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Article(id=1241102818917011713, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1241102813938380911, articleNumber=null, orderNo=null, doi=10.20043/j.cnki.MPM.202404306, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=1713283200000, receivedDateStr=2024-04-17, revisedDate=null, revisedDateStr=null, acceptedDate=null, acceptedDateStr=null, onlineDate=1773831570605, onlineDateStr=2026-03-18, pubDate=1724515200000, pubDateStr=2024-08-25, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1773831570605, onlineIssueDateStr=2026-03-18, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1773831570605, creator=13701087609, updateTime=1773831570605, updator=13701087609, issue=Issue{id=1241102813938380911, tenantId=1146029695717560320, journalId=1227665162245664772, year='2024', volume='51', issue='16', pageStart='2881', pageEnd='3072', issueExtLink='null', onlineDate='null', pubDate='null', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=null, createTime=1773831569418, creator=13701087609, updateTime=1773831807198, updator=13701087609, preIssue=null, nextIssue=null, ext={EN=IssueExt(id=1241103811318706322, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1241102813938380911, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1241103811318706323, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1241102813938380911, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null}, startPage=3029, endPage=3034, ext={EN=ArticleExt(id=1241102819235778834, articleId=1241102818917011713, tenantId=1146029695717560320, journalId=1227665162245664772, language=EN, title=Latent class analysis of mental health literacy among HIV-positive men who have sex with men, columnId=1228016573156360233, journalTitle=Modern Preventive Medicine, columnName=Disease Control and Prevention, runingTitle=null, highlight=null, articleAbstract=
Objective

To explore potential classifications and characteristics of mental health literacy among HIV-positive men who have sex with men.

Methods

From November 2023 to January 2024, 226 HIV-positive MSM in a tertiary hospital in Nanjing were selected by the convenience sampling method and were investigated by general information questionnaire and multicomponent mental health literacy scale. Latent class analysis and multivariate logistic regression analysis were used to explore the categorical characteristics and influencing factors of mental health literacy in this group.

Results

The mental health literacy characteristics of HIV-positive MSM could be classified into low literacy group (22.1%), resource deficient group (38.1%), and high literacy group (39.8%). Multiple logistic regression analysis showed that patients aged 18-34 (OR=5.573, 95%CI=1.020-30.449) were more likely to be in the resource deficient group than the low literacy group, and those who had participated in learning mental health skills (OR=0.126, 95%CI=0.033-0.476) were more likely to be in the high literacy group. Compared with the high literacy group, patients with literacy level of junior high school or below (OR=15.992, 95%CI=2.036-125.591), high school or junior college (OR=2.805, 95%CI=1.098-7.166), length of time to diagnosis of HIV infection <1 year (OR=8.440, 95%CI=1.628-43.742), and with comorbidities (OR=6.619, 95%CI=1.077-40.663) were more likely to be in the low literacy group; and patients with a monthly per capita family income of <3000 yuan (OR=6.241, 95%CI=1.088-35.814) were more likely to be in the resource deprived group.

Conclusion

There are three potential categories of mental health literacy among HIV-positive MSM. In the future, targeted intervention strategies should be developed to improve the level of their mental health literacy and further improve their mental health according to this group’s different category characteristics and influencing factors.

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目的

探索HIV阳性男男性行为（men who have sex with men,MSM）心理健康素养的潜在类别及其影响因素。

方法

于2023年11月至2024年1月，便利选取南京市某三级甲等医院226名HIV阳性MSM，采用一般资料调查问卷和多元心理健康素养量表进行调查。运用潜在类别分析和多元logistic回归分析探究该群体心理健康素养的分类特征与影响因素。

结果

HIV阳性MSM心理健康素养特征可分为低素养组（22.1％）、资源匮乏组（38.1％）、高素养组（39.8％）3类。多元logistic回归分析显示，与低素养组相比，年龄18~34岁（OR=5.573，95%CI=1.020~30.449）的患者更易进入资源匮乏组；参加过心理健康技能学习（OR=0.126，95%CI=0.033~0.476）的患者更易进入高素养组。与高素养组相比，文化程度为初中及以下（OR=15.992，95%CI=2.036~125.591）、高中或专科（OR=2.805,95%CI=1.098~7.166）、HIV感染确诊时长<1年（OR=8.440，95%CI=1.628~43.742），有并发症（OR=6.619，95%CI=1.077~40.663）的患者更容易进入低素养组；家庭人均月收入<3 000元（OR=6.241，95%CI=1.088~35.814）的患者更易进入资源匮乏组。

结论

HIV阳性MSM心理健康素养存在3个潜在类别，未来应根据该群体不同类别特征和影响因素制定针对性干预策略，以提高其心理健康素养水平，进一步改善其心理健康。

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宋艳，E-mail：
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游心怡（1999—），女，硕士在读，研究方向：传染病护理

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游心怡（1999—），女，硕士在读，研究方向：传染病护理

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游心怡（1999—），女，硕士在读，研究方向：传染病护理

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Self-disclosure experience of HIV-positive MSM based on social-ecological theory: a qualitative study[J]. Chinese Journal of AIDS & STD, 2024, 30(3): 289-294., articleTitle=Self-disclosure experience of HIV-positive MSM based on social-ecological theory: a qualitative study, refAbstract=null), Reference(id=1241102832452031453, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241102818917011713, doi=null, pmid=null, pmcid=null, year=2024, volume=28, issue=3, pageStart=1068, pageEnd=1076, url=null, language=null, rfNumber=[19], rfOrder=26, authorNames=Verinumbe T, Katomski AS, Turpin G, journalName=AIDS and Behavior, refType=null, unstructuredReference=Verinumbe T, Katomski AS, Turpin G, et al. Characterizing the relationship between HIV peer support groups and internalized stigma among people living with HIV in Nigeria[J]. AIDS and Behavior, 2024, 28(3): 1068-1076., articleTitle=Characterizing the relationship between HIV peer support groups and internalized stigma among people living with HIV in Nigeria, refAbstract=null), Reference(id=1241102832544306145, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241102818917011713, doi=null, pmid=null, pmcid=null, year=2022, volume=28, issue=4, pageStart=494, pageEnd=497, url=null, language=null, rfNumber=[20], rfOrder=27, authorNames=李潇, 韩晶, 刘宇, journalName=中国艾滋病性病, refType=null, unstructuredReference=李潇，韩晶，刘宇，等．中青年HIV感染男男性行为者抑郁现状及其影响因素的研究进展[J]．中国艾滋病性病，2022，28（4）：494-497., articleTitle=中青年HIV感染男男性行为者抑郁现状及其影响因素的研究进展, refAbstract=null), Reference(id=1241102832636580839, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241102818917011713, doi=null, pmid=null, pmcid=null, year=2022, volume=28, issue=4, pageStart=494, pageEnd=497, url=null, language=null, rfNumber=[20], rfOrder=28, authorNames=Li X, Han J, Liu Y, journalName=Chinese Journal of AIDS & STD, refType=null, unstructuredReference=Li X, Han J, Liu Y, et al. Depression and its related factors of young-middle men who have sex with men with HIV infections[J]. Chinese Journal of AIDS & STD, 2022, 28(4): 494-497., articleTitle=Depression and its related factors of young-middle men who have sex with men with HIV infections, refAbstract=null)], funds=[Fund(id=1241102827712467682, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241102818917011713, awardId=SJCX24_0853, language=CN, fundingSource=江苏省研究生培养创新工程研究生科研与实践创新计划(SJCX24_0853), fundOrder=null, country=null), Fund(id=1241102827834102506, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241102818917011713, awardId=RCMS23014, language=CN, fundingSource=南京市第二医院人才托举工程资助项目(RCMS23014), fundOrder=null, country=null)], companyList=[AuthorCompany(id=1241102820003336517, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241102818917011713, xref=1., ext=[AuthorCompanyExt(id=1241102820011725126, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241102818917011713, companyId=1241102820003336517, language=EN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=School of Nursing, Nanjing University of Chinese Medicine, Nanjing, Jiangsu 210023, China), AuthorCompanyExt(id=1241102820020113736, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241102818917011713, companyId=1241102820003336517, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=1.南京中医药大学护理学院，江苏 南京 210023)]), AuthorCompany(id=1241102820217246028, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241102818917011713, xref=2., ext=[AuthorCompanyExt(id=1241102820225634637, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241102818917011713, companyId=1241102820217246028, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=2. 南京中医药大学附属南京医院（南京市第二医院）护理部)])], figs=[ArticleFig(id=1241102824977781383, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241102818917011713, language=EN, label=Fig.1, caption=Distribution of Characteristics of HIV-Positive MSM Mental Health Literacy Potential Category Groups, figureFileSmall=CTFMTLrOxFjSoNRS0vzGdg==, figureFileBig=KQMqDWGnHiw0nA+wmYG1xA==, tableContent=null), ArticleFig(id=1241102825204273801, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241102818917011713, language=CN, label=图1, caption=HIV阳性MSM心理健康素养潜在类别组特征分布, figureFileSmall=CTFMTLrOxFjSoNRS0vzGdg==, figureFileBig=KQMqDWGnHiw0nA+wmYG1xA==, tableContent=null), ArticleFig(id=1241102825439154846, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241102818917011713, language=EN, label=Table 1, caption=

General information on HIV-positive MSM

, figureFileSmall=null, figureFileBig=null, tableContent=
项目分类人数构成比
（%）		项目分类人数构成比
（%）
年龄（岁）18~3414363.3家庭人均月收入（元）<3 000219.3
35~496629.23 000~6 0006026.5
≥50177.5>6 00014564.2
民族汉族21695.6医疗费用支付城镇医保17075.2
其他104.4新农合208.8
宗教有167.1自费或其他3615.9
无21092.9HIV感染确诊时长（年）<14519.9
文化程度初中及以下156.61~35524.3
高中或专科8738.5>3~109943.8
本科及以上12454.9>102711.9
婚姻状况已婚4821.2有无参加心理技能学习有4319.0
未婚、离异或丧偶17878.8无18381.0
工作状态在职18682.3有无并发症有2410.6
无业/病休83.5无20289.4
其他3214.2整体健康状况好13358.8
家庭居住地城镇16070.8一般8537.6
农村6629.2差83.5
), ArticleFig(id=1241102825539818144, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241102818917011713, language=CN, label=表1, caption=

HIV阳性MSM一般资料

, figureFileSmall=null, figureFileBig=null, tableContent=
项目分类人数构成比
（%）		项目分类人数构成比
（%）
年龄（岁）18~3414363.3家庭人均月收入（元）<3 000219.3
35~496629.23 000~6 0006026.5
≥50177.5>6 00014564.2
民族汉族21695.6医疗费用支付城镇医保17075.2
其他104.4新农合208.8
宗教有167.1自费或其他3615.9
无21092.9HIV感染确诊时长（年）<14519.9
文化程度初中及以下156.61~35524.3
高中或专科8738.5>3~109943.8
本科及以上12454.9>102711.9
婚姻状况已婚4821.2有无参加心理技能学习有4319.0
未婚、离异或丧偶17878.8无18381.0
工作状态在职18682.3有无并发症有2410.6
无业/病休83.5无20289.4
其他3214.2整体健康状况好13358.8
家庭居住地城镇16070.8一般8537.6
农村6629.2差83.5
), ArticleFig(id=1241102825661452971, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241102818917011713, language=EN, label=Table 2, caption=

Latent class analysis model fit indicators of HIV-positive MSM mental health literacy(n=226)

, figureFileSmall=null, figureFileBig=null, tableContent=
模型AICBICaBICEntroyLMRBLRT类别概率
16 756.1116 831.3636 761.639----
26 273.5606 427.4856 284.8690.876<0.001<0.0010.425/0.575
36 128.8116 361.4086 145.8990.8650.004<0.0010.398/0.381/0.221
46 100.7536 412.0226 123.6200.8880.445<0.0010.372/0.089/0.305/0.235
), ArticleFig(id=1241102825749533360, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241102818917011713, language=CN, label=表2, caption=

HIV阳性MSM心理健康素养潜在类别模型拟合指标（n=226）

, figureFileSmall=null, figureFileBig=null, tableContent=
模型AICBICaBICEntroyLMRBLRT类别概率
16 756.1116 831.3636 761.639----
26 273.5606 427.4856 284.8690.876<0.001<0.0010.425/0.575
36 128.8116 361.4086 145.8990.8650.004<0.0010.398/0.381/0.221
46 100.7536 412.0226 123.6200.8880.445<0.0010.372/0.089/0.305/0.235
), ArticleFig(id=1241102825858585274, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241102818917011713, language=EN, label=Table 3, caption=

Univariate analysis of 3 potential categories of mental health literacy among HIV-positive MSM [n(%)]

, figureFileSmall=null, figureFileBig=null, tableContent=
项目高素养组（90）资源匮乏组（86）低素养组（50）统计量P
年龄（岁）21.238b<0.001
18~3459（65.6）65（75.6）19（38.0）
35~4927（30.0）17（19.8）22（44.0）
≥504（4.4）4（4.7）9（18.0）
民族1.889a0.418
汉族87（96.7）83（96.5）46（92.0）
其他3（3.3）3（3.5）4（8.0）
宗教0.967a0.617
有5(5.6)6(7.0)5(10.0)
无85(94.4)80(93.0)45(90.0)
文化程度25.352b<0.001
初中及以下2(2.2)4(4.7)9(18.0)
高中或专科23(25.6)39(45.3)25(50.0)
本科及以上65(72.2)43(50.0)16(32.0)
婚姻状况4.963a0.084
已婚25(27.8)17(19.8)6(12.0)
未婚、离异或丧偶65(72.2)69(80.2)44(88.0)
工作状态4.487a0.339
在职69(76.7)74(86.0)43(86.0)
无业/病休5(5.6)1(1.2)2(4.0)
其他16(17.8)11(12.8)5(10.0)
家庭居住地8.317a0.016
城镇73(81.8)53(61.6)34(68.0)
农村17(18.9)33(38.4)16(32.0)
医疗费用支付2.300a0.681
城镇医保69(76.7)65(75.6)36(72.0)
新农合7(7.8)6(7.0)7(14.0)
自费或其他14(15.6)15(17.4)7(14.0)
家庭人均月收入（元）10.412b0.005
<3 0002(2.2)15(17.4)4(8.0)
3 000~6 00020(22.2)22(25.6)18(36.0)
>6 00068(75.6)49(57.0)28(56.0)
HIV感染确诊时长（年）7.266b0.026
<112(13.3)18(20.9)15(30.0)
1~321(23.3)21(24.4)13(26.0)
>3~1042(46.7)39(45.3)18(36.0)
>1015(16.7)8(9.3)4(8.0)
有无并发症16.209a<0.001
有2(2.2)10(11.6)12(24.0)
无88(97.8)76(88.4)38(76.0)
有无参加过心理
技能学习19.995a<0.001
有30(33.3)9(10.5)4(8.0)
无60(66.7)77(89.5)46(92.0)
整体健康状况11.169b0.004
好63(70.0)49(57.0)21(42.0)
一般26(28.9)33(38.3)26(52.0)
差1(1.1)4(4.7)3(6.0)
), ArticleFig(id=1241102827355951816, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241102818917011713, language=CN, label=表3, caption=

HIV阳性MSM心理健康素养3个潜在类别的单因素分析[n(%)]

, figureFileSmall=null, figureFileBig=null, tableContent=
项目高素养组（90）资源匮乏组（86）低素养组（50）统计量P
年龄（岁）21.238b<0.001
18~3459（65.6）65（75.6）19（38.0）
35~4927（30.0）17（19.8）22（44.0）
≥504（4.4）4（4.7）9（18.0）
民族1.889a0.418
汉族87（96.7）83（96.5）46（92.0）
其他3（3.3）3（3.5）4（8.0）
宗教0.967a0.617
有5(5.6)6(7.0)5(10.0)
无85(94.4)80(93.0)45(90.0)
文化程度25.352b<0.001
初中及以下2(2.2)4(4.7)9(18.0)
高中或专科23(25.6)39(45.3)25(50.0)
本科及以上65(72.2)43(50.0)16(32.0)
婚姻状况4.963a0.084
已婚25(27.8)17(19.8)6(12.0)
未婚、离异或丧偶65(72.2)69(80.2)44(88.0)
工作状态4.487a0.339
在职69(76.7)74(86.0)43(86.0)
无业/病休5(5.6)1(1.2)2(4.0)
其他16(17.8)11(12.8)5(10.0)
家庭居住地8.317a0.016
城镇73(81.8)53(61.6)34(68.0)
农村17(18.9)33(38.4)16(32.0)
医疗费用支付2.300a0.681
城镇医保69(76.7)65(75.6)36(72.0)
新农合7(7.8)6(7.0)7(14.0)
自费或其他14(15.6)15(17.4)7(14.0)
家庭人均月收入（元）10.412b0.005
<3 0002(2.2)15(17.4)4(8.0)
3 000~6 00020(22.2)22(25.6)18(36.0)
>6 00068(75.6)49(57.0)28(56.0)
HIV感染确诊时长（年）7.266b0.026
<112(13.3)18(20.9)15(30.0)
1~321(23.3)21(24.4)13(26.0)
>3~1042(46.7)39(45.3)18(36.0)
>1015(16.7)8(9.3)4(8.0)
有无并发症16.209a<0.001
有2(2.2)10(11.6)12(24.0)
无88(97.8)76(88.4)38(76.0)
有无参加过心理
技能学习19.995a<0.001
有30(33.3)9(10.5)4(8.0)
无60(66.7)77(89.5)46(92.0)
整体健康状况11.169b0.004
好63(70.0)49(57.0)21(42.0)
一般26(28.9)33(38.3)26(52.0)
差1(1.1)4(4.7)3(6.0)
), ArticleFig(id=1241102827456615116, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241102818917011713, language=EN, label=Table 4, caption=

Multiple logistic regression analyses of mental health potential categories among HIV-positive MSM (n=226)

, figureFileSmall=null, figureFileBig=null, tableContent=
项目变量β标准误Wald χ2POR（95%CI）
C3与C1比较1)常数项-1.5682.0500.5850.444
文化程度
初中及以下2.7721.0526.9500.00815.992（2.036~125.591）
高中或专科1.0310.4794.6440.0312.805（1.098~7.166）
参加心理技能学习-2.0740.6799.3220.0020.126（0.033~0.476）
HIV感染确诊时长（年）
<12.1330.8396.4560.0118.440（1.628~43.742）
有并发症1.8900.9264.1640.0416.619（1.077~40.663）
C3与C2比较1)常数项-1.3281.8000.5440.461
参加心理技能学习-1.2870.4617.7970.0050.276（0.112~0.681）
家庭人均月收入（元）
<3 0001.8310.8914.2200.0406.241（1.088~35.814）
C1与C2比较2)常数项0.2411.7930.0180.893
年龄（岁）
18~341.7180.8663.9310.0475.573（1.020~30.449）
文化程度
初中及以下-1.8200.8724.3550.0370.162（0.029~0.895）
), ArticleFig(id=1241102827574055634, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241102818917011713, language=CN, label=表4, caption=

HIV阳性MSM心理健康素潜类别的的多元logistic回归分析(n=226）

, figureFileSmall=null, figureFileBig=null, tableContent=
项目变量β标准误Wald χ2POR（95%CI）
C3与C1比较1)常数项-1.5682.0500.5850.444
文化程度
初中及以下2.7721.0526.9500.00815.992（2.036~125.591）
高中或专科1.0310.4794.6440.0312.805（1.098~7.166）
参加心理技能学习-2.0740.6799.3220.0020.126（0.033~0.476）
HIV感染确诊时长（年）
<12.1330.8396.4560.0118.440（1.628~43.742）
有并发症1.8900.9264.1640.0416.619（1.077~40.663）
C3与C2比较1)常数项-1.3281.8000.5440.461
参加心理技能学习-1.2870.4617.7970.0050.276（0.112~0.681）
家庭人均月收入（元）
<3 0001.8310.8914.2200.0406.241（1.088~35.814）
C1与C2比较2)常数项0.2411.7930.0180.893
年龄（岁）
18~341.7180.8663.9310.0475.573（1.020~30.449）
文化程度
初中及以下-1.8200.8724.3550.0370.162（0.029~0.895）
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HIV阳性男男性行为者心理健康素养的潜在类别分析
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游心怡 1 , 文琪 1 , 王文慧 2 , 徐兴莲 2 , 杨雯雯 1 , 吴雨函 1 , 宋艳 2
现代预防医学 | 疾病预防控制 2024,51(16): 3029-3034
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现代预防医学 | 疾病预防控制 2024, 51(16): 3029-3034
HIV阳性男男性行为者心理健康素养的潜在类别分析
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游心怡1, 文琪1, 王文慧2, 徐兴莲2, 杨雯雯1, 吴雨函1, 宋艳2
作者信息
  • 1.南京中医药大学护理学院，江苏 南京 210023
  • 2. 南京中医药大学附属南京医院（南京市第二医院）护理部

    • 游心怡（1999—），女，硕士在读，研究方向：传染病护理

通讯作者:

宋艳，E-mail：
Latent class analysis of mental health literacy among HIV-positive men who have sex with men
Xin-yi YOU1, Qi WEN1, Wen-hui WANG2, Xing-lian XU2, Wen-wen YANG1, Yu-han WU1, Yan SONG2
Affiliations
  • School of Nursing, Nanjing University of Chinese Medicine, Nanjing, Jiangsu 210023, China
出版时间: 2024-08-25 doi: 10.20043/j.cnki.MPM.202404306
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摘要
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目的

探索HIV阳性男男性行为（men who have sex with men,MSM）心理健康素养的潜在类别及其影响因素。

方法

于2023年11月至2024年1月，便利选取南京市某三级甲等医院226名HIV阳性MSM，采用一般资料调查问卷和多元心理健康素养量表进行调查。运用潜在类别分析和多元logistic回归分析探究该群体心理健康素养的分类特征与影响因素。

结果

HIV阳性MSM心理健康素养特征可分为低素养组（22.1％）、资源匮乏组（38.1％）、高素养组（39.8％）3类。多元logistic回归分析显示，与低素养组相比，年龄18~34岁（OR=5.573，95%CI=1.020~30.449）的患者更易进入资源匮乏组；参加过心理健康技能学习（OR=0.126，95%CI=0.033~0.476）的患者更易进入高素养组。与高素养组相比，文化程度为初中及以下（OR=15.992，95%CI=2.036~125.591）、高中或专科（OR=2.805,95%CI=1.098~7.166）、HIV感染确诊时长<1年（OR=8.440，95%CI=1.628~43.742），有并发症（OR=6.619，95%CI=1.077~40.663）的患者更容易进入低素养组；家庭人均月收入<3 000元（OR=6.241，95%CI=1.088~35.814）的患者更易进入资源匮乏组。

结论

HIV阳性MSM心理健康素养存在3个潜在类别，未来应根据该群体不同类别特征和影响因素制定针对性干预策略，以提高其心理健康素养水平，进一步改善其心理健康。

艾滋病病毒  /  男男性行为  /  心理健康素养  /  潜在类别分析  /  影响因素
Objective

To explore potential classifications and characteristics of mental health literacy among HIV-positive men who have sex with men.

Methods

From November 2023 to January 2024, 226 HIV-positive MSM in a tertiary hospital in Nanjing were selected by the convenience sampling method and were investigated by general information questionnaire and multicomponent mental health literacy scale. Latent class analysis and multivariate logistic regression analysis were used to explore the categorical characteristics and influencing factors of mental health literacy in this group.

Results

The mental health literacy characteristics of HIV-positive MSM could be classified into low literacy group (22.1%), resource deficient group (38.1%), and high literacy group (39.8%). Multiple logistic regression analysis showed that patients aged 18-34 (OR=5.573, 95%CI=1.020-30.449) were more likely to be in the resource deficient group than the low literacy group, and those who had participated in learning mental health skills (OR=0.126, 95%CI=0.033-0.476) were more likely to be in the high literacy group. Compared with the high literacy group, patients with literacy level of junior high school or below (OR=15.992, 95%CI=2.036-125.591), high school or junior college (OR=2.805, 95%CI=1.098-7.166), length of time to diagnosis of HIV infection <1 year (OR=8.440, 95%CI=1.628-43.742), and with comorbidities (OR=6.619, 95%CI=1.077-40.663) were more likely to be in the low literacy group; and patients with a monthly per capita family income of <3000 yuan (OR=6.241, 95%CI=1.088-35.814) were more likely to be in the resource deprived group.

Conclusion

There are three potential categories of mental health literacy among HIV-positive MSM. In the future, targeted intervention strategies should be developed to improve the level of their mental health literacy and further improve their mental health according to this group’s different category characteristics and influencing factors.

Human immunodeficiency virus  /  Men who have sex with men  /  Latent class analysis  /  Mental health literacy  /  Influencing factors
游心怡, 文琪, 王文慧, 徐兴莲, 杨雯雯, 吴雨函, 宋艳. HIV阳性男男性行为者心理健康素养的潜在类别分析. 现代预防医学, 2024 , 51 (16) : 3029 -3034 . DOI: 10.20043/j.cnki.MPM.202404306
Xin-yi YOU, Qi WEN, Wen-hui WANG, Xing-lian XU, Wen-wen YANG, Yu-han WU, Yan SONG. Latent class analysis of mental health literacy among HIV-positive men who have sex with men[J]. Modern Preventive Medicine, 2024 , 51 (16) : 3029 -3034 . DOI: 10.20043/j.cnki.MPM.202404306
正文
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目前，我国男男性行为者（men who have sex with men,MSM）HIV感染率持续上升[1]，且病情进展快，在感染后平均4~8年进展至艾滋病期[2]，已成为艾滋病防控的重点人群。因受疾病与性向的双重污名，该群体易产生抑郁、焦虑和自杀意念等心理问题，导致其出现服药依从性低、病毒载量高、生活质量差等不良健康结局[3-4]。心理健康素养是指个体具有的有关心理健康的信念和知识，有助于识别、管理或预防心理疾病[5]。研究显示，高水平心理健康素养有利于个体识别心理疾病，减轻病耻感，采取更积极的态度去寻求及时有效的支持和治疗[6]。目前鲜见HIV阳性MSM心理健康素养的研究，且现有相关研究多呈现人群总体心理健康素养水平，忽略了个体间异质性。因此，本研究通过潜在类别分析（latent class analysis,LCA）探寻HIV阳性MSM心理健康素养特征的潜在类别，识别不同类别的群体差异和影响因素，为后续制定针对性、个性化干预策略提供依据。
1　对象与方法
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1.1　研究对象
2023年11月至2024年1月,采用便利抽样法选取南京市某三甲医院感染科门诊符合标准的HIV阳性MSM作为研究对象。纳入标准：1)年龄≥18岁；2)已确诊为HIV阳性；3)感染途径为男男性行为；4)能够进行流畅的言语表达；5)对本研究知情同意，自愿参与研究。排除标准：1)存在认知功能受损或其他精神性疾病；2)合并有心、脑、肾等重要器官功能严重损害。本研究经南京中医药大学附属医院伦理委员会批准（2023-SL-kt029）
1.2　研究工具
1.2.1　一般资料调查问卷
由研究者参阅相关文献自行设计，内容包括：(1)一般人口学特征:年龄、民族、宗教信仰、文化程度、婚姻状况、工作状态、家庭居住地、家庭人均月收入、医疗费用支付等；(2)疾病相关资料:HIV感染确诊时长、并发症情况、整体健康状况等。
1.2.2　多元心理健康素养量表（multicomponent mental health literacy，MHL）
由Jung等[7]研制，用于评估成人的心理健康素养水平。本研究采用明志君等[8]汉化修订版本，包括心理健康知识、信念和资源共3个维度22个条目，采用二分法计分。其中，知识和信念维度均采用Likert 5级评分加“不知道”选项，知识维度为正向题，选择“非常同意”“同意”计1分；信念维度为反向题，选择“非常不同意”“不同意”计1分，其余选择计0分；资源维度为是非题，“是”计1分，“否”计0分。总分为0~22分，量表得分越高表明个体心理健康素养水平越高。本研究该量表Cronbach α系数为0.833。
1.3　调查方法
由研究者对符合纳入标准的HIV阳性MSM进行问卷调查，采用统一指导语解释研究的目的和内容，取得其知情同意后发放问卷。问卷填写采用匿名形式，填写完毕后当场回收。由研究者仔细核查，若存在缺项及填写错误，及时请患者进行补充和修改。本次共发放问卷230份，回收有效问卷226份，有效回收率为98.26%。
1.4　统计学方法
采用Mplus 8.4软件进行LCA，由1个类别开始，依次增加类别个数，并通过潜在类别模型评价指标以及分类的实际意义确定最佳模型。评价模型拟合度的3个指标分别为艾凯克信息标准(Akaike Information Criteria,AIC)、贝叶斯信息标准(Bayesian Information Criteria,BIC)、经样本调整的贝叶斯信息标准(Sample-Size-Adjusted BIC,aBIC)，值越小表明拟合效果越好。熵（Entropy）值用于评价模型分类准确度，范围在0~1，越接近1，分类准确度越高，>0.8时表示准确率90%以上。似然比检验（Lo-Mendell- Rubin Likelihood RatioTest,LMR）和基于Bootstrap似然比检验（Bootstrap Likelihood Ratio Test,BLRT）用于比较模型之间的拟合差异，P<0.05表示k个类别优于k-1个类别。使用SPSS26.0软件进行无序多分类logistic回归分析，探讨HIV阳性MSM的人口学资料和疾病相关资料与其心理健康素养潜类别分布之间的关系。检验水准α=0.05。
2　结果
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2.1　一般资料
本研究共纳入226名HIV阳性MSM，年龄为18~73（34.72±9.53）岁，心理健康素养总分（11.98±5.10）分，见表1。
2.2　HIV阳性MSM心理健康素养的潜在类别分析
本研究以MHL的22个条目为外显指标，探索性建立1~4个潜在类别模型，模型评价指标见表2。当保留3个类别时，AIC、BIC和aBIC值逐渐降低，Entropy值理想，LMR和BLRT值均达到显著水平（P<0.05）,当保留4个类别时，Entropy值虽达到最大，但LMR水平未达到显著水平（P>0.05）。因此，综合考虑3个类别时模型拟合最优。
2.3　HIV阳性MSM心理健康素养潜在类别的命名
由图1可知，C1组相较于其他2个类别，各条目得分均处于较低水平，故命名为“低素养组”，占比为22.1％。C2组条目得分概率大多处在中等偏上水平，但在18~22条目，即资源维度，呈现较低水平，故将其命名为“资源匮乏组”，占比38.1%。C3组相较于其他2个类别，各条目得分概率均处于中等偏上水平，故将其命名为“高素养组”，占比39.8%。
2.4　HIV阳性MSM心理健康素养潜在类别的单因素分析
HIV阳性MSM心理健康素养的3个潜在类别在患者的年龄、文化程度、家庭居住地、家庭人均月收入、HIV感染确诊时长、有无并发症、有无参加过心理技能学习、整体健康状况的分布情况不同，差异有统计学意义（P<0.05），见表3。
2.5　HIV阳性MSM心理健康素养潜在类别的多元logistic回归分析
将单因素分析中有统计学意义的变量为自变量，以心理健康素养3个潜在类别为因变量（C1为低素养组，C2为资源匮乏组，C3为高素养组），进行无序多分类logistic回归分析。结果表明，C3与C1相比，文化程度为初中及以下（OR=15.992）、高中或专科（OR=2.805）、HIV感染确诊时长<1年（OR=8.440）、有并发症（OR=6.619）的患者更容易进入C1，参加过心理健康技能学习（OR=0.126）的患者更易进入C3；C3与C2相比，家庭人均月收入<3 000元（OR=6.241）的患者更易进入C2；C1与C2相比，年龄18~34岁（OR=5.573）的患者更易进入C2，见表4。
3　讨论
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3.1　HIV阳性MSM心理健康素养特征可分为3个潜在类别
LCA识别HIV阳性MSM心理健康素养的个体差异性，可分为3类，分别是：“低素养组”该类别占比22.1％，在心理健康知识、信念、资源各维度得分均较低，表明此类人群对于心理健康关注度较低，很少主动去了解心理健康相关知识，对于解决心理问题的积极性也较低[9]；“资源匮乏组”占总体的38.1%，该类别人群虽对心理知识有一定了解，但由于自身条件及外部因素限制，较少利用心理健康相关资源；“高素养组”占比39.8%，该类人群对心理健康有正确的认识，能够及时识别自身心理健康问题并积极利用心理健康资源。上述3组类别存在明显的异质性，提示医护人员需根据不同组别心理健康素养的潜在特征，采取针对性、个性化的干预措施，以改善其心理健康素养状况。
3.2　HIV阳性MSM心理健康特征潜在类别的影响因素分析
本研究显示，年龄较小、家庭人均月收入<3 000元的患者归属于资源匮乏组的概率更大，可能与青年群体信息获取能力较强，使用社交媒体更为频繁[10]，可以多渠道获取健康信息，因而相较于低素养组，其在心理健康素养知识、信念维度方面得分更高。然而，对于部分经济收入较低的患者，面对自身的心理健康问题，即使有相关了解且能够及时识别，但考虑心理求助费用问题，较少转化为资源进行利用。另外，公众对精神疾病的认知仍然不足，寻求专业心理服务的污名化普遍存在，加之疾病、性向的双重污名[11]，HIV阳性MSM向心理健康专业人员披露过程中易遭遇歧视和隐私泄露[12]，进而不愿向其倾诉或寻求帮助和支持，降低了该群体利用心理健康资源的可能性。未来医务人员可积极开展对性少数持肯定态度、易获取的心理健康干预，如国外开展的性少数群体肯定性心理干预项目（effective skills to empower effective men，ESTEEM），在改善HIV阳性MSM心理健康方面展现了良好的干预效果[13],后续可考虑在文化调试的基础上在国内干预与验证。
本研究显示，文化程度较低、HIV感染确诊时长<1年，有并发症的患者更容易进入低素养组。文化程度较低者学习能力和获取信息能力相对较弱，不易掌握心理健康相关知识，进而阻碍个体早期识别心理疾病和正确认识心理求助，影响心理健康水平[14]。加之，由于疾病确诊时间较短，MSM尚未建立积极有效的应对策略，倾向刻意忽视、逃避关注自身状况[15]，同时该阶段大多患者未做好向亲人、朋友表露感染状况的准备，难以获得足够的社会支持，这往往会加重患者的心理压力，出现消极应对的情况，阻碍其获取心理健康相关信息[16]。另外，出现艾滋病相关并发症的患者，躯体症状更为严重，更为关注生理层面健康，而易忽略自身心理健康素养相关需求。因此，医务人员应对该组别特征人群进行抑郁、焦虑等常见心理健康问题筛查[17]，及时提供心理健康相关健康教育，以更好地治疗和管理其出现的心理问题。针对尚未表露感染状况的患者，医务人员可以给予表露相关知识，使其能够温和、有效地向亲友表露自身状况，且可考虑在患者向亲友表露初期给予双方心理支持，共同应对疾病带来的心理冲击[18]，进而利于患者获得强有力的社会支持，缓解独自承担病情的身心压力。此外，MSM社区艾防人员可以积极组织社会公益、同伴互助活动[19]，使其获取同伴、医务人员和社会组织等的接纳、关怀，为其积极应对疾病带来的身心负担提供帮助，进而提高自身心理健康素养水平。
本研究显示，参加过心理技能学习的患者更易进入高素养组。通过心理技能学习，患者对心理健康能够有更为正确的认识，更愿意寻求他人帮助，这有利于个体产生积极情绪[20]，形成积极应对方式。另外，针对HIV感染者的心理技能学习，多由专科医疗机构、艾防社区人员等组织提供。该群体通过与工作人员积极接触，信任度提高，逐步转变对心理咨询服务的错误观念与消极态度，后续遇到心理困扰仍会向其积极寻求心理帮助，形成正向循环，进一步提升心理健康素养水平。这提示医护人员可以积极开展HIV阳性MSM心理保健相关课程、发放心理健康保健手册、建立心灵关怀微信公众号等方式以普及该群体心理技能学习，进而提高其心理健康素养水平。
本研究通过潜在类别分析将HIV阳性MSM心理健康素养分为低素养组、资源匮乏组和高素养组3类，提示医护人员探究该群体心理健康素养时，需考虑个体间异质性，实施针对性心理健康干预，以改善不同类别心理健康素养水平。本研究存在一些不足之处，调查对象仅来源于单所医院，样本代表具有局限性,且为横断面调查，无法确定上述因素与心理健康素养间的因果关系。未来可开展多中心、大样本调查的纵向调查及干预研究，为制订不同特征HIV阳性MSM心理健康素养提升方案提供参考依据。
基金
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  • 江苏省研究生培养创新工程研究生科研与实践创新计划(SJCX24_0853)
  • 南京市第二医院人才托举工程资助项目(RCMS23014)
文献
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2024年第51卷第16期
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doi: 10.20043/j.cnki.MPM.202404306
  • 接收时间：2024-04-17
  • 首发时间：2026-03-18
  • 出版时间：2024-08-25
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  • 收稿日期：2024-04-17
基金
江苏省研究生培养创新工程研究生科研与实践创新计划(SJCX24_0853)
南京市第二医院人才托举工程资助项目(RCMS23014)
作者信息
    1.南京中医药大学护理学院，江苏 南京 210023
    2. 南京中医药大学附属南京医院（南京市第二医院）护理部

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鹅膏菌科Amanitaceae 2 11 5.26 鹅膏菌属 Amanita 10 4.78
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红菇科 Russulaceae 3 23 11.00 小皮伞属 Marasmius 6 2.87
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