Division of Epidemiology and Biostatistics, Graduate School of Public Health, San Diego State University, 5500 Campanile Drive (MC-4162), San Diego, CA, 92182, USA.
Department of Psychology, University of Massachusetts Dartmouth, Dartmouth, MA, USA.
AIDS Behav. 2018 May;22(5):1639-1651. doi: 10.1007/s10461-017-1953-9.
As efforts to end the HIV epidemic accelerate there is emphasis on reaching those living with undiagnosed HIV infection. Newly diagnosed individuals face a number of psychosocial challenges, yet we know little about depressive symptoms in the weeks immediately following diagnosis and how disclosure, coping, and other factors may affect short and longer-term depressive symptoms. Purposively sampled Ugandan outpatients completed structured interviews immediately prior to testing for HIV, daily for 28 days after receiving their test results, and at 3 and 6 months post-test. The sample included a total of 244 participants: 20 who tested HIV positive at baseline and who provided 342 daily data points, and 224 who tested HIV negative at baseline and who provided 4388 daily data points. We used linear mixed effects modeling to examine changes in depressive symptom scores over the 28 day daily interview period and predictors of depressive symptom scores and changes over time. Results from the mixed modeling revealed that while those diagnosed with HIV showed initially high depressive symptoms following diagnosis, their symptoms decreased significantly and on average fell below the cutoff for possible depression approximately 15 days after diagnosis. Among those who tested HIV-negative, on average their depressive symptoms were below the cutoff for possible depression and did not change over time. Among those diagnosed with HIV, disclosure, especially to a partner, on a particular day was associated with higher depressive symptoms that day. However, those who disclosed to their partner during the 28 days after diagnosis had significantly lower depression scores by the end of the 28 days as well as lower depression scores 3 and 6 months after diagnosis than did those who did not disclose to their partner during the 28 days after diagnosis. Scoring higher on HIV-related stigma on a particular day was associated with higher depressive symptoms that day and engaging in positive coping on a particular day was associated with lower depressive symptoms that day. Positive coping also accelerated the decrease in depressive symptoms over time. These data underscore the importance of timely disclosure to partners and suggest that regular depression screening after diagnosis and provision of mental health services could improve HIV care engagement and treatment outcomes.
随着终结艾滋病疫情的努力加速推进，重点放在了发现那些尚未确诊的艾滋病毒感染者上。新确诊的个体面临着一系列的心理社会挑战，但我们对诊断后数周内的抑郁症状以及告知、应对等因素如何影响短期和长期抑郁症状知之甚少。乌干达的门诊患者采用目的性抽样，在接受艾滋病毒检测前立即完成结构访谈，在收到检测结果后每天进行，共 28 天，在检测后 3 个月和 6 个月时进行。该样本共包括 244 名参与者：20 名在基线时艾滋病毒检测呈阳性，提供了 342 个每日数据点；224 名在基线时艾滋病毒检测呈阴性，提供了 4388 个每日数据点。我们采用线性混合效应模型来研究 28 天每日访谈期间抑郁症状评分的变化，以及预测抑郁症状评分和随时间变化的因素。混合模型的结果表明，虽然那些被诊断患有艾滋病毒的人在诊断后最初表现出较高的抑郁症状，但他们的症状显著下降，平均在诊断后约 15 天，抑郁症状评分低于可能抑郁的临界值。在那些艾滋病毒检测阴性的人中，平均而言，他们的抑郁症状低于可能抑郁的临界值，且随时间没有变化。在被诊断患有艾滋病毒的人中，在某一天告知他人，特别是告知伴侣，与当天更高的抑郁症状相关。然而，那些在诊断后 28 天内告知伴侣的人，在 28 天结束时抑郁评分显著降低，在诊断后 3 个月和 6 个月时的抑郁评分也低于那些在诊断后 28 天内没有告知伴侣的人。在某一天艾滋病毒相关耻辱感得分较高与当天更高的抑郁症状相关，而在某一天积极应对与当天较低的抑郁症状相关。积极应对也加速了抑郁症状随时间的下降。这些数据强调了及时向伴侣告知的重要性，并表明在诊断后定期进行抑郁筛查并提供心理健康服务可以改善艾滋病毒护理参与和治疗效果。
