Division of General Pediatrics, Department of Medicine, Children's Hospital Boston, Boston, MA 02215, USA.
Cultur Divers Ethnic Minor Psychol. 2011 Jul;17(3):295-302. doi: 10.1037/a0024056.
People living with HIV (PLWH) exhibit more severe mental health symptoms, including depression and posttraumatic stress disorder (PTSD) symptoms, than do members of the general public. We examined whether perceived discrimination, which has been associated with poor mental health in prior research, contributes to greater depression and PTSD symptoms among HIV-positive Black men who have sex with men (MSM), who are at high risk for discrimination from multiple stigmatized characteristics (HIV-serostatus, race/ethnicity, sexual orientation). A total of 181 Black MSM living with HIV completed audio computer-assisted self-interviews (ACASI) that included measures of mental health symptoms (depression, PTSD) and scales assessing perceived discrimination due to HIV-serostatus, race/ethnicity, and sexual orientation. In bivariate tests, all three perceived discrimination scales were significantly associated with greater symptoms of depression and PTSD (i.e., reexperiencing, avoidance, and arousal subscales; all p values < .05). The multivariate model for depression yielded a three-way interaction among all three discrimination types (p < .01), indicating that perceived racial discrimination was negatively associated with depression symptoms when considered in isolation from other forms of discrimination, but positively associated when all three types of discrimination were present. In multivariate tests, only perceived HIV-related discrimination was associated with PTSD symptoms (p < .05). Findings suggest that some types of perceived discrimination contribute to poor mental health among PLWH. Researchers need to take into account intersecting stigmata when developing interventions to improve mental health among PLWH.
HIV 感染者（PLWH）表现出更严重的心理健康症状，包括抑郁和创伤后应激障碍（PTSD）症状，比一般公众更严重。我们研究了感知歧视是否会导致感染艾滋病毒的黑人男男性行为者（MSM）的抑郁和 PTSD 症状更严重，这些人由于多种污名化特征（艾滋病毒状况、种族/族裔、性取向）而面临歧视的高风险。共有 181 名感染艾滋病毒的黑人 MSM 通过音频计算机辅助自我访谈（ACASI）完成了调查，其中包括心理健康症状（抑郁、PTSD）和评估由于 HIV 状况、种族/族裔和性取向而导致的感知歧视的量表。在双变量检验中，所有三种感知歧视量表都与更严重的抑郁和 PTSD 症状显著相关（即再体验、回避和觉醒子量表；所有 p 值<.05）。抑郁的多变量模型显示了所有三种歧视类型之间的三向交互作用（p<.01），这表明单独考虑种族歧视时，感知到的种族歧视与抑郁症状呈负相关，但当存在所有三种歧视类型时，它与抑郁症状呈正相关。在多变量检验中，只有感知到的与艾滋病毒相关的歧视与 PTSD 症状相关（p<.05）。研究结果表明，某些类型的感知歧视会导致 PLWH 的心理健康状况不佳。研究人员在制定改善 PLWH 心理健康的干预措施时，需要考虑到相互交织的污名。
