Ali Usman, Riaz Umar, Doyle Heather, Satti Asghar, Mahmood Nashmia, Rasheed Summayyah, Zahra Kalsoom
Department of Management, Association of People Living with HIV, Pakistan.
Program Management Unit, United Nations Development Program (UNDP), Pakistan.
PLOS Glob Public Health. 2024 Nov 4;4(11):e0003882. doi: 10.1371/journal.pgph.0003882. eCollection 2024.
The objective of this analysis is to identify the prevalence of depressive symptoms and its predictors in the national cohort of people living with HIV (PLHIV) in Pakistan. This is a secondary data analysis of the National Stigma Index Study 2.0. We screened PLHIV in the Stigma Index study for depressive symptoms using the Urdu version of the Patient Health Questionnaire (PHQ)-9. We used stepwise multiple linear regression to identify predictors of depressive symptoms. We also explored the moderating effect of stigma faced by PLHIVs while accessing HIV health services on depressive symptoms. Data was analyzed using the Statistical Package for Social Sciences Version 26 and PROCESS MACRO Version 4.2. A total of 1,497 PLHIV participated in the original study. Based on the PHQ-9 depressive symptom categories, 39.89% had no depressive symptoms, 24.42% had mild depressive symptoms, 16.89% had moderate depressive symptoms, 10.17% had moderately severe depressive symptoms, and 8.61% had severe depressive symptoms. Results of multiple linear regression show that being worried to meet basic life needs such as food and shelter in last 12 months (2.188, 95% Confidence interval 3.98-5.68, p < .01), female sex (3.599, 95% CI 2.703-4.49, p < .01), substance use (31.33, 95% CI 2.379-3.88, p < .01), being employed (-1.627, 95% CI -2.36 to -.88, p < .01), being recruited through limited chain referral as opposed to recruitment from HIV service delivery sites (-2.147, 95% CI -3.41 to -.88, p< .01), and doing sex work (1.143, 95% CI .225-2.061, p < .01) were significant predictors of depressive symptoms. There is a high prevalence of depressive symptoms among PLHIV in Pakistan. Inability to meet basic life needs, female sex, substance use, employment, and facing stigma in the healthcare setting were predictors of depression. There is a need of socioeconomic empowerment, stigma reduction in healthcare settings, and a robust screening program for depressive symptoms for PLHIV community in the country.
本分析的目的是确定巴基斯坦全国艾滋病毒感染者（PLHIV）队列中抑郁症状的患病率及其预测因素。这是对全国耻辱感指数研究2.0的二次数据分析。我们在耻辱感指数研究中使用乌尔都语版患者健康问卷（PHQ）-9对PLHIV进行抑郁症状筛查。我们使用逐步多元线性回归来确定抑郁症状的预测因素。我们还探讨了PLHIV在获得艾滋病毒健康服务时所面临的耻辱感对抑郁症状的调节作用。使用社会科学统计软件包第26版和PROCESS宏第4.2版进行数据分析。共有1497名PLHIV参与了原始研究。根据PHQ-9抑郁症状类别，39.89%没有抑郁症状，24.42%有轻度抑郁症状，16.89%有中度抑郁症状，10.17%有中度严重抑郁症状，8.61%有严重抑郁症状。多元线性回归结果显示，在过去12个月中担心无法满足诸如食物和住所等基本生活需求（2.188，95%置信区间3.98 - 5.68，p <.01）、女性（3.599，95%CI 2.703 - 4.49，p <.01）、药物使用（31.33，95%CI 2.379 - 3.88，p <.01）、就业（-1.627，95%CI -2.36至-.88，p <.01）、通过有限的链式转诊而非从艾滋病毒服务提供地点招募（-2.147，95%CI -3.41至-.88，p<.01）以及从事性工作（1.143，95%CI.225 - 2.061，p <.01）是抑郁症状的显著预测因素。巴基斯坦PLHIV中抑郁症状的患病率很高。无法满足基本生活需求、女性、药物使用、就业以及在医疗环境中面临耻辱感是抑郁的预测因素。该国需要增强PLHIV社区的社会经济权能，减少医疗环境中的耻辱感，并开展针对抑郁症状的强有力筛查项目。
