Study On The Construction Of The Assessment Tool Of HIV-related Psychological Distress

BackgroundWith the transition of global AIDS treatment into the "chronic disease era",the mental health of the AIDS population has emerged as a medical and social issue that cannot be ignored.In the realm of AIDS psychological research,apart from anxiety and depression,HIV-related psychological distress(HRPD)is attracting more and more attention among researchers at home and abroad.However,the complexity of the concept and connotation of HRPD has not been explored,and there are some issues such as vague definition and lack of theoretical basis,which further limits the generation of accurate specific tools of assessing HRPD.Objectives1.To define the concept of HRPD and analyze the structure elements.2.To develop the HIV-related psychological distress scale(HRPDS)and evaluate the psychometric properties.3.To investigate the current status and influence factors of HRPD among HIV/AIDS patients who received antiretroviral therapy treatment(ART)in Beijing.Methods1.Relevant studies on HRPD were gathered through systematic retrieval of commonly used databases at home and abroad.Firstly,based on the theory of psychological stress and Lazarus’ stress and coping theory,the concept analysis method proposed by Walker and Avant was adopted to analyze the concept of HRPD.Then,using the Delphi expert consultation method,the concept and specific structure elements of HRPD were defined.2.The items of HRPDS were developed preliminary using the established structure elements of HRPD as the theoretical framework,in conjunction with literature research,semi-structured interview,group discussion,Delphi expert consultation,and pre-survey.A total of 330 HIV/AIDS patients were used for item selection to form a formal scale,329 HIV/AIDS patients were chosen again for the survey,to evaluate the reliability and the validity of the HRPDS,and the optimal cut-off values were determined by plotting the ROC curve using the Kessler-10 scale as the criterion.3.Using a cross-sectional survey method,a convenience sample of 765 HIV/AIDS patients was recruited in Beijing and surveyed online by using a general data questionnaire and HRPDS.The influencing factors were examined using Chi-square,Fisher’s exact probability method,and logistic regression.Results1.According to the results of concept analysis,HRPD are actual or potential multidimensional distressful experiences experienced by HIV/AIDS patients after receiving clinical treatment,they are intertwined by physical,psychological,social,and spiritual trauma,which mainly includes four dimensions(distress of disease life,distress of treatment adherence,distress of identity and distress of disclosure)and eight components.2.HRPDS which includes 4 dimensions and 22 items were developed,the Cronbach’s α coefficient was 0.871 for the total scale and 0.853～0.893 for the subscales,and the split-half(odd-even)correlation coefficient was 0.931.The total CVI value of the scale was 0.950,and the CVI of each item was 0.800～1.000.The exploratory factor analysis extracted four common factors,which were distress of disease life(7 items),distress of treatment adherence(3 items),distress of identity(6 items)and distress of disclosure(6 items),with a cumulative variance contribution rate of 65.186%,and the confirmatory factor analysis showed a reasonable fit of the factor model.The optimal cut-off value for HRPD screening was determined by the Youden Index’s maximum value,which was 63 points.3.Among the 765 HIV/AIDS patients investigated,the detection of rate of HRPD was 83.27%.Logistic regression analysis showed that no fixed work,receiving antiviral therapy for 1～3 years,not taking medication on time and poor mental health were risk factors for HRPD,while marital status(married),adhering to condom use,long time to diagnosis,and high monthly income(>10,000 yuan)were protective factors.Conclusions1.The defined concept and structural elements of HRPD are scientific and reliable,and it can provide a theoretical basis for relevant research on HRPD in the future.2.The HRPDS developed in this study is reliable and valid,making it useful for medical staff to scientifically and systematically assess HRPD among HIV/AIDS patients.3.HRPD is common among HIV/AIDS patients who received ART,and the prevalence of it is high.It is suggested that healthcare workers should pay more attention to the evaluation of HRPD and provide timely intervention for patients with risk factors,so as to improve their quality of life.