Here at Body & Soul we know there is a strong link between HIV and poor mental health because we see the evidence in the work we do every day with our members. This anecdotal evidence is backed up by academic research into the effects of HIV on mental health: it has long been known that depression is more common among people living with HIV than in the general population, with one study finding that nearly a third of HIV patients in the UK considered suicide in the previous week. In other words, not only is suicidal ideation more prevalent in people living with HIV than it is in the general population, but it would appear that suicidal ideation is a regular feature in their lives – not something extraordinary. This is worrying.
So why is it that people living with HIV experience higher rates of depression, anxiety and suicidal ideation? The answer is complex, but there are certain factors that are likely to play an important role in shaping this phenomenon. Firstly, stigma still surrounds HIV, and the effect of this stigma is particularly problematic among African communities, where there is often a higher level of anxiety around the disclosure of HIV status to family and friends. People who have not disclosed their status to anyone are estimated to be twice as likely to have suicidal thoughts as other groups, so the ability to share one’s status with family and friends is crucial.
The stigma surrounding disclosure can lead to increased social isolation, and this isolation is a factor that further exacerbates poor mental health. Fear of rejection by family and friends can have a huge impact on a person’s sense of self-worth, something that is reinforced by stigmatising and/or discriminatory language in the media and on social networks. It is not hard to see how this vicious cycle of isolation and deteriorating mental health can lead to suicidal thoughts.
Aside from stigma, unmet practical needs are another important factor in suicidality. Many of our members live in poverty and are unable to work because of mental illness or physical illness connected with their HIV diagnosis. The spectre of homelessness looms large for many. 60% of members who have been exposed to trauma in their lives (including practical stressors such as unmet basic needs) have contemplated suicide. This week Samaritans issued a report – Dying from Inequality – which outlines how low income, debt and poor housing play an important part in the high prevalence of suicide in disadvantaged communities. The idea that these factors may be driving people to end their lives in a country as wealthy as the United Kingdom is a real indictment of society.
There are many factors that contribute to the suicide rates we are seeing in this country at the moment – some of them are psychological, some are practical, but they are all interconnected. HIV is deeply embedded in this system of connections, often as a causal factor with far-reaching consequences for people’s lives. The whole-person approach championed by Body & Soul is crucial in relieving some of the known risk factors for suicide: we provide our members with practical support through our casework team; therapeutic support through our range of evidence-based treatments; and interpersonal support through the connections made by members within a safe and supportive community of members, mentors, volunteers and staff. By taking into account all aspects of our members’ lives, we alleviate stress, build resilience and help them to build lives worth living.
In her next post, Ida will talk about Dialectical Behaviour Therapy (DBT) and why an approach with DBT at its heart is equally well suited to supporting people affected by HIV and people affected by suicidal behaviour.