Risk of suicide attempts among patients with sexually transmitted infections: A Nationwide population-based matched cohort study

BACKGROUND: While human immunodeficiency virus (HIV) is generally considered a risk factor for suicide, longitudinal evidence regarding suicide risk across a broader spectrum of sexually transmitted infections (STIs) remains limited. This study investigated the risk of subsequent suicide attempts following diagnoses of various STIs. METHODS: Using the Taiwan National Health Insurance Research Database (NHIRD), we conducted a nationwide longitudinal cohort study spanning 1998 to 2013. Patients diagnosed with HIV, genital warts, gonorrhea, syphilis, chlamydia, or trichomoniasis were enrolled (n = 71,666) and matched 1:4 with non-STI controls (n = 286,664) by age, sex, income, urbanization, and psychiatric comorbidities. The primary outcome was suicide attempts, analyzed using Cox proportional hazard models. RESULTS: Patients with STIs exhibited a significantly elevated risk of suicide attempts compared to matched controls (hazard ratio [HR]: 5.64, 95% confidence interval [CI]: 5.30-6.00). Elevated risks were observed across all subgroups, with syphilis (HR: 8.08, 95% CI: 6.90-9.46) and trichomoniasis (HR: 6.77, 95% CI: 6.22-7.37) demonstrating the strongest associations. The mean interval from enrollment to suicide attempt was notably shorter in the STI group compared to controls (4.60 vs 7.36 years). Sex-stratified analyses revealed distinct risk profiles, including markedly high risks in men with HIV and trichomoniasis. CONCLUSIONS: Patients with STIs are at a significantly increased risk of suicide attempts, often occurring within a shorter timeframe post-diagnosis. These findings highlight the critical need for integrating proactive suicide risk assessment and psychosocial support into routine STI care to mitigate these adverse outcomes.