Department of Biostatistics and Epidemiology, School of Public Health, Sun Yat-sen University, #74 Zhongshan 2nd Road, Guangzhou, 510080, China.
Department of Infectious Disease, Guangzhou Number Eight People's Hospital, #627 Dongfeng Road, Guangzhou, 510080, China.
BMC Public Health. 2018 Jan 15;18(1):138. doi: 10.1186/s12889-018-5053-1.
Previous studies have shown positive association between HIV-related stigma and depression, suicidal ideation, and suicidal attempt among people living with HIV/AIDS (PLWH). But few studies have examined the mechanisms among HIV-related stigma, depression, and suicidal status (suicidal ideation and/or suicidal attempt) in PLWH. The current study examined the relationships among perceived and internalized stigma (PIS), depression, and suicidal status among PLWH in Guangzhou, China using structural equation modeling.
Cross-sectional study by convenience sampling was conducted and 411 PLWH were recruited from the Number Eight People's Hospital from March to June, 2013 in Guangzhou, China. Participants were interviewed on their PIS, depressive symptoms, suicidal status, and socio-demographic characteristics. PLWH who had had suicidal ideation and suicidal attempts since HIV diagnosis were considered to be suicidal. Structural equation model was performed to examine the direct and indirect associations of PIS and suicidal status. Indicators to evaluate goodness of fit of the structural equation model included Chi-square Statistic, Comparative Fit Index (CFI), Root Mean Square Error of Approximation (RMSEA), Standardized Root Mean Square Residual (SRMR), and Weighted Root Mean Square Residual (WRMR).
More than one-third (38.4%) of the PLWH had depressive symptoms and 32.4% reported suicidal ideation and/or attempt since HIV diagnosis. The global model showed good model fit (Chi-square value = 34.42, CFI = 0.98, RMSEA = 0.03, WRMR = 0.73). Structural equation model revealed that direct pathway of PIS on suicidal status was significant (standardized pathway coefficient = 0.21), and indirect pathway of PIS on suicidal status via depression was also significant (standardized pathway coefficient = 0.24). There was a partial mediating effect of depression in the association between PIS and suicidal status.
Our findings suggest that PIS is associated with increased depression and the likelihood of suicidal status. Depression is in turn positively associated with suicidal status and plays a mediating role between PIS and suicidal status. Therefore, to reduce suicidal ideation and attempt in PLWH, targeted interventions to reduce PIS and improve mental health status of PLWH are warranted.
既往研究显示，HIV 相关污名与 HIV 感染者/艾滋病患者（PLWH）的抑郁、自杀意念和自杀企图之间存在正相关。但鲜有研究探讨 PLWH 中 HIV 相关污名、抑郁和自杀状况（自杀意念和/或自杀企图）之间的作用机制。本研究采用结构方程模型，检验了广州市 PLWH 中感知污名和内化污名与抑郁和自杀状况之间的关系。
采用便利抽样方法，于 2013 年 3 月至 6 月在广州市第八人民医院招募了 411 名 PLWH 进行横断面研究。对参与者进行感知污名、抑郁症状、自杀状况和社会人口学特征的访谈。自 HIV 诊断以来有过自杀意念和自杀企图的 PLWH 被认为是自杀者。采用结构方程模型检验感知污名和自杀状况之间的直接和间接关联。评价结构方程模型拟合优度的指标包括卡方统计量、比较拟合指数（CFI）、近似均方根误差（RMSEA）、标准化均方根残差（SRMR）和加权均方根残差（WRMR）。
超过三分之一（38.4%）的 PLWH 有抑郁症状，32.4%报告自 HIV 诊断以来有过自杀意念和/或企图。总体模型显示出良好的模型拟合（卡方值=34.42，CFI=0.98，RMSEA=0.03，WRMR=0.73）。结构方程模型显示，感知污名对自杀状况的直接路径具有统计学意义（标准化路径系数=0.21），感知污名通过抑郁对自杀状况的间接路径也具有统计学意义（标准化路径系数=0.24）。抑郁在感知污名与自杀状况之间起部分中介作用。
我们的研究结果提示，感知污名与抑郁的增加和自杀状况的发生相关。抑郁又与自杀状况呈正相关，在感知污名与自杀状况之间起中介作用。因此，为了降低 PLWH 的自杀意念和企图，需要针对减少感知污名和改善 PLWH 心理健康状况进行干预。
