印度南部艾滋病毒/艾滋病感染者（PLHA）的耻辱感、抑郁与生活质量之间的关联 - 基于社区的横断面研究。
Association between stigma, depression and quality of life of people living with HIV/AIDS (PLHA) in South India - a community based cross sectional study.
机构信息
AIDS Prevention and Control Project, Voluntary Health Services, Adyar, Chennai, 600 113, India.
出版信息
BMC Public Health. 2012 Jun 21;12:463. doi: 10.1186/1471-2458-12-463.
BACKGROUND
India has around 2.27 million adults living with HIV/AIDS who face several challenges in the medical management of their disease. Stigma, discrimination and psychosocial issues are prevalent. The objective of the study was to determine the prevalence of severe stigma and to study the association between this, depression and the quality of life (QOL) of people living with HIV/AIDS (PLHA) in Tamil Nadu.
METHODS
This was a community based cross sectional study carried out in seven districts of Tamil Nadu, India, among 400 PLHA in the year 2009. The following scales were used for stigma, depression and quality of life, Berger scale, Major Depression Inventory (MDI) scale and the WHO BREF scale. Both Stigma and QOL were classified as none, moderate or severe/poor based on the tertile cut off values of the scale scores. Depression was classified as none, mild, moderate and severe. Logistic regression analyses were performed to study the risk factors.
RESULTS
Twenty seven per cent of PLHA had experienced severe forms of stigma. These were severe forms of personalized stigma (28.8%), negative self-image (30.3%), perceived public attitude (18.2%) and disclosure concerns (26%). PLHA experiencing severe depression were 12% and those experiencing poor quality of life were 34%. Poor QOL reported in the physical, psychological, social and environmental domains was 42.5%, 40%, 51.2% and 34% respectively. PLHA who had severe personalized stigma and negative self-image had 3.4 (1.6-7.0) and 2.1 (1.0-4.1) times higher risk of severe depression respectively (p < .001). PLHA who had severe depression had experienced 2.7(1.1-7.7) times significantly poorer QOL.
CONCLUSIONS
Severe forms of stigma were equivalently prevalent among all the categories of PLHA. However, PLHA who had experienced severe depression had only developed poor QOL. A high level of social support was associated with a high level of QOL.
背景
印度约有 227 万成年人感染艾滋病毒/艾滋病，他们在疾病的医疗管理方面面临着诸多挑战。污名化、歧视和心理社会问题普遍存在。本研究的目的是确定严重污名的流行程度，并研究这种污名与泰米尔纳德邦艾滋病毒/艾滋病感染者（PLHA）的抑郁和生活质量（QOL）之间的关系。
方法
这是 2009 年在印度泰米尔纳德邦的七个地区进行的一项基于社区的横断面研究，共纳入 400 名 PLHA。本研究使用 Berger 量表、主要抑郁量表（MDI）和世界卫生组织 BREF 量表来评估污名、抑郁和生活质量。根据量表评分的三分位数截断值，将污名和 QOL 分为无、中度或严重/差。将抑郁分为无、轻度、中度和重度。采用逻辑回归分析来研究危险因素。
结果
27%的 PLHA 经历了严重的污名化。这些污名化包括严重的个性化污名（28.8%）、消极的自我形象（30.3%）、感知的公众态度（18.2%）和披露担忧（26%）。经历严重抑郁的 PLHA 占 12%，生活质量差的占 34%。在身体、心理、社会和环境领域报告的不良 QOL 分别为 42.5%、40%、51.2%和 34%。经历严重个性化污名和消极自我形象的 PLHA 患严重抑郁的风险分别增加了 3.4 倍（1.6-7.0）和 2.1 倍（1.0-4.1）（p<0.001）。经历严重抑郁的 PLHA 的 QOL 显著下降了 2.7 倍（1.1-7.7）。
结论
所有类别的 PLHA 都同样存在严重的污名化形式。然而，经历严重抑郁的 PLHA 只有较差的 QOL。高水平的社会支持与高水平的 QOL 相关。
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