Study On The Prevalence And Influencing Factors Of Depressive Symptoms Among People Living With HIV In Jiangsu Province

Background:With the in-depth popularization of antiretroviral therapy,AIDS has gradually turned into a controllable chronic infectious disease.As such,the mental health of people living with HIV(PLWHA)has gradually become a new public health problem,attracting widespread attention from scholars from all over the world.Depression is one of the most common psychological symptoms of mental health status among PLWHA and has brought many serious negative consequences to PLWHA.Depression not only increases the painful psychological experience of individuals,but also reduces their quality of life.Depressed patients have a high suicide and disability rate which also has great social influence with an extremely heavy social burden.Data from previous studies showed the combined prevalence of depression among PLWHA in China is 53.8%(47.7%-60.0%).However,few studies currently exist on the mental health of PLWHA in Jiangsu Province,and there is no relevant epidemiological survey on the subject.At present,domestic research on depressive symptoms among PLWHA mostly studied the relationship between individual factors and depression in PLWHA from the perspectives of personal sociological information and external environment.Additionally,the research methods were mostly traditional single factored,with logistic regression analysis and less in-depth discussion on the pathways of related factors affecting the occurrence of depression.In this study,we carried out an on-site questionnaire survey to make up for the insufficiency of the epidemiological survey of depression among PLWHA in Jiangsu Province.Objective:1.Investigate the sociodemographic characteristics,sexual risk behaviors,antiviral treatment related conditions,medical expenses and general conditions of PLWHA in Jiangsu Province;2.Identify individual risk factors and influencing factors of depressive symptoms in PLWHA in Jiangsu Province through an on-site epidemiological informative method;3.Perform an in-depth analysis of the path of action of depressive symptoms and the interrelationship between the influencing factors among this population,in order to propose targeted preventive measures.Provide theoretical guidance and suggestions for establishing mental health services structures to satisfy the needs of PLWHA.Methods:1.Cluster sampling is used to select AIDS designated treatment clinics in Nanjing,Suzhou,Yangzhou,and Yancheng in Jiangsu Province.We then conduct a questionnaire survey among PLWHA attending the selected clinics to collect data on their demographic characteristics,sexual behavior characteristics,and knowledge on AIDS.To grasp a better understanding of the situation in Jiangsu Province,we also collate data on PLWHA HIV antiviral treatment,medical expenses,and patients’ mental health(depression,stress).2.We analyze the data obtained from the survey to identify the relevant factors associate with depression in PLWHA in Jiangsu Province.The R software Bayesian model averaging method(BMA package)is used in place of the single factor analysis to first screen out the variables with posterior probability>0.50;The SPSS23.0 software is used to perform multivariate logistic regression analysis.The independent variable selection method and the two-sided test is used in the regression method,statistical significance level is α=0.05.3.We further analyzed the relationship between the influencing factors and the path of action that affect depression in the infected.Use the Process macro program compiled by Hayes to test the mediating effect of stress between coping styles and depressive symptoms,and the moderating effect of social support.A two-sided test,and α=0.05 was considered statistically significant.Results:1.A total of 1,000 questionnaires is distributed in our survey,of which 983 are valid.Depressive symptoms detection rate among PLWHA in Jiangsu Province is 45.3%;and 44.3% of the infected people had an average monthly income of less than 5,000 yuan.The majority of participants(68.8%)reported being gay/bisexual;90.8% were infected with HIV through sexual transmission;and 21.7%Self-reported that they had missed medication in the past 3 months.Furthermore,in the past 6 months,17.0% had unprotected high-risk sex,35.1% had searched for a sexual partner through the Internet,24.2% had reported suicidal thoughts,and only 5.4% received professional psychological consultation.The annual economic burden of disease for all 983 survey subjects is 2416(1648-3870)yuan,of which the direct economic burden is 1696(1096-2899)yuan and the indirect economic burden is 500(0-1040)yuan.2.The analysis of factors affecting depressive symptoms in infected patients showed that: missed medication in the past 3 months(OR=1.793,95%CI: 1.179-2.728),stress ≥43 points(OR=8.788,95%CI: 5.814-13.284),positive coping style(OR=0.254,95%CI: 0.179-0.362),social support>56points(OR=0.357,95%CI: 0.252-0.507),unprotected sex in the past 6 months(OR= 1.830,95% CI:1.160-2.887),searching for sexual partners through the Internet in the past 6 months,and suicidal thoughts in the past 6 months are all significant factors influencing depression in PLWHA.3.Results from the moderated mediation model test show that the coping styles of infected persons can not only directly affect depressive symptoms,but also affect depressive symptoms through the mediation effect of stress.Stress plays an incomplete mediating role in it,whiles social support moderates both the association between coping style and depressive symptoms,as well as moderate the mediary chain of "coping style-stress-depressive symptoms".Conclusions:1.The mental health problems of PLWHA in Jiangsu Province are serious.Individuals,families,and society need to work together to reduce discrimination and stigma against PLWHA,and improve their accessibility to mental health services in order to improve their physical and mental health of patients.2.Missed medications in the past 3 months,suicidal thoughts in the past 6 months,unprotected sex in the past 6 months,searched for sexual partners through the internet in the past 6 months,and high pressure,contributed to the increased risk of depressive symptoms.Social support and active coping are protective factors for depression in PLWHA in Jiangsu Province.3.Therefore focus on the evaluation of the level of social support needed in the prevention and intervention process for depression in PLWHA is recommended.For PLWHA with insufficient social support,government and family should take corresponding measures to increase their social support and increase the utilization of social support.For those with good social support,focus should be placed on guiding the infected to learn a positive and optimistic attitude towards life,and improve their ability to cope with pressure.