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Syndemics of psychosocial problems and HIV risk: A systematic review of empirical tests of the disease interaction concept

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  • Tsai, Alexander C.
  • Burns, Bridget F.O.

Abstract

In the theory of syndemics, diseases co-occur in particular temporal or geographical contexts due to harmful social conditions (disease concentration) and interact at the level of populations and individuals, with mutually enhancing deleterious consequences for health (disease interaction). This theory has widespread adherents in the field, but the extent to which there is empirical support for the concept of disease interaction remains unclear. In January 2015 we systematically searched 7 bibliographic databases and tracked citations to highly cited publications associated with the theory of syndemics. Of the 783 records, we ultimately included 34 published journal articles, 5 dissertations, and 1 conference abstract. Most studies were based on a cross-sectional design (32 [80%]), were conducted in the U.S. (32 [80%]), and focused on men who have sex with men (21 [53%]). The most frequently studied psychosocial problems were related to mental health (33 [83%]), substance abuse (36 [90%]), and violence (27 [68%]); while the most frequently studied outcome variables were HIV transmission risk behaviors (29 [73%]) or HIV infection (9 [23%]). To test the disease interaction concept, 11 (28%) studies used some variation of a product term, with less than half of these (5/11 [45%]) providing sufficient information to interpret interaction both on an additive and on a multiplicative scale. The most frequently used specification (31 [78%]) to test the disease interaction concept was the sum score corresponding to the total count of psychosocial problems. Although the count variable approach does not test hypotheses about interactions between psychosocial problems, these studies were much more likely than others (14/31 [45%] vs. 0/9 [0%]; χ2 = 6.25, P = 0.01) to incorporate language about “synergy” or “interaction” that was inconsistent with the statistical models used. Therefore, more evidence is needed to assess the extent to which diseases interact, either at the level of populations or individuals, to amplify HIV risk.

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  • Tsai, Alexander C. & Burns, Bridget F.O., 2015. "Syndemics of psychosocial problems and HIV risk: A systematic review of empirical tests of the disease interaction concept," Social Science & Medicine, Elsevier, vol. 139(C), pages 26-35.
    • Handle: RePEc:eee:socmed:v:139:y:2015:i:c:p:26-35
    DOI: 10.1016/j.socscimed.2015.06.024
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    1. Chakrapani, Venkatesan & Kaur, Manmeet & Tsai, Alexander C. & Newman, Peter A. & Kumar, Rajesh, 2022. "The impact of a syndemic theory-based intervention on HIV transmission risk behaviour among men who have sex with men in India: Pretest-posttest non-equivalent comparison group trial," Social Science & Medicine, Elsevier, vol. 295(C).
    2. Brewis, Alexandra & Wutich, Amber & Galvin, Michael & Lachaud, James, 2022. "Localizing syndemics: A comparative study of hunger, stigma, suffering, and crime exposure in three Haitian communities," Social Science & Medicine, Elsevier, vol. 295(C).
    3. Boateng, Godfred O. & Workman, Cassandra L. & Miller, Joshua D. & Onono, Maricianah & Neilands, Torsten B. & Young, Sera L., 2022. "The syndemic effects of food insecurity, water insecurity, and HIV on depressive symptomatology among Kenyan women," Social Science & Medicine, Elsevier, vol. 295(C).
    4. Kazumi Tsuchiya & Olivia Toles & Christopher Levesque & Kimberly Horner & Eric Ryu & Linus Chan & Jack DeWaard, 2021. "Perceived structural vulnerabilities among detained noncitizen immigrants in Minnesota," PLOS ONE, Public Library of Science, vol. 16(6), pages 1-22, June.
    5. Snodgrass, Jeffrey G. & Lacy, Michael G. & Cole, Steven W., 2022. "Internet gaming, embodied distress, and psychosocial well-being: A syndemic-syndaimonic continuum," Social Science & Medicine, Elsevier, vol. 295(C).
    6. Shrestha, Shikhar & Bauer, Cici X.C. & Hendricks, Brian & Stopka, Thomas J., 2022. "Spatial epidemiology: An empirical framework for syndemics research," Social Science & Medicine, Elsevier, vol. 295(C).
    7. Randolph C. H. Chan & Don Operario & Winnie W. S. Mak, 2020. "Effects of HIV-Related Discrimination on Psychosocial Syndemics and Sexual Risk Behavior among People Living with HIV," IJERPH, MDPI, vol. 17(6), pages 1-15, March.
    8. Tsai, Alexander C. & Tomlinson, Mark & Comulada, W. Scott & Rotheram-Borus, Mary Jane, 2016. "Food insufficiency, depression, and the modifying role of social support: Evidence from a population-based, prospective cohort of pregnant women in peri-urban South Africa," Social Science & Medicine, Elsevier, vol. 151(C), pages 69-77.
    9. S. Raquel Ramos & Geetha Beauchamp & Darrell P. Wheeler & Leo Wilton & Darren L. Whitfield & Donte T. Boyd & Lisa Hightow-Weidman & Sheldon D. Fields & LaRon E. Nelson & on behalf of the HPTN 073 Team, 2022. "Optimizing PrEP Continuance: A Secondary Analysis Examining Perceived Autonomy Support and Care Coordination Quality among Black MSM in HPTN 073," IJERPH, MDPI, vol. 19(8), pages 1-10, April.
    10. Himmelgreen, David & Romero-Daza, Nancy & Heuer, Jacquelyn & Lucas, William & Salinas-Miranda, Abraham A. & Stoddard, Theresa, 2022. "Using syndemic theory to understand food insecurity and diet-related chronic diseases," Social Science & Medicine, Elsevier, vol. 295(C).
    11. Danni Xia & Yingjie Chen & Ruijie Chang & Chen Xu & Xiaoyue Yu & Yujie Liu & Hui Chen & Rongxi Wang & Shangbin Liu & Xin Ge & Yuxuan Wang & Ajuan Liang & Fan Hu & Yong Cai & Ying Wang, 2022. "Psychosocial Problems and Condomless Anal Sex among Transgender Women in Two Cities of China: Study Based on the Syndemic Framework," IJERPH, MDPI, vol. 19(23), pages 1-14, December.
    12. Hatcher, Abigail M. & Gibbs, Andrew & McBride, Ruari-Santiago & Rebombo, Dumisani & Khumalo, Mzwakhe & Christofides, Nicola J., 2022. "Gendered syndemic of intimate partner violence, alcohol misuse, and HIV risk among peri-urban, heterosexual men in South Africa," Social Science & Medicine, Elsevier, vol. 295(C).
    13. Saxena, Akshar & Mendenhall, Emily, 2022. "Syndemic thinking in large-scale studies: Case studies of disability, hypertension, and diabetes across income groups in India and China," Social Science & Medicine, Elsevier, vol. 295(C).
    14. Quinn, Katherine G., 2022. "Applying an intersectional framework to understand syndemic conditions among young Black gay, bisexual, and other men who have sex with men," Social Science & Medicine, Elsevier, vol. 295(C).
    15. Risto Nikunlaakso & Kaisa Reuna & Kirsikka Selander & Tuula Oksanen & Jaana Laitinen, 2022. "Synergistic Interaction between Job Stressors and Psychological Distress during the COVID-19 Pandemic: A Cross-Sectional Study," IJERPH, MDPI, vol. 19(21), pages 1-10, October.
    16. Ouafik, Maxence R. & Buret, Laetitia & Scholtes, Beatrice, 2022. "Mapping the current knowledge in syndemic research applied to men who have sex with men: A scoping review," Social Science & Medicine, Elsevier, vol. 306(C).
    17. Tomori, Cecilia & McFall, Allison M. & Solomon, Sunil S. & Srikrishnan, Aylur K. & Anand, Santhanam & Balakrishnan, P. & Mehta, Shruti H. & Celentano, David D., 2018. "Is there synergy in syndemics? Psychosocial conditions and sexual risk among men who have sex with men in India," Social Science & Medicine, Elsevier, vol. 206(C), pages 110-116.

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    AIDS/HIV; Social determinants;

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