Perceived HIV Stigma, Depressive Symptoms, Self-esteem, and Suicidal Ideation Among People Living with HIV/AIDS in China: a Moderated Mediation Modeling Analysis

Abstract

Objective: Suicidal ideation is an important public health challenge among people living with HIV (PLWH) across the world and in China. HIV stigma, depression, and self-esteem have been associated with suicidal ideation. However, the underlying mechanisms remain not fully understood.

Methods: Study data were derived from a sample of 465 PLWH in China. Suicidal ideation after HIV diagnosis was used as outcome variable. HIV stigma, depressive symptoms, and self-esteem were measured using reliable instruments and used as predictor, mediator, and moderator, respectively. Mediation and moderated mediation model were used for data analysis.

Results: 31.6% of PLWH in China had suicidal ideation after HIV diagnosis. The association between perceived HIV stigma and suicidal ideation was partially mediated by depression (indirect effect = 0.02, 95% CI = [0.02, 0.03]) with the path from perceived HIV stigma to depressive symptoms being moderated by self-esteem (interaction effect = - 0.02, 95% CI [- 0.03, - 0.01]).

Conclusions: Study findings suggested a mediation mechanism of HIV stigma on suicidal ideation through depressive symptoms, and self-esteem might weaken the mediation mechanism by moderating the perceived HIV stigma-depressive symptoms pathway.

Keywords: Depressive symptoms; Moderated mediation; People living with HIV; Perceived HIV stigma; Self-esteem; Suicidal ideation.

Fig. 1

Hypothetical model of perceived HIV stigma and suicidal ideation among PLWH

Fig. 2

Mediated model for perceived HIV stigma, depressive symptoms, and suicidal ideation among PLWH. (Covariates were controlled: age, gender, education, monthly disposable income, and marital status. ^***P < 0.001.)

Fig. 3

Moderated mediation model for perceived HIV stigma, depressive symptoms, self-esteem, and suicidal ideation among PLWH. (Covariates were controlled: age, gender, education, monthly disposable income, and marital status. ^**P < 0.01, ^***P < 0.001.)

Fig. 4

The final moderated mediation model with statistically significant pathways. (Covariates were controlled: age, gender, education, monthly disposable income, and marital status. ^**P < 0.01, ^***P < 0.001.)