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Factors associated with current major depression: social factors rather than HIV status  Limin Mao, Christy Newman, Michae...
 
major depression and gay men: literature <ul><li>A large US random household study in LA, SF, NY and Chicago (1996-98): 17...
HIV and Depression: our study <ul><li>Three data collection phases, mixed methods </li></ul><ul><li>Three major perspectiv...
Data analyses: Y and Xs <ul><li>Y (Dependent variable): MDD based on a self-screening tool of PHQ9 score equal to or great...
Rates of current MDD: PHQ9>=9, DSM-IV standards
Overview of our study participants: I <ul><li>Compared with men in the general population in Australia (cf ABS): middle-ag...
Overview of our study participants: II <ul><li>Compared with other community samples (eg. GCPS, HIM and pH):  </li></ul><u...
Factors  independently   associated with current MDD <ul><li>Younger age </li></ul><ul><li>Lower income </li></ul><ul><li>...
Discussion <ul><li>Multiple pathways between stress, maladaptive coping, major depression and HIV/AIDS: causes, symptoms, ...
Implications <ul><li>Patient self-screening of major depression in GP practices to help early detection and diagnosis by G...
 
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Factors associated with current major depression: social factors rather than HIV status

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This paper gives and overview of factoes associated with depression among gay men. This paper was presented by Limin Mao et. al. at the AFAO HIV Educators Conference 2008.

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  • Transcript of "Factors associated with current major depression: social factors rather than HIV status"

    1. 1. Factors associated with current major depression: social factors rather than HIV status Limin Mao, Christy Newman, Michael Kidd, Deborah Saltman, Adrian Booth, Cathy Pell, Marilyn McMurchie, Peter Canavan, Gavin Andrews, Sue Kippax
    2. 3. major depression and gay men: literature <ul><li>A large US random household study in LA, SF, NY and Chicago (1996-98): 17.2% </li></ul><ul><li>An Adelaide high HIV caseload GP practice (1998-03): 30% </li></ul><ul><li>A Melbourne study of PLWHA, majority male, recruited from four high HIV caseload GP practices and one general infectious disease clinic: 22% (sexual identification not collected) </li></ul><ul><li>Major depression: </li></ul><ul><ul><li>Gay men more susceptible than men in the general population; </li></ul></ul><ul><ul><li>PLWHA more susceptible than their counterparts </li></ul></ul>
    3. 4. HIV and Depression: our study <ul><li>Three data collection phases, mixed methods </li></ul><ul><li>Three major perspectives: </li></ul><ul><ul><li>HIV s100 GPs </li></ul></ul><ul><ul><li>Men who attended GP practices </li></ul></ul><ul><ul><li>A team of researchers from primary care, psychology, psychiatry and social sciences + community reps. </li></ul></ul><ul><li>In this presentation data are based on a sample of homosexually active, gay self-identified men who completed a patient survey in high HIV caseload GP practices in Sydney and Adelaide n=509 </li></ul><ul><li>Factors associated with Major Depressive Disorder (MDD) </li></ul>
    4. 5. Data analyses: Y and Xs <ul><li>Y (Dependent variable): MDD based on a self-screening tool of PHQ9 score equal to or greater than 10 </li></ul><ul><li>Xs (Factors): demographics, daily life stressors, coping strategies, social support, sexual activities, sexual risk taking, sexual function, drug and alcohol consumption, homosexual disclosure, gay community attachment, contact with the HIV epidemic, sexual relationships, seroconcordance in regular relationships, and HIV status. </li></ul><ul><li>Univariate, bivariate and multivariate analyses </li></ul>
    5. 6. Rates of current MDD: PHQ9>=9, DSM-IV standards
    6. 7. Overview of our study participants: I <ul><li>Compared with men in the general population in Australia (cf ABS): middle-aged (45 years old), affluent and well educated </li></ul><ul><li>But some are struggling and isolated: close to one quarter currently on pension; over 30% living alone; half with no regular partner </li></ul><ul><li>“ Out” and attached to gay community: only a minority (<5%) had not disclosed their homosexuality to anyone; nearly 40% felt some degree of involvement with gay community; very few (10%) had never known any PLWHA </li></ul>
    7. 8. Overview of our study participants: II <ul><li>Compared with other community samples (eg. GCPS, HIM and pH): </li></ul><ul><ul><li>higher proportion of HIV+ men (30%) </li></ul></ul><ul><ul><li>clinically well-served (eg…. </li></ul></ul><ul><ul><li>Drug use more common: in the six months prior to survey, about 80% of the men used some recreational drugs and around 9% injected </li></ul></ul><ul><ul><li>Fewer (over 20%) had 10 or more casual male partners </li></ul></ul><ul><ul><li>Sexual dysfunction more common: in the 12 months prior to survey, the most cited sexual difficulties were lack of interest in sex (47% of the men); anxiety over sexual performance (44% of the men); and trouble maintaining erection (44% of the men) </li></ul></ul>
    8. 9. Factors independently associated with current MDD <ul><li>Younger age </li></ul><ul><li>Lower income </li></ul><ul><li>More daily life stressors </li></ul><ul><li>Passive coping (in denial or being alone) </li></ul><ul><li>Less social support </li></ul><ul><li>Less gay community involvement </li></ul><ul><li>More sexual problems </li></ul>
    9. 10. Discussion <ul><li>Multiple pathways between stress, maladaptive coping, major depression and HIV/AIDS: causes, symptoms, consequences? </li></ul><ul><li>Homogenous sample (no difference between the sites): representative? </li></ul><ul><li>Homosexuality, homophobia and depression? </li></ul>
    10. 11. Implications <ul><li>Patient self-screening of major depression in GP practices to help early detection and diagnosis by GPs (onset and recurrent) </li></ul><ul><li>GP-led multidisciplinary clinical care </li></ul><ul><li>Shared model of care: community care and self-management </li></ul><ul><li>Early social and structural interventions (particularly well before and at an early stage of crisis points) to reduce isolation, increase self-esteem and self-acceptance, improve opportunities and enhance skills in social and sexual interactions?? </li></ul>
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