

Safren, S. A., O'Cleirigh, C. M., Skeer, M., Elsesser, S. A., & Mayer, K. H. (2013). Project enhance: A randomized controlled trial of an individualized HIV prevention intervention for HIV-infected men who have sex with men conducted in a primary care setting. Health Psychology, 32(2), 171–179.

What are the steps caregivers can take with an HIV positive friend or family member to prevent suicide?
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Section 6
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