Background
This study aimed to assess suicidality, depression, and anxiety following the introduction of integrative mental health care into HIV services for Thai youth living with HIV (YLHIV).
Methods
A multicenter prospective cohort study was conducted among YLHIV (aged 15-24 years) and age and sex-matched HIV-negative youth in Thailand. Participants were assessed for suicidality, depression and anxiety using the Columbia-Suicide Severity Rating Scale, Patient Health Questionnaire-9 (PHQ-9), and Generalized Anxiety Disorder 7-item (GAD-7) at baseline and 6 months. Significant suicidal risk was defined as suicidal ideation with a specific method, intention, or plan (baseline: lifetime and/or within 1 month; 6-month visit: during the past 6 months), with/without suicide attempts (baseline: lifetime and/or within 3 months; 6-month visit: during the past 6 months). Significant depressive and anxiety symptoms were defined as PHQ-9 and GAD-7 scores of ≥10 at both visits. At each visit, participants demonstrating low suicidal risk or mild depressive or anxiety symptoms received brief mental health counseling by HIV clinic staff, while those with significant suicidal risk or depressive or anxiety symptoms were referred to a psychiatrist for management. Comparisons of participants with mental health symptoms were performed by Chi-square or Fisher’s exact test for YLHIV vs. HIV-negative youth, and McNemar’s test for baseline vs. month 6 visits.
Results
Up to 2023, 200 YLHIV (median age 22 years, 59% male, 100% on ART, 86% virally suppressed) and 200 HIV-negative youth (median age 22 years, 59% male) were enrolled. There were no significant differences in mental health outcomes by HIV status at either visit. Compared with their baseline, YLHIV showed a significant decline at 6 months in the proportion of those at significant suicidal risk (4.5 vs. 1.0%; P=0.01), depressive symptoms (12.0 vs. 3.1%; P<0.001), and anxiety symptoms (7.5 vs. 2.1%; P=0.01). Among HIV-negative youth, there was a significant decline in the proportion experiencing significant depressive symptoms (7.5 vs. 2.0%, P=0.01); non-significant declines were observed among those at significant suicidal risk (3.0 vs. 0.5%; P=0.06) or anxiety symptoms (3.5 vs. 0.5%; P=0.13) (Table).
Conclusions
Providing integrated mental health care in the HIV clinic led to significant declines in suicidality, depression, and anxiety among Thai YLHIV. This model shows potential benefits for addressing the mental health care gap in routine HIV services.
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