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Connecting the dots: a comparison of network analysis and exploratory factor analysis to examine psychosocial syndemic indicators among HIV-negative sexual minority men

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Abstract

Syndemics, or comorbid and mutually reinforcing psychosocial problems, are associated with increased HIV risk among men who have sex with men (MSM). Although the dynamic interplay among syndemic indicators is theorized to be crucial for increasing risk of HIV acquisition, novel approaches are needed to understand how these syndemic problems interrelate. This study examined the associations between nine self-reported syndemic indicators in 194 MSM at high risk of HIV acquisition. We compared exploratory factor analyses (EFA) to a network analysis. In the present study, network analysis consisted of edges representing bidirectional partial polychoric correlations between nodes, which represent psychosocial syndemic indicators. EFA yielded a 1-factor solution including suicidal ideation (SI), injection drug use (IDU), depression, social anxiety, intimate partner violence, substance use, and sexual compulsivity, and excluded heavy drinking and childhood sexual abuse. Network analysis yielded a pattern of interconnectedness with the most central nodes being SI, IDU, substance use, and depression. Statistically significant relationships (absolute edge weights) were found between SI and depression, social anxiety, and IDU, and IDU and substance use. These results suggest that depression and substance use, especially more severe presentations of these conditions such as SI and IDU, are prominent interconnected components of the HIV syndemic among MSM at high risk for HIV acquisition. SI, IDU, substance use, and depression may indeed be prudent targets of intervention. Future research on the inclusion of these syndemic indicators in analytical models involving interaction terms may be warranted.

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Notes

  1. A hyperparameter of γ = .5 was employed to produce a network with higher specificity and sensitivity than that of a smaller hyperparameter, such as .25 or .1. Sensitivity analyses using hyperparameters of γ = .25 and γ = .1 were conducted, though are not reported here, to determine the appropriateness of a hyperparameter of γ = .5. Network analyses using hyperparameters of γ = .25 and γ = .1 revealed a pattern of results that were not ostensibly different than that of the network analysis presented in the current study, using a hyperparameter of γ = .5. Because the hyperparameter of γ = .5 is more a conservative estimate than that of smaller hyperparameters, and the pattern of results between all three hyperparameters tested were nearly identical, the network analysis using a hyperparameter of γ = .5 is presented to produce a network with higher specificity and sensitivity.

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Acknowledgements

The project described was supported by P01AI074415 (Altfeld), an unrestricted research grant from Alere, Harvard University Center for AIDS Research 5P30AI060354. Some of the author time was supported by 9K24DA040489 and 1P30MH116867 (Safren). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institute of Drug Abuse, National Institute of Allergy and Infectious Diseases, the National Institutes of Health, or any of the other funders.

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Authors and Affiliations

  1. Department of Psychology, University of Miami, Coral Gables, FL, USA

    J. S. Lee, S. A. Bainter, T. R. Glynn, B. G. Rogers, C. Albright & S. A. Safren

  2. Department of Public Health Sciences, University of Miami School of Medicine, Miami, FL, USA

    A. W. Carrico

  3. Fenway Institute at Fenway Health, Boston, MA, USA

    C. O’Cleirigh, K. H. Mayer & S. A. Safren

  4. Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA

    C. O’Cleirigh

  5. Harvard Medical School, Boston, MA, USA

    K. H. Mayer

  6. Division of Infectious Diseases, Beth Israel Deaconess Medical Center, Boston, MA, USA

    K. H. Mayer

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S. A. Safren receives royalties from Oxford University Press, Humana/Springer, and Guilford for books on psychotherapeutic treatment approaches, including working with populations similar to those discussed in this manuscript. J. S. Lee, S. A. Bainter, A. W. Carrico, T. R. Glynn, B. G. Rogers, C. Albright, C. Albright, and K. H. Mayer do not have any conflicts of interest to report.

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All procedures followed were in accordance with ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2000. Informed consent was obtained from all patients for being included in the study.

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Lee, J.S., Bainter, S.A., Carrico, A.W. et al. Connecting the dots: a comparison of network analysis and exploratory factor analysis to examine psychosocial syndemic indicators among HIV-negative sexual minority men. J Behav Med 43, 1026–1040 (2020). https://doi.org/10.1007/s10865-020-00148-z

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