To the Editor.—
We applaud efforts by Perry and colleagues1 to focus attention on the psychiatric effects of the acquired immunodeficiency syndrome epidemic and, specifically, to assess the possible impact of human immunodeficiency virus (HIV) testing on suicidal ideation. Their article states that 1 week after notification of seropositivity, 27.1% of individuals reported suicidal ideation, whereas at study entry, 28.6% did so. However, as discussed below, their reassuring conclusion that "suicidal ideation did not increase after HIV testing" is not warranted by their data.For two reasons at least, subjects' reported level of suicidal ideation would be expected to decline from first to second assessment, entirely independent of any effect of learning test results. First, repeated administration of a psychiatric symptom checklist itself produces score decline, a retest artifact that is widely documented in the psychiatric and psychometric literature.2-4 Extrapolating from previous reports, an artifactual drop to
Neugebauer R, Johnson J. Does HIV Testing Raise Levels of Suicidal Ideation?. JAMA. 1990;264(3):337–338. doi:10.1001/jama.1990.03450030053028
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