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Chen Z, He K, Chen Y, Zhang X, Ye Z, Xie C, Luo T, Fu X, Shi W, Zhang Z, Cao L, Li Y. Sleep quality mediates the effect of medical social support on depression symptoms in patients with HIV/AIDS. BMC Public Health 2024; 24:1429. [PMID: 38807089 PMCID: PMC11134677 DOI: 10.1186/s12889-024-18174-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Accepted: 02/21/2024] [Indexed: 05/30/2024] Open
Abstract
OBJECTIVES The purpose of our study is to further understanding of the depression symptoms of HIV/AIDS patients in Guilin, Guangxi via exploring whether there is a mediating effect of sleep quality on medical-social support and depression symptoms and therefore provide a theoretical basis for application of medical-social support to alleviate depression symptoms of HIV/AIDS patients. METHODS A convenience sampling method was used to select 200 HIV/AIDS patients for the study. Depression symptoms, sleep quality, and medical-social support of the study participants were investigated using The Center for Epidemiological Studies Depression Scale (CES-D), The Pittsburg Sleep Quality Index (PSQI), and The Medical Outcomes Study Social Support Survey (MOS-SSS), respectively. Predictors of depression symptoms were explored by multiple linear regression, and Pearson correlation was used to analyze the relationship between sleep quality, medical-social support, and depression symptoms. Mediating effect analysis was performed by nonparametric Bootstrap test. RESULTS In this study, the incidence of depression symptoms was 54.4%. Multiple linear regression analysis showed that leanness (β = 0.161, P = 0.008), obesity (β = 0.186, P = 0.002), sleep quality score > 7 (β = 0.331, P < 0.001), and medical-social support score > 56 (β = -0.247, P < 0.001) could influence depression symptoms of HIV and Pearson's correlation analysis demonstrated that there was a two-way correlation between sleep quality, medical social support and depression symptoms (P < 0.05). In addition, Bootstrap tests showed that medical-social support might affect depression symptoms not only directly but also indirectly through the mediating effect of sleep quality with the direct and mediating effects accounting for 77.25% and 22.75% of the total effect, respectively. CONCLUSION The prevalence of depression symptoms is high among HIV/AIDS patients in Guilin City. The depressive symptoms of PLWHs(people living with HIV) are related to their sleep quality and medical-social support, and sleep quality partially mediates the relationship between medical-social support and depression symptoms. Therefore, interventions to improve sleep quality and medical-social support have the potential to allay the depression symptoms of HIV/AIDS patients.
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Affiliation(s)
- Ziqi Chen
- Department of Environmental Health and Occupational Medicine, School of Public Health, Guilin Medical University, Guilin, Guangxi, 541199, People's Republic of China
- Guangxi Health Commission Key Laboratory of Entire Lifecycle Health and Care, Guilin Medical University), Guilin, Guangxi, 541199, People's Republic of China
| | - Kailian He
- Department of Environmental Health and Occupational Medicine, School of Public Health, Guilin Medical University, Guilin, Guangxi, 541199, People's Republic of China
- Health and Wellness Section, Yibin Center for Disease Control and Prevention, Yibin, Sichuan, 644600, People's Republic of China
| | - Yulu Chen
- Department of Environmental Health and Occupational Medicine, School of Public Health, Guilin Medical University, Guilin, Guangxi, 541199, People's Republic of China
- Guangxi Health Commission Key Laboratory of Entire Lifecycle Health and Care, Guilin Medical University), Guilin, Guangxi, 541199, People's Republic of China
| | - Xiashuang Zhang
- Department of Environmental Health and Occupational Medicine, School of Public Health, Guilin Medical University, Guilin, Guangxi, 541199, People's Republic of China
- Guangxi Health Commission Key Laboratory of Entire Lifecycle Health and Care, Guilin Medical University), Guilin, Guangxi, 541199, People's Republic of China
| | - Zeyan Ye
- Department of Environmental Health and Occupational Medicine, School of Public Health, Guilin Medical University, Guilin, Guangxi, 541199, People's Republic of China
- Guangxi Health Commission Key Laboratory of Entire Lifecycle Health and Care, Guilin Medical University), Guilin, Guangxi, 541199, People's Republic of China
| | - Chaofan Xie
- Department of Environmental Health and Occupational Medicine, School of Public Health, Guilin Medical University, Guilin, Guangxi, 541199, People's Republic of China
- Guangxi Health Commission Key Laboratory of Entire Lifecycle Health and Care, Guilin Medical University), Guilin, Guangxi, 541199, People's Republic of China
| | - Tingyu Luo
- Department of Environmental Health and Occupational Medicine, School of Public Health, Guilin Medical University, Guilin, Guangxi, 541199, People's Republic of China
- Guangxi Health Commission Key Laboratory of Entire Lifecycle Health and Care, Guilin Medical University), Guilin, Guangxi, 541199, People's Republic of China
| | - Xiaofeng Fu
- Department of AIDS Control and Prevention, Guilin Center for Disease Control and Prevention, Guilin, Guangxi, 541000, People's Republic of China
| | - Wuxiang Shi
- Health Management Unit, Faculty of Humanities and Management, Guilin Medical University, Guilin, Guangxi, 541199, People's Republic of China
| | - Zhiyong Zhang
- Department of Environmental Health and Occupational Medicine, School of Public Health, Guilin Medical University, Guilin, Guangxi, 541199, People's Republic of China
- Guangxi Health Commission Key Laboratory of Entire Lifecycle Health and Care, Guilin Medical University), Guilin, Guangxi, 541199, People's Republic of China
| | - Liang Cao
- Department of Environmental Health and Occupational Medicine, School of Public Health, Guilin Medical University, Guilin, Guangxi, 541199, People's Republic of China.
- Department of Experimental Teaching Center, School of Public Health, Guilin Medical University, Guilin, Guangxi, 541199, People's Republic of China.
| | - You Li
- Department of Environmental Health and Occupational Medicine, School of Public Health, Guilin Medical University, Guilin, Guangxi, 541199, People's Republic of China.
- Guangxi Health Commission Key Laboratory of Entire Lifecycle Health and Care, Guilin Medical University), Guilin, Guangxi, 541199, People's Republic of China.
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Knippler ET, Martinez AJ, Amiri I, Madundo K, Mmbaga BT, Goldston DB, Relf MV, Knettel BA. Challenges and opportunities for improving mental health care and preventing suicide among people living with HIV: Perspectives of mental health professionals in Tanzania. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0002762. [PMID: 38363789 PMCID: PMC10871509 DOI: 10.1371/journal.pgph.0002762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 01/17/2024] [Indexed: 02/18/2024]
Abstract
People living with HIV (PLWH) experience unique stressors that contribute to emotional distress, and PLWH are more than twice as likely to die by suicide when compared to the general population. In countries like Tanzania, there is a relatively high burden of HIV but few resources to support mental health needs. To gain a better understanding of mental health challenges experienced by PLWH in northern Tanzania and identify opportunities for intervention, we interviewed 12 mental health professionals working in the Kilimanjaro region. Thematic analysis was used to explore drivers and impacts of emotional distress, community influences on mental health, and gaps and barriers to existing mental health care. Perspectives from mental health workers highlight the compounding effects of stress related to HIV status, family conflict, finances, and other social challenges, which can lead to poor HIV treatment outcomes and suicidal ideation. Cultural beliefs and stigma surrounding both mental health and HIV limit care-seeking behavior for mental health issues. Those who do seek care often encounter barriers related to poor mental health infrastructure, including a lack of providers, limited financial resources, and little integration into other health services. There is a clear need for investment in the mental health care system, as well as interventions to improve knowledge and perceptions of mental health and comprehensively address stressors. We describe feedback on a proposed telehealth counseling intervention integrated into routine HIV services, which shows strong potential to mitigate barriers to mental health treatment, reduce suicidal ideation, and support the wellbeing of PLWH.
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Affiliation(s)
- Elizabeth T. Knippler
- Duke Center for AIDS Research, Durham, North Carolina, United States of America
- Duke University School of Nursing, Durham, North Carolina, United States of America
| | - Alyssa J. Martinez
- Duke Global Health Institute, Durham, North Carolina, United States of America
| | - Ismail Amiri
- Duke Global Health Institute, Durham, North Carolina, United States of America
| | - Kim Madundo
- Kilimanjaro Christian Medical Centre, Moshi, Tanzania
- Kilimanjaro Christian Medical University, Moshi, Tanzania
| | - Blandina T. Mmbaga
- Duke Global Health Institute, Durham, North Carolina, United States of America
- Kilimanjaro Christian Medical Centre, Moshi, Tanzania
- Kilimanjaro Christian Medical University, Moshi, Tanzania
- Kilimanjaro Clinical Research Institute, Moshi, Tanzania
| | - David B. Goldston
- Department of Psychiatry & Behavioral Sciences, Duke University, Durham, North Carolina, United States of America
| | - Michael V. Relf
- Duke University School of Nursing, Durham, North Carolina, United States of America
- Duke Global Health Institute, Durham, North Carolina, United States of America
| | - Brandon A. Knettel
- Duke University School of Nursing, Durham, North Carolina, United States of America
- Duke Global Health Institute, Durham, North Carolina, United States of America
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Pauley A, Buono M, Metcalf M, West K, Rent S, Nkenguye W, Sawe Y, Mikindo M, Kilasara J, Boshe J, Knettel BA, Mmbaga BT, Staton CA. " A Man Never Cries": A Mixed-Methods Analysis of Gender Differences in Depression and Alcohol Use in Moshi, Tanzania. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.11.14.23298216. [PMID: 38014016 PMCID: PMC10680871 DOI: 10.1101/2023.11.14.23298216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2023]
Abstract
Background Unhealthy alcohol use negatively impacts many components of health and wellness, including mental health conditions like major depressive disorder (MDD). Globally, gender differences are common for both alcohol use behaviors and MDD, but these differences have not been studied within Moshi, Tanzania. To provide more effective and culturally appropriate mental health treatments, gender nuances around these conditions must be known. As such, this study aims to explore gender differences in MDD, alcohol use, and other aspects of mental well-being among patients at Kilimanjaro Christian Medical Center (KCMC) in Moshi. Methods Six hundred and seventy-six patients presenting for care at the KCMC Emergency Department (ED) and Reproductive Health Centre (RHC) were enrolled in this mixed-methods study between October 2021 and May 2022. Patients were selected through systematic random sampling and completed quantitative surveys including the Alcohol Use Disorder Identification Test (AUDIT) and the Patient Health Questionnaire 9 (PHQ-9). Nineteen patients were purposively chosen from the study population to participate in in-depth interviews (IDIs) exploring topics related to alcohol use, gender, and depression. Descriptive frequencies, univariate log-binomial regressions, and a linear regression model were used to analyze quantitative data, all of which were analyzed in RStudio. A grounded theory approach was used to analyze all IDIs in NVivo. Results Average [SD] PHQ-9 scores were 7.22 [5.07] for ED women, 4.91 [4.11] for RHC women, and 3.75 [4.38] among ED men. Similarly, ED women held the highest prevalence of MDD (25%) as compared to RHC women (11%) and ED men (7.9%) (p<0.001). Depressive symptoms were associated with higher AUDIT scores only for ED men (R2 = 0.11, p<0.001). Our qualitative analysis showed that while present for women, social support networks were notably absent for men in Moshi, the lack of which was seen to play a role in alcohol use. For men, alcohol was described as a coping mechanism for stress. Conclusion Intersectionality of gender, alcohol use, and depression is influenced by sociocultural and behavioral norms in Moshi. As such, multi-layered, gender-differentiated programming should be considered for the treatment of substance use and mental health conditions in this region.
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Affiliation(s)
- Alena Pauley
- Duke Global Health Institute, Duke University, Durham, NC, USA
| | - Mia Buono
- Duke Global Health Institute, Duke University, Durham, NC, USA
| | | | - Kirstin West
- Duke Global Health Institute, Duke University, Durham, NC, USA
| | - Sharla Rent
- Duke Global Health Institute, Duke University, Durham, NC, USA
- Duke Department of Pediatrics, Duke University Medical Center, Durham, NC, USA
| | - William Nkenguye
- Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Yvonne Sawe
- Kilimanjaro Clinical Research Institute, Moshi, Tanzania
| | | | - Joseph Kilasara
- Kilimanjaro Clinical Research Institute, Moshi, Tanzania
- Department of Clinical Nursing, Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Judith Boshe
- Kilimanjaro Clinical Research Institute, Moshi, Tanzania
- Kilimanjaro Christian Medical Center, Moshi, Tanzania
| | - Brandon A Knettel
- Duke Global Health Institute, Duke University, Durham, NC, USA
- Duke University School of Nursing, Durham, NC, USA
| | - Blandina T Mmbaga
- Duke Global Health Institute, Duke University, Durham, NC, USA
- Kilimanjaro Clinical Research Institute, Moshi, Tanzania
- Kilimanjaro Christian Medical Center, Moshi, Tanzania
| | - Catherine A Staton
- Duke Global Health Institute, Duke University, Durham, NC, USA
- Duke Department of Surgery, Duke University Medical Center, Durham, NC, USA
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Minja L, Knettel BA, Pan W, Madundo K, Amiri I, Joel L, Knippler E, Relf MV, Vissoci JRN, Staton CA, Msoka EF, Tarimo CS, Katiti V, Mmbaga BT, Goldston DB. Validation of a culturally sensitive, Swahili-translated instrument to assess suicide risk among adults living with HIV in Tanzania. Glob Ment Health (Camb) 2023; 10:e67. [PMID: 38024799 PMCID: PMC10643229 DOI: 10.1017/gmh.2023.59] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 09/05/2023] [Accepted: 09/28/2023] [Indexed: 12/01/2023] Open
Abstract
In Tanzania, there are high rates of suicidal thoughts and behavior among people living with HIV (PLWH), yet few instruments exist for effective screening and referral. To address this gap, we developed and validated Swahili translations of the Columbia Suicide Severity Rating Scale (C-SSRS) Screen Version and two accompanying scales assessing self-efficacy to avoid suicidal action and reasons for living. We administered a structured survey to 80 PLWH attending two HIV clinics in Moshi, Tanzania. Factor analysis of the items revealed four subscales: suicide intensity, self-efficacy to avoid suicide, fear and social concern about suicide, and family and spirituality deterrents to suicide. The area under the receiver operating curve showed only suicide intensity, and fear and social concern met the prespecified cutoff of ≥0.7 in accurately identifying patients with a plan and intent to act on suicidal thoughts. This study provides early evidence that brief screening of intensity of suicidality in the past month, assessed by the C-SSRS Screen Version, is a strong, resource-efficient strategy for identifying suicide risk in the Tanzanian setting. Patients who report little fear of dying and low concern about social perceptions of suicide may also be at increased risk.
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Affiliation(s)
- Linda Minja
- Kilimanjaro Clinical Research Institute, Moshi, Tanzania
| | - Brandon A. Knettel
- Duke University School of Nursing, Durham, NC, USA
- Duke Global Health Institute, Duke University, Durham, NC, USA
| | - Wei Pan
- Duke University School of Nursing, Durham, NC, USA
- Department of Population Health Sciences, Duke University, Durham, NC, USA
| | - Kim Madundo
- Kilimanjaro Christian Medical Centre, Moshi, Tanzania
- Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Ismail Amiri
- Kilimanjaro Clinical Research Institute, Moshi, Tanzania
- Duke Global Health Institute, Duke University, Durham, NC, USA
- Kilimanjaro Christian Medical Centre, Moshi, Tanzania
| | - Louise Joel
- Kilimanjaro Christian Medical Centre, Moshi, Tanzania
| | - Elizabeth Knippler
- Duke University School of Nursing, Durham, NC, USA
- Duke Center for AIDS Research, Duke University, Durham, NC, USA
| | - Michael V. Relf
- Duke University School of Nursing, Durham, NC, USA
- Duke Global Health Institute, Duke University, Durham, NC, USA
| | - Joao Ricardo N. Vissoci
- Duke Global Health Institute, Duke University, Durham, NC, USA
- Duke Department of Emergency Medicine, Durham, NC, USA
| | - Catherine A. Staton
- Duke Global Health Institute, Duke University, Durham, NC, USA
- Duke Department of Emergency Medicine, Durham, NC, USA
| | - Elizabeth F. Msoka
- Kilimanjaro Clinical Research Institute, Moshi, Tanzania
- Kilimanjaro Christian Medical Centre, Moshi, Tanzania
- Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | | | - Victor Katiti
- Kilimanjaro Clinical Research Institute, Moshi, Tanzania
- Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Blandina T. Mmbaga
- Kilimanjaro Clinical Research Institute, Moshi, Tanzania
- Duke Global Health Institute, Duke University, Durham, NC, USA
- Kilimanjaro Christian Medical Centre, Moshi, Tanzania
- Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - David B. Goldston
- Department of Psychiatry & Behavioral Sciences, Duke University, Durham, NC, USA
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