Depressive and Anxiety Symptoms Predict Sustained Quality of Life Deficits in HIV-Positive Ugandan Adults Despite Antiretroviral Therapy

Abstract

The impact of psychosocial status at onset of antiretroviral therapy on changes in quality of life (QOL) and subjectively rated health (SRH) among adults on highly active antiretroviral therapy (HAART) in resource-limited settings is poorly understood. Therefore, we evaluate the association between stigma, anxiety, depression, and social support and change in QOL and SRH in HIV-infected Ugandan adults during an 18-month period.Psychosocial indicators were assessed at enrollment using structured questionnaires. QOL and SRH measures were assessed at months 0, 6, 12, and 18 using the Medical Outcomes Survey-HIV. Linear mixed models determined risk estimated differences in QOL and SRH in relation to quartiles of each psychosocial status indicator. Repeated measures generalized estimating equations modeling was implemented to assess differences in likelihood of improved versus nonimproved SRH during follow-up.QOL scores and SRH improved significantly for all participants over 18 months (P < 0.0001). The gain in QOL increased dose-dependently as baseline depressive symptoms (time∗depression P < 0.001) and anxiety levels (time∗anxiety P < 0.001) declined. Lower social support was associated with worse QOL at baseline (P = 0.0005) but QOL improvement during follow-up was not dependent on baseline level of social support (time∗social support P = 0.8943) or number of stigmatizing experiences (time∗stigma P = 0.8662). Psychosocial determinants did not predict changes in SRH in this study.High levels of depression and anxiety symptoms at HAART initiation predicts lower gains in QOL for HIV-positive patients for as long as 18 months. Long-term QOL improvements in HIV-infected adults may be enhanced by implementation of psychosocial interventions to reduce depression and anxiety in HIV-infected adults.

A stress management intervention for adults living with HIV in Nigerian community settings

“…The presence of disease conditions could result in depressive feelings, increased stress and anxiety, and poorer satisfaction with life in any person, including in the population of older adults living with a life-threatening disease such as human immunodeficiency virus (HIV). [ 8 , 9 ] Older adults living with HIV face higher stress levels than younger adults who are HIV-positive. [ 1 ] Although there are numerous evidence-based stress management techniques and/or interventions, a meta-analytic study suggests that cognitive-behavioral interventions can consistently yield larger effects than other kinds of stress management interventions.…”

The relationship of social support, mental health, and health-related quality of life in human immunodeficiency virus-positive men who have sex with men

“…While social support, especially support utilization, was negatively associated with depressive symptoms. The results from some studies had indicated a high level of depressive symptoms were related to a poor level of medication compliance and could reduce the quality of life and treatment outcome, [ 13 , 19 , 20 ] while social support was confirmed to alleviate the level of depression. [ 10 , 21 ] Support utilization reflects the degree of utilizing various types of available support, such as modes of pouring out to other people, seeking help, and participating in social activities in their daily lives.…”

Caregiver socioemotional health as a determinant of child well‐being in school‐aged and adolescent Ugandan children with and without perinatal HIV exposure

“…Caregiver depressive symptoms, anxiety and social support, were each defined as a composite variable in participant Likert‐scaled response to several questions using a structured questionnaire . Caregiver depressive symptom score was defined as sum of responses to 15 questions where feelings associated with depression were presented.…”