HIV and Youth in Thailand: Addressing Suicide Risk

“Mental illness can negatively impact quality of life as well as HIV treatment outcomes, and is usually under-recognized, under-diagnosed, and under-treated,” says Tavitiya Sudjaritruk, M.D., Ph.D.

An expert in pediatric infectious diseases at Chiang Mai University in Thailand, Dr. Sudjaritruk conducted research showing that 14% of Thai adolescents and young adults in her cohort reported having lifetime suicidal ideation and/or behaviors. Realizing that there were limited data on the risk of suicide among youth living with and at risk for HIV in Asia, she and her team decided to act.

The result is a new study led by Dr. Sudjaritruk that seeks to fill in these critical knowledge gaps. The goal? To help these Thai youth access early screening and link those with mental health issues to appropriate care. The research is sponsored by amfAR’s TREAT Asia program and the U.S. National Institutes of Health through the IeDEA Asia-Pacific program.

Dr. Sudjaritruk’s earlier work focused on non-AIDS-related comorbidities among adolescents living with HIV, such as bone health and liver, renal, and cardiovascular diseases. But in the course of taking care of her patients she realized that mental health issues—including depression, anxiety disorders, as well as suicidal ideation—were pervasive. “That’s why I shifted my focus to mental health,” she says.

Adds Dr. Sudjaritruk, who has collaborated with amfAR’s TREAT Asia program since 2008 as a research network site investigator, mental health is often overlooked in healthcare settings because “in routine medical care, healthcare providers usually focus on patients’ physical illness and adherence to antiretroviral medications. Also, as mental illness is a sensitive issue—a good relationship between patient and healthcare provider is required to support open conversations and reliable symptom reporting.”

Her study will have two phases. The first phase has recently been completed, and allowed Dr. Sudjaritruk to translate and validate culturally appropriate adaptations of existing English-language suicide and other mental health screening tools.

Asked about the importance of cultural sensitivity, Dr. Sudjaritruk responded: “Since most mental health assessment tools are usually developed and validated in high-income countries, they may not capture the constructs they are intended to measure in resource-limited countries, including Thailand. Without reliable instruments, it is impossible to evaluate the burden of the problems and identify appropriate interventions for our population.”

The second phase of the study is a three-year prospective cohort study that started enrolling in December 2022 that aims to assess the prevalence and incidence of suicidality among this population compared with their HIV-negative age- and sex-matched counterparts. Factors associated with suicidality also will be identified.