A Cross-sectional Study On The Mental Health Among People Living With HIV/AIDS

ObjectivesThe goal of this study is to investigate the mental health status among people living with HIV/AIDS (PLWHA) who had a history of selling blood. The main aims of this study are:(1) To understand the general characteristics of PLWHA who has a history of selling blood and basic information about their family;(2) To investigate the mental health status of PLWHA, and analyze factors associated with mental health status;(3) To find out about the needs for psychological support services of PLWHA.MethodsThis study is a cross-sectional study. The psychological stress model is introduced as the fundamental theory and framework. Qualitative interview, quantitative survey and psychological test were conducted for data collection. Data collection is done in 7 village of high HIV/AIDS prevalence in central China. Firstly, we did face-to-face interview with five PLWHAs. Then we randomized 200 PLWHA who had a history of selling blood and one of their family members (e. g. spouse, or adolescent children) to participate in the survey. The structured questionnaire was used. At the same time, the respondents completed self-report psychological measures including the Depression Anxiety Stress Scales (21-item) and Connor-Davidson Resilience Scale (25-item). Each questionnaire was input into the computer twice by two skilled typists after checking and coding. SPSS 11.5 were used to do data analysis with t-test, chi-square test, multivariate regression analysis and Logistic regression analysis.Results1 Socio-demographic characteristics and HIV-related informationIn the last year, 49.0% of 200 HIV/AIDS families reported that their Per Capita Annual Net Income was less than 400RMB Yuan. In 73 (36.5%) out of 200 HIV/AIDS families, the couples are both HIV-positive. Among PLWHA who had a history of selling blood, more than half (51.5%) were female, and the median age is 42 years old. HIV-positive people in this study are all peasants. 75.0% of them completed the education of primary school and junior middle school. 86.0% of HIV-positive respondents were married and 18 respondents' spouses have died of MDS and 6 persons divorced or separated with their spouses directly because of HIV/AIDS. 42.5% of HIV-positive respondents reported their relatives' deaths of AIDS. 195 family members of PLWHA were included in this study, and 176 family members were HIV-positive respondents' spouses and the others are their children. The majority of the family members (93.3%) had participated in HIV antibody screening. 37.4% of family members was HIV-positive. There were 69 family members are HIV-positive with a history of selling blood. So there were totally 269 HIV-positive respondents in this study.HIV-positive respondents had sold blood more than 400 times at most, and the majority of them are detected HIV-positive around the year of 2000. Up to the survey, there were 40 HIV-positive respondents who had never participated in CD4 lymphocyte test. Among those HIV-positive respondents who knew their CD4 count of the last test, the mean of CD4 count was 210/μl. 81.4% of HIV-positive respondents were taking free medicine mostly from the center of disease control (96.6%), 57.7% of whom considered the medicine was effective. During the last month before the survey, 94.8% of HIV-positive respondents had different HIV-related physical symptoms, and 24.5% of them had more than three different kinds of specify symptoms. 52.4% of HIV-positive respondents claimed that the current physical condition was a great obstruction to heavy farm work.2 Mental Health Status and related factors2.1 Believes to fateCompared with HIV-negative respondents, HlV-positive respondents were more likely to believe that everything happened in life was due to fate. Many of them maintained that "poor or rich are dependent on one's fate" (34.5%), "the time and date of birth can influence one's whole life" (24.2%), "one's talent are born with" (23.8%), "everything has already been arranged by the God" (21.9%), "there are some methods to approach good things and to avoid bad things" (22.3%).2.2 HIV-related discrimination65.1% of HIV-positive respondents feel discrimination from others, and 8.2% reported severe discrimination.2.3 Social support13.8%——38.7% of HIV-positive respondents felt that the attitude of family members, relatives and neighbors towards them were worse than before finding out that they were HIV-positive. 89.6% had intimate friends with whom they could speak their mind to. But 42.7% of HIV-positive respondents claimed that very few or no one would give a hand when they were ill in bed. 36.4% said that very few or even no one would give any good advice when they were facing difficulties. In daily life, their family members took care of them for a long time (63.1%), dealt with lots of daily affairs for them (55.7%) and helped them to perform housework like washing clothes or cooking meals (50.9%). Moreover, about 90% of family members didn't feel shamed of living with a HIV carrier.2.4 Depression, anxiety, stress and relevant factorsAmong HlV-positive respondents, the median scores of depression, anxiety and stress were 8, 6 and 8, respectively. The medians were all higher than that in both general Chinese population (5.04, 5.01, 7.51) and HIV-negative respondents. The prevalence of depression among HIV-positive respondents was 71.7%, and 55.2% for anxiety and 19.6% for stress. The result of one-wayχ~2 test indicated that sex, education, family income, H1V-related physical symptoms, impact of current physical condition on daily life, AIDS-related discrimination, social support and resilience were associated with depression, anxiety and stress. Through multivariate regression analysis, more specify symptoms, severe AIDS-related discrimination and more impact of current physical conditions on daily life can increase the degree of depression, anxity and stress of HIV-positive people, while good resilience and social support will decrease the degree of negative emotions.2.6 Suicidal ideationIn the last year, high rate of suicidal ideation were detected in HIV-positive respondents (32.3%), and 16 (5.9%) HIV-positive respondents had committed suicide. The results from Logistic regression indicate that depression is a risk predictors of attempted suicide (OR=3.175), while fine social support can decrease the risk of suicidal ideation (OR=0.331).3. Needs of psychological support serviceThe matter that HIV-positive respondents worried about the most was their children's education and life in the future (52.4%). Other worries include their own HIV/AIDS progression (32.7%), transmission of HIV to their family members (7.1%), and family income (5.2%). 95.5% of HIV-positive respondents prefer to participate in psychological support service. They hope to communicate with other patients (69.9%) and family planning staffs (43.5%) with their concerns. Psychological consultation is also needed (26.4%).Conclusions1. Psychiatric disorders like depression, anxiety and stress are common among people living with HIV/AIDS who had a history of selling blood. And the prevalence of suicidal ideation is also high in HIV carders.2. HIV-positive persons with severe social discrimination and poor physical conditions are more likely to suffer from psychiatric disorders like depression, anxiety and stress, while higher family income, adequate social support and good resilience will decrease the risk.3. Significant predicators of suicidal ideation are the psychiatric disorder particularly depressive symptoms. Good support from family members is associated with the decrease in the risk of suicidal ideation.4. The Majority of HIV-positive people prefer to participate in the psychological support service. They hope communicate with other AIDS patients, family members or friends. Consultation to psychiatric doctors is also needed. These are sound evidence for the establishment of social support networks for AIDS patients.Suggestions1. More attention should be paid to the mental health problems of people living with HIV/AIDS who sold blood in rural areas of central China. These problems include depression, anxiety disorder and suicidal ideation.2. Something should to be done to provide adequate mental care and psychological support for AIDS patients. For example, integrating psychological consultation into family planning service, or adding resilience intervention to group activities of PLWHA can help to address the needs of this population.