Psychological pathway to suicidal ideation among people living with HIV/AIDS in China: A structural equation model

People living with HIV/AIDS (PLWHA) have higher rates of suicide than does the general population. It is critical to interpret the intricate relationships among various psychological variables that increase the risk of suicidal ideation among PLWHA in China. An institutional based cross-sectional study was conducted from Jul to Aug 2016 in Nanjing, China, using a self-reporting questionnaire. A total of 465 PLWHA participated. Sociodemographic, psychological variables and suicide information about the participants were collected. Structural equation modeling (SEM)-path analysis was used to analyze the cross-sectional data. The final structural equation model had a highly satisfactory fit. Among PLWHA, perceived stigma had the greatest accumulated total effect on suicidal ideation, with both a direct effect and indirect effect through self-esteem and depression. Additionally, self-esteem had the second greatest total effect on suicidal ideation and was influenced by social support. Depression contributed directly to suicidal ideation and partly mediated the association of perceived stigma and self-esteem with suicidal ideation. These findings suggest that self-esteem and depression, particularly perceived stigma, play important roles in suicidal ideation among PLWHA. Enhancing personal self-esteem or social support might also reduce perceived stigma and may be an important target for intervention to decrease suicidal ideation among PLWHA.