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Article(id=1240375115444179297, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1240375105386238038, articleNumber=null, orderNo=null, doi=10.20043/j.cnki.MPM.202312233, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=1702483200000, receivedDateStr=2023-12-14, revisedDate=null, revisedDateStr=null, acceptedDate=null, acceptedDateStr=null, onlineDate=1773658072577, onlineDateStr=2026-03-16, pubDate=1711296000000, pubDateStr=2024-03-25, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1773658072577, onlineIssueDateStr=2026-03-16, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1773658072577, creator=13701087609, updateTime=1773658072577, updator=13701087609, issue=Issue{id=1240375105386238038, tenantId=1146029695717560320, journalId=1227665162245664772, year='2024', volume='51', issue='6', pageStart='961', pageEnd='1152', issueExtLink='null', onlineDate='null', pubDate='null', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=null, createTime=1773658070179, creator=13701087609, updateTime=1773658539618, updator=13701087609, preIssue=null, nextIssue=null, ext={EN=IssueExt(id=1240377074414833974, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1240375105386238038, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1240377074414833975, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1240375105386238038, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null}, startPage=1088, endPage=1093, ext={EN=ArticleExt(id=1240375116245291405, articleId=1240375115444179297, tenantId=1146029695717560320, journalId=1227665162245664772, language=EN, title=Cross-lagged analyses of the relationship between depressive symptoms and HIV infection risk behaviors among young 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 the longitudinal bidirectional relationship between depressive symptoms and HIV infection risk behaviors among young men who have sex with men (YMSM).

Methods

A longitudinal study design was used to recruit 489 YMSM from September 2017 to January 2018 (T1), and two follow-up surveys were completed from July to September 2018 (T2) and from June to July 2019 (T3), respectively. The cross-lagged path analysis model was used to analyze the causality, time series relationship and interactive direction between depressive symptoms and HIV infection risk behaviors.

Results

Data of 347 YMSM were analyzed using cross-lagged path analysis. The results showed that T1 depressive symptoms significantly and positively predicted T2 HIV infection risk behaviors (β=0.071, 95% CI: 0.000-0.142), and T2 depressive symptoms significantly and positively predicted T3 HIV infection risk behaviors (β=0.072, 95% CI: 0.000-0.143). However, T1 HIV infection risk behaviors did not significantly predict T2 depressive symptoms and T2 HIV infection risk behaviors did not significantly predict T3 depressive symptoms.

Conclusion

Depressive symptoms among YMSM significantly and positively predicted HIV infection risk behaviors, with a unidirectional causal temporal relationship. Therefore, the level of depressive symptoms should be considered as an essential factor in HIV infection risk behavior interventions for YMSM.

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目的

探究年轻男男性行为者（YMSM）抑郁症状与HIV感染风险行为的纵向双向关系。

方法

采用纵向研究设计，于2017年9月至2018年1月（T1）招募YMSM 489名，分别于2018年7—9月（T2）、2019年6—7月（T3）完成两次随访调查。使用交叉滞后模型分析YMSM的抑郁症状与HIV感染风险行为的因果时序关系及作用方向。

结果

最终对347名YMSM人群进行交叉滞后路径分析，结果显示，T1抑郁症状显著正向预测T2 HIV感染风险行为（β=0.071，95% CI：0.000~0.142），T2抑郁症状显著正向预测T3 HIV感染风险行为（β=0.072，95% CI: 0.000~0.143）。然而，T1 HIV感染风险行为对T2抑郁症状、T2 HIV感染风险行为对T3抑郁症状的预测作用均不显著。

结论

YMSM人群中抑郁症状能显著正向预测HIV感染风险行为，两者间为单向因果时序关系。因此，针对YMSM进行HIV感染风险行为干预时，应将抑郁症状水平作为重要因素加以考虑。

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燕虹，E-mail：
, copyrightStatement=本刊刊出的所有文章不代表中华预防医学会和本刊编委会的观点，除非特别声明。, copyrightOwner=中华预防医学会和四川大学华西公共卫生学院, extLink=null, articleAbsUrl=null, sourceXml=N1zkQHdqJD1UvM13ZXNxjQ==, magXml=jtgY673EtBi9NeRF3UzWow==, pdfUrl=null, pdf=RK/ztvaTZFCZ0waclANtAg==, pdfFileSize=601381, pdfExtLink=null, richHtmlUrl=null, mobilePdfUrl=null, reviewReport=null, pdfFirstPage=null, abstractGraph=j4Q64L8MRhVxhvBXA00ovw==, abstractGraphContent=null, abstractVideo=null, citation=null, cebUrl=null, magXmlContent=wsCSbaef+wSwV3rN+sX2zA==, mapNumber=null, authorCompany=null, fund=null, authors=

刘丹（1997—），女，硕士在读，研究方向：流行病学研究

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刘丹（1997—），女，硕士在读，研究方向：流行病学研究

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刘丹（1997—），女，硕士在读，研究方向：流行病学研究

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LGBT Health, 2020, 7(3): 155-165., articleTitle=Victimization in early adolescence, stress, and depressive symptoms among aging sexual minority men: findings from the multicenter AIDS cohort study, refAbstract=null)], funds=[Fund(id=1240746308697387919, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240375115444179297, awardId=81673196, language=CN, fundingSource=国家自然科学基金(81673196), fundOrder=null, country=null)], companyList=[AuthorCompany(id=1240746302913442241, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240375115444179297, xref=1., ext=[AuthorCompanyExt(id=1240746302930219457, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240375115444179297, companyId=1240746302913442241, language=EN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=Department of Epidemiology and Health Statistics, School of Public Health, Wuhan University, Wuhan, Hubei 430071, China), AuthorCompanyExt(id=1240746302938608066, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240375115444179297, companyId=1240746302913442241, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=1.武汉大学公共卫生学院流行病与卫生统计学系，湖北 武汉 430071)]), AuthorCompany(id=1240746303035077066, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240375115444179297, xref=2., ext=[AuthorCompanyExt(id=1240746303043465676, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240375115444179297, companyId=1240746303035077066, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=2.武汉城市学院)])], figs=[ArticleFig(id=1240746307694949221, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240375115444179297, language=EN, label=Fig.1, caption=A cross-lagged model of depressive symptoms and HIV infection risk behaviors in YMSM, figureFileSmall=c9TJU9fRsMl/zsAcbgexcw==, figureFileBig=k1qx2HrcCwclFafYhLYaew==, tableContent=null), ArticleFig(id=1240746307770446695, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240375115444179297, language=CN, label=图1, caption=YMSM抑郁症状与HIV感染风险行为的交叉滞后模型

注：***为P<0.001; **为P<0.01; *为P<0.05。

, figureFileSmall=c9TJU9fRsMl/zsAcbgexcw==, figureFileBig=k1qx2HrcCwclFafYhLYaew==, tableContent=null), ArticleFig(id=1240746307875304299, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240375115444179297, language=EN, label=Table 1, caption=

General information of YMSM in the three surveys

, figureFileSmall=null, figureFileBig=null, tableContent=
变量类别T1 (n=489)T2 (n=399)T3 (n=347)χ2/F值P值
年龄（岁,）ab21.26±2.1221.20±2.1621.21±1.820.0790.924
户口类型[n(%)]a0.1960.907
城市254(51.9)207(51.9)185(53.3)
农村235(48.1)192(48.1)162(46.7)
民族[n(%)]a0.3730.830
汉族449(91.8)370(92.7)322(92.8)
少数民族40(8.2)29(7.3)25(7.2)
文化程度[n(%)]a1.8240.935
初中及以下11(2.2)10(2.5)7(2.0)
高中或中专85(17.4)60(15.0)51(14.7)
本科或大专354(72.4)299(74.9)263(75.8)
硕士及以上39(8.0)30(7.5)26(7.5)
父亲文化程度[n(%)]a0.9040.924
初中及以下199(40.7)171(42.9)149(42.9)
高中或中专183(37.4)141(35.3)120(34.6)
大专及以上107(21.9)87(21.8)78(22.5)
母亲文化程度[n(%)]a1.3580.851
初中及以下254(51.9)218(54.6)186(53.6)
高中或中专163(33.3)120(30.1)106(30.6)
大专及以上72(14.7)61(15.3)55(15.9)
就业情况[n(%)]24.111<0.001
学生268(54.8)182(45.6)136(39.2)
在业177(36.2)182(45.6)183(52.7)
无业/失业/其他44(9.0)35(8.8)28(8.1)
婚姻状况[n(%)]0.004c
未婚482(98.6)399(100.0)347(100.0)
已婚/离婚/丧偶7(1.4)0(0.0)0(0.0)
月可支配金额[元，n(%)]57.708<0.001
≤1 00086(17.6)38(9.5)27(7.8)
1 001~3 000260(53.2)196(49.1)148(42.7)
3 001~6 00095(19.4)124(31.1)102(29.4)
>6 00048(9.8)41(10.3)70(20.2)
性取向[n(%)]0.598c
同性恋391(80.0)334(83.7)287(82.7)
异性恋4(0.8)1(0.3)3(0.9)
双性恋70(14.3)43(10.8)39(11.2)
不确定24(4.9)21(5.3)18(5.2)
性别认同[n(%)]1.9770.740
是447(91.4)369(92.5)322(92.8)
否19(3.9)12(3.0)14(4.0)
不确定23(4.7)18(4.5)11(3.2)
艾滋病感染情况[n(%)]b55.144<0.001
阴性213(44.2)77(43.8)85(78.7)
阳性21(4.4)10(5.7)9(8.3)
不清楚248(51.5)89(50.6)14(13.0)
), ArticleFig(id=1240746307963384688, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240375115444179297, language=CN, label=表1, caption=

三次调查中YMSM的一般情况

, figureFileSmall=null, figureFileBig=null, tableContent=
变量类别T1 (n=489)T2 (n=399)T3 (n=347)χ2/F值P值
年龄（岁,）ab21.26±2.1221.20±2.1621.21±1.820.0790.924
户口类型[n(%)]a0.1960.907
城市254(51.9)207(51.9)185(53.3)
农村235(48.1)192(48.1)162(46.7)
民族[n(%)]a0.3730.830
汉族449(91.8)370(92.7)322(92.8)
少数民族40(8.2)29(7.3)25(7.2)
文化程度[n(%)]a1.8240.935
初中及以下11(2.2)10(2.5)7(2.0)
高中或中专85(17.4)60(15.0)51(14.7)
本科或大专354(72.4)299(74.9)263(75.8)
硕士及以上39(8.0)30(7.5)26(7.5)
父亲文化程度[n(%)]a0.9040.924
初中及以下199(40.7)171(42.9)149(42.9)
高中或中专183(37.4)141(35.3)120(34.6)
大专及以上107(21.9)87(21.8)78(22.5)
母亲文化程度[n(%)]a1.3580.851
初中及以下254(51.9)218(54.6)186(53.6)
高中或中专163(33.3)120(30.1)106(30.6)
大专及以上72(14.7)61(15.3)55(15.9)
就业情况[n(%)]24.111<0.001
学生268(54.8)182(45.6)136(39.2)
在业177(36.2)182(45.6)183(52.7)
无业/失业/其他44(9.0)35(8.8)28(8.1)
婚姻状况[n(%)]0.004c
未婚482(98.6)399(100.0)347(100.0)
已婚/离婚/丧偶7(1.4)0(0.0)0(0.0)
月可支配金额[元，n(%)]57.708<0.001
≤1 00086(17.6)38(9.5)27(7.8)
1 001~3 000260(53.2)196(49.1)148(42.7)
3 001~6 00095(19.4)124(31.1)102(29.4)
>6 00048(9.8)41(10.3)70(20.2)
性取向[n(%)]0.598c
同性恋391(80.0)334(83.7)287(82.7)
异性恋4(0.8)1(0.3)3(0.9)
双性恋70(14.3)43(10.8)39(11.2)
不确定24(4.9)21(5.3)18(5.2)
性别认同[n(%)]1.9770.740
是447(91.4)369(92.5)322(92.8)
否19(3.9)12(3.0)14(4.0)
不确定23(4.7)18(4.5)11(3.2)
艾滋病感染情况[n(%)]b55.144<0.001
阴性213(44.2)77(43.8)85(78.7)
阳性21(4.4)10(5.7)9(8.3)
不清楚248(51.5)89(50.6)14(13.0)
), ArticleFig(id=1240746308059853684, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240375115444179297, language=EN, label=Table 2, caption=

Characteristics of HIV infection risk behaviors of YMSM in the three surveys [n (%)]

, figureFileSmall=null, figureFileBig=null, tableContent=
条目T1 (n=489)T2 (n=399)T3 (n=347)
近6个月同性性伴数（个）
<2262(53.6)212(53.1)180(51.9)
2~3172(35.2)140(35.1)122(30.6)
≥455(11.2)47(11.8)45(13.0)
近6个月性伴HIV感染
无333(68.1)280(70.2)231(66.6)
有18(3.7)18(4.5)13(3.7)
不详138(28.2)101(25.3)103(29.7)
近6个月无保护性肛交
无303(62.0)263(65.9)222(64.0)
有时164(33.5)119(29.8)108(31.1)
一直22(4.5)17(4.3)17(4.9)
近6个月商业性行为
无464(94.9)381(95.5)333(96.0)
有25(5.1)18(4.5)14(4.0)
近6个月非法药物使用
无478(97.8)395(99.0)339(97.7)
有11(2.2)4(1.0)8(2.3)
近6个月同性性行为角色
只做插入方161(32.9)146(36.6)111(32.0)
两者皆有248(50.7)164(41.1)166(47.8)
只做被插入方80(16.4)89(22.3)70(20.2)
近6个月其他性病感染
无474(97.0)363(90.1)319(92.0)
有15(3.0)36(8.9)28(8.0)
), ArticleFig(id=1240746308143739767, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240375115444179297, language=CN, label=表2, caption=

三次调查中YMSM HIV感染相关高危行为特征[n (%)]

, figureFileSmall=null, figureFileBig=null, tableContent=
条目T1 (n=489)T2 (n=399)T3 (n=347)
近6个月同性性伴数（个）
<2262(53.6)212(53.1)180(51.9)
2~3172(35.2)140(35.1)122(30.6)
≥455(11.2)47(11.8)45(13.0)
近6个月性伴HIV感染
无333(68.1)280(70.2)231(66.6)
有18(3.7)18(4.5)13(3.7)
不详138(28.2)101(25.3)103(29.7)
近6个月无保护性肛交
无303(62.0)263(65.9)222(64.0)
有时164(33.5)119(29.8)108(31.1)
一直22(4.5)17(4.3)17(4.9)
近6个月商业性行为
无464(94.9)381(95.5)333(96.0)
有25(5.1)18(4.5)14(4.0)
近6个月非法药物使用
无478(97.8)395(99.0)339(97.7)
有11(2.2)4(1.0)8(2.3)
近6个月同性性行为角色
只做插入方161(32.9)146(36.6)111(32.0)
两者皆有248(50.7)164(41.1)166(47.8)
只做被插入方80(16.4)89(22.3)70(20.2)
近6个月其他性病感染
无474(97.0)363(90.1)319(92.0)
有15(3.0)36(8.9)28(8.0)
), ArticleFig(id=1240746308219237244, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240375115444179297, language=EN, label=Table 3, caption=

Scores and correlation analysis for each variable (r)

, figureFileSmall=null, figureFileBig=null, tableContent=
变量得分（分，）抑郁症状T1抑郁症状T2抑郁症状T3RBHI T1RBHI T2RBHI T3
抑郁症状T118.16±11.041.000
抑郁症状T216.64±10.390.541a1.000
抑郁症状T317.13±10.670.471a0.519a1.000
RBHI T111.05±2.850.316a0.172b0.222a1.000
RBHI T211.20±3.110.173b0.196a0.198a0.378a1.000
RBHI T311.12±2.850.191a0.132c0.210a0.385a0.376a1.000
), ArticleFig(id=1240746308345066370, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240375115444179297, language=CN, label=表3, caption=

各变量的得分及相关性分析（r）

, figureFileSmall=null, figureFileBig=null, tableContent=
变量得分（分，）抑郁症状T1抑郁症状T2抑郁症状T3RBHI T1RBHI T2RBHI T3
抑郁症状T118.16±11.041.000
抑郁症状T216.64±10.390.541a1.000
抑郁症状T317.13±10.670.471a0.519a1.000
RBHI T111.05±2.850.316a0.172b0.222a1.000
RBHI T211.20±3.110.173b0.196a0.198a0.378a1.000
RBHI T311.12±2.850.191a0.132c0.210a0.385a0.376a1.000
), ArticleFig(id=1240746308433146756, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240375115444179297, language=EN, label=Table 4, caption=

Path coefficients of the cross-lagged model

, figureFileSmall=null, figureFileBig=null, tableContent=
路径β(95% CI)
抑郁症状T1→抑郁症状T20.530 (0.466~0.549)
抑郁症状T1→HIV感染风险行为T20.071 (0.000~0.142)
抑郁症状T2→抑郁症状T30.501 (0.430~0.571)
抑郁症状T2→HIV感染风险行为T30.072 (0.000~0.143)
HIV感染风险行为T1→抑郁症状T20.054 (-0.010~0.117)
HIV感染风险行为T1→HIV感染风险行为T20.316 (0.284~0.372)
HIV感染风险行为T2→抑郁症状T30.057 (-0.011~0.125)
HIV感染风险行为T1→HIV感染风险行为T30.357 (0.280~0.434)
抑郁症状T1↔HIV感染风险行为T10.328 (0.234~0.422)
抑郁症状T2↔HIV感染风险行为T20.126 (0.022~0.230)
抑郁症状T3↔HIV感染风险行为T30.137 (0.034~0.241)
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交叉滞后模型路径系数

, figureFileSmall=null, figureFileBig=null, tableContent=
路径β(95% CI)
抑郁症状T1→抑郁症状T20.530 (0.466~0.549)
抑郁症状T1→HIV感染风险行为T20.071 (0.000~0.142)
抑郁症状T2→抑郁症状T30.501 (0.430~0.571)
抑郁症状T2→HIV感染风险行为T30.072 (0.000~0.143)
HIV感染风险行为T1→抑郁症状T20.054 (-0.010~0.117)
HIV感染风险行为T1→HIV感染风险行为T20.316 (0.284~0.372)
HIV感染风险行为T2→抑郁症状T30.057 (-0.011~0.125)
HIV感染风险行为T1→HIV感染风险行为T30.357 (0.280~0.434)
抑郁症状T1↔HIV感染风险行为T10.328 (0.234~0.422)
抑郁症状T2↔HIV感染风险行为T20.126 (0.022~0.230)
抑郁症状T3↔HIV感染风险行为T30.137 (0.034~0.241)
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年轻男男性行为者抑郁症状与HIV感染风险行为的交叉滞后分析
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刘丹 1 , 刘昕 1 , 肖琛嫦 2 , 李佳钰 1 , 翟萌曦 1 , 王启文 1 , 周龙辉 1 , 王世捷 1 , 俞斌 1 , 燕虹 1
现代预防医学 | 疾病预防控制 2024,51(6): 1088-1093
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现代预防医学 | 疾病预防控制 2024, 51(6): 1088-1093
年轻男男性行为者抑郁症状与HIV感染风险行为的交叉滞后分析
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刘丹1, 刘昕1, 肖琛嫦2, 李佳钰1, 翟萌曦1, 王启文1, 周龙辉1, 王世捷1, 俞斌1, 燕虹1
作者信息
  • 1.武汉大学公共卫生学院流行病与卫生统计学系，湖北 武汉 430071
  • 2.武汉城市学院

    • 刘丹（1997—），女，硕士在读，研究方向：流行病学研究

通讯作者:

燕虹，E-mail：
Cross-lagged analyses of the relationship between depressive symptoms and HIV infection risk behaviors among young men who have sex with men
Dan LIU1, Xin LIU1, Chen-chang XIAO2, Jia-yu LI1, Meng-xi ZHAI1, Qi-wen WANG1, Long-hui ZHOU1, Shi-jie WANG1, Bin YU1, Hong YAN1
Affiliations
  • Department of Epidemiology and Health Statistics, School of Public Health, Wuhan University, Wuhan, Hubei 430071, China
出版时间: 2024-03-25 doi: 10.20043/j.cnki.MPM.202312233
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摘要
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目的

探究年轻男男性行为者（YMSM）抑郁症状与HIV感染风险行为的纵向双向关系。

方法

采用纵向研究设计，于2017年9月至2018年1月（T1）招募YMSM 489名，分别于2018年7—9月（T2）、2019年6—7月（T3）完成两次随访调查。使用交叉滞后模型分析YMSM的抑郁症状与HIV感染风险行为的因果时序关系及作用方向。

结果

最终对347名YMSM人群进行交叉滞后路径分析，结果显示，T1抑郁症状显著正向预测T2 HIV感染风险行为（β=0.071，95% CI：0.000~0.142），T2抑郁症状显著正向预测T3 HIV感染风险行为（β=0.072，95% CI: 0.000~0.143）。然而，T1 HIV感染风险行为对T2抑郁症状、T2 HIV感染风险行为对T3抑郁症状的预测作用均不显著。

结论

YMSM人群中抑郁症状能显著正向预测HIV感染风险行为，两者间为单向因果时序关系。因此，针对YMSM进行HIV感染风险行为干预时，应将抑郁症状水平作为重要因素加以考虑。

年轻男男性行为者  /  抑郁症状  /  HIV感染风险行为  /  交叉滞后分析
Objective

To explore the longitudinal bidirectional relationship between depressive symptoms and HIV infection risk behaviors among young men who have sex with men (YMSM).

Methods

A longitudinal study design was used to recruit 489 YMSM from September 2017 to January 2018 (T1), and two follow-up surveys were completed from July to September 2018 (T2) and from June to July 2019 (T3), respectively. The cross-lagged path analysis model was used to analyze the causality, time series relationship and interactive direction between depressive symptoms and HIV infection risk behaviors.

Results

Data of 347 YMSM were analyzed using cross-lagged path analysis. The results showed that T1 depressive symptoms significantly and positively predicted T2 HIV infection risk behaviors (β=0.071, 95% CI: 0.000-0.142), and T2 depressive symptoms significantly and positively predicted T3 HIV infection risk behaviors (β=0.072, 95% CI: 0.000-0.143). However, T1 HIV infection risk behaviors did not significantly predict T2 depressive symptoms and T2 HIV infection risk behaviors did not significantly predict T3 depressive symptoms.

Conclusion

Depressive symptoms among YMSM significantly and positively predicted HIV infection risk behaviors, with a unidirectional causal temporal relationship. Therefore, the level of depressive symptoms should be considered as an essential factor in HIV infection risk behavior interventions for YMSM.

Young men who have sex with men  /  Depressive symptoms  /  HIV infection risk behaviors  /  Cross-lagged analysis
刘丹, 刘昕, 肖琛嫦, 李佳钰, 翟萌曦, 王启文, 周龙辉, 王世捷, 俞斌, 燕虹. 年轻男男性行为者抑郁症状与HIV感染风险行为的交叉滞后分析. 现代预防医学, 2024 , 51 (6) : 1088 -1093 . DOI: 10.20043/j.cnki.MPM.202312233
Dan LIU, Xin LIU, Chen-chang XIAO, Jia-yu LI, Meng-xi ZHAI, Qi-wen WANG, Long-hui ZHOU, Shi-jie WANG, Bin YU, Hong YAN. Cross-lagged analyses of the relationship between depressive symptoms and HIV infection risk behaviors among young men who have sex with men[J]. Modern Preventive Medicine, 2024 , 51 (6) : 1088 -1093 . DOI: 10.20043/j.cnki.MPM.202312233
正文
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年轻男男性行为者（young men who have sex with men, YMSM）是HIV感染的高危人群之一[1]。由于YMSM性行为活动较为活跃、性感觉寻求水平相对较高，所以其发生HIV感染的可能性更大[2]。多性伴、与阳性性伴发生性行为、无保护肛交等HIV感染风险行为是YMSM感染HIV的重要影响因素[3]。近年来，国内外的研究[4-5]发现抑郁症状与YMSM的HIV感染风险行为存在关联。抑郁程度越高的YMSM更容易持续发生HIV感染风险行为[6]。同时也有研究发现HIV感染者出现抑郁症状的可能性明显增加[7]。现有研究多关注二者之间的相关性，但是对于二者的相互影响以及因果时序关系并不明确。
本研究旨在通过对YMSM人群的追踪调查，分析抑郁症状与HIV感染风险行为是否存在双向关系，以期为我国YMSM人群HIV感染预防控制和行为干预提供科学依据。
1 对象与方法
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1.1 研究对象
2017年9月至2018年1月（T1）在华中地区三个省会城市（武汉、长沙、南昌市）当地规模较大具有代表性的男同性恋社区组织的协助下，采取机遇抽样与同伴推动抽样相结合的方式，通过互联网宣传、同伴推荐、外展活动以及例行的艾滋病自愿检测服务招募YMSM，并进行基线调查。研究对象纳入标准：（1）年龄16～24岁；（2）生理性别为男性；（3）曾经有过男男性行为；（4）同意参与调查并自愿签署知情同意书。本研究已通过武汉大学医学伦理委员会审查（伦理审批号：WHU-2016YF0034）。
研究采用问卷调查的方式，共招募YMSM 489人。因部分随访对象担忧隐私暴露删除了联系方式或因各种原因离开调查的城市，以致后续随访出现失访问题。在2018年7—9月（T2）通过微信或电话联系调查对象，并通知他们到男同性恋社区组织现场自填问卷完成第一次随访，共随访399人；在2019年6—7月（T3）按上述同样流程完成第二次随访，共随访347人。失访人群经验证为随机失访。
1.2 测量方法
1.2.1 一般情况调查表
自编一般情况调查表，调查内容包括一般人口学特征（年龄、民族、文化程度、职业、经济状况）、性取向、性别认同、以及自我报告艾滋病感染情况。
1.2.2 流调中心抑郁量表[8]
用于测量研究对象最近一周的抑郁频率。共20个条目，0（没有）~3（5~7天）4级评分，将4个反向条目进行反向计分后计算总分，为0~60分，≥16分即认为具有抑郁症状。
1.2.3 HIV感染相关高危行为评分[9]
参考基于德尔菲方法建立的MSM个体HIV感染风险评估工具中的相关条目，收集过去6个月参与者的信息来预测HIV感染风险评分。评估包括七个项目：（1）男性性伴侣的数量；（2）HIV阳性的伴侣状况；（3）无保护肛交；（4）男男商业性行为；（5）性传播感染（sexually transmitted infections, STI）的症状，或STI的诊断（如淋病）；（6）使用非法药物；（7）肛交角色。计算七个项目的总分，总分越高，HIV感染的可能性就越高。
1.3 质量控制
由经过培训的调查员使用电子问卷对所有招募的研究对象进行面对面调查，并定期联系和提醒调查对象到固定的地点填写随访调查问卷，同时接受HIV与其他性传播疾病的检测。问卷回收时要求调查员现场检查问卷填写的完整性，并进行逻辑检查，若发现问题，及时与研究对象沟通完善。
1.4 统计分析方法
采用SPSS 26.0进行描述性分析和相关性分析，计数资料用例数（构成比）描述，计量资料用()描述，变量间关系采用Pearson相关性分析。采用Mplus 8.3软件进行交叉滞后分析，本研究采用最大似然估计（maximum likelihood estimation, ML）进行模型估计，为了方便模型的解释，对交叉滞后模型施加了约束。检验水准α=0.05。
2 结果
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2.1 年轻男男性行为者基线个人特征
基线调查时共纳入489名符合标准的YMSM。基线YMSM平均年龄为（21.26±2.12）岁。51.9%为城市户口，91.8%为汉族，54.8%为学生，98.6%未婚，月可支配金额1 001~3 000元占比最多，为53.2%，文化程度为本科及以上的人数占比较高，为80.4%。三次调查HIV感染阳性占比分别为4.4%、5.7%、8.3%。三次调查中，研究对象的基本特征除就业、婚烟状况、月可支配金额和艾滋病感染情况外差异均无统计学意义。详见表1。
2.2 HIV感染相关高危行为
在参与基线并完成两次随访的347名YMSM中，84.7%的YMSM人群至少有过一种HIV感染风险行为。其中，过去6个月有多性伴的YMSM占43.6%，自述过去6个月发生过无保护性肛交的占36.0%，68.0%的研究对象自述在过去 6 个月的肛交过程中曾作为被插入方，仅2.3%的YMSM在过去6个月使用了非法药物。详见表2。
2.3 各研究变量的平均值、标准差及相关矩阵
基线及两次随访的YMSM抑郁症状得分分别为（18.156±11.038）分、（16.643±10.387）分、（17.133±10.674）分，HIV感染风险行为评分分别为（11.051±2.854）分、（11.202±3.106）分、（11.120±2.851）分，三次得分差异均无统计学意义。相关分析的结果显示（表3），抑郁症状与HIV感染风险行为在相同时间点均呈显著正相关（0.196 ≤ r≤ 0.316,P<0.001），在不同时间点也呈显著正相关（0.132 ≤ r≤ 0.222, P<0.05）。
2.4 抑郁症状与HIV感染风险行为的交叉滞后分析
利用Mplus 8.3软件构建交叉滞后效应模型，采用极大似然法考察模型拟合情况。将表1中P<0.05的就业情况、婚烟状况、月可支配金额作为混杂因素加入交叉滞后模型中加以控制。无约束模型拟合指标显示，χ2（8）=56.992（P<0. 001，n=347）；拟合优度指标：CFI =0.889，TLI =0.709；近似误差均方根RMSEA=0.133。约束模型拟合指标显示，χ2（12）=60.511（P<0. 001，n=347）；拟合优度指标：CFI=0.890，TLI=0.808；近似误差均方根RMSEA=0.108，证实了所建构的交叉滞后效应模型具有良好的适配性。由于约束指标拟合更优，并且更易于解释，故本文决定采用约束模型进行后续分析。
图1和表4显示，所有的自回归路径均为正向且具有统计学意义，同一时期的抑郁症状与HIV感染风险行为的相关性均显著。T1抑郁症状显著正向预测T2 HIV感染风险行为（β=0.071, 95% CI: 0.000~0.142），T2抑郁症状显著正向预测T3 HIV感染风险行为（β=0.072, 95% CI: 0.000~0.143）。T1 HIV感染风险行为对T2抑郁症状、T2 HIV感染风险行为对T3抑郁症状的预测作用均不显著。
3 讨论
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既往关于YMSM人群的研究多为横断面研究，大多仅评估抑郁症状与性风险行为之间的相关性[10]，检验抑郁症状与HIV感染风险行为的因果关系的能力不强，且很少有研究关注二者的作用方向。本研究采用3次间隔半年以上的交叉滞后模型分析了YMSM抑郁症状与HIV感染风险行为之间的双向关系，发现T1抑郁症状、T2抑郁症状分别可以正向预测T2HIV感染风险行为和T3HIV感染风险行为。
研究结果显示，84.7%的YMSM人群至少有过一种HIV感染风险行为，高于一般大学生（15.0%）[11]。其中性伴数量、无保护肛交和性角色风险占比较大，这与以往的研究一致[12]。本研究调查得到YMSM人群抑郁症状得分为（18.2±11.0）分，略高于国内同期调查的MSM人群的抑郁症状评分（17.1±10.7）分[13]。YMSM人群尤其是HIV感染者面临更多的心理健康挑战，如艾滋病相关歧视[14-15]。一项针对广州市YMSM人群的研究发现YMSM人群发生抑郁症状的风险更大[2]，提示在干预中需要关注YMSM人群的抑郁症状水平。
尽管有大量证据表明，抑郁症状会增加男男性行为者的性风险行为，但很少有研究关注YMSM抑郁症状与HIV感染风险行为之间是否存在双向关系。本研究通过交叉滞后分析，仅发现YMSM人群抑郁症状正向预测HIV感染风险行为。一项纳入美国多地的746名MSM的纵向队列研究提出，中等程度的抑郁症状可以预测HIV阳性MSM的性风险行为[16]。一项在瑞士开展的HIV队列研究结果显示，重度抑郁会增加注射吸毒者共享注射器的风险[17]。各国针对性少数群体的研究也发现抑郁症状可以显著预测HIV感染风险行为的发生[17-18]。抑郁症状对YMSM人群HIV感染风险行为的影响可能是因为抑郁症状带来的无助感和绝望感降低了该人群对保护行为的兴趣和决心。
然而，一项针对马里兰州居民HIV预防的纵向研究发现，药物使用是抑郁症状的危险因素[19]，这与本研究的结果不一致。可能是由于上述研究仅调查了一种风险行为与抑郁症状的关系，而本研究以评分的形式综合考虑了多个性风险行为，而且这些行为中多性伴、无保护肛交和被插入式性角色占比较高，而药物使用行为占比较低。同时，本研究抑郁症状和HIV感染风险行为的自回归系数均呈正相关，说明随时间变化的进程中，两者都表现比较稳定，短时效应和长时效应可能是一致的。相较于HIV感染风险行为，抑郁症状的状态更容易持续，为保护自身不受这些危险因素的影响，YMSM人群往往会采取一些不健康的行为方式来消除或平衡消极情绪体验[20]。因此，抑郁症状更可能受个体内的影响，无法通过HIV感染风险行为来预测半年后抑郁症状的状态。
本研究还存在一定的局限性，包括：（1）HIV感染风险行为是通过自我报告获得，可能存在报告偏倚；（2）由于研究对象的特殊性，采用机遇抽样和同伴推动抽样相结合的方式招募YMSM，样本的代表性和研究结论外推存在一定的局限性；（3）随访过程中出现了一定数量的失访，可能对结果产生一定的影响；（4）本研究纳入的混杂变量有限，无法完全排除其他相关变量对YMSM的抑郁症状和HIV感染风险行为的影响，未来需进一步纳入多变量进行研究。
综上，YMSM人群的抑郁症状可以正向预测HIV感染风险行为，有抑郁症状的YMSM人群更有可能具有HIV感染高风险行为。因此，在针对YMSM人群进行HIV干预时，需要关注抑郁症状的早期识别和管理，采用多方面的手段如强化教育和咨询、定期筛查、心理疏导等来减少YMSM人群HIV感染风险行为的发生以及其他性疾病的传播。
基金
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  • 国家自然科学基金(81673196)
文献
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2024年第51卷第6期
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doi: 10.20043/j.cnki.MPM.202312233
  • 接收时间：2023-12-14
  • 首发时间：2026-03-16
  • 出版时间：2024-03-25
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  • 收稿日期：2023-12-14
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国家自然科学基金(81673196)
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    1.武汉大学公共卫生学院流行病与卫生统计学系，湖北 武汉 430071
    2.武汉城市学院

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2种不同金属材料的力学参数
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Family		 属数
Number of
genus		 种数
Number of
species		 占总种数比例
Percentage of
total species (%)		 属
Genus		 种数
Number of
species		 占总种数比例
Percentage of total
species (%)
鹅膏菌科Amanitaceae 2 11 5.26 鹅膏菌属 Amanita 10 4.78
小菇科 Mycenaceae 2 12 5.74 丝盖伞属 Inocybe 5 2.39
多孔菌科 Polyporaceae 8 14 6.70 蜡蘑属 Laccaria 5 2.39
红菇科 Russulaceae 3 23 11.00 小皮伞属 Marasmius 6 2.87
小菇属 Mycena 11 5.26
光柄菇属 Pluteus 5 2.39
红菇属 Russula 17 8.13
栓菌属 Trametes 5 2.39
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