Which symptom includes recurrent thoughts of death?

• A. Recurrent thoughts of death
• B. Insomnia
• C. Weight change
• D. Fatigue

Answer: (A)

Recurrent thoughts of death signal suicidality, a dangerous symptom that suggests a person may be contemplating ending their life. In practice, this is a red flag that requires immediate assessment and safety planning. The reason this symptom stands out is that it directly points to suicidal ideation, which needs to be explored: ask about intent, planning, access to means, and any prior attempts, and determine the level of risk. In the HIV care setting, recognizing suicidality is especially important because depression is common and can lead to poor ART adherence and worse health outcomes; addressing it promptly can improve both mental health and HIV treatment success.

Insomnia, weight changes, and fatigue can occur with depression or other illnesses but are nonspecific and don’t by themselves indicate suicidality. They may accompany depressive episodes, but the presence of recurrent thoughts of death specifically highlights the risk that requires safety assessment and appropriate intervention.