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Depressive Symptoms Mediate the Associations of Stigma with Medication Adherence and Quality of Life in Tuberculosis Patients in China

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  • 1 School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, P. R. China;
  • | 2 School of management, Hainan Medical University, Haikou, P. R. China;
  • | 3 Center for Disease Control and Prevention of Hubei Province, Wuhan, P. R. China

Stigma has been associated with health-related outcomes such as medication adherence and quality of life (QOL) in patients with tuberculosis (TB); however, the mechanisms via which TB-related stigma interferes with specific outcomes are unclear. This study aimed to determine whether depressive symptoms were one of the mechanisms that mediated the associations between TB-related stigma and both medication adherence and QOL in patients with TB. A cross-sectional survey was conducted between October 1, 2013, and March 31, 2014, in Hubei Province, central China, and data were collected from 1,342 patients with TB, using a structured questionnaire that measured TB-related stigma, depressive symptoms, medication adherence, and QOL. Multiple imputation was used to account for missing data. Structural equation modeling was performed to assess the mediating effect of depressive symptoms on the associations of TB-related stigma with medication adherence and QOL. Mediation analyses showed that depressive symptoms partially mediated the association between TB-related stigma and medication adherence (standardized indirect effect = −0.16, 95% bias-corrected confidence interval [CI] [−0.19, −0.13], P < 0.01). Moreover, depressive symptoms fully mediated the association between TB-related stigma and QOL (standardized indirect effect = −0.17, 95% bias-corrected CI [−0.21, −0.14], P < 0.01). The results suggest that depressive symptoms played a key role in the relationships among TB-related stigma, medication adherence, and QOL in patients with TB. Therefore, the alleviation of depressive symptoms could be an important strategy for improving medication adherence and QOL in patients with TB.

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Author Notes

Address correspondence to Yanhong Gong or Xiaoxv Yin, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, P. R. China. E-mails: gongyanhong@hust.edu.cn or yxx@hust.edu.cn

Financial support: This project was funded by Young Scholars Fund of the Health and Family Planning Commission of Hubei Province (No. QJX2012-25) and the National Philosophy and Social Science Foundation of China (No. 15ZDC037).

Disclaimer: The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Authors’ addresses: Lei Qiu, Zuxun Lu, Yanhong Gong, and Xiaoxv Yin, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, P. R. China, E-mails: qiuleihk@163.com, zuxunlu@yahoo.com, gongyanhong@hust.edu.cn, and yxx@hust.edu. Yeqing Tong, Center for Disease Control and Prevention of Hubei Province, Wuhan, P. R. China, E-mail: 63382251@qq.com.

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