Brathwaite Rachel, Mutumba Massy, Nannono Sylivia, Namatovu Phionah, Ssewamala Fred M
International Center for Child Health and Development, Brown School, Washington University in St. Louis, St. Louis, MO, 63130, USA.
Department of Health Behavior and Biological Sciences, University of Michigan School of Nursing, 400 North Ingalls Building, Ann Arbor, MI, 48109-5482, USA.
AIDS Behav. 2025 Apr 17. doi: 10.1007/s10461-025-04706-x.
We investigated the mediating role of alcohol use expectancies between three psychological/emotional states (depressive symptoms, hopelessness, and adverse childhood experiences (ACE)) and problematic alcohol and substance use among YLHIV in Uganda. We defined problematic substance use according to the National Institute on Drug Abuse (NIDA)-modified Alcohol, Smoking, and Substance Involvement Screening Test (NM-ASSIST) to derive a Substance Involvement (SI) score to identify participants' risk level. We grouped moderate and high risk into one category to represent 'problematic use' or use that would qualify as a substance use disorder. We tested the proposed mediation models using the PROCESS macro for mediation, moderation, and conditional process analysis version 4.1 for SPSS. We observed that higher scores for depressive symptoms, hopelessness, and ACE, were each associated with increased levels of global AUE (GAUE). However, mediation analyses revealed significant indirect effects of depressive symptoms (1.03, 95% CI 1.0002 to 1.0926), hopelessness (1.11, 95% CI 1.0172 to 1.3349), and ACE (1.08, 95% CI 1.0027 to 1.2695) on problematic substance use via GAUE. Also negative AUE (NAUE) significantly mediated the relationship between depressive symptoms, hopelessness, and ACE and problematic substance use. Our study highlights the significant role of GAUE and NAUE in mediating the relationship between ACE, depressive symptoms, hopelessness, and problematic substance use among YLHIV. The findings suggest that interventions targeting GAUE and NAUE and possibly providing effective coping mechanisms for managing depressive symptoms, hopelessness, and the impact of ACE may be crucial in reducing substance use among YLHIV.
我们研究了饮酒预期在乌干达感染艾滋病毒的青少年（YLHIV）的三种心理/情绪状态（抑郁症状、绝望感和童年不良经历（ACE））与酒精和物质使用问题之间的中介作用。我们根据美国国家药物滥用研究所（NIDA）修改后的酒精、吸烟和物质使用筛查测试（NM - ASSIST）来定义物质使用问题，以得出物质使用参与度（SI）得分，从而确定参与者的风险水平。我们将中度和高风险归为一类，以代表“问题性使用”或符合物质使用障碍标准的使用情况。我们使用SPSS的PROCESS宏版本4.1进行中介、调节和条件过程分析，对提出的中介模型进行了测试。我们观察到，抑郁症状、绝望感和ACE的得分越高，与总体饮酒预期（GAUE）水平的升高均相关。然而，中介分析显示，抑郁症状（1.03，95%置信区间1.0002至1.0926）、绝望感（1.11，95%置信区间1.0172至1.3349）和ACE（1.08，95%置信区间1.0027至1.2695）通过GAUE对物质使用问题产生显著的间接影响。此外，消极饮酒预期（NAUE）也显著中介了抑郁症状、绝望感和ACE与物质使用问题之间的关系。我们的研究强调了GAUE和NAUE在中介ACE、抑郁症状、绝望感与YLHIV物质使用问题之间关系中的重要作用。研究结果表明，针对GAUE和NAUE的干预措施，以及可能为管理抑郁症状、绝望感和ACE的影响提供有效的应对机制，对于减少YLHIV的物质使用可能至关重要。
