HIV相关知识及预期污名化对男男性行为者抑郁的影响——基于潜在类别分析  

Influence of HIV-related Knowledge and Anticipated Stigma on Depression of Men Who Have Sex with Men:a Latent Class Analysis

作　　者：戴振威 司明玉 吴奕锦 陈旭[1] 付佳琪 黄依漫 王浩[1] 肖伟军 于飞 米国栋 苏小游[1] DAI Zhenwei;SI Mingyu;WU Yijin;CHEN Xu;FU Jiaqi;HUANG Yiman;WANG Hao;XIAO Weijun;YU Fei;MI Guodong;SU Xiaoyou(School of Population Medicine and Public Health,Chinese Academy of Medical Sciences&Peking Union Medical College,Beijing 100005,China;Danlan Public Welfare,Beijing 100020,China)

机构地区：[1]中国医学科学院北京协和医学院群医学及公共卫生学院,北京市100005 [2]淡蓝公益,北京市100020

出　　处：《中国全科医学》2022年第30期3803-3809,共7页Chinese General Practice

基　　金：国家卫生健康委员会亚洲区域合作专项(BLXM01);中国医学科学院医学与健康科技创新工程(2020-I2M-2-015)。

摘　　要：背景中国男男性行为(MSM)者的抑郁发生率高于一般人群,长期的抑郁症状不仅会对身体造成损害,还会增加自残、自杀等行为的发生,因此MSM者的抑郁问题亟待解决。目的探索MSM者抑郁的潜在类别,并进一步探究HIV相关知识及预期污名化对抑郁的影响。方法本研究采用便利抽样的方法,于2020-12-16至2021-03-02通过同性社交软件Blued7.5平台选取1394例未感染HIV或感染状态未知的MSM者进行线上问卷调查,包括一般资料调查表、HIV知识问卷、HIV预期污名量表、简版流调中心抑郁量表(CES-D10),对抑郁进行潜在类别分析,并采用多因素Logistic回归分析探讨不同抑郁类别与HIV相关知识及预期污名化的相关性。结果最终收回问卷1396份,有效问卷1394份,有效率为99.9%。以CES-D10的10个条目为外显指标,依次选取1~5个潜在类别模型对MSM者抑郁状况进行探索性潜在类别分析,最终选择含有4个类别的模型,各组的类别概率:“无明显抑郁”占40.1%,“可能存在抑郁风险”占21.6%,“可能存在轻微抑郁”占28.0%,“可能存在中至重度抑郁”占10.3%。为检验该分类的准确性,将根据CES-D10的截断值所判断的抑郁结果(0=无抑郁,1=存在抑郁)与潜在类别分析所得结果进行一致性检验(0=无明显抑郁+可能存在抑郁风险,1=可能存在轻微抑郁+可能存在中至重度抑郁),结果显示Kappa=0.735(P<0.001)。多因素Logistic回归分析结果显示,高水平HIV相关知识(OR=0.926,P=0.001)、本科及以上受教育程度(OR=0.642,P=0.003)是可能存在抑郁风险的影响因素;HIV预期污名化(OR=1.594,P<0.001)、已婚(OR=0.593,P=0.026)是可能存在轻微抑郁的影响因素;高水平HIV相关知识(OR=0.935,P=0.026)、HIV预期污名化(OR=2.239,P<0.001)、无固定工作(OR=1.518,P=0.045)是可能存在中至重度抑郁的影响因素。结论MSM者的抑郁具有明显的类别特征,本研究可为针对MSM者的抑郁状况施行精准�Background Chinese men who have sex with men(MSM)have a higher prevalence of depression than the general population.Long-term depression symptoms could increase the risk of having physical harm,self-harm and suicide.Therefore,depression issues among MSM need to be solved urgently.Objective To explore the latent classes of depression,and the influence of HIV-related knowledge and anticipated stigma on depression among MSM.Methods Usingthe General Information Questionnaire,HIV Knowledge Questionnaire,Anticipated HIV Stigma Scale and 10-item Center for Epidemiologic Studies Depression Scale(CES-D-10),an online questionnaire survey was conducted from December 2020 to March 2021 via the same-sex social network of Blued7.5.A total of 1396 MSM with HIVinfection or unclear status of HIVinfection were sampled by use of convenience sampling to attend the survey.The latent classes of depressive symptoms were analyzed by latent class analysis.Multinomial Logistic regression analysis was used to explore the correlation of the latent class of depression with HIV-related knowledge or anticipated HIV stigma.Results Finally,1394 cases(99.9%.)who returned responsive questionnaires were included.The 10 items of CES-D-10 were taken as observed indicators,and exploratory latent class analysis was employed to identify the latent classes of depression based on model from 1 to 5 classes.The 4-class model was finally selected,and the probabilities of each class were 40.1%(no obvious depression),21.6%(possible risk of depression),28.0%(possible mild depression),and 10.3%(possible moderate to severe depression).The accuracy of the classification was assessed by test for homogeneity according to the cut-off value of CES-D-10(0=no depression,1=depression)and the results of latent class analysis(0=no obvious depression and possible risk of depression,1=possible mild depression and possible moderate to severe depression),and the result showed that Kappa=0.735(P<0.001).Multinomial Logistic regression analysis indicated that a high level of HIV-

关 键 词：抑郁 男男性行为者 同性恋 男性 HIV相关知识 预期污名化 潜在类别分析 

分 类 号：R749.42[医药卫生—神经病学与精神病学]