Religious coping mechanism in reducing depression in PLWHA: comparison of generalized structural equation modelling and logistic regression modellin

Abstract

Background People living with HIV/AIDS (PLWHA) are at higher risk of depression compared to HIV uninfected individuals. In addition to pharmacological treatments for depression among PLWHA, psychosocial interventions may facilitate coping with depression. Religious coping is one example of a psychosocial intervention that may help PLWHA confront both health problems and life stressors. The association between religious coping and depression among PLWHA has been examined in higher income countries using regression analyses. To my knowledge, few studies have been conducted on the African continent examining the relationship between religious coping and depression in PLWHA. Further, no study has utilized the generalized structural equation modelling (GSEM) technique to examine the above relationship. Yet literature suggests that this technique is useful in its potential to explore potential mediators and latent confounders as well to quantify each of the factors’ contribution to the covariance structure. This study contributes to the biostatistics literature and aims at addressing this gap. The study compares the GSEM approach to that of the logistic regression approach in exploring the relationship between religious coping and depression. Methods and material A secondary data analysis of a longitudinal study carried out at two specialized HIV clinics in Uganda was conducted. Data from the two sites were combined for analysis. To assess the factors associated with major depressive disorder, multivariable logistic regression and GSEM were utilized in Stata/IC version 14.1.

Results Results of the logistic regression procedures suggested that stigma score (aOR = 1.08 95% CI (1.03-1.14) P = 0.002), childhood traumatic experience (aOR = 1.02 95% CI (1.00-1.05) P = 0.017), study site (aOR = 2.17 95% CI (1.48-4.98) P = 0.001), negative life events (aOR = 1.12 95% CI (0.99-1.28) P = 0.083), resilience score (aOR = 0.97 95% CI (0.95-0.99) P = 0.001), coping score (aOR = 1.04 95% CI (1.01-1.08) P = 0.003) and education (aOR = 0.69 95% CI (0.47-1.01) P = 0.054) were significantly associated with depression. However, when controlling for potential confounding factors, no significant association was found between depression and negative and positive religious coping among PLWHA (aOR = 1.12 95% CI (0.91-1.36) P = 0.282 and aOR = 1.01 95% CI (0.92-1.11) P = 0.784, respectively).On the other hand, results from fitting GSEMs showed that stigma score (aOR = 1.15 95% CI (1.10-1.20) P <0.001), childhood trauma score (aOR= 7.87 CI (3.88-15.95) P <0.001), study site, marital status, negative life events, social support score (aOR = 0.32 95% CI (0.21-0.48) P <0.001) and socio-economic status (aOR = 0.72 95% CI (0.50-1.04) P = 0.079) were significant in predicting depression. In addition, there was some evidence that negative religious coping was associated with depression among PLWHA (aOR = 1.18 95% CI (0.99-1.40) P = 0.061). Both modelling procedures thus suggest that stigma score, childhood trauma score, study site and negative life events were predictive of depression. Discussion and conclusion On comparing GSEM and logistic regression, the results obtained in this study suggest that the approaches differ only slightly. The GSEM approach found that negative religious coping was marginally significantly associated with depression. These findings, however, do not suggest superiority of either technique, but instead suggest that researchers should consider

utilizing GSEM in analyzing mental health data. While some of the factors associated with depression differed between the two techniques both approaches suggested consistently that stigma score, childhood trauma score, study site, marital status and negative life events are associated with depression.