The relationship between HIV serostatus disclosure, self-stigma, social support and suicidal ideation in AIDS patients
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摘要:
目的 分析AIDS患者的歧视知觉和自杀意念,以及歧视知觉、自杀意念和HIV感染结果告知及社会支持之间的关系。 方法 采用一般特征调查表、领悟社会支持量表(perceived social support scale, PSSS)、歧视知觉量表(self-stigma scale, SSS)和贝克自杀意念量表中文版(Beck scale for suicide ideation-Chinese version, BSI-CV)对某省会城市1 276名AIDS患者进行匿名调查。 结果 54.2%(692/1 276)的样本报告自己在过去1周或抑郁最严重时有过自杀意念。多因素分析显示,控制其他因素,歧视知觉(OR=0.57, 95% CI: 0.45~0.72, P < 0.001)与社会支持呈负相关,感染结果告知(OR=1.47, 95% CI: 1.12~1.92, P=0.005)与社会支持呈正相关。歧视知觉(OR=5.53, 95% CI: 4.21~7.27, P < 0.001)与自杀意念呈正相关,社会支持(OR=0.58, 95% CI: 0.45~0.76, P < 0.001)与自杀意念呈负相关。感染结果告知在患者的歧视知觉与社会支持间起部分中介作用(中介效应占总效应比例为29.0%);社会支持在患者的歧视知觉与自杀意念间起部分中介作用(中介效应占总效应比例为17.5%)。 结论 AIDS患者当中有自杀意念的比例较高。低歧视知觉、将感染结果告知家人、朋友及固定伴侣的患者领悟到的社会支持更高。高歧视知觉、低社会支持的患者自杀意念较强。感染结果告知在患者的歧视知觉与社会支持间起部分中介作用,而社会支持则在患者的歧视知觉与自杀意念间起部分中介作用。 Abstract:Objective To investigate self-stigma and suicidal ideation in acquired immunodeficiency syndrome (AIDS) patients, and to explore the relationship between self-stigma, suicidal ideation, human immunodeficiency virus (HIV) serostatus disclosure and social support in AIDS patients. Methods A total of 1 276 AIDS patients in a provincial capital city were investigated anonymously using the general situation questionnaire, perceived social support scale (PSSS), self-stigma scale (SSS), and Beck scale for suicide ideation-Chinese version (BSI-CV). Results 54.2% (692/1 276) of the sample reported that they have suicidal ideation in the past week or the most severe depression. Multivariate analysis showed that after controlling for other factors, self-stigma was negatively correlated with social support (OR=0.57, 95% CI: 0.45-0.72, P < 0.001), and HIV serostatus disclosure was positively correlated with social support (OR=1.47, 95% CI: 1.12-1.92, P=0.005); self-stigma was positively correlated with suicidal ideation (OR=5.53, 95% CI: 4.21-7.27, P < 0.001), and social support was negatively correlated with suicidal ideation (OR=0.58, 95% CI: 0.45-0.76, P < 0.001). HIV serostatus disclosure played a partial mediating effect between self-stigma and social support (the mediating effect accounted for 29.0% of the total effect); social support played a partial mediating effect between self-stigma and suicidal ideation (the mediating effect accounted for 17.5% of the total effect). Conclusions The proportion of suicidal ideation is higher among AIDS patients. Patients with low self-stigma and who inform family, friends, and regular partners of the infection results perceive higher social support. Patients with high self-stigma and low social support have stronger suicidal ideation. The HIV serostatus disclosure plays a partial mediating role between self-stigma and social support in AIDS patients, while social support plays a partial mediating role between self-stigma and suicidal ideation. -
表 1 过去1周或抑郁最严重时自杀意念单因素分析[n(%)]
Table 1. Univariate analysis of suicidal ideation in the past 1 week or at the the most serve depression [n(%)]
变量 调查对象(n=1 276) 无自杀意念组(n=584) 有自杀意念组(n=692) χ2值 P值 HIV感染途径 143.62 < 0.001 男男同性行为感染 792(62.1) 259(44.3) 533(77.0) 其他途径感染 484(37.9) 325(55.7) 159(23.0) 性别 0.05 0.820 男 1 224(95.9) 561(96.1) 663(95.8) 女 52(4.1) 23(3.9) 29(4.2) 年龄(岁) 8.11 0.004 ≤33 704(55.2) 297(50.9) 407(58.8) >33 572(44.8) 287(49.1) 285(41.2) 户籍地 10.88 < 0.001 城市 743(58.2) 369(63.2) 374(54.0) 农村 533(41.8) 215(36.8) 318(46.0) 民族 4.58 0.032 汉族 1 192(93.4) 555(95.0) 637(92.1) 少数民族 84(6.6) 29(5.0) 55(7.9) 婚姻状况 0.24 0.623 未婚、离异、丧偶 1 006(71.8) 464(79.5) 542(78.3) 在婚 270(21.2) 120(20.5) 150(21.7) 独生子女 1.38 0.240 是 552(43.3) 263(45.0) 289(41.8) 否 724(56.7) 321(55.0) 403(58.2) 受教育情况 13.35 < 0.001 大学专科、本科在读学生 133(10.4) 41(7.0) 92(13.3) 非在读学生 1 143(89.6) 543(93.0) 600(86.7) 学历 1.07 0.302 本科以下 610(47.8) 270(46.2) 340(49.1) 本科及以上 666(52.2) 314(53.8) 352(50.9) 平均月收入(元) 49.62 < 0.001 ≤4 000 535(41.9) 183(31.3) 352(50.9) >4 000 741(58.1) 401(68.7) 340(49.1) 将感染结果告知家人、朋友、固定伴侣 3.42 0.064 是 970(76.0) 458(78.4) 512(74.0) 否 306(24.0) 126(21.6) 180(26.0) 除AIDS外患有其他慢性病 7.79 0.005 是 418(32.8) 168(28.8) 250(36.1) 否 858(67.2) 416(71.2) 442(63.9) 最近1次体检结果正常 0.58 0.446 是 975(76.4) 452(77.4) 523(75.6) 否 301(23.6) 132(22.6) 169(24.4) 歧视知觉 207.40 < 0.001 低(SSS≤34分) 601(47.1) 403(69.0) 198(28.6) 高(SSS>34分) 675(52.9) 181(31.0) 494(71.4) 社会支持 48.70 < 0.001 低(PSSS≤51分) 636(49.8) 229(39.2) 407(58.8) 高(PSSS>52分) 640(50.2) 355(60.8) 285(41.2) 表 2 感染结果告知、社会支持中介效应的检验
Table 2. Testing the mediating effect of HIV serostatus disclosure and social support
变量 自变量 因变量 回归方程 β值 sx OR(95% CI)值 χ2值 P值 感染结果告知在歧视知觉与社会支持间中介效应的依次检验 第1步 歧视知觉 社会支持 Y=-0.59X -0.59 0.12 0.50(0.44~0.70) 25.51 < 0.001 第2步 歧视知觉 感染结果告知 M1=-0.45X -0.45 0.14 0.60(0.49~0.84) 10.48 0.001 第3步 歧视知觉 社会支持 Y=-0.57X -0.57 0.12 0.57(0.45~0.72) 23.02 < 0.001 感染结果告知 +0.38M2 0.38 0.14 1.47(1.12~1.92) 7.78 0.005 社会支持在歧视知觉与自杀意念间中介效应的依次检验 第1步 歧视知觉 自杀意念 Y=1.76X 1.76 0.14 5.82(4.44~7.63) 162.58 < 0.001 第2步 歧视知觉 社会支持 M2=-0.57X -0.57 0.12 0.57(0.45~0.72) 23.02 < 0.001 第3步 歧视知觉 自杀意念 Y=1.71X 1.71 0.14 5.53(4.21~7.27) 150.79 < 0.001 社会支持 -0.54M2 -0.54 0.14 0.58(0.45~0.76) 15.69 < 0.001 -
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