| Objectives:To investigate the perceived discrimination among people living with HIV/AIDS(PLWHA),how it influences depression and suicidal ideation via mediation,in order to provide scientific evidence for psychological intervention among PLWHA.Methods:We surveyed 465 eligible PLWHA from July-August 2016 in No 2.Nanjing Hospital for their sociodemographics,HIV infections(transmission route,infection timeframe,antiretroviral therapy initiation,liver function and coinfections),disease disclosure,psychosocial factors(perceived discrimination,social support,depression,resilience,self-esteem)and related behaviors(sexual risk behaviors,medication adherence,suicidal actions).We conducted univariate,bivariate and multiple logistic regression analysis using SPSS version 20.0,and conducted mediation analysis using AMOS version 24.0.Results:1)Descriptives:Among 465 PLWHA,their mean age was 37.22±12.01.Most of them were male(95.1%),and majorly from urban area(63.7%),38.5%had a college degree or above,53.3%were unmarried,and 32.5%married.50.3%were homosexual.51.8%cohabited with family members whereas 29.5%lived by themselves.After infected with HIV,70.5%disclosed their infection statuses to family members.78.9%of the PLWHA were infected with HIV for more than 1 year.Transmission route was mainly sexual transmission(94.2%),among which 73.1%were homosexually transmitted while 21.1%were heterosexually transmitted.There were 67.7%of them had been taking antiretroviral medications for more than 12 months.Among 418 PLWHA who had been taking antiretroviral medicines over 1 month,86.3%were adherent.60.4%reported had had sex in the past 6 months.Consistent condom use proportions were 86.49%,68.72%,64.29%among those had sex with spouse,male-male sex,and extramarital sex,respectively.29.0%of the PLWHA had low social support,29.9%reported low resilience,and 15.3%had low self-esteem.2)Perceived discrimination and its correlates:Scores of perceived discrimination was between 43-118,and averaged 81.25±12.69.25.2%had higher perceived discrimination.Marital status,sexual orientation,social support,depression,self-esteem were the correlates of perceived discrimination.Divorced/widowed PLWHA were 1.96(95%CI:1.57-6.10)times more likely to have a high level perceived discrimination compared with unmarried PLWHA.Bisexual/unsure and homosexual sexual orientation were 2.62(95%CI:1.35-5.08)and 2.23(95%CI:1.05-3.66)times more likely to have a high level perceived discrimination compared with heterosexuals.Depressed PLWHA were 1.97(95%CI:1.18-3.29)times more likely to experience a high level perceived discrimination compared with non-depressed.PLWHA with low self-esteem were 3.10(95%CI:1.15-3.13)times more likely to experience a high level perceived discrimination compared with those of high self-esteem.3)Perceived discrimination as mediator for depression:Scores of depression ranged 0-54,with an average of 13.89±11.57.38.1%were at high-level of depression..Among those who reported high-level of perceived discrimination,59.0%had depression.This is higher than the proportion among those with low-level of perceived discrimination(31.0%).PLWHA with high-level of perceived discrimination were 2.18(95%CI:1.30-3.65)times more likely to have depression compared with those with low-level of perceived discrimination.Medication analysis results suggest:when add the social support,self-esteem,resilience to perceived discrimination and depression,respectively,social support,self-esteem and resilience are working as mediation variable,the mediation effects were 0.052,0.196 and 0.083,respectively accounted for 12.15%of the total effect of each model,45.79%and 19.39%.Perceived discrimination influenced depression both directly and indirectly.The total effect is 0.429,0.207 is direct effect,0.222 is indirect effect.Self-esteem directly influenced depression with the effect size of-0.504.Social support influenced depression both directly(-0.147)and indirectly(-0.064)with a total effect of-0.211.Resilience influenced depression indirectly(-0.245).4)Perceived discrimination as mediator for suicidal ideation:Among surveyed PLWHA,31.6%reported had suicidal thoughts,11.4%had suicidal plans.Patients with high-level perceived discrimination reported higher(50.4%)suicidal thoughts then those with low-level perceived discrimination(25.3%).PLWHA with high-level of perceived discrimination were 2.04(95%CI:1.22-3.40)times more likely to have suicidal ideation compared with those with low-level of perceived discrimination.Medication analysis results suggest:When add the resilience,social support,self-esteem,depression between perceived discrimination and suicidal ideation respectively,social support,self-esteem,depression,have the effect of intervening variable,the mediation effects were 0.005,0.098 and 0.129,respectively accounted for 1.33%of the total effect of each model,26.2%and 34.49%.Perceived discrimination influenced suicidal ideation directly and indirectly.The total effect is 0.374,0.226 is direct effect,0.149 is indirect effect.Depression directly influenced suicidal ideation with the effect size of 0.218.Self-esteem influenced suicidal ideation both directly(-0.148)and indirectly(-0.110)with a total effect of-0.258.Social support only influenced suicidal ideation indirectly(--0.070).Conclusion:1)PLWHA had high-level of perceived discrimination.Those divorced/widowed,bisexual/unsure sexual orientation,low social support and self-esteem,and depressed PLWHA were more likely to have higher level of perceived discrimination.2)A large proportion of PLWHA reported depressive symptoms.Those with high-levels of perceived discrimination were more likely to report depression.Perceived discrimination could influence depression indirectly through self-esteem,resilience and social support.Self-esteem had the largest mediation effect.3)Many PLWHA reported suicidal ideation.Those with high-levels of perceived discrimination were more likely to report suicidal ideation.Perceived discrimination could influence suicidal ideation indirectly through self-esteem,depression and social support.Depression had the largest mediation effect.4)Divorced/widowed,bisexual/unsure sexual minorities should be focused for PLWHA psychological interventions.We need to pay close attention to their perceived discrimination and how it impacts depression and suicidal ideation.Interventionists might want to improve their self-esteem,resilience,and social support in order to buffer the negative impact introduced by perceived discrimination,so as to improve PLWHA's quality of life. |
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