A Multidimensional Approach to Assessing Infectious Disease Risk: Identifying Risk Classes Based on Psychological Characteristics

Abstract

Prevention of infectious diseases depends on health-related behavior, which is often influenced by psychological characteristics. However, few studies assessing health-related behavior have examined psychological characteristics to identify risk groups, and this multidimensional approach might improve disease risk assessment. We aimed to characterize subgroups based on psychological characteristics and examine their influence on behavior and disease risk, using chlamydia as a case study. Selected participants (heterosexuals aged 18–24 years and females aged 18–24 years who had sex with both men and women) in a Dutch longitudinal cohort study (the Mathematical Models Incorporating Psychological Determinants: Control of Chlamydia Transmission (iMPaCT) Study) filled out a questionnaire and were tested for chlamydia (2016–2017). Latent class analysis was performed to identify risk classes using psychological predictors of chlamydia diagnosis. Two classes were identified: class 1 (n = 488; 9% chlamydia diagnosis) and class 2 (n = 325; 13% chlamydia diagnosis). The proportion of participants with high shame, high impulsiveness, and lower perceived importance of health was higher in class 2 than in class 1. Furthermore, persons in class 2 were more likely to be male and to report condomless sex compared with class 1, but the number of recent partners was comparable. Thus, risk classes might be distinguished from each other by psychological characteristics beyond sexual behavior. Therefore, the impact of the same intervention could differ, and tailoring interventions based on psychological characteristics might be necessary to reduce chlamydia prevalence most effectively.

Identifying Sexually Transmitted Infection Risk Groups Based on Behavioral and Psychological Characteristics Among Heterosexuals During the COVID-19 Pandemic

“…Nevertheless, the sample size was large enough to conduct the LCA, and fit statistics of these analyses showed that the latent class model performed well. Furthermore, the behavioral and psychological measures included in the LCA have been identified as predictors for STI diagnosis in previous work in the same cohort, and, therefore, could be viewed as reliable proxy measures for STI risk 16,18 . Second, the majority of participants were highly educated Dutch females, which means that the results may not be generalizable to the general population 15,29 .…”

“…Impulsiveness has often been associated with high numbers of partners and higher STI risk. 16,18,27 Impulsive individuals may focus their attention more on immediate rewards of the situation, compared with more reflective individuals, which explains their propensity toward risky decision making. 28 Therefore, as the duration of strict COVID-19 restrictions was not known, impulsive individuals might have had more difficulty complying with physical distancing measures in terms of reducing (sexual) contacts.…”

“…Furthermore, we showed that individuals who reported multiple partners during lockdown were also more impulsive compared with other subgroups. Impulsiveness has often been associated with high numbers of partners and higher STI risk 16,18,27 . Impulsive individuals may focus their attention more on immediate rewards of the situation, compared with more reflective individuals, which explains their propensity toward risky decision making 28 .…”

“…Psychological characteristics may be independent predictors of acquiring an STI, and of health care-seeking behavior (ie, STI testing) 16 . However, few studies examined psychological characteristics in the time of COVID-19.…”

Modelling the impact of tailored behavioural interventions on chlamydia transmission

“…Psychological mechanisms of behaviour, such as risk perception, knowledge, or attitudes regarding condom use and STI testing [5][6][7][8] , may play an important role in improving STI control 9,10 . For example, psychological characteristics may also help to identify different types of individuals in a population at high risk for acquiring chlamydia (i.e., many partners and inconsistent condom use) that would not be identified based on sexual behaviour alone 11,12 . Previous studies showed that high impulsiveness [13][14][15] , low perceived importance of health 8 , and STI-related stigma and shame [16][17][18][19] , are associated with risky decisionmaking in terms of sexual behaviour.…”