HIV感染者/艾滋病患者自杀死亡危险因素理论框架构建——基于扎根理论的定性研究  

Theoretical framework of suicide risk factors among people living with HIV/AIDS: a qualitative study based on grounded theory

作　　者：毕凤英 闫冬勤 陈曦[2] 罗丹[1] BI Fengying;YAN Dongqin;CHEN Xi;LUO Dan(Xiangya School of Public Health,Central South University,Changsha 410078,Hunan,China;Hunan Center for Disease Control and Prevention,Changsha 410005,Hunan,China)

机构地区：[1]中南大学湘雅公共卫生学院,湖南长沙410078 [2]湖南省疾病预防控制中心,湖南长沙410005

出　　处：《山东大学学报（医学版）》2022年第1期109-117,共9页Journal of Shandong University:Health Sciences

基　　金：湖南省自然科学基金(2019JJ40401)

摘　　要：目的分析湖南省HIV感染者/艾滋病患者的自杀死亡危险因素,构建该人群自杀死亡危险因素的理论框架,为更好地开展针对该人群的自杀预防工作提供基础资料。方法2019年11月1日至2020年1月17日期间,采用方便抽样,根据信息饱和原则,选取湖南省3个市级区域内、2013~2019年间自杀死亡的18例HIV感染者/艾滋病患者作为目标人,以死者的知情信息人作为访谈对象,采用心理解剖技术,通过与知情信息人进行半定式访谈了解自杀死亡患者的自杀行为特征以及个体、人际关系和社区环境3个层面的相关因素。采用扎根理论,借助Nvivo 11.0软件对访谈资料进行分析,探讨自杀者的自杀死亡危险因素,并结合自杀死亡案例,构建该人群的自杀死亡危险因素理论框架。结果自杀死亡影响因素可以归纳为个体、人际关系、社区环境3个层面:个体层面的主要因素有躯体健康状况、精神心理状况和人格特质;人际关系层面主要有家庭因素、社会支持和生活事件;社区环境层面主要是生活环境对艾滋病的容忍度。3个层面的因素均可直接作用于HIV感染者/艾滋病患者的自杀死亡,也可以相互作用,共同导致自杀死亡的发生。结论个体、人际关系和社区环境因素既可直接影响HIV感染者/艾滋病患者的自杀行为,也有间接作用;根据研究构建的自杀死亡危险因素理论框架,针对躯体和心理健康状况、主要生活事件、疾病相关压力及降低社区歧视等采取措施应列为该人群自杀行为干预的切入点。Objective To determine the risk factors of completed suicide among people living with HIV/AIDS(PLWHA)in Hunan Province,construct the theoretical framework explaining the relationship between the risk factors and completed suicide,and provide evidence for suicide prevention among PLWHA.Methods According to the principle of information saturation,three cities were selected conveniently in Hunan Province and a psychosocial autopsy study for 18 suicides who had committed suicide from 2013 to 2019 was conducted.During November 1,2019 to January 17,2020,semi-structured interviews were conducted on two informants for each suicide case.Information on characteristics of suicidal behavior and influencing factors of three levels,which were individual,interpersonal and community,was collected.Grounded theory was conducted to explore the influencing factors of completed suicide using Nvivo 11.0 software.According to the suicide cases,model explaining the relationship between the risk factors and completed suicide was conducted based on the theory of ecological model of suicide prevention.Results Influencing factors of completed suicide could be summarized into three levels:individual,interpersonal and community level.Factors on individual level mainly included physical status,psychological status and personal traits;factors on interpersonal level mainly included family-related factors,social support and life events;and factors on community level mainly included the tolerance of the surrounding environment for AIDS.Factors of the three levels could directly impact suicidal behaviors,as well as interact with each other to lead to the occurrence of suicide.Conclusion Factors on individual,interpersonal and community level have both direct and indirect effect on suicidal behavior among PLWHA.Based on the theoretical framework,interventions targeting for physical and psychological status,major life events,HIV-related stress and reduction of discrimination should be marked as the starting point of suicide prevention.

关 键 词：HIV感染者/艾滋病患者 自杀死亡 影响因素 心理解剖 扎根理论 

分 类 号：R512.91[医药卫生—内科学]