Dyadic Internalized Stigma, Resilience, and Psychological Distress Among People with HIV and their Family Members: An Actor-Partner Interdependence Mediation Model Analysis

Despite robust evidence showing the mediation role of psychological resilience in the impacts of HIV-related stigma on psychological distress, most studies were conducted from an intrapersonal perspective. Limited studies have examined the dyadic effects of HIV-related stigma and resilience on psychological distress for people with HIV (PWH) and their family members. This study aimed to explore the actor-partner effect and the mediation role of resilience in the relationship between internalized stigma and psychological distress among PWH and family members dyads. Between October 2023 and December 2023, a total of 800 PWH-family member dyads were recruited from two urban cities and nine rural counties in Guangxi, China. All participants completed validated questionnaires capturing demographic characteristics, internalized stigma, resilience, and psychological distress. This study employed the actor-partner interdependence mediation model to examine both individual (actor) and dyadic (partner) pathways, along with resilience as a mediator. For actor effects, resilience partially mediated the relationship between internalized stigma and psychological distress in PWH (β = 0.08, SE = 0.01, p < 0.001) but not in their family members (β = -0.00, SE = 0.01, p = 0.68). Regarding partner effects, indirect effects were significant in the association between family members' internalized stigma and PWH's psychological distress through PWH's resilience (β = 0.03, SE = 0.01, p < 0.01). This study underscores the complex interplay between internalized stigma, resilience, and psychological distress in PWH-family member dyads. Psychological health promotion programs would benefit from adopting family-centered strategies that attend to stigma reduction and resilience improvement for both PWH and family members.