The mediating role of executive function in the relationship between self-stigma and self-injury or suicidal ideation among men who have sex with men living with HIV

Abstract

BackgroundMen who have sex with men (MSM) living with HIV suffer from psychosocial pressures and marginalization as a result of being HIV-positive and belonging to a sexual minority group, and self-injury or suicidal ideation are prevalent among this group. Studies have found that both perceived self-stigma and altered executive function is related to self-injury or suicidal ideation. However, the combined contribution of self-stigma and executive function to self-injury or suicidal ideation remains unclear, especially in MSM living with HIV. Therefore, this study is conducted to explore the mechanism of self-injury or suicidal ideation by hypothesizing that executive function plays a mediating role in the relationship between self-stigma and self-injury or suicidal ideation.MethodsWe conducted a cross-sectional survey among 448 MSM living with HIV who were recruited in the HIV clinic of a tertiary general hospital in Changsha, China, from November 2021 to February 2022. A questionnaires survey was adopted to collect sociodemographic and disease-related information and data related to executive function (including working memory, inhibition, and task monitoring), self-stigma, and self-injury or suicidal ideation. Structural equation modeling and bootstrap testing were used to investigate the potential mediating role of executive function in the relationship between self-stigma and suicidal ideation.ResultsThe participants were aged 18–76 years. Those who had ever had self-injury or suicidal ideation accounted for 32.8% of the total. A higher level of self-stigma and poorer executive function were associated with more frequent self-injury or suicidal ideation (p < 0.01). The mediation model analysis showed a good fit (x2/df = 1.07, p = 0.381). The direct effect of self-stigma on self-injury or suicidal ideation (β = 0.346, p < 0.001) and the indirect effect of self-stigma via executive function (β = 0.132, p < 0.001) were significant, with the indirect effect accounting for 27.6% of the total effect.ConclusionsThis study demonstrates that executive function mediates the relationship between self-stigma and self-injury or suicidal ideation among MSM living with HIV. It suggests that future studies targeting enhancing executive function and decreasing self-stigma may reduce self-injury or suicidal ideation among MSM living with HIV.

HIV-related stigma, depression and suicidal ideation among HIV-positive MSM in China: a moderated mediation model

“…In our study, the rate of suicidal ideation among HIV-positive MSM was 48.4%, which was higher than the previous study conducted in Anhui in 2015 (31.0%) and Changsha in 2022 (32.8%), but similar to the research conducted in Chengdu in 2018 (48.0%) [ 19 , 37 , 38 ]. A possible reason is that the participants in our study were recruited during the COVID-19 pandemic.…”

“…On the other hand, HIV-positive MSM face dual pressures, including sexual minority identification and discrimination against individuals living with HIV, both in China and in other countries [ 22 , 41 ]. These pressures may gradually worsen their survival situation and lead to the occurrence of suicidal ideation [ 37 ]. Therefore, it is necessary to take measures to strengthen identity recognition and reduce HIV-stigma, thereby reducing the prevalence of suicidal ideation among HIV-positive MSM.…”

“…A qualitative study conducted in Uganda showed that increasing knowledge of specific care concerning MSM among healthcare providers in general healthcare settings to mitigate negative experiences of MSM is helpful to identity recognition [42]. Another cross-sectional survey conducted in Changsha pointed out that increasing awareness of mental health conditions and strengthening self-regulation skills are useful to avoid HIV-related stigma and further reduce suicidal ideation among HIVpositive MSM [37]. In addition, during an epidemic like COVID-19, it is particularly important for the government and relevant agencies to provide online and offline HIV care support interventions to HIV-positive MSM [43,44].…”

Stigma and fear of getting sick in the care of people living with HIV: an exploratory systematic review

“…It is important to note that HIV does not define a person, and living with the virus should not be a cause for shame or discrimination. However, due to a lack of education and awareness about HIV, as well as the associated negative stereotypes, many people still suffer from self-stigma, feeling guilty and self-recriminating in a situation that goes far beyond their responsibility [1][2][3][4]. Regarding anticipated stigma, this refers to the prejudices and negative stereotypes that exist in society about HIV and that lead to the exclusion and marginalization of people who could be at risk of con-tracting it [5,6].…”