A Critical Examination of Suicidal Ideation Among Perinatal Women Living with HIV: Unveiling the Hidden Crisis
Suicidal ideation (SI) within the context of perinatal women infected with HIV represents a deeply complex and urgently pressing public health concern. A novel systematic review, meta-analysis, and meta-regression conducted by Shahiri and colleagues, published in BMC Psychiatry in 2025, sheds unprecedented light on the prevalence and risk determinants of SI in this vulnerable population. This comprehensive synthesis analyzes data extracted from 18 international studies encompassing more than five thousand women to chart a clearer statistical and epidemiological understanding of the crisis at hand.
The study delineates a sobering overall prevalence of suicidal ideation at 20.5% among pregnant women with HIV, a figure that signals alarm bells for global health authorities. Importantly, this prevalence is broken down by critical periods: prenatal, perinatal, and during the broader pregnancy window. The nuanced data reveal SI prevalence rates of approximately 15% prenatally and nearly 20% during the perinatal period, suggesting that early pregnancy itself may confer a marginally lower but still significant risk that warrants targeted intervention.
Temporal trends spotlight a disturbing pattern: the highest suicide ideation rates, at 34.5%, occurred in studies dated from 2000 to 2014, with a notable decline observed in more recent years. From 2015 to 2019, prevalence dropped to just above 20%, and from 2020 to 2024, it further decreased to approximately 17%. While these trends may reflect advances in HIV treatment and mental health services, the persistence of significant rates underscores the complexity and multi-faceted drivers of mental health deterioration in this group.
Economically stratifying the data introduces an intriguing insight into the interactions between health outcomes and national wealth measured by gross domestic product (GDP). Contrary to what might be expected, higher GDP countries exhibited elevated SI prevalence—surpassing 24%—with the United States reporting the highest individual country prevalence at roughly 24.2%. This counterintuitive finding calls for dissecting the psycho-social and structural disparities that may paradoxically exacerbate distress in wealthier nations’ perinatal HIV populations.
Crucially, the meta-analysis identifies partner violence as a potent risk factor amplifying suicidal ideation risk by nearly 44%. This finding elucidates the confluence of interpersonal violence and chronic illness as a synergistic stress vector, further unraveling the web of vulnerabilities faced by these women. At the same time, a protective trend emerged with higher educational attainment conspicuously decreasing the propensity for SI by 20%, highlighting education’s buffering role against psychological distress through empowerment, increased access to resources, and health literacy.
Delving deeper, the meta-regression analyses indicate significant heterogeneity influenced by GDP, partner violence, year of study, age, and depression, factors that collectively dictate the variability among individual studies. This statistical insight spotlights the intertwined socio-economic, demographic, and clinical contributors shaping suicidal ideation prevalence, thus reinforcing the need for highly nuanced, context-specific intervention frameworks rather than one-size-fits-all solutions.
The systematic review’s implications resound across healthcare systems and policymaking spheres. The authors advocate for integrating proactive suicide risk assessment into routine prenatal care for HIV-positive women, emphasizing that suicidal ideation may often surface even in the absence of conspicuous depressive symptomatology. This paradigm shift is essential to preemptively identify at-risk individuals to mobilize timely, multidisciplinary mental health interventions.
Moreover, these findings underscore the necessity of holistic prevention models that transcend simple HIV treatment. Addressing interpersonal violence emerges as a paramount public health priority, requiring cross-sectoral collaboration inclusive of domestic violence prevention programs, psychosocial support networks, and trauma-informed care tailored specifically for pregnant HIV-positive women. Simultaneously, efforts to bolster educational opportunities must be foregrounded as an upstream preventive strategy with long-term mental health dividends.
The review’s geographical scope, although wide-ranging, poses inherent challenges due to under-representation of low-income countries where HIV prevalence is often highest. This limitation indicates an urgent call for expanded research in such contexts to elucidate region-specific risk profiles, cultural nuances, and health system constraints that inform suicide prevention efforts globally. The findings, however, robustly highlight that suicidal ideation among perinatal women with HIV is not confined to traditionally resource-poor settings.
Scientifically, the study’s integration of various analytical modalities—from meta-analysis to meta-regression—expands research rigor and provides greater clarity in disentangling confounding determinants. The sophisticated approach provides compelling evidence that earlier assumptions of uniform risk distribution are overly simplistic, spotlighting layered intersections between socio-economic status, violence, education, time periods, and psychological states.
This review will inevitably catalyze further research into tailored intervention designs, including integrating technology-based mental health screening tools within prenatal and antenatal clinics, and deploying community health workers trained to identify and support women demonstrating suicidal ideation. Additionally, understanding how HIV-related stigma, treatment adherence challenges, and broader social determinants intersect with mental health remains a fertile research frontier with critical implications.
While the findings inspire cautious optimism given the downward trend in SI prevalence over recent years, they also flag a warning: that approximately one in five perinatal women living with HIV continue grappling with suicidal thoughts, warranting urgent, targeted actions. Failure to address this silent epidemic risks devastating consequences for mothers, infants, and families, amplifying the global burden of HIV beyond virological and obstetric dimensions into profound psychosocial territories.
In sum, Shahiri and colleagues’ landmark review offers a powerful lens on an often-overlooked population at the nexus of infectious disease and mental health vulnerabilities. Their work challenges clinicians, researchers, and policymakers alike to rethink perinatal HIV care comprehensively by embedding psychological well-being at the core of intervention strategies. As global health narratives evolve, integrating mental health as an indispensable component of maternal HIV care emerges not only as best practice but as a moral imperative to safeguard the futures of these women and their children.
Subject of Research: Prevalence and risk factors for suicidal ideation among perinatal women living with HIV infection
Article Title: Prevalence of and risk factors for suicidal ideation among perinatal women with HIV infection: a systematic review, meta-analysis, and meta-regression
Article References: Shahiri, S., Mirzohreh, ST., Azizi, H. et al. Prevalence of and risk factors for suicidal ideation among perinatal women with HIV infection: a systematic review, meta-analysis, and meta-regression. BMC Psychiatry 25, 742 (2025). https://doi.org/10.1186/s12888-025-07210-7
Image Credits: AI Generated
DOI: https://doi.org/10.1186/s12888-025-07210-7
Keywords: Suicidal ideation, perinatal women, HIV infection, partner violence, education, mental health, systematic review, meta-analysis, meta-regression
