Introduction. HIV positive men who have sex with men (HIVMSM), facing severe stigma and many stressors, have high prevalence of mental health problems, such as depression. However, there is a lack of mental health promotion and treatment services targeting HIVMSM in China. The Three Good Things (TGT) exercise is one of the commonly used positive psychology interventions; its benefits in reducing depression have been scientifically proven in many disease groups. Yet, TGT has not been applied among HIVMSM. In addition, social support has shown to be protective of depression. The emergence of electronic social media allows for integration of social networking and TGT exercise among HIVMSM. / Objectives. This study aimed to evaluate the efficacy of a one-month online intervention combining TGT with social networking (TGT-SN) versus a control of dissemination of information in reducing depressive symptoms among HIVMSM in Chengdu, China. / Methods. A randomized controlled trial design was applied. A total of 205 HIVMSM were recruited and randomly assigned to the TGT-SN (N=100) or control group (N=105) by four well-trained peer fieldworkers. Self-administered surveys were given to all participants at baseline, at the end of the 1-month intervention (T1), and at the 3-month (T2) and 6-month (T3) post-intervention follow-ups. The intervention was delivered via “QQ”, the most widely used Chinese social networking service. Participants in TGT-SN group were divided into four “QQ” groups, each the size of 20-30 persons. Participants in TGT-SN were asked to post three things they experienced that they feel grateful about daily onto the QQ platform and share them with members of their group. They were also asked to read others’ messages and give positive and encouraging feedbacks to those messages. Members of the control group received information about mental health promotion from research assistants via QQ once a week during the one-month intervention period. The primary mental health outcome was probable case of mild to severe depression measured by Center for Epidemiologic Studies Depression Scale (CES-D). Secondary psychological outcomes include depressive symptoms, anxiety, positive and negative affect, life satisfaction, subjective happiness, gratitude level, and perceived social support. Generalized Estimating Equation models were fit. Structural equation modeling was applied for mediation analysis. / Results. Among all participants, the prevalence of probable mild, moderate, and severe depression were, respectively, 14.6%, 9.3%, and 35.6% at baseline. All baseline background characteristics and outcome measures were balanced (statistically non-significant) between the two groups. Based on data obtained at T1, T2 and T3 that were analyzed by GEE model, there was a significant main effect of TGT-SN on reducing depression (B=-2.35, 95% CI=-4.53, -0.16, p=0.035), indicating significantly lower depression score in the intervention group as compared with that of control group. Nonetheless, such significant effect became non-significant (B=-1.67, 95% CI=-3.79, 0.46, p=0.124) when controlled for baseline depression score. Significant differences were also found between the TGT-SN and the control group in anxiety symptoms (B=-1.14, 95% CI=-2.06, -0.22, p=0.016) and negative affect (B=-2.08, 95% CI=-3.62, -0.55, p=0.008). The effect of TGT-SN on reducing depression was most evident at T3. Structural equation modeling indicated that gratitude and negative affect fully mediated the effect of TGT-SN in reduction of depression and anxiety (mediation effect=-0.17, 95% CI=-0.30, -0.04, p<0.05) at T3. / Conclusions. TGT-SN is a feasible, acceptable, sustainable, and scalable intervention to improve mental health among HIVMSM. It is warranted to increase awareness and policy support for mental health services for people living with HIV (PLWH). Mental health services should be integrated into the HIV/AIDS care system as a key component. Future translational studies are needed to further investigate the efficacy and effectiveness of the intervention in other groups of PLWH and in other cultures and countries. / 研究背景：艾滋病在男男性接觸（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國蔓延。艾滋病陽性的男男性接觸（HIV positive men who have sex with men, HIVMSM）人群面臨極大的壓力，心理疾病（例如抑鬱症）的患病率很高。但是，目前我國對HIVMSM人群的心理健康服務比較缺乏。“三件好事情”是最被廣泛使用的能有效降低抑鬱症的積極心理學干預。這項練習要求參與者每天寫下三件令他們感到高興或者感激的事情。“三件好事情”這兩練習還沒有在HIVMSM 人群中應用。此外，社會支持對抑鬱症有保護作用。電子社交網絡是一種潛在的有效的平台，可以將調查對象（HIVMSM）的“好事情”相互傳遞，加強“三件好事情”的效果。 / 研究目的：本研究的目的是在中國成都市使用隨機對照研究評估積極心理學結合社會網絡干預對減少HIVMSM人群抑鬱症的效果。 / 研究方法：本研究採用隨機對照試驗。四名同伴調查員共招募205位HIVMSM，其中100人被隨機分配到“三件好事情結合電子社交網絡組（TGT-SN）”，105人被分配到對照組。所有參與本研究的調查對象將在隨機分組之前完成基線調查（T0），並在一個月的干預結束時（T1）、干預結束后三個月（T2）、十二個月（T3）時完成隨訪調查。 / TGT-SN干預通過騰訊QQ實施。騰訊QQ是在中國最被普遍使用的社交網絡。TGT-SN組的調查對象將被分配到4個QQ組，每組20-30人。TGT-SN干預要求調查對象在一個月的干預期，每天需要完成以下三個任務：i）每天回想當天發生的三件或以上令自己開心、感激的事情，并將這三件好事情發佈到各自的QQ群留言板；ii）每天閱讀本QQ群其他組員發佈的三件好事情；iii）每天對組員發佈的三件好事情進行正面的積極的評論。被隨機分配到對照組的調查對象在一個月的干預期內，每週收到一條有關心理健康促進的信息。 / 本研究的主要結果為抑鬱症狀，採用美國國立衛生研究院流行病學研究中心抑鬱量表。次級結果包括焦慮症狀、正性和負性情緒、生活滿意度、主觀幸福感、感恩心理、以及社會支持。分析採用廣義估計方程模型（GEE）。中介效應分析採用結構方程模型。 / 研究結果：所有調查對象中，59.5%有輕度到重度抑鬱症（CESD≥16）。TGT-SN和對照組基線所有的背景變量及結果變量均無顯著性差異。基於對T1、T2和T3數據的GEE模型分析，相比于對照組，TGT-SN對降低抑鬱症有顯著主效應（B=-2.35, 95% CI=-4.53, -0.16; p=0.035）。但是此顯著主效應在控制基線抑鬱症狀后變為不顯著（B=-1.67, 95% CI=-3.79, 0.46, p=0.124）。相比于對照組，TGT-SN對降低焦慮症狀（B=-1.29, 95% CI=-2.22, -0.36; p=0.007）和負性情緒（B=-2.24, 95% CI=-3.73, -0.74; p=0.003）也有顯著效果。TGT-SN對降低抑鬱症的效果在T3最為顯著。結構方程模型表明，負性情緒和感恩心理對TGT-SN干預降低T3時抑鬱症和焦慮症的效果中發揮完全中介效應（中介效應=-0.17, 95%置信區間=-0.30, -0.04; p<0.05）。 / 研究結論：TGT-SN能有效減少HIVMSM人群的心理健康問題（例如抑鬱症和焦慮症），並且是可行的和被HIVMSM所接受的干預措施。TGT-SN練習的實施成本較低並且不需要心理學專家的參與，因此可以在資源有限的國家和地區（例如中國）推廣實施。未來需要更多的研究來評估TGT-SN干預在其他艾滋病病毒感染者人群中以及其它國家的效力和效果。" / Li, Jinghua. / Thesis Ph.D. Chinese University of Hong Kong 2015. / Includes bibliographical references (leaves 136-149). / Abstracts also in Chinese; some appendixes in Chinese. / Title from PDF title page (viewed on 06, October, 2016). / Li, Jinghua. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only.
| Identifer | oai:union.ndltd.org:cuhk.edu.hk/oai:cuhk-dr:cuhk_1291478 |
| Date | January 2015 |
| Contributors | Li, Jinghua (author.), Lau, Joseph, T. F. (thesis advisor.), Chinese University of Hong Kong Graduate School. Division of Public Health. (degree granting institution.) |
| Source Sets | The Chinese University of Hong Kong |
| Language | English, Chinese, Chinese |
| Detected Language | English |
| Type | Text, bibliography, text |
| Format | electronic resource], electronic resource, remote, 1 online resource (xxii, 187 leaves) : illustrations (some color), computer, online resource |
| Coverage | China, Chengdu, China, Chengdu, China, Chengdu, China, Chengdu, China |
| Rights | Use of this resource is governed by the terms and conditions of the Creative Commons "Attribution-NonCommercial-NoDerivatives 4.0 International" License (http://creativecommons.org/licenses/by-nc-nd/4.0/) |
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