Psychological pathway to suicidal ideation among people living with HIV/AIDS in China: A structural equation model

Social support as a mediator between mental health and stigma among newly HIV-positive men who have sex with men

OBJECTIVES

The sociocultural context of China gives rise to unique experiences of HIV-related stigma and adverse impacts on mental health among men who have sex with men (MSM) living with HIV. However, few studies have explored the stigma among families in the cultural context of China and the role of social support as a mediator to explain how HIV-related stigma results in poor psychological well-being. This study aims to test the mediating effect of social support between HIV-related stigma and family stigma on the mental health of MSM.

METHODS

This cross-sectional study recruited newly MSM with HIV in two cities (Beijing and Wuhan) in China as participants from February 2021 to August 2022. A total of 257 MSM with HIV were recruited for the study. The mediating effects were examined using mediation models (SAS PROC CAUSALMED).

RESULTS

The overall total effect of HIV-related stigma on mental health was β = -1.483 (bootstrap 95% CI = -1.881, -1.104 p < 0.001), and the mediating effect of social support was β = -0.321 (bootstrap 95% CI = -0.571, -0.167 p = .001). A higher level of stigma from family predicts lower mental health with an overall total effect of β = -1.487 (bootstrap 95% CI = -1.823, -1.101 p < 0.001), while the indirect effect (mediation effect) of social support on mental health is β = -0.281 (bootstrap 95% CI = -0.477, -0.142 p = .003).

CONCLUSIONS

Given the mediating effect of social support on mental health, programs enhancing social support and decreasing stigmatization should be designed to improve the mental health of MSM with HIV, the interventions are needed at both the family and community levels. Public health campaigns in China that frame HIV and same-sex behavior as chronic issues and normal phenomena can correct misinformation related to HIV and MSM that leads to stigma and negative emotional reactions.

Analysis of the Mediation Effects of Adverse Mental Health Outcomes in HIV-Infected Women of Childbearing Age from Multiple Perspectives Including Discrimination Perception

Objective

To Analysis of the mediation effects of adverse mental health outcomes in HIV-infected women of childbearing age from multiple perspectives including discrimination perception, social capital, and other factors.

Methods

A cross-sectional survey was conducted among 553 people in Xinjiang region of China using Survey scale. AMOS was used to identify factors that influenced the "discrimination perception/mental resilience/social capital-depression-poor mental health outcomes" pathway.

Results

A total of 44.85% and 42.13% of the study participants had anxiety and depression symptoms, as perceived discrimination increased, the higher the level of depression in HIV-infected women of childbearing age. Correlation coefficient among depression with poor mental health outcomes was also significant. Psychological resilience, social capital and depression have mediating effects on perceived discrimination and poor mental health outcomes, discrimination perception had an indirect effect on depression through social capital and an indirect effect on adverse mental health outcomes through depression and psychological resilience. The modified model has a good fitting effect.

Conclusion

Discrimination perception was shown to affect adverse mental health outcomes by impacting mental resilience, depression, and social capital. The findings suggest the need for measures to reduce adverse mental health outcomes by decreasing discrimination perception, increasing social capital, and enhancing psychological resilience.

Global trends in depression among patients living with HIV: A bibliometric analysis

Background

Human immunodeficiency virus (HIV) related depression has seriously affected the quality of life and treatment outcomes of patients living with HIV (PLWH), which has become a hot topic in recent years. This study aims to discover the main keywords, predict frontier topics, and give meaningful suggestions for researchers by bibliometric analysis.

Methods

Publications between 1999 and 2022 on depression in HIV/AIDS were searched in the Web of Science core collection. Microsoft Excel 2010 and VOSviewer were utilized to key contributors (e.g., authors, journals, institutions, and countries). VOSviewer and CiteSpace were used to analyze the knowledge evolution, collaborative maps, hot topics, and keywords trends in this field.

Results

In total, 8,190 publications were included in the final analysis. From 1999 to 2021, the number of published articles roughly presents a steadily increasing trend. The United States, South Africa, and the United Kingdom were three key contributing countries/regions to this field. University Calif San Francisco (United States), University Calif Los Angeles (United States), and Johns Hopkins University (United States) were three key contributing institutions. Safren, Steven A. was the most productive and highest cited author. AIDS Care was the top prolific journal. Antiretroviral therapy and adherence, men has sex with men, mental health, substance abuse, stigma, and Sub-Saharan Africa were the central topics regarding the depression-related research in HIV/AIDS.

Conclusion

This bibliometric analysis reported the publication trend, major contributing countries/regions, institutions, authors, journals and mapped the knowledge network of depression-related research on HIV/AIDS. In this field, topics such as “adherence,” “mental health,” “substance abuse,” “stigma,” “men who have sex with men” and “South Africa” have attracted considerable attention.

Global Systematic Review of Common Mental Health Disorders in Adults Living with HIV

PURPOSE OF THE REVIEW

By reviewing the most recent common mental health disorders (CMHD) studies in people living with HIV (PLWH) (2018-2020), this review discusses the prevalence of CMHD, factors associated with CMHD in PLWH, mental health in PLWH from vulnerable groups, the impact of CMHD on HIV disease progression and adherence to antiretroviral therapy and the efficacy of different treatment approaches.

RECENT FINDINGS

After screening for eligibility 142 studies were included in the final systematic review. Only 27% of studies were conducted in Sub-Saharan Africa, which carries the highest burn of HIV disease globally. Despite the well-established increased risk of CMHD in PLWH, the current prevalence remains high, with studies reporting 28%-62% of PLWH having mental health symptoms.

CONCLUSION

Despite the significant challenges that CMHDs present to successful HIV treatment, there are many mental health treatments and interventions which can improve outcomes in PLWH and opportunities to task-shift and integrate mental health care with HIV care.

Determinants Model in Reducing HIV-Related Stigma in Health care Workers: A Systematic Review

Background: The stigma accepted by people living with HIV (PLWHA) is a major obstacle in HIV prevention, especially from health workers. Aims: This study aims to determine the factors associated with HIV stigma among health workers. Methods: This systematic review was conducted using the 2015 PRISMA guidelines. All publications by reading the title and abstract. In the final screening stage, the authors read the full text of the remainder of the article and held back studies that were consistent with inclusion criteria, focusing on HIV-related stigma determinants published in 2010-2020. Results: The stigma that comes from health workers to PLWHA can come from personal beliefs or a lack of personal confidence, which can be derived from self-confidence, self-confidence, knowledge, working time, and institutional support or policies from the workplace that create discriminatory behavior when dealing with PLWHA. The created stigma can reduce social interactions and the quality of life of PLWHA. Conclusion: It is important to find determinants to formulate appropriate intervention plans in reducing HIV-related stigma, especially among health workers.

Depression and Suicidal Behaviors Among HIV-Infected Inmates in Lesotho: Prevalence, Associated Factors and a Moderated Mediation Model

Depression and suicidal behaviors are two common psychiatric problems observed among people living with HIV. The situation is worse among HIV-infected inmates. The present study aimed to assess the prevalence and associated factors of depression and suicidal behaviors among HIV-infected inmates, and to clarify the mechanisms underlying the impact of HIV-related stigma on suicidal behaviors. The data from 402 HIV-infected inmates in Lesotho showed the prevalence of depression and suicidal behaviors was 53.0% and 8.2%. Female and institution maladaptation were risk factors for depression, and the risk factor for suicidal behaviors was non-participation of institution activities. Moreover, HIV-related stigma indirectly increased inmates' suicidal behaviors through elevated depression. Such indirect effect was stronger for inmates with a lower level of meaning in life. These findings indicate more concern should be given to high-risk subgroups, and both depression and meaning in life are intervention targets for suicide prevention among HIV-infected inmates.

Prevalence of suicidal ideation, suicide attempt, and suicide plan among HIV/AIDS: A systematic review and meta-analysis

BACKGROUND

Suicidality is common in people living with HIV/AIDS. However, the prevalence estimates of the suicidality vary between studies. Here, we performed a systematic review and estimated the prevalence of suicidal behavior in this population.

METHODS

Systematic search of PubMed, Embase, Web of Science, CINAHL, Scopus and PsycINFO for relevant studies published before August 29, 2020. A random-effects model was used to pool the estimates of the prevalence of suicidal ideation, attempts and plans, which were also stratified by continent or region and screening instrument from the studies included in this meta-analysis.

RESULTS

Suicide prevalence data were extracted from 36 studies(n=32,818) from 15 countries. The overall pooled crude prevalence estimates of suicidal ideation, plans, and attempts were 20.9% [95% confidence interval (CI) 16.5-21.6%],8.1% (95% CI 5.4-11.3%), and 7.5% (95% CI 5.7-9.5%), respectively. For lifetime suicidal ideation and attempts prevalence, this was 22.4% (95% CI 15.9-29.8%), and 12.0% (95% CI 6.9- 18.1%), respectively. Summary prevalence estimates ranged across assessment modalities from 6.5% to 33.7%. Pooled estimates were generally higher for females, as compared with males (risk ratios in the range 1.48-1.85). The leave-one-out analysis showed that no single study significantly affected the final pooled results.

Perceived discrimination and mental health symptoms among persons living with HIV in China: the mediating role of social isolation and loneliness

Perceived discrimination is significantly associated with mental health symptoms among persons living with HIV (PLWH). However, little is known about the factors mediating this relationship. We aimed to examine the mediating role of social isolation and loneliness in the association between perceived discrimination and mental health symptoms among PLWH. A multicenter (Shanghai, Kunming, Nanning, Hengyang, and Changning in China) cross-sectional study was conducted in 2017. Data from 883 PLWH were used for statistical analysis. Perceived discrimination, mental health symptoms, loneliness and social isolation were assessed through self-report questionnaires. Structural equation modeling (SEM) showed a satisfactory model fit (CMIN/DF = 2.676, GFI = 0.998, CFI = 0.997, NFI = 0.995, TLI = 0.985, RMSEA = 0.044 [0.000, 0.090]) and a significant total indirect effect (β = 0.058, SE = 0.009, Z = 6.444, p < 0.01). Both loneliness (β = 0.042, SE = 0.008, Z = -5.250, p < 0.01) and social isolation (β = 0.016, SE = 0.004, Z = -4.000, p < 0.01) were determined to be significant mediators of the association between perceived discrimination and mental health symptoms. Interventions that combat loneliness and social isolation may help ameliorate the adverse consequences of perceived discrimination on mental health.

Prevalence and risk factors for youth suicidality among perinatally infected youths living with HIV/AIDS in Uganda: the CHAKA study

BACKGROUND

Research from high income countries indicates that suicide is a major mental health care concern and a leading cause of preventable deaths among children and adolescents. Proper assessment and management of youth suicidality is crucial in suicide prevention, but little is known about its prevalence and associated risk factors in Sub-Saharan Africa. In low income countries there is an increased risk of suicide among persons with HIV/AIDS even in the presence of the highly active antiretroviral therapy.

OBJECTIVE

To determine the prevalence of and risk factors for youth suicidality among perinatally infected youth living with HIV/AIDS in Uganda.

METHODS

We studied 392 HIV positive children (5-11 years) and adolescents (12-17 years) and their caregivers in Kampala and Masaka districts. Caregivers were administered the suicide assessment section of the MINI International Psychiatric Interview. Socio-demographic characteristics, psychiatric diagnoses, and psychosocial and clinical factors were assessed and suicidality (suicidal ideation and or suicidal attempt) was the outcome variable. Logistic regression was used to calculate odds ratios adjusting for study site and sex at 95% confidence intervals.

RESULTS

Caregivers reported a suicidality rate of 10.7% (CI 8-14.1) in the past one month with higher rates among urban female (12.4%, CI 8.6-17.7) than male (8.7%, CI 5.4-13.8) youth. Lifetime prevalence of attempted suicide was 2.3% (n = 9, CI 1.2-4.4) with the highest rates among urban female youth. Among children, caregivers reported a lifetime prevalence of attempted suicide of 1.5%. The self-reported rate of attempted suicide in the past month was 1.8% (n = 7, CI 0.8-3.7) with lifetime prevalence of 2.8% (n = 11, CI 1.6-5.0). The most common methods used during suicide attempts were cutting, taking overdose of HIV medications, use of organophosphates, hanging, stabbing and self-starvation. Clinical correlates of suicidality were low socioeconomic status (OR = 2.27, CI 1.06-4.87, p = 0.04), HIV felt stigma (OR = 2.10, CI 1.04-3.00, p = 0.02), and major depressive disorder (OR = 1.80, CI 0.48-2.10, p = 0.04). Attention-deficit/hyperactivity disorder was protective against suicidality (OR = 0.41, CI 0.18-0.92, p = 0.04).

CONCLUSION

The one-month prevalence of suicidality among CA-HIV was 10.7%.

Assessment of Pharmacy Student Perceptions Toward Common Stigmas Associated with Persons Living with HIV

Objective. To analyze pharmacy students' views of societal stigmas often facing persons living with human immunodeficiency virus (HIV). Methods. A 20-item survey conducted across a dual-campus school of pharmacy examined students' approval of societal aspects of the lives of persons living with HIV. Pharmacy students anonymously exchanged completed survey instruments to learn about peers' viewpoints. Survey instruments were analyzed and ranked by most commonly occurring responses and gender designations. Chi square tests were used for statistical analyses, with p<.05 considered significant. Results. Over three years, 260 female students and 104 male students (364 total) completed the survey. Approximately one fifth of the study sample stated that they did not have a problem placing their children (if applicable) in a daycare center with children who were living with HIV. Greater than one third of the students in the study sample were not opposed to placing their elderly parents (if applicable) in a facility that included residents living with HIV. Fewer female than male students had reservations about couples living with HIV being allowed to have children. Male students were less averse than female students to having their name and picture associated with HIV prevention on the internet. Conclusion. This study revealed that some pharmacy students held stigmatizing beliefs regarding persons living with HIV. The discriminatory views of participants in this study sample may directly or indirectly affect health outcomes of persons living with HIV. To better address health care challenges within this community, Doctor of Pharmacy programs should provide sustainable opportunities for students to explore their own HIV biases and additional education about the difficulties that persons living with HIV encounter.

Adverse Birth Outcomes as Indicators of Poor Fetal Growth Conditions in a French Newborn Population-A Stratified Analysis by Neighborhood Deprivation Level

Background: Adverse birth outcomes are related to unfavorable fetal growth conditions. A latent variable, named Favorable Fetal Growth Condition (FFGC), has been defined by Bollen et al., in 2013; he showed that this FFGC latent variable mediates the effects of maternal characteristics on several birth outcomes. Objectives: The objectives of the present study were to replicate Bollen’s approach in a population of newborns in Paris and to investigate the potential differential effect of the FFGC latent variable according to the neighborhood socioeconomic level. Methods: Newborn health data were available from the first birth certificate registered by the Maternal and Child Care department of the City of Paris. All newborns (2008–2011) were geocoded at the mother residential census block. Each census block was assigned a socioeconomic deprivation level. Several mothers’ characteristics were collected from the birth certificates: age, parity, education and occupational status and the occupational status of the father. Three birth outcomes were considered: birth weight (BW), birth length (BL) and gestational age (GA). Results: Using a series of structural equation models, we confirm that the undirected model (that includes the FFGC latent variable) provided a better fit for the data compared with the model where parental characteristics directly affected BW, BL, and/or GA. However, the strength, the direction and statistical significance of the associations between the exogenous variables and the FFGC were different according to the neighborhood deprivation level. Conclusion: Future research should be designed to assess the how robust the FFGC latent variable is across populations and should take into account neighborhood characteristics to identify the most vulnerable group and create better design prevention policies.

Suicide Risk in Persons with HIV/AIDS in South Korea: a Partial Test of the Interpersonal Theory of Suicide

PURPOSE

The high disease burden associated with human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) is linked to the elevated suicide risk in this population. Informed by the interpersonal theory of suicide, this study examined how and under which conditions depression is related to suicide risk in people living with HIV/AIDS.

METHODS

A total of 202 outpatients with HIV/AIDS participated in a cross-sectional and multi-center survey involving four university hospitals in South Korea. This self-reported survey included the Hospital Anxiety and Depression Scale, Interpersonal Needs Questionnaire, and Mini-International Neuropsychiatric Interview suicidality module.

RESULTS

Participants' mean age was 48.6 (SD = 13.4) and the majority was male (89.1%). The proportions of those at high, medium, and low suicide risk were 18.5%, 20%, and 15.4%, respectively. Depression was associated with suicide risk directly and indirectly by increasing perceived burdensomeness (PB) and the indirect effect of depression on suicide risk mediated by PB was contingent on the level of thwarted belongingness (TB). PB was associated with suicide risk even after controlling for depression, suggesting its independent effect on suicide risk.

CONCLUSIONS

PB and TB are potential mechanisms through which depression is associated with suicide risk, supporting the applicability of the interpersonal theory of suicide to understanding a complex interplay of risk factors in people with HIV/AIDS. Moreover, given the independent association of PB with suicide risk, as well as a protective effect of TB in suicide risk, monitoring and management of these factors should be included in the care of people with HIV/AIDS.

Association between perceived HIV stigma, social support, resilience, self-esteem, and depressive symptoms among HIV-positive men who have sex with men (MSM) in Nanjing, China

Among Chinese HIV-positive men who have sex with men (MSM), high levels of depression are common. The association between HIV and depression is attributed to several factors, particularly HIV-related stigma. However, to date, how HIV-related stigma leads to depression among Chinese HIV-positive MSM is still unclear. As such, this study aims to examine the relationships between perceived HIV stigma, social support, resilience, self-esteem, and depressive symptoms among HIV-positive MSM in China. We conducted a cross-sectional survey study among 347 HIV-positive MSM from July to August 2016 in Nanjing, China. Measurements were sociodemographic and psychological constructs including perceived HIV stigma, social support, resilience, self-esteem, and depressive symptoms. Structural equation modeling (SEM) was used to examine the relationships among these constructs. Overall,134 (38.6%) participants had depressive symptoms. Perceived stigma was directly associated with depressive symptoms (β = .196, p < .001). Perceived stigma also indirectly affected depressive symptoms (β = .200, p < .001)through social support and self-esteem. Social support (β = -.124, p = .004) and self-esteem (β = -.536, p = .001), but not resilience, were direct predictors of depressive symptoms. Resilience was directly associated with self-esteem (β = .512, p < .001). Perceived HIV stigma could directly and indirectly impact depressive symptoms in HIV-positive MSM. Improving personal self-esteem, resilience and social support might reduce impact of perceived stigma on depressive symptoms among HIV-positive MSM in China.

A pathway analysis of exploring how HIV-related stigma affects social capital among people living with HIV/AIDS in China

HIV-related stigma is the most common and serious social problem which people living with HIV/AIDS (PLWHA) have to face. However, the impact of HIV stigma on social capital is not yet clear. Therefore, this study aims to understand the relationship between HIV stigma and social capital, and explore the mechanism of how HIV stigma influences social capital among Chinese PLWHA on this basis. An institutional based cross-sectional study was conducted from Nov 2015 to Jan 2016 in Wuhan, China, using a self-reporting questionnaire. A total of 552 PLWHA participated, and 520 valid questionnaires were included. Multiple linear regression analysis showed that lower education level, lower monthly income, higher internalized stigma, and anticipated stigma were significantly associated with lower social capital. Results of path analysis showed that although perceived community stigma has no direct effect on social capital, but it can affect social capital through internalized stigma and anticipated stigma. In conclusion, increased HIV stigma and reduced social capital are frequent among PLWHA in China. Perceived community stigma may cause PLWHA to internalize stigma and anticipate stigmatizing experiences, resulting in the reduction of social capital. These findings suggest that perceived community stigma should become the target of stigma intervention strategy among Chinese PLWHA.