School of Psychology, Faculty of Health Sciences, Curtin University, GPO Box U1987, Perth, Western Australia 6845, Australia.
Department of Social Policy and Intervention, University of Oxford, Oxford, United Kingdom; Brighton and Sussex Medical School, University of Sussex, Brighton, United Kingdom.
J Affect Disord. 2020 Nov 1;276:418-423. doi: 10.1016/j.jad.2020.07.101. Epub 2020 Jul 20.
Adolescents living with HIV may be at elevated risk of psychological problems, which are correlated with negative health outcomes. In cross-sectional research with HIV-affected adolescents, bullying victimisation and internalised HIV stigma have been associated with poorer psychological health. We extended these findings and tested longitudinal associations between bullying victimisation, internalised stigma, and mental health among adolescents living with HIV. We also tested whether relationships between bullying victimisation and psychological symptoms were mediated by internalised stigma.
Adolescents living with HIV (n = 1060, 10-19 years, 55% female), who had ever initiated HIV treatment in 53 public health facilities in the Eastern Cape, South Africa, were interviewed and followed up 18 months later (n = 995, 94% retention). Participants completed well-validated measures of depression, anxiety, posttraumatic stress, bullying victimisation, and internalised stigma.
After adjusting for baseline mental health and sociodemographic characteristics, baseline internalised stigma prospectively predicted poorer outcomes on all psychological measures. Bullying victimisation at baseline was not directly associated with any psychological measures at follow up; however, it was indirectly associated with all psychological measures via internalised stigma.
Reliance on self-report measures and poor reliability of the depression scale.
Bullying victimisation is associated with internalised stigma, which in turn predicts psychological symptoms over time. Interventions reducing internalised stigma and associated psychological distress are needed, and these should be integrated into HIV care to ensure optimal HIV management. The implementation of bullying prevention programs may reduce internalised stigma and promote mental health among adolescents living with HIV.
感染 HIV 的青少年可能面临更高的心理问题风险，这些问题与不良健康结果相关。在针对受 HIV 影响的青少年的横断面研究中，遭受欺凌和内化的 HIV 耻辱感与较差的心理健康相关。我们扩展了这些发现，并测试了感染 HIV 的青少年中欺凌受害、内化耻辱感与心理健康之间的纵向关联。我们还测试了欺凌受害与心理症状之间的关系是否通过内化耻辱感而产生中介作用。
在南非东开普省 53 个公共卫生机构中接受过 HIV 治疗的感染 HIV 的青少年（n=1060，年龄 10-19 岁，55%为女性）接受了访谈，并在 18 个月后进行了随访（n=995，保留率为 94%）。参与者完成了经过充分验证的抑郁、焦虑、创伤后应激、欺凌受害和内化耻辱感的测量。
在调整基线心理健康和社会人口学特征后，基线内化耻辱感前瞻性地预测了所有心理测量结果的较差结局。基线时的欺凌受害与随访时的任何心理测量均无直接关联；然而，它通过内化耻辱感与所有心理测量呈间接关联。
依赖于自我报告的测量和抑郁量表的信度较差。
欺凌受害与内化耻辱感相关，而内化耻辱感又随时间预测心理症状。需要减少内化耻辱感和相关心理困扰的干预措施，并且应将这些措施整合到 HIV 护理中，以确保 HIV 管理的最佳效果。实施欺凌预防计划可能会减少内化耻辱感，并促进感染 HIV 的青少年的心理健康。
