Predicting health-related quality of life in people living with HIV in Nepal: mental health disorders and substance use determinants

Abstract

HIV-positive people often experience mental health disorders and engage in substance use. Such conditions tend to impair their health-related quality of life (QOL). Evidence, however, is limited about the influence of mental health disorders and substance use on QOL by gender. Also, little is known about the influences of anxiety and high levels of stress on QOL. We recruited 682 HIV-positive people in Nepal and measured their depression, anxiety, stress levels, substance use, and QOL. Multiple linear regressions assessed the association of mental health disorders and substance use with QOL. Presence of depressive symptoms was negatively associated with all domains of QOL including the physical (men: β = -0.68, p = 0.037; women: β = -1.37, p < 0.001) and the psychological (men: β = -1.08, p < 0.001; women: β = -1.13, p < 0.001). Those who experienced anxiety had lower scores in the physical (β = -0.89, p = 0.027) and psychological (β = -1.75, p = 0.018) QOL domains among men and in the spiritual QOL domain (β = -0.061, p = 0.043) among women. High stress levels were associated with lower scores across all QOL domains including the physical (men: β = -0.16, p < 0.001; women: β = -0.14, p < 0.001) and the psychological (men: β = -0.09, p < 0.001; women: β = -0.10, p < 0.001). Substance-using men were more likely to have lower scores in physical (β = -0.70, p = 0.039) and psychological (β = -0.073, p = 0.002) domains. Among women, meanwhile, substance use was negatively associated with the psychological domain only (β = -0.77, p = 0.005). In conclusion, mental health disorders and substance use had negative associations with QOL. Attention should be given to addressing the mental health care needs of HIV-positive people to improve their QOL.

Changes and determinants of health-related quality of life among people newly diagnosed with HIV in China: a 1-year follow-up study

“…Consistent with cross-sectional studies in Nepal and Hong Kong, this study found that higher levels of stress were associated with worse HRQoL [ 18 , 48 ]. The fact that HIV-positive individuals experienced higher levels of stress than the general population has been consistently documented by many previous studies [ 49 ].…”

“…They also struggle with psychosocial problems such as depression, anxiety, and a lack of social support [ 16 , 17 ]. All these factors may negatively influence HRQoL [ 18 , 19 ]. O’Keefe and Wood found that the majority of decreases in HRQoL, particular in the psychological domain, occurred in early stages of HIV progression [ 20 ].…”

Role of psychosocial status in predicting health-related quality of life at 1-year follow-up among newly diagnosed people living with HIV

“…The initial diagnosis may be disruptive for the majority of individuals since they have to face a future life with HIV infection, and struggle with multiple HIV-specific stressors such as stigma, disclosure, psychological adjustment and making treatment decisions [6]. The fact that individuals who perceived higher levels of stress would be more vulnerable to poor HRQoL has been well documented in previous cross-sectional studies [11, 37]. The results from this study further highlighted that stress at the time of diagnosis had a long-term negative impact on HRQoL for at least 1 year.…”

Quality of life and its correlated factors among patients with substance use disorders: a systematic review and meta-analysis

“…Being married [ 12 , 13 ] or male [ 14 , 15 ] and having good social support [ 16 , 17 ] were positively associated with mental health, social and environmental QoL domains, while being older, homeless, or unemployed tended to negatively affect all QoL domains. Having mental disorders [ 18 ], severe SUD [ 19 ], or comorbidities [ 20 , 21 ], being HIV-positive [ 22 , 23 ], and experiencing trauma symptoms [ 16 , 17 ] negatively affected all QoL domains. Receiving short-term methadone treatment [ 22 ] was positively associated with better QoL across all domains.…”