The COVID-19 pandemic and unemployment, subsistence needs and mental health among adults with HIV in the United States

Abstract

Objective:To evaluate whether reported prevalence of unemployment, subsistence needs, and symptoms of depression and anxiety among adults with diagnosed HIV during the COVID-19 pandemic were higher than expected.Design:The Medical Monitoring Project (MMP) is a complex sample survey of adults with diagnosed HIV in the United States.Methods:We analyzed 2015–2019 MMP data using linear regression models to calculate expected prevalence, along with corresponding prediction intervals (PI), for unemployment, subsistence needs, depression, and anxiety for June–November 2020. We then assessed whether observed estimates fell within the expected prediction interval for each characteristic, overall and among specific groups.Results:Overall, the observed estimate for unemployment was higher than expected (17% vs. 12%) and exceeded the upper limit of the PI. Those living in households with incomes ≥400% of FPL were the only group where the observed prevalence of depression and anxiety during the COVID-19 period was higher than the PIs; in this group, the prevalence of depression was 9% compared with a predicted value of 5% (75% higher) and the prevalence of anxiety was 11% compared with a predicted value 5% (137% higher). We did not see elevated levels of subsistence needs, although needs were higher among Black and Hispanic compared with White persons.Conclusions:Efforts to deliver enhanced employment assistance to persons with HIV and provide screening and access to mental health services among higher income persons may be needed to mitigate the negative effects of the US COVID-19 pandemic.

The impact of the COVID‐19 pandemic on mental health, associated factors and coping strategies in people living with HIV: a scoping review

“…found that 71.8% of the participants reported feeling more depressed than usual [48]. In a study in which researchers conducted a month‐12 follow‐up assessment, the rates of depression symptoms nearly tripled from month 12 to the post‐lockdown assessment [57] Similarly, 21 studies (46.7%) assessed anxiety [19, 22, 25, 26, 31–33, 35, 36, 38–41, 43, 48, 50, 51, 54, 56, 59, 62] and 11 studies assessed loneliness [21, 23, 26, 27, 31, 32, 37, 42, 44, 46, 62]. The stress of dealing with the pandemic was assessed in eight studies [21, 23, 32, 37, 42, 44, 46, 62], and other mental health outcomes examined in these studies include schizophrenia, attention deficit hyperactivity disorder, autism, intellectual delay, insomnia, bipolar disorder, panic disorder and PTSD [20, 22, 28, 30, 33, 37, 38, 40, 55, 60, 61, 64].…”

“…Of those, 283 were removed after initial screening due to duplication, and 727 articles were excluded based on screening titles and abstracts. The remaining 78 full‐text articles were assessed for eligibility, and 45 studies met the inclusion criteria and were, therefore, included in the final review and data extraction [19–63]. See Figure 1 for the PRISMA flowchart of the study selection and rationales for the exclusion of full‐text articles.…”

“…At the structural level, financial insecurity and economic hardship were also associated with mental health outcomes during the pandemic [21,23,61]. Unemployment [25,38,44], working less during the pandemic [28], not having enough money/income [28,38,49,53], ability to cover basic http://onlinelibrary.wiley.com/doi/10.1002/jia2.26060/full | https://doi.org/10.1002/jia2.26060 needs [23] and lower education level [49] were found to be correlated with various mental health distresses in included studies. Indeed, one study found that those with stable salaried jobs or who are self-employed had less mental health distress during the pandemic [30].…”

Income or Job Loss and Psychological Distress During the COVID-19 Pandemic

“…The start of the COVID-19 pandemic brought record levels of unemployment, which were above 14% by April 2020, 1 , 2 and a worsening of mental health 3 , 4 , 5 , 6 , 7 across the US compared with before the pandemic. The burden of pandemic job loss was felt unequally, with younger; less-educated; Asian, Black, and Hispanic; female; and low-wage workers more likely to lose their jobs.…”