Amiya Rachel M, Poudel Krishna C, Poudel-Tandukar Kalpana, Pandey Basu D, Jimba Masamine
Department of Community and Global Health, Graduate School of Medicine, University of Tokyo, Tokyo, Japan.
Department of Public Health, School of Public Health and Health Sciences, University of Massachusetts-Amherst, Amherst, Massachusetts, United States of America.
PLoS One. 2014 Mar 6;9(3):e90959. doi: 10.1371/journal.pone.0090959. eCollection 2014.
Depression and suicidal thinking occur frequently alongside HIV/AIDS, triggering profound detrimental impacts on quality of life, treatment adherence, disease progression, and mortality. Yet the psychosocial factors contributing to these psychiatric comorbidities remain underexplored, particularly in the developing country context. This study thus examined different dimensions of perceived family support in relation to depression and suicidal ideation among people living with HIV/AIDS (PLWHA) in Nepal.
A cross-sectional survey of 322 adult PLWHA residing in the Kathmandu Valley, Nepal was conducted. Data were analyzed using multiple logistic regressions for correlates of Beck Depression Inventory (BDI)-Ia-defined depressive symptoms and suicidal ideation in the past 2 weeks. Perceived family support, measured using the 10-item Nepali Family Support and Difficulty Scale, was entered into separate models, in turn, as a composite score, for each sub-scale (emotional, instrumental, and negative support), and for each individual item.
Overall, 25.5% of participants registered BDI-Ia-defined depression, with significantly lower rates among those with perceived family support scores in the highest (AOR = 0.19; 95% CI = 0.07, 0.55) and middle (AOR = 0.38; 95% CI = 0.17, 0.86) tertiles relative to those with lowest-tertile scores. Meanwhile, 14.0% reported suicidal thinking, with significantly lower rates among those in the highest perceived family support tertile relative to the lowest (AOR = 0.25; 95% CI = 0.07, 0.91). Broken down by support sub-scale, only negative support (i.e. family difficulty) was significant in its correlations with both outcomes - a trend similarly reflected in the item-wise analyses.
Our findings highlight an important role for family support in determining experiences of depression and suicidality among PLWHA. Incorporating family counseling and support services - with special focus on ameliorating negative interaction and bolstering emotional support - into HIV care and treatment services may help to improve mental health along with overall wellness and treatment outcomes for HIV-positive populations in Nepal and similar settings.
抑郁症和自杀念头经常与艾滋病毒/艾滋病同时出现，对生活质量、治疗依从性、疾病进展和死亡率产生深远的不利影响。然而，导致这些精神疾病共病的社会心理因素仍未得到充分探索，特别是在发展中国家的背景下。因此，本研究调查了尼泊尔艾滋病毒/艾滋病感染者（PLWHA）中感知到的家庭支持与抑郁症和自杀意念之间关系的不同维度。
对居住在尼泊尔加德满都谷地的322名成年PLWHA进行了横断面调查。使用多重逻辑回归分析过去2周内贝克抑郁量表（BDI）-Ia定义的抑郁症状和自杀意念的相关因素。使用10项尼泊尔家庭支持与困难量表测量的感知家庭支持，依次作为综合得分纳入单独模型，每个子量表（情感、工具性和消极支持）以及每个单独项目。
总体而言，25.5%的参与者符合BDI-Ia定义的抑郁症标准，在感知家庭支持得分最高（调整后比值比[AOR]=0.19；95%置信区间[CI]=0.07，0.55）和中等（AOR=0.38；95%CI=0.17，0.86）三分位数的参与者中，抑郁症发生率显著低于得分最低三分位数的参与者。同时，14.0%的参与者报告有自杀念头，在感知家庭支持最高三分位数的参与者中，自杀念头发生率显著低于最低三分位数的参与者（AOR=0.25；95%CI=0.07，0.91）。按支持子量表细分，只有消极支持（即家庭困难）与这两个结果均显著相关——这一趋势在逐项分析中也有类似体现。
我们的研究结果突出了家庭支持在决定PLWHA的抑郁和自杀经历方面的重要作用。将家庭咨询和支持服务——特别关注改善消极互动和加强情感支持——纳入艾滋病毒护理和治疗服务中，可能有助于改善尼泊尔及类似环境中艾滋病毒阳性人群的心理健康以及整体健康状况和治疗效果。
