艾滋病阳性男男性接触人群心理健康及高危行为研究

HIV positive men who have sex with men (HIV+MSM), facing severe stigma and many stressors, have high prevalenceof psychological problems. One study among HIV-infected MSM in China reported 48% have depression and 48% have suicide ideation. Yet, mental health promotion services targeting this population are very scarce in China. Recently, effective evidence-based positive psychology interventions (PPI) have been developed. The Three Good Things exercise is one of the PPI, which requires participants to write down experiences of three things that he/she feels grateful about. It has been shown to be effective in reducing depression through creation of positive affect in many disease groups but its effect has not been tested among HIV+MSM. Furthermore, social support has shown to be protective of depression. The emergence of electronic social media allows for excellent opportunities to integrate social networking with PPI. This study investigates the efficacy of a one-month experiment combining PPI using the Three Good Things with social networking (TGT-SN), compared to a one-month experiment only using Three Good Things (TGT), versus a control on information dissemination among 480 HIV+MSM in Sichuan Province China in reducing depressive symptoms. Online surveys will be administered to all participants at baseline, at the end of the 1-month experiment, and at the 3-month and 12-month post-experiment follow-up. It is hypothesized that participants in TGT and TGT-SN groups, as compared to control group participants, will report less depressive symptoms, better psychological outcomes (e.g. positive affect, life satisfaction, subjective happiness, gratitude level, and perceived social support), and better behavioral outcomes (e.g. less unprotected anal sex and higher service utilization rate). Both absolute and relative risk reduction will be reported; GEE models will be fit. The novel method combining the Three Good Things approach with electronic social networking can be delivered at virtually no cost with a large coverage and is hence potentially sustainable and scalable.

艾滋病在男男性接触（Men Who Have Sex With Men, MSM）人群中的感染率正在以前所未有的速度在我国蔓延。国内HIV阳性MSM人群中，48%患有抑郁症状，亦有48%有自杀意念。而心理健康状况不佳明显与身体健康差及高危性行为相关，从而加速艾滋病在MSM人群中的传播。目前我国对HIV阳性MSM人群的心理健康服务比较缺乏。本研究应用随机对照试验，将积极心理学应用到HIV阳性MSM人群，并探讨积极心理学（"三件好事情"）结合电子社交网络（腾讯QQ）的方法降低HIV阳性MSM人群抑郁症状、改善心理健康状态、减少高危性行为的效果和机制。为政府部门进行MSM人群艾滋病的预防和控制提供一套有效的、低成本的，利于推广的心理支持服务，降低艾滋病相关高危性行为，遏制艾滋病在MSM人群中的传播。

[项目背景] 艾滋病在男男性接触（men who have sex with men, MSM）人群中的感染率逐年增长。艾滋病阳性的男男性接触（HIV positive men who have sex with men, HIVMSM）心理疾病的患病率很高。目前我国对HIVMSM人群的心理健康服务比较缺乏。..[研究目的] 本研究的目的是用随机对照研究评估积极心理学结合社会网络干预对减少HIVMSM人群抑郁症的效果。..[研究方法] 本研究采用随机对照试验。最终纳入本研究的调查对象共404人，其中129人被随机分配到“三件好事情结合电子社交网络组（TGT-SN）”，139人被分配到“三件好事情（TGT-only）”，136人被分配到对照组。所有参与本研究的调查对象在随机分组之前完成基线调查（T0），并在干预结束时（T1）、干预结束后三个月（T2）、六个月（T3）、及十二个月（T4）时完成随访调查。TGT-SN干预通过QQ实施。TGT-SN要求调查对象在一个月的干预期，每天完成三件好事情并发布在QQ群上；阅读其他组员发布的三件好事情并进行正面积极的评论。TGT-only只要求调查对象每天记录三件好事情。本研究的主要结果为抑郁症状。分析采用广义估计方程模型（GEE）。..[研究结果]所有调查对象中，55.9%有轻度到重度抑郁症。TGT-SN、TGT-only和对照组基线所有的背景变量及结果变量均无显著性差异。基于GEE模型分析，相比于对照组，1）TGT-SN对降低抑郁症有显著主效应（p=0.029）。但是此显著主效应在控制基线抑郁症状后变为边际显著（p=0.085）；2）TGT-only对降低抑郁症在控制基线抑郁症状后变为不显著。3）在控制了基线数据后，TGT-SN对降低焦虑症状（p=0.006）和负性情绪（p=0.019）依然有显著效果；4）TGT-only对降低焦虑症状和负性情绪没有显著主效果；5）对提升正向心理健康方面，TGT-only组对提升感恩水平（p=0.023）及主观幸福（p=0.038）有显著主效应。但是此主效应在控制基线数据后均变为不显著。..[研究结论]TGT-SN能有效减少HIVMSM人群的心理健康问题，并且是可行的和被HIVMSM所接受的干预措施。TGT-SN练习的实施成本较低并且不需要心理学专家的参与，因此可以在资源有限的国家和地区推广实施。

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