Study of HIV in rural America paints picture of suicide, isolation

ATHENS, Ohio – A four-year study of people with HIV and AIDS who live in rural America is painting a picture of isolation, depression and thoughts of suicide. Early findings from the project reveal that most participants feel cut off from support services, have seriously limited access to health care and are living in poverty – issues researchers say have led many to consider suicide.

In fact, preliminary findings from 201 people enrolled to date in the Ohio University study show that 38 percent of them say they have thought about committing suicide; 6 percent said they would have killed themselves if given the chance.

"That's one out of every 16 people. I don't think that's a trivial number or one we should take lightly," said Timothy Heckman, an associate professor of psychology in the university's College of Arts and Sciences. "That rate is comparable to, if not higher than, those you would find in urban areas."

The work was presented in late March at the Annual Conference of the Society of Behavioral Medicine in Seattle and is among the first findings from a project researchers hope will draw attention to AIDS and HIV in rural America. The study, funded by a $1.3 million grant from the National Institute of Mental Health, ultimately will include at least 360 people living in 11 states. The research was designed to collect data on a population largely overlooked by AIDS researchers, and to test the feasibility of delivering badly needed support services via telephone to individuals who don't have access to the types of programs available in urban centers.

A life in rural America for someone with HIV or AIDS often means isolation from support networks and health care services, Heckman said. The close-knit nature of rural life can make it difficult to keep an HIV diagnosis confidential. All of these things can cause depression which, in some cases, can lead to suicidal thoughts.

Still, Heckman said he was surprised at the early data. Particularly alarming is the lack of a demographic profile for those individuals who had suicidal thoughts. Of the 201 people in the recently presented study, 152 were men, 49 were women, 74 percent were white and 46 percent had been diagnosed with AIDS.

But people with AIDS were no more likely to be suicidal than people living with HIV, the virus that causes AIDS. Whites were as prone to depression as people of color. And women were just as vulnerable to suicidal thoughts as men.

"My first thought is that we're not going to be able to use demographic groups to identify those individuals at greatest risk for suicide," he said. "It's based more on psychosocial issues such as social isolation and ways of coping."

The study, which Heckman began in 1999 while a faculty member at the Medical College of Wisconsin, is exploring these issues, with the hope of devising interventions to address them. Since coming to Ohio University in July 2000, Heckman has continued those efforts, including exploring the possibility of delivering support services via a telephone-based support group he created called Project Connect.

Project Connect brings together six rural residents living with HIV or AIDS for a conversation monitored by two mental health practitioners. The idea is to offer support services, advice on how to access social services and effective coping strategies – all over the telephone. The network mimics an in-person support group setting that isn't available in most rural areas of the country.

The phone network is ongoing in Ohio, Rhode Island, Pennsylvania, Virginia, West Virginia, Michigan, Wisconsin, Montana and Alaska. The researchers are hoping to enroll at least 360 people; 270 are registered now. To be included, participants must be at least 18 years old, have HIV or AIDS and live in a town with a population of 50,000 or fewer that is at least 20 miles from a city of 100,000 or more.

But researchers now are expanding their focus to include a parallel project on suicide among these populations, prompted by the high rate of suicidal thoughts revealed in their preliminary data analyses. With support from a new one-year, $140,000 grant from NIMH, researchers are exploring issues that lead individuals to contemplate suicide.

Researchers are working with AIDS services organizations in Indiana and New York on this project, two states not included in the original study of Project Connect. So far, 85 people have been enrolled in the suicide study.

"I think we'll learn a lot more about suicide in this study," Heckman said. "We can use these data to conceptualize interventions that might provide assistance to this vulnerable group."

Co-authors of the recently presented research include Jeffrey G. Miller and Seth C. Kalichman of the Medical College of Wisconsin and Arlene Kochman of Yale University School of Medicine.

Attention editors, reporters: A copy of the conference abstract on which this article is based is available by calling Kelli Whitlock at (740) 593-2868 or Charlene Clifford at (740) 593-0946.

Written by Kelli Whitlock.