The relationship between social support and suicidal ideation among newly diagnosed people living with HIV: the mediating role of HIV-related stress

Figures & data

Figure 1. Hypothesized model for relationships between social support, HIV-related stress, depression and suicidal ideation among newly diagnosed PLWH (n = 557)

Table 1. Sample characteristics of 557 participants

		Suicidal ideation n (%)
Characteristics	Total n (%)	Yes (n = 139)	No (n = 418)	p value
Gender
Male	515 (92.5)	133 (95.7)	382 (91.4)	0.097^a
Female	42 (7.5)	6 (4.3)	36 (8.6)
Age
18-29	315 (56.6)	77 (55.4)	238 (56.9)	0.949^a
30-39	124 (22.3)	32 (23.0)	92 (22.0)
≥40	118 (21.2)	30 (21.6)	88 (21.1)
Household registration
Urban	283 (50.8)	214 (51.2)	69 (49.6)	0.751^a
Rural	274 (49.2)	204 (48.8)	70 (50.4)
Marital status
Single	347 (62.3)	85 (61.2)	262 (62.7)	0.146^a
Married	139 (25.0)	30 (21.6)	109 (26.1)
Divorced/widowed	71 (12.7)	24 (17.3)	47 (11.2)
Education
Primary school or below	31 (5.6)	5 (3.6)	26 (6.2)	0.490^a
Junior high school	105 (18.9)	25 (18.0)	80 (19.1)
High school	166 (29.8)	47 (33.8)	119 (28.5)
College or above	255 (45.8)	62 (44.6)	193 (46.2)
Employment
Employed	391 (70.2)	90 (64.7)	301 (72.0)	0.105^a
Unemployed/retired/other	166 (29.8)	49 (35.3)	117 (28.0)
Income (yuan)
≤ 4000	339 (60.9)	95 (68.3)	244 (58.4)	0.037^a
> 4000	218 (39.1)	44 (31.7)	174 (41.6)
Transmission mode
Heterosexual	226 (40.6)	48 (34.5)	178 (42.6)	0.206^a
Homosexual	322 (57.9)	89 (64.0)	233 (55.7)
Other	9 (1.6)	2 (1.4)	7 (1.7)
CD4 count (cells/mm^3)
< 200	77 (13.8)	20 (14.4)	57 (13.6)	0.258^a
200-500	369 (66.3)	98 (70.5)	271 (64.8)
> 500	111 (19.9)	21 (15.1)	90 (21.5)
Symptoms
Without	358 (64.3)	56 (40.3)	302 (72.2)	< 0.001^a
With	199 (35.7)	83 (59.7)	116 (27.8)
Social support, median (IQR)	29.0 (23.0–34.0)	26.0 (19.0–31.0)	30.0 (25.0–35.0)	< 0.001^b
HIV-related stress, median (IQR)	26.0 (15.0–39.5)	42.0 (31.0–54.0)	22.0 (13.0–33.0)	< 0.001^b
PHQ-9, median (IQR)	7.0 (3.0–13.0)	14.0 (8.0–19.0)	6.0 (2.0–10.0)	< 0.001^b

IQR: Interquartile range; ^a Chi-square test; ^b Mann–Whitney test

Figure 2. Final model for associations between social support, HIV-related stress, depression and suicidal ideation among newly diagnosed PLWH (n = 557)

Note: The individual monthly income and HIV-related symptoms were controlled as covariates in the GSEM; d1-d9: items of PHQ-9 scale; *p < 0.05; ** p < 0.001

Table 2. Results of GSEM, direct effects (n = 557)

Variables	SC	SE	95% CI	p value
Social support→Suicidal ideation	0.7564^a	0.0597	(0.6480, 0.8831)	< 0.001
HIV-related stress→Suicidal ideation	1.097^a	0.033	(1.0343, 1.1652)	0.002
Depression→Suicidal ideation	1.1256^a	0.1008	(0.9443, 1.3416)	0.187
Social support→HIV-related stress	−1.2891^b	0.2038	(−1.6886, −0.8896)	< 0.001
Social support→Depression	−0.0582^b	0.0472	(−0.1507, 0.0342)	0.217
HIV-related stress→Depression	0.2735^b	0.2334	(0.2277, 0.3193)	< 0.001

SC: standard coefficient; SE: standard error; ^a measure effect is OR; ^b measure effect is β

Table 3. Results of GSEM, indirect effects (n = 557)

Variables	SC	SE	95% CI	p value
Social support→HIV-related→stress Suicidal ideation	−0.1203	0.0425	(−0.2036, −0.0369)	0.005
Social support→Depression→Suicidal ideation	−0.0069	0.0072	(−0.0209, 0.0072)	0.337
Social support→HIV-related stress→Depression→Suicidal ideation	−0.0417	0.0322	(−0.1048, 0.0214)	0.196

SC: standard coefficient; SE: standard error

Figure A1. Model 1 for relationships between social support, HIV-related stress and suicidal ideation among newly diagnosed PLWH (n = 557)

Note: The individual monthly income and HIV-related symptoms were controlled as covariates in the GSEM; * p < 0.05; ** p < 0.001

Figure A2. Model 2 for relationships between social support, depression and suicidal ideation among newly diagnosed PLWH (n = 557)

Note: The individual monthly income and HIV-related symptoms were controlled as covariates in the GSEM; d1-d9: items of PHQ-9 scale; * p < 0.05; ** p < 0.001

Table A1. Results of the mediating effect of HIV-related stress on the relationship between social support and suicidal ideation (n = 557)

Model 1	SC	SE	95% CI	p value
Direct effect
Social support→Suicidal ideation	0.7580^a	0.0598	(0.6494, 0.8847)	< 0.001
HIV-related stress→Suicidal ideation	1.1374^a	0.0241	(1.0911, 1.1857)	< 0.001
Social support→HIV-related stress	−1.2431^b	0.1995	(−1.6341, −0.8522)	< 0.001
Indirect effect
Social support→HIV-related stress→Suicidal ideation	−0.1601	0.0349	(−0.2284, −0.0917)	< 0.001

SC: standard coefficient; SE: standard error; ^a measure effect is OR; ^b measure effect is β

Table A2. Results of the mediating effect of depression on the relationship between social support and suicidal ideation (n = 557)

Model 2	SC	SE	95% CI	p value
Direct effect
Social support→Suicidal ideation	0.7251^a	0.0586	(0.6188, 0.8495)	< 0.001
Depression→Suicidal ideation	1.3867^a	0.0859	(1.2282, 1.5657)	< 0.001
Social support→Depression	−0.4298^b	0.0818	(−0.5902, −0.2695)	< 0.001
Indirect effect
Social support→Depression Suicidal→ideation	−0.1405	0.0331	(−0.2054, −0.0757)	< 0.001

SC: standard coefficient; SE: standard error; ^a measure effect is OR; ^b measure effect is β

Data availability statement

The data that support the findings of this study are available on request from the corresponding author, D L. The data are not publicly available due to their containing information that could compromise the privacy of research participants.