Suicide Behavior Related Research Among People Living With HIV/AIDS Based On Social Capital Theory And Catastrophe Theory

Background:With antiretroviral therapy widely used the life expectancy of people living with HIV/AIDS（PLWHA）was improved significantly.But suicide,which is common in PLWHA populationbrings a new threat to their lives,now suicide has become a new direction of the current HIV/AIDS related research,and find new study theory in order to more in-depth understanding suicide is currently the key point in the study of suicide behavior among PLWHA.In recent years,social capital theory has been a hot topic in many fields such as politics,economy and health.Similarly,social capital theory will play a unique role in social problems such as AIDS and suicide.On the other hand,the study of behavior from the nonlinear perspective has become a hot spot in the field of behavior research,and suicide behavior is gradually considered as a nonlinear and discontinuous dynamic behavior process by relevant researchers.Among them,the most widely used nonlinear research theory is catastrophe theory,and the cusp catastrophe model based on this theory can well quantitatively calculate the prediction effect of influencing factors on suicidal behavior.At present,the research on social capital and nonlinear of suicidal behavior among PLWHA is still in a blank stage,and systematic research is urgently needed to fill this gap.Purpose:The purpose of this study is to know the status of suicide behavior among PLWHA and its related social and psychological factors,and then based on social capital theory and catastrophe theory,analyze the effect of social capital and the related psychological characteristics on suicide behavior among PLWHA from linear and nonlinear perspective,provide a scientific basis for exploring new prevention and intervention program for suicidal behavior among this population.Method:Using convenient sampling method,this study selected PLWHA who received follow-up treatment as research objects in Wuhan medical treatment center from November 2015 to January 2016,and conducted anonymous questionnaire survey on 523 PLWHA who met the inclusion criteria.Investigation content includes social demographic characteristics（age,gender,occupation,etc.）,AIDS related characteristics（infection route,infection time,antiviral treatment time,CD4,health tatus,etc.）,psychological characteristics（perceived stigma,post-traumatic stress disorder（PTSD）and resilience）,social capital,and suicidal behavior（including post-diagnosis suicidal ideation,suicide attempts,and suicidal ideation in past month）.We conducted descriptive analysis,chi-square test,variance analysis,multivariate logistic regression and multivariate linear regression using SPSS version 20.0,AMOS.24.0 software is used for structural equation model path analysis,and R software"Cusp"package is used for Cusp mutation model analysis.Results:1)Descriptives:Among 523 PLWHA,The average age of the partiipants was34.3±11.7 years old（16-73 years old）.The majority of ethnic groups are Han（95.0%）.The registered residence of the respondents was mainly in Wuhan,accounting for 65.6%.Urban and rural PLWHA accounted for 69.0%and 31.0%respectively.The majority（62.8%）of the respondents were unmarried.69.1%（n=355）were employed,8.4%were students,and 22.6%were retired or unemployed.Nearly half of the respondents（48.2%）earn less than 3,000 yuan a month.322 people（61.6%）were infected with HIV through homosexual contact,and the average time from the diagnosis of HIV+to the questionnaire survey was 1.6（0.7,3.1）years.The mean duration of antiviral therapy was 1.1（0.4,2.2）years,the mean CD4 cell count was 395,and 47.4%of the patients were in good health.The average score of social capital was 22.79±5.74.2)Suicidal behavior and influencing factors:Among the participants,173（33.0%）had suicidal ideation after diagnosis,13.7%（n=72）had suicide attempts,and12.2%（n=64）had suicidal ideation in past month.Multiple logistic regressionresults of suicidal ideation after diagnosis showed that,age 35-44（OR=2.34）and students（OR=2.55）are risk factors of suicidal ideation.Social capital（OR=0.95）,perceivedstigma（OR=1.70）,PTSD（OR=3.94）,and resilience（OR=1.60）were also found to be associated with post-diagnosis suicidal ideation（P<0.05）.Multivariate logistic results of suicide attempts after diagnosis showed that age 35-44 years old（OR=2.49）,social capital（OR=0.94）,perceived stigma（OR=2.42）and PTSD（OR=3.33）significantly affected the occurrence of suicide attempts.Multivariate Logistic results of suicidal ideation in the past month showed that self-assessed health status（OR=2.84）and PTSD（OR=4.10）had significant influence on suicidal ideation in the past month.Multivariate linear regression of overall suicidal behaviors showed that age（β=0.016,P=0.011）,health status（β=-0.198,P=0.014）,social capital（β=-0.027,P=0.003）,PTSD（β=0.037,P<0.001）,and resilience（β=-0.013,P=0.013）were the main factors affecting suicidal behavior.3)Psychological pathwayfrom social capital to suicidal behavior:Medication analysis results suggest:When add the perceived stigma,resilience andPTSDbetween social capital and suicidal behaviors respectively,perceived stigma,resilience andPTSDall have amediated effect,the mediating effects were-0.140,-0.106 and-0.0.029,respectively.In the comprehensive path analysis,the total effect of social capital on suicide behavior is-0.111,all of which are indirect effects.Perceived stigma indirectly affects suicidal behavior,and the effect is 0.274.Psychological resilience indirectly affects suicide behavior,the total effect is-0.069;PTSD had a direct effect on suicidal behavior,with a magnitude of 0.495.The specific psychological path of social capital on suicidal behaviors is that social capital influences perceivedstigma and resilience,further influences PTSD and finally leads to the occurrence of suicidal behaviors.4)Cusp catastrophe modeling of suicide behaviors:Social capital is the asymmetryvariable and perceived stigma is the bifurcationvariable,which together affect the catastropheprocess of PLWHA suicide behavior.Preliminary results of direct method indicates that the cusp catastrophe model is meaningful as a nonlinear method to study PLWHA suicide behavior.The results of the multivariate stochastic cusp catastrophe model showed that the fitting effect of the cusp mutation model（R²=0.483,AIC=1014,BIC=1052）was better than that of the linear regression model（R²=0.127,AIC=1507,BIC=1537）after controlling for the covariate variables.There was a significant negative correlation between social capital and suicidal behavior（a₁=-0.260,P<0.01）,which was split by discrimination perception（b₁=0.548,P<0.001）.Conclusions:（1）Suicidal behaviors are common in PLWHA population.Age,occupation are significantly correlated suicidal behaviors.High perceived stigma,the presence of PTSD and low resilience are important psychological factors affecting suicidal behaviors.（2）Social capital was significantly correlated with PLWHA suicide behavior,the higher the social capital,the lower the incidence of suicide behavior;In the dimension of social capital,social network and social trust was significantly associated with suicideamong PLWHA.（3）Perceived stigma,PTSD,resilienceplay mediated role in the relationsip of social capital and suicide.Social capital can reduce the perceived stigma and enhance the resilience of PLWHA,thus lightening the symptoms of PTSD and finally decrease the occurrence of suicidal behaviors;（4）.The linear relationship between social capital and suicide behavior amongPLWHA was limited,the fitting of the cusp catastrophe model to the suicidal behavior of PLWHA population is better than that of the linear model,which can effectively explain the non-linearity and discontinuity of the suicidal behavior of PLWHA population（5）The results of this study emphasize that the importance of PLWHA suicide prevention lies in enhancing the social capital and reducing perceived stigmaof thispopulationare important intervention ways to reduce suicide behaviors.