Suicidal ideas and coping in HIV-positives.

Suicidal thoughts reflect a coping effort, rather than anguish and depression, among some homosexual men infected with the AIDS-causing virus (HIV) but displaying no disease symptoms, psychologists suggest in a new report. Data from an ongoing study point to a distinction between "coping-related" and "distress-related" thoughts about killing oneself, the investigators conclude in the November JOURNAL OF PERSONALITY AND SOCIAL PSYCHOLOGY.

Stephen G. Schneider and his co-workers at the University of California, Los Angeles, assert hat HIV-positive homosexuals who have recently experienced the AIDS-related illness or death of a partner or friend -- and who believe they themselves cannot escape the immune-system disorder -- may entertain suicidal thoughts to gain a sense of mastery over the uncontrollable threat posed by AIDS in their own lives. These men report and display relatively little hopelessness, social isolation or other signs of emotional distress, but they often cite suicidal thoughts as a mental tactic to deal with fears of developing AIDS and facing a painful physical deterioration.

In contrast, HIV-negative homosexual men who reports suicidal thoughts appear more likely to think of suicide in conjunction with feelings of depression and hopelessness, a distress-related response observed among the general population, the team maintains.

The 778 homosexual and bisexual men in the sample entered the study between August 1987 and October 1988. Most were white, college-educated and integrated into the homosexual community of Los Angeles. None had AIDS at the time; 170 of the men knew their HIV status.

A total of 212 participants reported having had suicidal thoughts -- such as "I thought life was not worth living" or "I had some thoughts of killing myself" -- during the six months preceding the study, although they had not actually attempted suicide. Of these 212 men, 100 carried HIV.

Surprisingly, HIV-positive men with lower levels of the white blood cells used as markers of immune-system deterioration did not report more pronounced suicidal thoughts than did HIV-positives with healthier cell counts. Instead, the researchers found that loneliness and a lack of support from close friends in the past were associated with suicidal thinking among the infected volunteers. This suggests that counselors working with HIV-positive homosexual men should look for long-standing tendencies to withdraw or experience depression in the face of severe stress, Schneider and his co-workers contend.

Mental health workers might also target younger HIV-positive men, who often face the threat of illness or death with less psychological preparation than their older counterparts, the researchers point out. They found that depression increased among older HIV-negatives -- a trend that holds among men in general -- and among younger HIV-positives.

For now, the results apply only to HIV-positive homosexual and bisexual men with no signs of AIDS, the investigators caution. Suicidal thoughts that help people cope with grave threats remain largely unexplored, they say.