广州市HIV感染合并抑郁症状者耻辱感、压力与抑郁的结构方程模型

  目的  构建广州市艾滋病病毒(human immunodeficiency virus，HIV)感染合并抑郁症状者中耻辱感、压力与抑郁之间的结构方程模型，为改善HIV感染者抑郁症状提供参考依据。  方法  2017年8~12月对广州市第八人民医院门诊部的300名HIV感染合并抑郁症状者进行电子问卷调查，收集感染者的社会人口学特征、耻辱感、压力与抑郁情况等信息。采用结构方程模型对数据进行分析，探讨耻辱感对抑郁的影响机制。  结果  300名HIV感染合并抑郁症状者中，平均年龄28.2岁，92.3%为男性，抑郁量表得分M(P₂₅，P₇₅)为23(19，28)分，提示中度抑郁。对耻辱感与抑郁构建结构方程模型显示，模型拟合良好(Chi-Square/df=1.52，RMSEA=0.04，CFI=0.98，SRMR=0.04)。中介效应结果显示，耻辱感与抑郁之间的直接作用具有统计学意义(β=0.31，P < 0.001)，压力在耻辱感与抑郁程度之间的间接作用同样具有统计学意义(β=0.25，P < 0.001)。压力在耻辱感与抑郁程度之间呈部分中介作用。  结论  压力是HIV感染者耻辱感导致抑郁的重要中间环节，今后对HIV合并抑郁症状者的干预可以重点考虑对压力进行干预。

A structural equation model of HIV-related stigma,stress and depression among people living with HIV and depression in Guangzhou

  Objective  To examine the mechanism among HIV-related stigma, perceived stress, and severity of depression among people living with HIV and depression (PLWHD).  Methods  A total of 300 PLWHD were recruited from a large HIV treatment hospital in Guangzhou, China from August to October in 2017. Participants completed measures assessing HIV-related stigma, perceived stress, depression, and socio-demographic characteristics at baseline. Structural equation modeling (SEM) was performed to examine the direct and indirect associations between stigma and depression.  Results  Among the 300 participants (mean age=28.21 years, 92.3% male), the median score of CES-D was 23.0 (19.0, 28.0).The global model showed good model fit (Chi-square value=25.97, CFI=0.98, RMSEA=0.04, SRMR=0.04). Structural equation model revealed that stigma had significantly direct (pathway coefficient=0.31, P < 0.001) and indirect (pathway coefficient=0.25, P < 0.001) effects on depression.  Conclusions  Stress plays an important role in the mechanism between stigma and depression, thus future interventions need to pay more attention on stress.