To the Editor We read with interest the article by Lund-Sørenson et al1 regarding the association of hospitalization for infection and subsequent suicide. The authors postulated that the effect of inflammatory mediators may be causal. However, the strongest associations with suicide occurred in patients with human immunodeficiency virus and second viral hepatitis, the 2 infections with the greatest associations with stigma. In fact, suicide among patients with human immunodeficiency virus is most likely to occur shortly after the diagnosis,2 suggesting that it is the psychological impact of the diagnosis that induces much of the risk not the cumulative impact of ongoing inflammation. Furthermore, adverse drug reactions in these infections are likely major components, as the most common therapies used during the study period for these viruses (efavirenz in human immunodeficiency virus and interferon in hepatitis C) were associated with mood disorders and suicidality.3,4 Finally, the adverse psychological effect of isolation precautions for multidrug-resistant organisms also warrants consideration.5 The authors did note an association of length of stay and number of hospital admissions with subsequent suicidality, but these factors are also associated with risk for acquisition of a multidrug-resistant organism and the length of subsequent isolation. Do the authors have data that controls for the impact of hospital isolation?
Silverman M, Bondy L. Association Between Hospitalization for Infection and Suicide. JAMA Psychiatry. 2017;74(2):198–199. doi:10.1001/jamapsychiatry.2016.3247
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