Childhood trauma and METH abuse among men who have sex with men: Implications for intervention

Methamphetamine (METH) has become one of the most widely abused drugs in South Florida, particularly among MSM who may or may not be HIV seropositive. High rates of childhood trauma have been reported among HIV-infected MSM (Chartier et al., 2010), but, the association of childhood trauma, and mood disorders with methamphetamine use in HIV-infected men, has not been comprehensively explored. A better understanding of the association between these factors could improve existing substance abuse treatment intervention strategies and medical treatment programs (e.g., medication adherence; Carrico, 2010) to enhance positive health outcomes for male meth abusers living with the psychological consequences of childhood abuse. This study, as part of a larger study, examined the occurrence of childhood trauma and depression in a group of HIV seropositive METH abusing MSM. Significantly higher levels of depression symptom severity were found among METH users relative to non-METH users (p < .001). Irrespective of HIV status, METH users also reported higher frequencies of emotional, physical and sexual child abuse relative to non-METH users (p < .001). Among meth users, depression was predicted by childhood emotional neglect. These results suggest that childhood maltreatment may be implicated in the development of emotional distress (e.g., depression) and higher prevalence of methamphetamine/drug abuse in this population. These findings have important implications for substance abuse interventions, specifically targeting METH addiction among MSM. Addressing childhood trauma and depression may play a key role in enhancing the effectiveness of interventions for methamphetamine addiction.     

Distress and depression in men who have sex with men: the Urban Men's Health Study

OBJECTIVE: This study estimates the prevalence of depression and describes the correlates and independent associations of distress and depression among U.S. men who have sex with men. METHOD: A household-based probability sample of men who have sex with men (N=2,881) was interviewed between 1996 and 1998 in four large American cities. With cutoff points of 15 and 22 for the Center for Epidemiological Studies Depression Scale, individual correlates and predictors of distress and depression were examined, and multinomial logistic regression was performed. RESULTS: The 7-day prevalence of depression in men who have sex with men was 17.2%, higher than in adult U.S. men in general. Both distress and depression were associated with lack of a domestic partner; not identifying as gay, queer, or homosexual; experiencing multiple episodes of antigay violence in the previous 5 years; and very high levels of community alienation. Distress was also associated with being of other than Asian/Pacific Islander ethnicity and experiencing early antigay harassment. Depression was also associated with histories of attempted suicide, child abuse, and recent sexual dysfunction. Being HIV positive was correlated with distress and depression but not significantly when demographic characteristics, developmental history, substance use, sexual behavior, and current social context were controlled by logistic regression. CONCLUSIONS: Rates of distress and depression are high in men who have sex with men. These high rates have important public health ramifications. The predictors of distress and depression suggest prevention efforts that might be effective when aimed at men who have sex with men.     

Cross-sectional comparison of various sleep disturbances among sex- and age-matched HIV-infected versus HIV-uninfected individuals in China

Objective/BackgroundThis study assessed the prevalence and correlates of various sleep disturbances in HIV-infected patients compared to sex- and age-frequency-matched HIV-uninfected controls in China.MethodsThis cross-sectional analysis included 1469 HIV-infected cases and 2938 HIV-uninfected controls. Insomnia symptoms, poor sleep quality (Pittsburgh Sleep Quality Index [PSQI] >5) as well as their specific domains, were assessed.ResultsPrevalence of insomnia symptoms, poor sleep quality, and long sleep duration were higher in HIV-infected vs uninfected participants (23.7% vs 19.8%, 24.1% vs 19.9%, and16.1% vs 8.7%, respectively; all p < 0.05), and remained significant after adjusting for age, sex and education. An Age-stratified analysis showed that such differences were significant only at ages 18–29 and 30–44 years for insomnia symptoms and poor sleep quality long sleep duration was significant across all age groups. Among HIV-infected patients, multivariate analysis indicated that older age, depressive symptoms and frailty score were the most consistent variables associated with sleep disorders (ie, insomnia symptoms, poor sleep quality, short and long sleep durations), as well as all associations (if significant) were positive, excluding the negative associations of older age and depressive symptoms with short sleep duration. Regarding HIV-specific factors, only current CD4 cell count ≥500 cells/μL was negatively associated with insomnia symptoms.ConclusionsThe impact of HIV infection on sleep disturbances may differ across age groups and are more pronounced among young adults. Additionally, the phenomenon of prolonged sleep duration among HIV-infected patients should be noted, and its link to poor physical health warrants further investigation.     

Religiosity,internalized homonegativity and outness in Christian men who have sex with men

When exposed to their congregations' negative views of homosexuality, Christian men who have sex with men frequently struggle to reconcile their religious and sexual identities, possibly contributing to negative emotional states and behaviors associated with HIV/STI infection. To examine the influence of religiousity on internalized homonegativity and outness among Christian men who have sex with men, we used survey data from 1165 men who answered questions about their religious beliefs and sexual behavior. We stratified participants based on religious affiliation groupings: Catholic, Mainline Protestant and Evangelical Protestant. After using confirmatory factor analysis to verify that the selected measures of religiosity were equivalent between groups, we used structural equation modeling to examine the relationship between religiosity, internalized homonegativity and outness. Among Catholics and Mainline Protestants, religiosity was not associated with internalized homonegativy or outness. However, among Evangelical Protestants – a group more likely to ascribe to religious fundamentalism – increased religiosity was associated with increased internalized homonegativity, which contributed to decreased outness. Our findings suggest that mental health providers and sexuality educators should be more concerned about the influence of religiosity on internalized homonegativity and outness when clients have a history of affiliation with Evangelical Protestant faiths more so than Catholic or Mainline Protestant faiths.

     

A preliminary investigation of the reliability and validity of the Brief Assessment Schedule Depression Cards and the Beck Depression Inventory-Fast Screen to screen for depression in older stroke survivors

OBJECTIVE: To conduct an initial assessment of the reliability and validity of the Brief Assessment Schedule Depression Cards (BASDEC) and the Beck Depression Inventory-Fast Screen (BDI-FS) to screen for depression in older stroke survivors. METHODS: Participants from four inpatient rehabilitation units completed the BASDEC and the BDI-FS together with the Hospital Anxiety and Depression Scale (HADS) for comparison. The Structured Clinical Interview for DSM-IV Axis 1 Disorders (SCID) was then completed with all participants to ascertain a criterion depression diagnosis. The BASDEC and BDI-FS were subsequently completed for a second time. RESULTS: Forty-nine stroke survivors (M=78.80, SD=6.79 years) were included. The BASDEC and BDI-FS demonstrated acceptable internal consistency and test-retest reliability. The BASDEC (cut-off >or=7) resulted in a sensitivity of 1.0 and specificity of 0.95 for detecting major depression whereas the BDI-FS (cut-off >or=4) had a sensitivity of 0.71 and specificity of 0.74. When participants with minor depression were included in analyses, sensitivity lowered to 0.69 (specificity=0.97) for the BASDEC and 0.62 (specificity=0.78) for the BDI-FS. CONCLUSIONS: The BASDEC and BDI-FS were found to have acceptable reliability. The BASDEC demonstrated some advantage in criterion validity over the BDI-FS at the examined cut-offs.     

Neighborhood determinants of mood and anxiety disorders among men who have sex with men in New York City

Purpose

We examined the relationship between economic, physical, and social characteristics of neighborhoods, where men who have sex with men (MSM) lived and socialized, and symptom scores of depression and generalized anxiety disorder (GAD).

Methods

Participants came from a cross-sectional study of a population-based sample of New York City MSM recruited in 2010–2012 (n?=?1126). Archival and survey-based data were obtained on neighborhoods, where the men lived and where they socialized most often.

Results

MSM who socialized in neighborhoods with more economic deprivation and greater general neighborhood attachment experienced higher GAD symptoms. The relationship between general attachment to neighborhoods where MSM socialized and mental health depended on the level of gay community attachment: in neighborhoods characterized by greater gay community attachment, general neighborhood attachment was negatively associated with GAD symptoms, while in low gay community attachment neighborhoods, general neighborhood attachment had a positive association with GAD symptoms.

Conclusions

This study illustrates the downsides of having deep ties to social neighborhoods when they occur in the absence of broader access to ties with the community of one’s sexual identity. Interventions that help MSM cross the spatial boundaries of their social neighborhoods and promote integration of MSM into the broader gay community may contribute to the reduction of elevated rates of depression and anxiety in this population.

     

Hospital costs associated with depression in a cohort of older men living in Western Australia

Background

There is lack of information of the hospital costs related to depression. Here, we compare the costs associated with general hospital admissions over 2 years between older men with and without a documented past history of depression.

Methods

A community-based cohort of older men living in Perth, Western Australia, was assessed at baseline between 2001 and 2004 and followed up for 2 years by prospective data linkage. The participants were selected randomly from the Australia electoral roll. Two-year hospital costs were estimated.

Results

Among 5411 patients, 75% of 339 men with depressive symptoms had at least one hospital admission compared with 61% of 5072 men without depression (P< .001). Two-year median hospital costs in the depressed group were A$4153 compared with A$1671 in participants free from depression (P< .001). In multivariate analysis, the presence of clinically significant depressive symptoms remained an independent predictor of higher cost [incident rate ratios (RR)=1.44, 95% confidence interval (CI): 1.23–1.68] and was associated with being a high-cost user of health services (RR=2.04, 95% CI: 1.43–2.92).

Limitations

The estimation of costs was solely based on the main diagnosis, potentially leading to underestimates of the real cost differences.

Conclusions

Hospital care cost was higher for older men with documented evidence of past depression than those without. The issue of depression in later life must be tackled if we want to optimize the use of limited hospital resources available.     

三个常用抑郁量表筛查癫痫患者伴抑郁的比较

目的比较贝克抑郁量表第2版(BDI-Ⅱ)、医院焦虑抑郁量表-抑郁分量表(HADS-D)、流调用抑郁自评量表(CES-D)用于对癫痫患者伴抑郁的筛查。方法采用BDI-Ⅱ、HADS-D、CES-D评价117例癫痫患者的抑郁情况,采用ROC曲线比较HADS-D、BDI-Ⅱ、CES-D的筛查性能。结果癫痫伴抑郁患者共33例。BDI-Ⅱ取临界值16,抑郁筛查的灵敏性和特异性大约都是90%,CES-D取临界值15时灵敏性大于80%,特异性72.6%。HADS-D在临界值9分时灵敏性和特异性均大于80%,而HADS-D临界值7分的敏感性91.3%,特异性76.8%。三个量表的阴性预测值都大于90%,ROC曲线下面积的比较没有统计学差异(均P0.05)。结论 HADS-D是一种对癫痫伴抑郁更简洁、方便有效的筛查工具。     

Prevalence of postnatal depression in Western Nigerian women: a controlled study

Objective The objective of this study is to compare the prevalence of depression in postpartum women and that of non-postpartum women. Method A total of 876 women recruited at 6 weeks postpartum and 900 matched non-postpartum women were administered the Beck's Depressive Inventory (BDI) and translated local version of the EPDS. Psychiatric diagnosis was made using the using the modified non-patient version of Structured Clinical Interview for DSM-III-R (SCID-NP). Results Depressive disorder was diagnosed in 128 (14.6%) of the postpartum women and in 55 (6.3%) of the non-postpartum women, and the difference was found to be significant (t=8.919, df=875, P<0.001). The postpartum women had higher EPDS and BDI scores than the non-postpartum women. The EPDS correlated well with the SCID-NP diagnosis with a Spearman's correlation of 0.600 (P<0.001) and with the BDI score with a Spearman's correlation of 0.461 (P<0.001). The sensitivity of the EPDS at cut-off score of 8/9 was 94% and specificity was 97%. Conclusion The prevalence of postnatal depression in Nigeria is comparable to that of the western world and the Yoruba version of EPDS is a valid instrument for screening postnatal women for depressive disorders in a Nigerian community.     

100例男男性接触者社会支持与自尊水平的对照研究

目的了解深圳市男男性接触者(MSM)自尊状况和社会支持系统状况,探索男男性接触者的心理特征。方法研究对象为居住在深圳地区现有的男男性接触者人群及正常对照组各100人。采用方便抽样方法进行1:1对照研究,进行社会支持评定量表(SSRS)、自尊量表(SES)评定。结果社会支持系统三纬度的对照研究中男男性接触者组在客观支持以及对支持的利用度方面与对照组存在差异(P0.05);在主观支持中两组差异无统计学意义。自尊评定中的男男性接触组总分均分高于对照组,差异有统计学意义(P0.01)。结论男男性接触群体得到的直接客观的社会支持和对现有资源和支持的利用度更少,其自尊程度高于非男男性接触者群体,需要社会各界的尊重与接纳,减少社会排斥,支持和帮助他们提高心理健康水平。     

Relationship of psychological morbidity and quality of life to illness-related disclosure among HIV-infected persons

OBJECTIVE: The aim of this study was to examine the relationship between HIV-related disclosure and quality of life, anxiety and depression among HIV-infected subjects in South India. METHODOLOGY: 68 subjects (35 men and 33 women) were assessed for quality of life and psychological morbidity using WHOQOL-BREF and the Hospital Anxiety and Depression Scale (HADS). Details of disclosure were collected using a semistructured interview. RESULTS: Certain disclosure-related variables appear to relate significantly with quality of life among HIV-infected persons. A positive outcome related to disclosure and extent to which a subject felt the need to disclose were significantly associated with higher scores on the total quality of life measure and in the social and environmental domains of the WHOQOL-BREF. No relationship was found between disclosure-related variables and psychological morbidity or other domains of quality of life. The type of disclosure (voluntary/without consent) did not appear to influence quality of life in this sample. CONCLUSION: Disclosure-related variables may have an important influence on QOL in the context of HIV infection in India.     

Screening for late life depression: cut-off scores for the Geriatric Depression Scale and the Cornell Scale for Depression in Dementia among Japanese subjects

BACKGROUND: Proper screening of depression among older adults depends on accurate cut-off scores. Recent articles have recommended the Geriatric Depression Scale (GDS) and the Cornell Scale for Depression in Dementia (CSDD) for this screening. However, there has been no investigation of the sensitivity and specificity of either scale using Japanese subjects. The purpose of the present study was to identify appropriate GDS and CSDD cut-offs for Japanese older adults. METHODS: The GDS and the CSDD were interview-administered to nondepressed Japanese older adults (n = 74) and to Japanese older adults with a SCID-IV diagnosis of major or minor depression (n = 37). Depressed subjects were also administered the Hamilton Depression Rating Scale (HDRS). Data were also collected on demographic variables, mental status, health status, and medication use. RESULTS: ROC curve analysis identified a cut-off score of 6 for the GDS which had a sensitivity of 0.973, a specificity of 0.959, a False Positive Rate (FPR) of 0.894, and a False Negative Rate (FNR) of 0. A cutoff score of 5 for the CSDD yielded a sensitivity of 1, a specificity of 0.919, a FPR of 0.942, and a FNR of 0. Comparisons indicate current HDRS cut-offs may overlook subthreshold depression. The GDS cut-off score identified among Japanese subjects was the same as that reported for Western subjects. CONCLUSIONS: Due to the substantial prevalence of psychiatric disorders found in false-negative subjects, the above cut-off scores were chosen to optimize the potential for true positives. These scores are recommended for alerting physicians and other caregivers as to when more intensive depression evaluation is needed.     

Homelessness and drug abuse among young men who have sex with men in New York city: a preliminary epidemiological trajectory

The objective of this paper is to profile the role of homelessness in drug and sexual risk in a population of young men who have sex with men (YMSM). Data are from a cross-sectional survey collected between 2000 and 2001 in New York City (N = 569). With the goal of examining the import of homelessness in increased risk for the onset of drug and sexual risk, we compare and contrast three subgroups: (1) YMSM with no history of homelessness, (2) YMSM with a past history of homelessness but who were not homeless at the time of the interview, and (3) YMSM who were currently homeless. For each group, we describe the prevalence of a broad range of stressful life events (including foster care and runaway episodes, involvement in the criminal justice system, etc.), as well as selected mental health problems (including past suicide attempts, current depression, and selected help-seeking variables). Additionally, we examine the prevalence of selected drug and sexual risk, including exposure to a broad range of illegal substances, current use of illegal drugs, and prevalence of lifetime exposure to sex work. Finally, we use an event history analysis approach (time-event displays and paired t-test analysis) to examine the timing of negative life experiences and homelessness relative to the onset of drug and sexual risk. High levels of background negative life experiences and manifest mental health distress are seen in all three groups. Both a prior experience of homelessness and currently being homeless are both strongly associated with both higher levels of lifetime exposure to drug and sexual risk as well as higher levels of current drug and sexual risk. Onset of these risks occur earlier in both groups that have had an experience of housing instability (e.g., runaway, foster care, etc.) but are delayed or not present among YMSM with no history of housing instability. Few YMSM had used drug prior to becoming homeless. While causal inferences are subject to the limitations of a cross-sectional design, the findings pose an empirical challenge to the prevailing assumption that prior drug use is a dominant causal factor in YMSM becoming homeless. More broadly, the data illustrate the complexity of factors that must be accounted for, both in advancing our epidemiological understanding of the complexity of homelessness and its relationship to the onset of drug and sexual risk among high risk youth populations.     

Implications of two-stage depression screening for identifying persons with thoughts of self-harm

Objective

Persons with thoughts of self-harm may need evaluation for suicide risk. We examine the prevalence of thoughts of self-harm and whether persons with thoughts of self-harm are identified when two-stage depression screening is used.

Methods

Data are from the 2005–2010 National Health and Nutrition Examination Surveys. Persons responding positively to question nine of the Patient Health Questionnaire-9 (PHQ-9) are identified as having thoughts of self-harm. We compare two depression cutoff scores for the Patient Health Questionnaire-2 (PHQ-2) to see what percentage of persons with thoughts of self-harm would be identified as needing further screening with the PHQ-9.

Results

The prevalence of thoughts of self-harm was 3.5%. Persons 12–17 years old, poor and reporting fair or poor health were more likely to report thoughts of self-harm. A cutoff score of three on the PHQ-2 identified 49% of persons with thoughts of self-harm for further screening with the PHQ-9. A cut point of two increased the proportion of persons with thoughts of self-harm continuing for further screening to 76%.

Conclusions

Using a lower cutoff score, two, the PHQ-2 captures more persons with thoughts of self-harm. One quarter of persons with self-harm thoughts may not be identified for further screening when two-stage screening is used.     

Psychological pathway to suicidal ideation among men who have sex with men in Shanghai,China: A structural equation model

We aimed to explore the relationships and develop an inter-theoretical model among psychological variables in the progression to suicidal ideation among men who have sex with men (MSM). A cross-sectional study was conducted among 547 MSM in four districts in Shanghai from March to May in 2014. Socio-demographic, psychological, and behavioral information of the participants was collected. A structural equation model (SEM)-Path Analysis was constructed to interpret the intricate relationships among various psychological variables. Suicidal ideation among MSM during the past year was 10.6%. The developed model agreed well with existing suicide models and had a good fit to the data (χ²/df = 2.497, comparative fit index = 0.983, root mean squared error of approximation = 0.052). Suicidal ideation was predicted by perceived defeat and entrapment (β = 0.21, p < 0.001), which was in turn predicted by temperament (β = 0.60, p < 0.001) and perceived social support (β = 0.34, p < 0.001). Perceived social support fully mediated the relationships among mood states, perceived social status, and perceived defeat and entrapment. MSM with certain types of temperament might be predisposed to a higher perception of defeat and entrapment. Perceived social support can effectively alleviate the negative appraisals and emotions and lower the risk for suicidal ideation among MSM.     

Affective differences in Iowa Gambling Task performance associated with sexual risk taking and substance use among HIV-positive and HIV-negative men who have sex with men

We investigated the relationship between emotional distress and decision making in sexual risk and substance use behavior among 174 (ages 25 to 50 years, 53% black) men who have sex with men (MSM), a population at increased risk for HIV. The sample was stratified by HIV status. Measures of affective decision making, depression, anxiety, sex acts, and substance use during the past 60 days were collected at our research center. Negative binomial regression models were used to examine the relationship between age, HIV status, anxiety, depression, and IGT performance in the prediction of number of risky sex acts and substance use days. Among those without anxiety or depression, both number of risky sex acts and drug use days decreased with better performance during risky trials (i.e., last two blocks) of the IGT. For those with higher rates of anxiety, but not depression, IGT risk trial performance and risky sex acts increased concomitantly. Anxiety also interacted with IGT performance across all trials to predict substance use, such that anxiety was associated with greater substance use among those with better IGT performance. The opposite was true for those with depression, but only during risk trials. HIV-positive participants reported fewer substance use days than HIV-negative participants, but there was no difference in association between behavior and IGT performance by HIV status. Our findings suggest that anxiety may exacerbate risk-taking behavior when affective decision-making ability is intact. The relationship between affective decision making and risk taking may be sensitive to different profiles of emotional distress, as well as behavioral context. Investigations of affective decision making in sexual risk taking and substance use should examine different distress profiles separately, with implications for HIV prevention efforts.     

Psychosocial health problems increase risk for HIV among urban young men who have sex with men: Preliminary evidence of a syndemic in need of attention

BACKGROUND: Young men who have sex with men (YMSM) experience disparities in HIV rates and potentially in mental health, substance abuse, and exposure to violence. PURPOSE: We assessed the extent to which these psychosocial health problems had an additive effect on increasing HIV risk among YMSM. METHODS: An urban sample of 310 ethnically diverse YMSM reported on psychosocial health problems, sexual risk behaviors, and HIV status. A count of psychosocial health problems was calculated to test the additive relationship to HIV risk. RESULTS: The prevalence of psychosocial health problems varied from 23% for regular binge drinking to 34% for experiencing partner violence. Rates of sexual risk behaviors were high and 14% of YMSM reported receiving a HIV+ test result. Psychosocial health problems cooccurred, as evidenced by significant bivariate odds ratios (ORs) between 12 of the 15 associations tested. Number of psychosocial health problems significantly increased the odds of having multiple anal sex partners (OR=1.24), unprotected anal sex (OR=1.42), and an HIV-positive status (OR 1.42), after controlling for demographic factors. CONCLUSIONS: These data suggest the existence of cooccurring epidemics, or "syndemic," of health problems among YMSM. Disparities exist not only in the prevalence of HIV among YMSM but also in research to combat the epidemic within this vulnerable population. Future research is needed to identify risk and resiliency factors across the range of health disparities and develop interventions that address this syndemic.     

Health-related quality of life and health locus of control beliefs among HIV-infected treated patients

Obsjective:This study examined the relations between health locus of control (HLOC) beliefs and health-related quality of life (HRQL) in 302 HIV-infected patients enrolled in a French cohort, 44 months (M44) after they began highly active antiretroviral therapy (HAART). Methods: HLOC beliefs were measured with the Multidimensional Health Locus of Control (MHLOC) scale and HRQL, with the Medical Outcome Study Short-Form Health Survey (MOS-SF-36). Results: Internal HLOC beliefs at the initiation of treatment were associated with both physical HRQL in multivariate analysis, while chance HLOC beliefs on beginning HAART were associated with mental HRQL at M44. Conclusion: These findings suggest the importance of considering the psychological characteristics and psychosocial beliefs of patients at the initiation of ARV treatment to optimise the long-term HRQL of HIV-infected patient and to develop adaptive intervention on coping strategies.