广州市HIV感染合并抑郁症状者耻辱感、压力与抑郁的结构方程模型
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摘要
目的构建广州市艾滋病病毒(human immunodeficiency virus,HIV)感染合并抑郁症状者中耻辱感、压力与抑郁之间的结构方程模型,为改善HIV感染者抑郁症状提供参考依据。方法 2017年8～12月对广州市第八人民医院门诊部的300名HIV感染合并抑郁症状者进行电子问卷调查,收集感染者的社会人口学特征、耻辱感、压力与抑郁情况等信息。采用结构方程模型对数据进行分析,探讨耻辱感对抑郁的影响机制。结果 300名HIV感染合并抑郁症状者中,平均年龄28.2岁,92.3%为男性,抑郁量表得分M(P_(25),P_(75))为23(19,28)分,提示中度抑郁。对耻辱感与抑郁构建结构方程模型显示,模型拟合良好(Chi-Square/df=1.52,RMSEA=0.04,CFI=0.98,SRMR=0.04)。中介效应结果显示,耻辱感与抑郁之间的直接作用具有统计学意义(β=0.31,P<0.001),压力在耻辱感与抑郁程度之间的间接作用同样具有统计学意义(β=0.25,P<0.001)。压力在耻辱感与抑郁程度之间呈部分中介作用。结论压力是HIV感染者耻辱感导致抑郁的重要中间环节,今后对HIV合并抑郁症状者的干预可以重点考虑对压力进行干预。
Objective To examine the mechanism among HIV-related stigma, perceived stress, and severity of depression among people living with HIV and depression(PLWHD).Methods A total of 300 PLWHD were recruited from a large HIV treatment hospital in Guangzhou, China from August to October in 2017. Participants completed measures assessing HIV-related stigma, perceived stress, depression, and socio-demographic characteristics at baseline. Structural equation modeling(SEM) was performed to examine the direct and indirect associations between stigma and depression.Results Among the 300 participants(mean age=28.21 years, 92.3% male), the median score of CES-D was 23.0(19.0,28.0).The global model showed good model fit(Chi-square value=25.97, CFI=0.98, RMSEA=0.04, SRMR=0.04). Structural equation model revealed that stigma had significantly direct(pathway coefficient=0.31, P<0.001) and indirect(pathway coefficient=0.25, P<0.001) effects on depression.Conclusions Stress plays an important role in the mechanism between stigma and depression, thus future interventions need to pay more attention on stress.
Objective To examine the mechanism among HIV-related stigma, perceived stress, and severity of depression among people living with HIV and depression(PLWHD).Methods A total of 300 PLWHD were recruited from a large HIV treatment hospital in Guangzhou, China from August to October in 2017. Participants completed measures assessing HIV-related stigma, perceived stress, depression, and socio-demographic characteristics at baseline. Structural equation modeling(SEM) was performed to examine the direct and indirect associations between stigma and depression.Results Among the 300 participants(mean age=28.21 years, 92.3% male), the median score of CES-D was 23.0(19.0,28.0).The global model showed good model fit(Chi-square value=25.97, CFI=0.98, RMSEA=0.04, SRMR=0.04). Structural equation model revealed that stigma had significantly direct(pathway coefficient=0.31, P<0.001) and indirect(pathway coefficient=0.25, P<0.001) effects on depression.Conclusions Stress plays an important role in the mechanism between stigma and depression, thus future interventions need to pay more attention on stress.
引文
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[13] 杨雨薇,孙红敏,胡明军,等.298例接受抗病毒治疗艾滋病患者的心理健康状况及其影响因素分析 [J].中华疾病控制杂志,2017,21(12):1219-1222.DOI:10.16462/j.cnki.zhjbkz.2017.12.008.Yang YW,Sun HM,Hu MJ,et al.Analysis of mental health status and related factors in 298 AIDS patients receiving antiretroviral therapy.[J].Chin J Dis Control Prev,2017,21(12):1219-1222.DOI:10.16462/j.cnki.zhjbkz.2017.12.008.
[14] Zang,C.,Guida J,Sun Y,et al.Collectivism culture,HIV stigma and social network support in anhui,China:a path analytic model [J].AIDS Patient Care STDS,2014.28(8):452-458.DOI:10.1089/apc.2014.0015.
[15] 石凯,何玉凤,邹运铎.艾滋病患者自我歧视形成的个人及家庭影响因素研究 [J].中华疾病控制杂志,2014.18(12):1206-1208,1220.Shi K,He YF,Zou YZ.Personal and family's factors influencing the self-discrimination of AIDS patients [J].Chin J Dis Control Prev,2014.18(12):1206-1208,1220.
[16] 杨翌,张孔来,李泽荣,等.艾滋病病毒感染者生活质量与相关耻辱的关系 [J].中国公共卫生,2005,21(6):675-676.Yang Y,Zhang KL,Li ZR,et al.,Relationship between quality of life and stigma among people living with HIV/AIDS [J].Chin Public Health,2005,21(6):675-676.
[17] Marshall GJ Jr.The adverse effects of psychological stress on immunoregulatory balance:applications to human inflammatory diseases [J].Immunol Allergy Clin North Am,2011,31(1):133-140.DOI:10.1016/j.iac.2010.09.013.
[18] Lopez CR,Antoni MH,Seay J,et al.Stress Management,Depression,and Immune Status in Lower-Income Racial/Ethnic Minority Women Co-infected with HIV and HPV [J].Journal of Applied Biobehavioral Research 2013,18:37-57.DOI:10.1111/jabr.12003.
[18] Lopez CR,Antoni MH,Pereira D,et al.Stress management,depression,and immune status in lower-income racial/ethnic minority women co-infected with HIV and HPV [J].J Appl Biobehav Res 2013,18:37-57.DOI:10.1111/jabr.12003.
[19] Scott-Sheldon LA,Kalichman SC,Carey MP,et al.Stress management interventions for HIV+ adults:a meta-analysis of randomized controlled trials,1989 to 2006 [J].Health Psychol,2008.27(2):129-139.DOI:10.1037/0278-6133.27.2.129.
[2] Niu L,Luo D,Liu Y,et al.The mental health of people living with HIV in China,1998-2014:a systematic review [J].PLoS One,2016.11(4):e0153489.DOI:10.1371/journal.pone.0153489.
[3] Ciesla,JA,RobertsJE.Meta-analysis of the relationship between HIV infection and risk for depressive disorders [J].Am J Psychiatry,2001.158(5):725-730.DOI:10.1176/appi.ajp.158.5.725.
[4] Leserman J.HIV disease progression:depression,stress,and possible mechanisms [J].Biol Psychiatry,2003,54(3):295-306.DOI:10.1016/S0006-3223(03)00323-8.
[5] Wang M,Armour C,Wu Y,et al.Factor structure of the CES-D and measurement invariance across gender in Mainland Chinese adolescents [J].J Clin Psychol,2013,69(9):966-979.DOI:10.1002/jclp.21978.
[6] Lee EH.Review of the psychometric evidence of the perceived stress scale.[J] Asian Nurs Res,2012,6(4):121-127.DOI:10.1016/j.anr.2012.08.004.
[7] 王萱,段莉,王耐,等.知觉压力量表的应用现状 [J].承德医学院学报,2018,35(3):242-244.DOI:10.15921/j.cnki.cyxb.2018.03.028.Wang X,Duan L,Wang N,et al.The application status of Perceived Stress Scale [J].Journal of Chengde Medical Collage,2018,35(3):242-244.DOI:10.15921/j.cnki.cyxb.2018.03.028.
[8] Berger BE,Ferrans CE,Lashley FR.Measuring stigma in people with HIV:psychometric assessment of the HIV stigma scale [J].Res Nurs Health,2001,24(6):518-529.DOI:10.1002/nur.10011.
[9] 崔展宇,黄辉煌,李玥漪,等.HIV/AIDS病人歧视知觉的研究进展 [J].中国艾滋病性病,2018,24(10):1066-1069.DOI:10.13419/j.cnki.aids.2018.10.30.Cui ZY,Huang HH,Li YY,et al.Research advance of HIV/AIDS stigma [J].Chin J AIDS STD,2018,24(10):1066-1069.DOI:10.13419/j.cnki.aids.2018.10.30.
[10] Yves R.Lavaan:an R package for structural equation modeling [J].Journal of Statistical Software,2012,48(2):1-36.DOI:10.18637/jss.v048.i02.
[11] 王济川,王小倩,姜宝法.结构方程模型:方法与应用 [M].北京:高等教育出版社,2011:17-23.Wang JC,Wang XQ,Jiang BF.Structural Equation Models,Methods and Applications [M].Beijing:Higher Education Press,2011:17-23.
[12] Owe-Larsson B,Sall L,Salamon E,et al.HIV infection and psychiatric illness [J].Afr J Psychiatry (Johannesbg),2009,12(2):115-128.DOI:10.4314/ajpsy.v12i2.43729.
[13] 杨雨薇,孙红敏,胡明军,等.298例接受抗病毒治疗艾滋病患者的心理健康状况及其影响因素分析 [J].中华疾病控制杂志,2017,21(12):1219-1222.DOI:10.16462/j.cnki.zhjbkz.2017.12.008.Yang YW,Sun HM,Hu MJ,et al.Analysis of mental health status and related factors in 298 AIDS patients receiving antiretroviral therapy.[J].Chin J Dis Control Prev,2017,21(12):1219-1222.DOI:10.16462/j.cnki.zhjbkz.2017.12.008.
[14] Zang,C.,Guida J,Sun Y,et al.Collectivism culture,HIV stigma and social network support in anhui,China:a path analytic model [J].AIDS Patient Care STDS,2014.28(8):452-458.DOI:10.1089/apc.2014.0015.
[15] 石凯,何玉凤,邹运铎.艾滋病患者自我歧视形成的个人及家庭影响因素研究 [J].中华疾病控制杂志,2014.18(12):1206-1208,1220.Shi K,He YF,Zou YZ.Personal and family's factors influencing the self-discrimination of AIDS patients [J].Chin J Dis Control Prev,2014.18(12):1206-1208,1220.
[16] 杨翌,张孔来,李泽荣,等.艾滋病病毒感染者生活质量与相关耻辱的关系 [J].中国公共卫生,2005,21(6):675-676.Yang Y,Zhang KL,Li ZR,et al.,Relationship between quality of life and stigma among people living with HIV/AIDS [J].Chin Public Health,2005,21(6):675-676.
[17] Marshall GJ Jr.The adverse effects of psychological stress on immunoregulatory balance:applications to human inflammatory diseases [J].Immunol Allergy Clin North Am,2011,31(1):133-140.DOI:10.1016/j.iac.2010.09.013.
[18] Lopez CR,Antoni MH,Seay J,et al.Stress Management,Depression,and Immune Status in Lower-Income Racial/Ethnic Minority Women Co-infected with HIV and HPV [J].Journal of Applied Biobehavioral Research 2013,18:37-57.DOI:10.1111/jabr.12003.
[18] Lopez CR,Antoni MH,Pereira D,et al.Stress management,depression,and immune status in lower-income racial/ethnic minority women co-infected with HIV and HPV [J].J Appl Biobehav Res 2013,18:37-57.DOI:10.1111/jabr.12003.
[19] Scott-Sheldon LA,Kalichman SC,Carey MP,et al.Stress management interventions for HIV+ adults:a meta-analysis of randomized controlled trials,1989 to 2006 [J].Health Psychol,2008.27(2):129-139.DOI:10.1037/0278-6133.27.2.129.
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