老年HIV感染者心理痛苦现状及影响因素研究

doi:10.3761/j.issn.0254-1769.2024.22.009

摘要/Abstract

摘要：

目的调查老年HIV感染者心理痛苦的现状，并分析其影响因素。方法通过便利抽样的方法，选取2022年 12月—2023年10月在上海市艾滋病定点诊疗机构艾滋病自愿咨询检测门诊定期随访年龄≥50岁的HIV感染者365例作为调查对象。使用一般资料调查表、HIV告知情况问卷、心理痛苦温度计、Lubben社会网络量表进行调查。采用二元Logistics回归分析探索老年HIV感染者心理痛苦的影响因素。结果最终纳入老年HIV感染者332例，105例（31.6%）存在心理痛苦。心理痛苦相关因素排名前3的条目分别是经济问题、担忧及睡眠、与孩子相处。二元Logistics回归分析结果显示，月收入<3 000元、HIV感染未告知、存在社会隔离是老年HIV感染者发生心理痛苦的影响因素（P<0.05）。结论老年HIV感染者的心理痛苦有待进一步改善。临床医护人员应关注老年HIV感染者心理痛苦水平，并针对影响因素制订有效的干预策略，以降低老年HIV感染者的心理痛苦程度。

关键词: 人类免疫缺陷病毒, 老年人, 心理痛苦, 影响因素分析, 心理护理学

Abstract:

Objective To describe the status and influencing factors of psychological distress in older people living with HIV in Shanghai. Methods Convenience sampling was used to select HIV patients with the age of 50 years old and above who attended follow-up visits at the voluntary counselling & testing clinic in Shanghai Public Health Clinical Center from December 2022 to October 2023. Data were collected using a general information questionnaire，HIV disclosure questionnaire，Distress Thermometer and Lubben Social Network Scale-6. Binary logistic regression was employed to analyze the factors influencing psychological distress. Results The prevalence of psychological distress among 332 participants was 105 cases（31.6%）. The top 3 items selected by participants in Psychological Distress Problem List were insurance/financial issues，worry and sleep，relationship with children. Factors associated with a higher level of psychological distress included lower monthly income，not HIV disclosure and higher levels of social isolation. Conclusion Psychological distress among older people living with HIV remains to be further reduced，and it is affected by many factors. Health care providers should pay more attention to psychological distress among older HIV patients，and develop targeted intervention according to relevant influencing factors，aiming to reduce their psychological distress.

Key words: HIV, Aged, Psychological Distress, Root Cause Analysis, Psychological Nursing

陆雪倩, 孙文秀, 潘燕云, 张林, 孙美艳. 老年HIV感染者心理痛苦现状及影响因素研究[J]. 中华护理杂志, 2024, 59(22): 2747-2752.

LU Xueqian, SUN Wenxiu, PAN Yanyun, ZHANG Lin, SUN Meiyan. Influencing factors related to psychological distress among older people living with HIV[J]. Chinese Journal of Nursing, 2024, 59(22): 2747-2752.

图/表 4

表1 调查对象的一般资料及心理痛苦单因素分析结果（n=332）

Table 1 The general information of the respondents and the results of the univariate analysis of the influencing factors of psychological distress（n=332）

表2 心理痛苦相关因素及发生频率（n=332）

Table 2 The factors of psychological distress and its frequency（n=332）

表3 自变量赋值

Table 3 Variable assignment

表4 调查对象心理痛苦影响因素的二元Logistics回归分析结果

Table 4 Results of binary Logistics regression analysis of factors influencing psychological distress of respondents

参考文献 33

[1]	Deeks SG, Lewin SR, Havlir DV. The end of AIDS:HIV infection as a chronic disease[J]. Lancet, 2013, 382(9903):1525-1533.
[2]	Smit M, Brinkman K, Geerlings S, et al. Future challenges for clinical care of an ageing population infected with HIV:a modelling study[J]. Lancet Infect Dis, 2015, 15(7):810-818.
[3]	Autenrieth CS, Beck EJ, Stelzle D, et al. Global and regional trends of people living with HIV aged 50 and over:estimates and projections for 2000-2020[J]. PLoS One, 2018, 13(11):e0207005.
[4]	The Lancet Healthy Longevity. Ageing with HIV[J]. Lancet Healthy Longev, 2022, 3(3):e119. DOI PMID
[5]	Brown MJ, Adeagbo O. HIV and aging:double stigma[J]. Curr Epidemiol Rep, 2021, 8(2):72-78.
[6]	Riba MB, Donovan KA, Andersen B, et al. Distress management,version 3.2019,NCCN clinical practice guidelines in oncology[J]. J Natl Compr Canc Netw, 2019, 17(10):1229-1249.
[7]	Mutumba M, Bauermeister JA, Harper GW, et al. Psychological distress among Ugandan adolescents living with HIV:examining stressors and the buffering role of general and religious coping strategies[J]. Glob Public Health, 2017, 12(12):1479-1491. DOI PMID
[8]	Heckman TG, Kochman A, Sikkema KJ, et al. Late middle-aged and older men living with HIV/AIDS:race differences in coping,social support,and psychological distress[J]. J Natl Med Assoc, 2000, 92(9):436-444. PMID
[9]	Vedhara K, Nott KH, Bradbeer CS, et al. Greater emotional distress is associated with accelerated CD4+ cell decline in HIV infection[J]. J Psychosom Res, 1997, 42(4):379-390. PMID
[10]	Brown T, Morgan K. Psychological distress and substance abuse in Jamaican youths living with HIV/AIDS[J]. West Indian Med J, 2013, 62(4):341-345.
[11]	马海棋, 翟惠敏, 李冰, 等. 接受抗病毒治疗HIV/AIDS患者艾滋病心理痛苦现状及影响因素[J]. 温州医科大学学报, 2023, 53(4):298-304.
	Ma HQ, Zhai HM, Li B, et al. Analysis of current situation and influencing factors of HIV-related psychological distress for HIV/AIDS patients who received antiretroviral therapy[J]. J Wenzhou Med Univ, 2023, 53(4):298-304.
[12]	莫园园, 蒋莉, 苏丽西, 等. 男男同性恋HIV感染者/艾滋病病人心理痛苦的研究[J]. 护理研究, 2019, 33(21):3754-3757.
	Mo YY, Jiang L, Su LX, et al. Study on psychological of HIV infectors/AIDS patients among male homosexuals[J]. Chin Nurs Res, 2019, 33(21):3754-3757.
[13]	莫小云. 艾滋病病毒感染者/艾滋病患者心理痛苦调查及个体化心理干预效果研究[D]. 南宁: 广西医科大学, 2017.
	Mo XY. Investigate the psychological distress status and evaluate the effect of individualized psychological intervention in HIV/AIDS[D]. Nanning: Guangxi Medical University, 2017.
[14]	Cohen M, Hoffman RG, Cromwell C, et al. The prevalence of distress in persons with human immunodeficiency virus infection[J]. Psychosomatics, 2002, 43(1):10-15. PMID
[15]	陈雨晴. 湖南省老年HIV感染者性伴告知及其影响因素研究[D]. 长沙: 中南大学, 2022.
	Chen YQ. Partner notification and association factors among old people living with HIV in Hunan province[D]. Changsha: Central South University, 2022.
[16]	张叶宁, 张海伟, 宋丽莉, 等. 心理痛苦温度计在中国癌症患者心理痛苦筛查中的应用[J]. 中国心理卫生杂志, 2010, 24(12):897-902.
	Zhang YN, Zhang HW, Song LL, et al. Application of the NCCN Distress Thermometer in Chinese cancer patients[J]. Chin Ment Health J, 2010, 24(12):897-902.
[17]	Obiajulu VO, Abiola T, Izehinosen CO, et al. Psychometric validity of the Distress Thermometer and problem check list in ART-naïve HIV infected patients in Northern Nigeria[J]. Afr Health Sci, 2019, 19(4):3172-3180. DOI PMID
[18]	Lubben J, Blozik E, Gillmann G, et al. Performance of an abbreviated version of the Lubben Social Network Scale among three European community-dwelling older adult populations[J]. Gerontologist, 2006, 46(4):503-513. DOI PMID
[19]	Chang QS, Sha F, Chan CH, et al. Validation of an abbreviated version of the Lubben Social Network Scale(“LSNS-6”) and its associations with suicidality among older adults in China[J]. PLoS One, 2018, 13(8):e0201612.
[20]	彭燕霞, 高云飞, 雍敬敬, 等. 社区老年人对数字健康技术焦虑的现状及护理对策分析[J]. 中华护理杂志, 2023, 58(11):1345-1351. DOI URL
	Peng YX, Gao YF, Yong JJ, et al. The current status and influencing factors of technophobia among the elderly from the perspective of digital health[J]. Chin J Nurs, 2023, 58(11):1345-1351. DOI URL
[21]	尹艳茹, 周洪昌, 刘梦如, 等. 老年维持性血液透析患者社会隔离现状的调查研究[J]. 中华护理杂志, 2023, 58(7):822-829. DOI URL
	Yin YR, Zhou HC, Liu MR, et al. Status and influencing factors of social isolation in elderly patients with maintenance hemodialysis[J]. Chin J Nurs, 2023, 58(7):822-829. DOI URL
[22]	Ma HQ, Zhu F, Zhai HM, et al. Prevalence of psychological distress among people living with HIV/AIDS:a systematic review and meta-analysis[J]. AIDS Care, 2023, 35(2):153-164.
[23]	陈东丽. 反刍性沉思在艾滋病患者心理痛苦与创伤后成长间的中介效应[J]. 中国民康医学, 2023, 35(22):146-149.
	Chen DL. Mediating effects of ruminant contemplation between psychological distress and posttraumatic growth in AIDS patients[J]. Med J Chin People’s Health, 2023, 35(22):146-149.
[24]	蔡畅, 汤后林, 李东民, 等. 我国艾滋病患者的死亡趋势及其相关危险因素分析[J]. 中华流行病学杂志, 2021, 42(1):121-125. PMID
	Cai C, Tang HL, Li DM, et al. Analysis on death trend in AIDS patients and related risk factors in China[J]. Chin J Epidemiol, 2021, 42(1):121-125. DOI PMID
[25]	Han SY, Hu Y, Pei YL, et al. Sleep satisfaction and cognitive complaints in Chinese middle-aged and older persons living with HIV:the mediating role of anxiety and fatigue[J]. AIDS Care, 2021, 33(7):929-937.
[26]	Li L, Liang LJ, Ji GP, et al. Perceived bonding by parents living with HIV and their adolescent children[J]. J Res Adolesc, 2016, 26(4):880-888.
[27]	何加敏, 朱政, 卢洪洲. HIV感染者合并慢性非传染性疾病多药依从性管理的研究进展[J]. 中华护理杂志, 2022, 57(14):1788-1793. DOI URL
	He JM, Zhu Z, Lu HZ. Research progress on polypharmacy ad-herence management in HIV-infected people with chronic non-communicable diseases[J]. Chin J Nurs, 2022, 57(14):1788-1793.
[28]	中国疾病预防控制中心性病艾滋病预防控制中心. 男男性行为人群预防艾滋病干预工作指南[EB/OL].(2016-05)[2024-01-17]. https://ncaids.chinacdc.cn/jb/jszn/201609/W020160913346815395954.pdf.
	Chinese Center for Disease Control and Prevention,Center for STD and AIDS Prevention and Control, Center for STD and AIDS Prevention and Control. Guidelines for HIV prevention and intervention among men who have sex with men[EB/OL].(2016-05)[2024-01-17]. https://ncaids.chinacdc.cn/jb/jszn/201609/W020160913346815395954.pdf.
[29]	Izudi J, Okoboi S, Lwevola P, et al. Effect of disclosure of HIV status on patient representation and adherence to clinic visits in eastern Uganda:a propensity-score matched analysis[J]. PLoS One, 2021, 16(10):e0258745.
[30]	Brown MJ, Serovich JM, Kimberly JA, et al. Disclosure and self-efficacy among HIV-positive men who have sex with men:a comparison between older and younger adults[J]. AIDS Patient Care STDS, 2015, 29(11):625-633.
[31]	苏闪闪, 郑蔚, 王丹丹, 等. 癌症患者社会疏离的概念分析[J]. 中华护理杂志, 2022, 57(9):1088-1093. DOI URL
	Su SS, Zheng W, Wang DD, et al. Social isolation in cancer patients:an evolutionary concept analysis[J]. Chin J Nurs, 2022, 57(9):1088-1093.
[32]	Emlet CA. An examination of the social networks and social isolation in older and younger adults living with HIV/AIDS[J]. Health Soc Work, 2006, 31(4):299-308. DOI PMID
[33]	Marziali ME, McLinden T, Card KG, et al. Social isolation and mortality among people living with HIV in British Columbia,Canada[J]. AIDS Behav, 2021, 25(2):377-388.