Effects of Syndemic Psychiatric Diagnoses on Health Indicators in Men Who Have Sex With Men
Effects of Syndemic Psychiatric Diagnoses on Health Indicators in Men Who Have Sex With Men
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DOI：
10.1037/hea0000724
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发表时间：
2019-06-01
影响因子：
4.2
通讯作者：
O'Cleirigh, Conall
中科院分区：
文献类型：
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作者：
Batchelder, Abigail W.;Choi, Karmel;O'Cleirigh, Conall
目的：症状群理论认为，共同发生的问题（例如，物质使用、抑郁和创伤）协同增加男男性行为者（MSM）感染艾滋病毒风险。然而，大多数调查评估这些问题的添加使用自我报告。方法：在有创伤史的HIV阴性MSM样本（n = 290）中，我们测试了四种临床诊断（物质使用障碍[SUD]）之间的双变量关系;重度抑郁症[MDD]，创伤后应激障碍[PTSD]和焦虑症）及其对三种健康指标（即，高风险性行为、去急诊室（ER）和性传播感染（STI））。结果如下：我们发现SUD和MDD之间存在显著的双变量关系（chi（2）= 4.85，p = 0.028），PTSD和MDD之间存在显著的双变量关系（chi（2）= 35.38，p = 0.028，p <0.001），但未发现SUD和PTSD之间存在显著关系（chi（2）= 3.64，p = 0.056）。诊断数量与高危性行为（发病率比[IRR] = 1.14，95% CI [1.03，1.26]，p = 0.009）和急诊就诊（比值比= 1.27; 95% CI [1.01，1.60]，p = 0.040）相关，但与性传播感染无关。没有发现诊断和健康相关指标之间的相互作用。结论：这是第一个研究，以证明临床诊断的风险行为和医疗保健利用与发展性创伤史的男男性接触者之间的累加效应。结果表明，需要优先考虑经验支持的治疗SUD和MDD，除了创伤治疗，为这一人群。
Objective: Syndemic theory posits that co-occurring problems (e.g., substance use, depression, and trauma) synergistically increase HIV risk in men who have sex with men (MSM). However, most investigations have assessed these problems additively using self-report. Method: In a sample of HIV-negative MSM with trauma histories (n = 290), we test bivariate relationships between four clinical diagnoses (substance use disorder [SUD]); major depressive disorder [MDD], posttraumatic stress disorder [PTSD], and anxiety disorders) and their additive and interactive effects on three health indicators (i.e., high-risk sex, visiting the emergency room [ER], and sexually transmitted infections [STIs]). Results: We found significant bivariate relationships between SUD and MDD (chi(2) = 4.85, p = .028) and between PTSD and MDD (chi(2) = 35.38, p = .028, p < .001) but did not find a significant relationship between SUD and PTSD (chi(2) = 3.64, p = .056). Number of diagnoses were associated with episodes of high-risk sex (incidence rate ratio [IRR] = 1.14, 95% CI [1.03, 1.26], p = .009) and visiting the ER (odds ratio = 1.27; 95% CI [1.01, 1.60], p = .040) but not with STIs. No interactions were found between diagnoses and health-related indicators. Conclusions: This is the first study to demonstrate additive effects of clinical diagnoses on risk behavior and health care utilization among MSM with developmental trauma histories. Results indicate the need to prioritize empirically supported treatments for SUD and MDD, in addition to trauma treatment, for this population.