'I was thinking too much': experiences of HIV-positive adults with common mental disorders and poor adherence to antiretroviral therapy in Zimbabwe.
'I was thinking too much': experiences of HIV-positive adults with common mental disorders and poor adherence to antiretroviral therapy in Zimbabwe.
复制标题
DOI：
10.1111/tmi.12502
复制
发表时间：
2015-07
期刊：
影响因子：
--
通讯作者：
Abas M
中科院分区：
文献类型：
--
作者：
Kidia K;Machando D;Bere T;Macpherson K;Nyamayaro P;Potter L;Makadzange T;Munjoma R;Marufu M;Araya R;Safren S;O'Cleirigh C;Chibanda D;Abas M
记录在艾滋病毒高流行环境中，精神健康状况不佳且坚持抗逆转录病毒治疗效果不佳的人的生活经历。对47名(女性=31名)HIV阳性成年人进行了深入的定性访谈，他们的得分高于当地确认的常见精神障碍量表的临界点。有目的的抽样被用来招募依从性较差的参与者。对医护人员进行了另外6次关键信息提供人访谈(女性=6人)。数据由一个跨学科的编码团队收集和归纳分析。参与者面临的主要挑战是压力源(贫困、耻辱、婚姻问题)和常见精神障碍的症状(“想得太多”、食欲和睡眠的变化、“心脏负担”和低能量水平)。在患有常见精神障碍的HIV阳性成年人中，过度思考似乎与反省密切相关，是对坚持抗逆转录病毒治疗影响最大的症状。反过来，过多的思考通常是由艾滋病毒/艾滋病患者面临的压力引发的，特别是贫困。最后，参与者希望获得私人咨询、参与创收活动以及家庭参与心理健康护理。更好地了解精神障碍的局部表现和潜在的压力源，可以帮助制定具有文化敏感性的干预措施，以减少常见的精神障碍和对抗逆转录病毒治疗的依从性较差。
To document the lived experiences of people with both poor mental health and suboptimal adherence to antiretroviral therapy in high HIV prevalence settings. In-depth qualitative interviews were conducted with 47 (female =31) HIV-positive adults who scored above the cut-point on a locally-validated scale for common mental disorders. Purposive sampling was used to recruit participants with evidence of poor adherence. Six additional key informant interviews (female = 6) were conducted with healthcare workers. Data were collected and analysed inductively by an interdisciplinary coding team. The major challenges faced by participants were stressors (poverty, stigma, marital problems) and symptoms of common mental disorders (“thinking too much”, changes to appetite and sleep, “burdened heart”, and low energy levels). Thinking too much, which appears closely related to rumination, was the symptom with the greatest negative impact on adherence to antiretroviral therapy among HIV-positive adults with common mental disorders. In turn, thinking too much was commonly triggered by the stressors faced by people living with HIV/AIDS, especially poverty. Finally, participants desired private counselling, access to income generating activities, and family engagement in mental health care. Better understanding of the local expression of mental disorders and of underlying stressors can inform the development of culturally sensitive interventions to reduce common mental disorders and poor adherence to antiretroviral therapy.