Suicidal thoughts and behaviour among South African adolescents living with HIV: Can social support buffer the impact of stigma?
Suicidal thoughts and behaviour among South African adolescents living with HIV: Can social support buffer the impact of stigma?
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DOI：
10.1016/j.jad.2018.10.102
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发表时间：
2019-02-15
影响因子：
6.6
通讯作者：
Cluver, Lucie
中科院分区：
文献类型：
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作者：
Casale, Marisa;Boyes, Mark;Cluver, Lucie
背景：艾滋病毒感染者是自杀意念和企图的高危人群，特别是在低收入环境中。然而，对这一人群自杀的风险和保护因素知之甚少。方法：一个适度的中介模型被用来测试潜在的（a）污名对自杀意念和企图的影响，直接的和通过抑郁介导的（B）社会支持资源对抑郁和自杀意念和企图的直接和压力缓冲作用，来自南非一个资源匮乏的卫生区的1053名10-19岁艾滋病毒阳性青少年。调查数据是通过对53个诊所进行全社区抽样并追踪到180多个社区收集的。两个支持资源的效果进行了测试：感知支持的可用性，从青少年的社会网络和结构化的诊所支持团体。污名是一个危险因素抑郁症（B = 0.295; p <0.001）和自杀的想法和行为（B = 0.185; p <0.001）。只有感知到的支持可用性与较少的抑郁直接相关（B =-0.182，p < .001）。然而，无论是感知支持的可用性和支持小组的参与有助于整体的压力缓冲效果缓和的直接和间接的关系之间的耻辱和自杀的想法和behavior.Limitations：在这项研究中使用的数据是自我报告和横截面。结论：研究结果表明，通过早期诊所和社区干预，加强对艾滋病毒阳性青少年的多种社会支持资源，可以保护他们免受精神健康状况不佳和自杀倾向的影响。
Background: Adolescents living with HIV represent a high-risk population for suicidal ideation and attempts, especially in low-income settings. Yet little is known about risk and protective factors for suicide in this population.Methods: A moderated mediation model was employed to test for potential (a) effects of stigma on suicidal ideation and attempts, both direct and mediated through depression and (b) direct and stress-buffering effects of social support resources on depression and suicidal ideation and attempts, among 1053 HIV-positive 10-19-year-old adolescents from a resource-scarce health district in South Africa. The survey data was collected using full community sampling of 53 clinics and tracing to over 180 communities. Effects of two support resources were tested: perceived support availability from the adolescents' social network and structured clinic support groups. Stigma was measured using the ALHIV-SS scale, depression through the CDI short form and social support through items from the MOS-SS.Results: Stigma was a risk factor for depression (B = 0.295; p < 001) and for suicidal thoughts and behaviour (B = 0.185; p < .001). Only perceived support availability was directly associated with less depression (B = -0.182, p < .001). However, both perceived support availability and support group participation contributed to the overall stress-buffering effects moderating the direct and indirect relationships between stigma and suicidal thoughts and behaviour.Limitations: The data used in this study was self-reported and cross-sectional.Conclusions: Findings suggest that strengthening multiple social support resources for HIV-positive adolescents, through early clinic and community-based interventions, may protect them from experiencing poor mental health and suicidal tendencies.