Effects of syndemic psychiatric diagnoses on health indicators in men who have sex with men.

Abstract

Objective: Syndemic theory posits that co-occurring problems (e.g., substance use, depression, and trauma) synergistically increase HIV risk in men who have sex with men (MSM). However, most investigations have assessed these problems additively using self-report. Method: In a sample of HIV-negative MSM with trauma histories (n = 290), we test bivariate relationships between four clinical diagnoses (substance use disorder [SUD]); major depressive disorder [MDD], posttraumatic stress disorder [PTSD], and anxiety disorders) and their additive and interactive effects on three health indicators (i.e., high-risk sex, visiting the emergency room [ER], and sexually transmitted infections [STIs]). Results: We found significant bivariate relationships between SUD and MDD (χ2 = 4.85, p = .028) and between PTSD and MDD (χ2 = 35.38, p = .028, p < .001) but did not find a significant relationship between SUD and PTSD (χ2 = 3.64, p = .056). Number of diagnoses were associated with episodes of high-risk sex (incidence rate ratio [IRR] = 1.14, 95% CI [1.03, 1.26], p = .009) and visiting the ER (odds ratio = 1.27; 95% CI [1.01, 1.60], p = .040) but not with STIs. No interactions were found between diagnoses and health-related indicators. Conclusions: This is the first study to demonstrate additive effects of clinical diagnoses on risk behavior and health care utilization among MSM with developmental trauma histories. Results indicate the need to prioritize empirically supported treatments for SUD and MDD, in addition to trauma treatment, for this population.

The impact of multiple-behavior HIV interventions as a function of regional disadvantages: An analysis of syndemics.

“…This article is intended solely for the personal use of the individual user and is not to be disseminated broadly. (Batchelder et al, 2019) but this meta-analysis did not have the power to estimate the effects of intersectionality. Future attempts at studying the impact of intersectionality will be well served by a greater accumulation of literature in the future (Earnshaw et al, 2015;Rice et al, 2018).…”

“…However, the research reports have considerable amounts of missing data (e.g., percentages of Black individuals), which might prevent identifying effects. In addition, syndemic conditions interact with each other (Batchelder et al, 2019) but this meta-analysis did not have the power to estimate the effects of intersectionality. Future attempts at studying the impact of intersectionality will be well served by a greater accumulation of literature in the future (Earnshaw et al, 2015; Rice et al, 2018).…”

Evaluation of a Newly Developed Transdiagnostic Cognitive Behavioral Therapy Group to Promote Healthy Aging Among Older People with HIV: Study Protocol for a Pilot Randomized Controlled Trial

“…Additionally, we engaged in active recruitment efforts, including posting flyers in the MGH ID and Behavioral Medicine clinics and utilizing community-based recruitment strategies that have been fruitful in recruiting for other clinical intervention studies involving PWH (eg). 56,57 This combined strategy was to ensure optimal intervention group sizes of about 7-8 members and a balanced control group sample size.…”

The Clinical Relevance of a Socioecological Conceptualization of Self-Worth

“…In addition, interventions that combine these strategies and aim to address internalized stigma and shame more generally may be adapted for improving self-worth. For example, a pilot study used metacognitive awareness of thoughts and emotions, mindful self-compassion, and cognitive restructuring to mitigate the negative impact of intersecting internalized stigmas and shame on health behaviors among people living with HIV and substance use disorders (Batchelder et al, 2019). Consistent with our proposed conceptualization of self-worth, this intervention was designed to be flexible, in that core concepts and skills were communicated using examples and exercises that could be tailored for each participant's needs and context, making it amenable to the influences of individuals' unique components of self-worth.…”