Mediators of Intervention Effects on Depressive Symptoms Among People Living With HIV: Secondary Analysis of a Mobile Health Randomized Controlled Trial Using Latent Growth Curve Modeling

Abstract

BackgroundAlthough several studies have investigated the effects of mobile health (mHealth) interventions on depression among people living with HIV, few studies have explored mediators of mHealth-based interventions to improve mental health in people living with HIV. Identifying influential mediators may enhance and refine effective components of mHealth interventions to improve mental health of people living with HIV.ObjectiveThis study aimed to examine mediating factors of the effects of a mHealth intervention, Run4Love, designed to reduce depression among people living with HIV using 4 time-point measurement data.MethodsThis study used data from a randomized controlled trial of a mHealth intervention among people living with HIV with elevated depressive symptoms in Guangzhou, China. A total of 300 patients were assigned to receive either the mHealth intervention (n=150) or a waitlist control group (n=150) through computer-generated block randomization. Depressive symptoms, coping, and HIV-related stigma were measured at baseline, 3-, 6-, and 9-month follow-ups. The latent growth curve model was used to examine the effects of the intervention on depressive symptoms via potential mediators. Mediating effects were estimated using bias-corrected 95% bootstrapped CIs (BCIs) with resampling of 5000.ResultsEnhanced positive coping and reduced HIV-related stigma served as effective treatment mediators in the mHealth intervention. Specially, there was a significant indirect effect of the mHealth intervention on the slope of depressive symptoms via the slope of positive coping (beta=–2.86; 95% BCI –4.78 to –0.94). The indirect effect of the mHealth intervention on the slope of depressive symptoms via the slope of HIV-related stigma was also statistically significant (beta=–1.71; 95% BCI –3.03 to –0.40). These findings indicated that enhancement of positive coping and reduction of HIV-related stigma were important mediating factors of the mHealth intervention in reducing depression among people living with HIV.ConclusionsThis study revealed the underlying mediators of a mHealth intervention to reduce depression among people living with HIV using latent growth curve model and 4 time-point longitudinal measurement data. The study results underscored the importance of improving positive coping skills and mitigating HIV-related stigma in mHealth interventions to reduce depression among people living with HIV.

Mediating Effects of Stigma and Depressive Symptoms in a Social Media–Based Intervention to Improve Long-term Quality of Life Among People Living With HIV: Secondary Analysis of a Randomized Controlled Trial

“…However, literature examining the mechanisms of QOL improvement in psychosocial interventions are scarce, especially in the long term. In addition, methods employed in previous studies such as repeated measures analyses of covariance and latent growth curve model could not identify the sequential and causal relationships when exploring intervention mechanisms [ 16 , 17 , 56 ]. Our study contributed to the literature by affirming the sequential and potential causal relationships between HIV-related stigma, depressive symptoms, and QOL, which have not been reported in previous studies.…”

“…Our study contributed to the literature by affirming the sequential and potential causal relationships between HIV-related stigma, depressive symptoms, and QOL, which have not been reported in previous studies. Furthermore, only a small number of studies used longitudinal data, of which, to the best of our knowledge, none examined the sequential relationships [ 16 , 17 , 56 ]. In this study, the use of SEM with longitudinal data allowed us to assign mediators and the outcomes in chronological order, thus shedding light on the potential causal relationships of the intervention mechanisms.…”

Training parameters and longitudinal adaptations that most strongly mediate walking capacity gains from high-intensity interval training post-stroke

“…SEM model fit was assessed with Chi-squared (χ 2 ), comparative fit index (CFI), root mean square error of approximation (RMSEA) and standardized root mean square residual (SRMR), with good model fit indicated by non-significant χ 2 , χ 2 /df < 2-5, CFI > 0.90-0.95, RMSEA < 0.06-0.10 and SRMR < 0.05-0.08. 34,35 Multicollinearity was assessed with variance inflation factors (VIFs) and condition indices, with lack of problematic multicollinearity indicated by VIFs < 5-10 and condition indices < 10-30. 36,37…”

Positive Coping as a Mediator of Mobile Health Intervention Effects on Quality of Life Among People Living With HIV: Secondary Analysis of the Randomized Controlled Trial Run4Love

“…Third, as all the 6 dimensions of QOL were improved in the intervention group at 3, 6, and 9 months, and the improvement was not limited to the mental health dimension, it is possible that the improvement in QOL was also related to other factors besides positive coping, such as reduced depressive symptoms, stress, and/or HIV-related stigma and increased social support [51][52][53]. Although it is beyond the scope of this study to incorporate other factors, one of our previous studies found mediating roles of perceived stress and depressive symptoms for suicide reduction [53], whereas another study found positive coping and HIV-related stigma as intervention mediators on depressive symptoms [52]. Therefore, other potential mediators should be further explored to clarify the mechanisms of intervention effects and processes of how mHealth interventions improve health outcomes for better designing and implementing effective mHealth interventions.…”