Structural equation modeling analysis of social support, coping strategies, depression and suicidal ideation among people living with HIV/AIDS in Changsha, China

INTRODUCTION: People living with HIV/AIDS (PLWHA) have a higher rate of suicide compared to the general population. Psychosocial factors closely correlate with suicidal ideation and it is essential to explain the relationships between related factors among PLWHA. OBJECTIVES: To establish a structural equation model and examine direct and indirect effects of social support, coping strategy, depression symptoms and suicidal ideation among PLWHA. PATIENTS AND METHODS: A total of 504 PLWHA completed a set of questionnaires in the HIV clinic of Changsha Infectious Disease Hospital between December 2015 and January 2016. RESULTS: Among the 504 respondents, a total of 27.2% (n=137) had experienced suicidal ideation in their lifetime. The goodness of fit for the two structural equations model was highly satisfactory. Depression symptoms had a significant direct impact on suicidal ideation (β(1)=0.401, β(2)=0.422), while problem-focused coping (β=−0.067), emotion-focused coping (β=−0.081) and social support (β=−0.137) had a significant indirect effect with suicidal ideation via depression symptoms. Factors of total effects were ranked from large to small as follows: depression, social support, emotion-focused coping and problem-focused coping. CONCLUSION: Findings provide more understanding of direct and indirect associations between variables, suggesting that depression screening services, and the strengthening of social support and psychological care services among PLWHA can potentially prevent suicide.