Mitzel Luke D, Vanable Peter A, Carey Michael P
Department of Psychology, Syracuse University, Syracuse, New York.
Centers for Behavioral and Preventive Medicine, The Miriam Hospital and Department of Psychiatry and Human Behavior, Brown University, Providence, Rhode Island.
Stigma Health. 2019 Aug;4(3):282-292. doi: 10.1037/sah0000144. Epub 2018 May 14.
Stigmatization due to HIV status may interfere with disease management among persons living with HIV (PLWHA) by heightening serostatus disclosure concerns and vulnerability to depressive symptoms.
In this cross-sectional study, indirect effects of disclosure concerns and depressive symptoms were examined for the association of stigma to treatment adherence (medication and clinic appointment adherence) in an outpatient sample of PLWHA.
Participants ( = 179; 47% White, 41% African-American; 35% MSM) completed measures of stigma-related experiences, concerns about disclosing HIV status, depression, and medication adherence; clinic appointment attendance was obtained from chart data.
Stigma had an indirect effect on medication adherence (but not clinic attendance) via disclosure concerns. Stigma had indirect effects on both medication adherence and clinic attendance via depressive symptoms. In path analyses including both disclosure concerns and depressive symptoms, combined indirect effects emerged for both medication adherence and clinic attendance. There was a significant indirect pathway from stigma to disclosure concerns to depression to clinic attendance, whereas the positioning of the mediators was swapped for the significant indirect pathway from stigma to medication adherence.
These analyses provide evidence that stigmatizing experiences negatively affect treatment adherence through the indirect effects of disclosure concerns and depressive symptoms. Disclosure concerns and depressive symptoms are two mechanisms worthy of further research to enhance understanding of the association between stigma and treatment adherence difficulties.
由于感染艾滋病毒而遭受的污名化可能会加剧血清学状态披露的担忧以及易患抑郁症状，从而干扰艾滋病毒感染者（PLWHA）的疾病管理。
在这项横断面研究中，在一组艾滋病毒感染者门诊样本中，研究了披露担忧和抑郁症状对污名与治疗依从性（药物治疗和门诊预约依从性）之间关联的间接影响。
参与者（ = 179；47%为白人，41%为非裔美国人；35%为男男性行为者）完成了与污名相关经历、对披露艾滋病毒感染状况的担忧、抑郁和药物依从性的测量；门诊预约出勤情况从病历数据中获取。
污名通过披露担忧对药物依从性有间接影响（但对门诊出勤没有间接影响）。污名通过抑郁症状对药物依从性和门诊出勤均有间接影响。在包括披露担忧和抑郁症状的路径分析中，药物依从性和门诊出勤均出现了综合间接影响。从污名到披露担忧再到抑郁再到门诊出勤存在一条显著的间接路径，而在从污名到药物依从性的显著间接路径中，中介变量的位置互换。
这些分析提供了证据，表明污名化经历通过披露担忧和抑郁症状的间接影响对治疗依从性产生负面影响。披露担忧和抑郁症状是两个值得进一步研究的机制，以加深对污名与治疗依从性困难之间关联的理解。
