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Assessment and Evaluation of Depression and Loneliness among People Living with HIV in Selected Places of Coastal Andhra Pradesh
Abstract
BACK GROUND: The AIDS pandemic continues to be an escalating health problem throughout the world. Mental health of PLHIVs is one of the neglected aspects in the Continuum care and most often it is under diagnosed as well as under treated. This study was proposed to assess the prevalence of depression and loneliness among PLHIV so that adequate measures could be taken to address their needs, and if required treatment of mental illness could be prioritized, which would rather be a more holistic approach. OBJECTIVES: To review key mental health issues such as loneliness and depression in the continuum of care for people living with HIV (PLHIV) & to provide a framework for integrating mental health services into HIV/AIDS interventions. METHODS: 380 PLHIV from the districts of East Godavari & Vishakhapatnam were interviewed using the SRQ-10 depression scale and R-UCLA loneliness scale for assessing the depression and loneliness respectively the responses were graded according to the standard guidelines and the mean scores for each scale were obtained. Statistical analysis was done using the student t-test and Chi square for categorical variables number and percentages were calculated. RESULTS: An overall 71.84% of subjects were depressed and 66.57% were found to be lonely. Loneliness & depression was significantly higher in female population. Depression as well as loneliness was found to be significantly associated with their educational status, financial status and the presence of opportunistic infections. CONCLUSION: The mental health indicators depression and loneliness need more stress in the continuum of care of PLHIV.
... After retrieving and evaluating the full texts, 28 articles did not meet our criteria. At the end of the screening process, 13 articles met all the inclusion and exclusion criteria and were recruited in this systematic review (Anil et al., 2016;Bhogle, 1991;Grover et al., 2019Grover et al., , 2018Malhotra et al., 2019;Mishra et al., 2013;Nayyar and Singh, 2011;Ninan and Gopinath, 2013;Samanta et al., 2012;Shettar et al., 2017;Singh and Mishra, 2009;Susheela et al., 2018;Upmanyu et al., 1994). ...
... Most (n = 4) studies were conducted in Karnataka (Anil et al., 2016;Ninan and Gopinath, 2013;Shettar et al., 2017;Susheela et al., 2018), followed by Punjab (n = 3) Nayyar and Singh, 2011;Upmanyu et al., 1994), Andhra Pradesh (n = 2) (Bhogle, 1991;Mishra et al., 2013), Delhi (n = 1) (Singh and Mishra, 2009) ...
... In a study by Bhogle S., both children and adult participants were recruited to evaluate how they perceived loneliness (Bhogle, 1991). A few studies included participants with preexisting chronic conditions (Mishra et al., 2013;Ninan and Gopinath, 2013). For example, Ninan et al. assessed loneliness among children with locomotor disabilities (Ninan and Gopinath, 2013). ...
p>
Introduction: Loneliness is a critical psychosocial problem that affects mental health and wellbeing of the individuals and communities. This systematic review synthesized the current evidence on the prevalence and correlates of loneliness from empirical studies conducted in India.
Methods: Adopting the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines, eight major databases and additional sources were searched. Studies were evaluated using following criteria: peer-reviewed journal articles, published in English language, presenting any quantitative form of evidence on loneliness, and studies conducted in India among the Indian population. A meta-analysis of the prevalence studies and narrative synthesis of the overall status and factors associated with loneliness were conducted.
Results: Among 1290 studies, only 13 met our criteria. All the studies reported a high burden of loneliness among the participants. The pooled prevalence among 3169 participants was 41% (95% confidence interval [CI] 18% - 63%). The burden of loneliness was higher among the elderly participants (44%, 95% CI 5% - 83%) compared to younger participants (24%, 95% CI 22% - 27%). Factors associated with loneliness included aging, family structure, marital status, religious practices, group membership, educational attainment, source and level of income, psychological attributes, and comorbid physical and mental health conditions among the affected individuals.
Conclusion: This review identified and evaluated the status and severity of loneliness and its correlates, which may inform future studies examining complex psychopathological and social dynamics associated with loneliness. Lastly, the current evidence necessitates the development of multipronged interventions to address the risk factors and alleviate the burden of loneliness in India.
</p
... After retrieving and evaluating the full texts, 28 articles did not meet our criteria. At the end of the screening process, 13 articles met all the inclusion and exclusion criteria and were recruited in this systematic review (Anil et al., 2016;Bhogle, 1991;Grover et al., 2019Grover et al., , 2018Malhotra et al., 2019;Mishra et al., 2013;Nayyar and Singh, 2011;Ninan and Gopinath, 2013;Samanta et al., 2012;Shettar et al., 2017;Singh and Mishra, 2009;Susheela et al., 2018;Upmanyu et al., 1994). ...
... Most (n = 4) studies were conducted in Karnataka (Anil et al., 2016;Ninan and Gopinath, 2013;Shettar et al., 2017;Susheela et al., 2018), followed by Punjab (n = 3) Nayyar and Singh, 2011;Upmanyu et al., 1994), Andhra Pradesh (n = 2) (Bhogle, 1991;Mishra et al., 2013), Delhi (n = 1) (Singh and Mishra, 2009) ...
... In a study by Bhogle S., both children and adult participants were recruited to evaluate how they perceived loneliness (Bhogle, 1991). A few studies included participants with preexisting chronic conditions (Mishra et al., 2013;Ninan and Gopinath, 2013). For example, Ninan et al. assessed loneliness among children with locomotor disabilities (Ninan and Gopinath, 2013). ...
p>
Introduction: Loneliness is a psychosocial problem that affects mental health and wellbeing of the individuals and communities. This systematic review synthesized the current evidence on the status and correlates of loneliness from empirical studies conducted in India.
Methods: Adopting the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines, eight major databases and additional sources were searched. Studies were evaluated using following criteria: peer-reviewed journal articles, published in English language, presenting any quantitative form of evidence on loneliness, and studies conducted in India among the Indian population. A meta-analysis of the prevalence studies and narrative synthesis of the overall status and factors associated with loneliness were conducted.
Results: Among 1290 studies, only 13 met our criteria. All the studies reported a high burden of loneliness among the participants. The pooled prevalence among 3169 participants was 41% (95% confidence interval [CI] 18% - 63%). The burden of loneliness was higher among the elderly participants (44%, 95% CI 5% - 83%) compared to younger participants (24%, 95% CI 22% - 27%). Factors associated with loneliness included aging, family structure, marital status, religious practices, group membership, educational attainment, source and level of income, psychological attributes, and comorbid physical and mental health conditions among the affected individuals.
Conclusion: This review identified and evaluated the status and severity of loneliness and its correlates, which may inform future studies examining complex psychopathological and social dynamics associated with loneliness. Lastly, the current evidence necessitates the development of multipronged interventions to address the risk factors and alleviate the burden of loneliness in India.
</p
... After retrieving and evaluating the full texts, 28 articles did not meet our criteria. At the end of the screening process, 13 articles met all the inclusion and exclusion criteria and were recruited in this systematic review (Anil, Prasad, & Puttaswamy, 2016;Bhogle, 1991;Grover et al., 2018;Grover, Verma, Singh, Dahiya, & Nehra, 2019;Malhotra et al., 2019;Mishra, Behera, & Jena, 2013;Nayyar & Singh, 2011;Ninan & Gopinath, 2013;Samanta, Mukherjee, Ghosh, & Dasgupta, 2012;Shettar, Karkal, Kakunje, Mendonsa, & Chandran, 2017;Singh & Mishra, 2009;Susheela, Valsaraj, & Savitha, 2018;Upmanyu, Sehgal, & Upmanyu, 1994). ...
... Studies were conducted in different states of India. Most (n = 4) studies were conducted in Karnataka (Anil et al., 2016;Ninan & Gopinath, 2013;Shettar et al., 2017;Susheela et al., 2018), followed by Punjab (n = 3) Nayyar & Singh, 2011;Upmanyu et al., 1994), Andhra Pradesh (n = 2) (Bhogle, 1991;Mishra et al., 2013), Delhi (n = 1) (Singh & Mishra, 2009), Haryana (n = 1) (Malhotra et al., 2019), and West Bengal (n = 1) (Samanta et al., 2012). A study by Grover et al. included participants from multiple states of India (Grover et al., 2018). ...
... A study by Grover et al. included participants from multiple states of India (Grover et al., 2018). In most of the studies (n = 10), University of California Los Angeles (UCLA) Loneliness Scale was used to evaluate loneliness among the participants (Anil et al., 2016;Bhogle, 1991;Grover et al., 2018Grover et al., , 2019Mishra et al., 2013;Nayyar & Singh, 2011;Shettar et al., 2017;Singh & Mishra, 2009;Susheela et al., 2018;Upmanyu et al., 1994). Other scales used for assessing loneliness, associated sociodemographic, and clinical conditions included differential loneliness scale (Upmanyu et al., 1994), Eysenck personality profiler (Singh & Mishra, 2009), loneliness and social dissatisfaction questionnaire (Ninan & Gopinath, 2013), Columbia suicide severity scale (Grover et al., 2018), patient health questionnaire (Grover et al., 2018), social connectedness scale (Grover et al., 2018), generalized anxiety disorder questionnaire (Grover et al., 2018), vulnerability to abuse screening scale , Bergan Facebook addiction scale (Shettar et al., 2017), Beck depression inventory (Singh & Mishra, 2009), internal-external scale (Nayyar & Singh, 2011), Institute for Personality and Ability Testing (IPAT) self-analysis anxiety scale (Nayyar & Singh, 2011), global school student health survey (Samanta et al., 2012), children attribution style questionnaire (Ninan & Gopinath, 2013), geriatric depression scale (Grover et al., 2018, activities of daily living scale (Susheela et al., 2018), and self-reported questionnaire (Malhotra et al., 2019;Mishra et al., 2013). ...
p> Introduction: Loneliness is a psychosocial problem that affects mental health and wellbeing of the individuals and communities. This systematic review aimed to synthesize the current evidence on the status and correlates of loneliness from empirical studies conducted in India.
Methods: Adopting the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines, eight major databases and additional sources were searched. Studies were evaluated using following criteria: peer-reviewed journal articles, published in English language, presenting any quantitative form of evidence on loneliness, and studies conducted in India among the Indian population. A meta-analysis of the prevalence studies and narrative synthesis of the overall status and factors associated with loneliness were conducted.
Results: Among 1031 studies, only 13 met our criteria. All the studies reported a high burden of loneliness among the participants. The pooled prevalence among 3169 participants was 41% (95% confidence interval [CI] 18% - 63%). The burden of loneliness was higher among the elderly participants (44%, 95% CI 5% - 83%) compared to younger participants (24%, 95% CI 22% - 27%). Factors associated with loneliness included aging, family structure, marital status, religious practices, group membership, educational attainment, source and level of income, psychological attributes, and comorbid physical and mental health conditions among the affected individuals.
Conclusion: This review identified and evaluated the status and severity of loneliness and its correlates, which may inform future studies examining complex psychopathological and social dynamics associated with loneliness. Lastly, the current evidence necessitates the development of multipronged interventions to address the risk factors and alleviate the burden of loneliness in India. </p
... After retrieving and evaluating the full texts, 28 articles did not meet our criteria. At the end of the screening process, 13 articles met all the inclusion and exclusion criteria and were recruited in this systematic review (Anil et al., 2016;Bhogle, 1991;Grover et al., 2019Grover et al., , 2018Malhotra et al., 2019;Mishra et al., 2013;Nayyar and Singh, 2011;Ninan and Gopinath, 2013;Samanta et al., 2012;Shettar et al., 2017;Singh and Mishra, 2009;Susheela et al., 2018;Upmanyu et al., 1994). ...
... Most (n = 4) studies were conducted in Karnataka (Anil et al., 2016;Ninan and Gopinath, 2013;Shettar et al., 2017;Susheela et al., 2018), followed by Punjab (n = 3) Nayyar and Singh, 2011;Upmanyu et al., 1994), Andhra Pradesh (n = 2) (Bhogle, 1991;Mishra et al., 2013), Delhi (n = 1) (Singh and Mishra, 2009) ...
... In a study by Bhogle S., both children and adult participants were recruited to evaluate how they perceived loneliness (Bhogle, 1991). A few studies included participants with preexisting chronic conditions (Mishra et al., 2013;Ninan and Gopinath, 2013). For example, Ninan et al. assessed loneliness among children with locomotor disabilities (Ninan and Gopinath, 2013). ...
Introduction: Loneliness is a critical psychosocial problem that affects mental health and wellbeing of the individuals and communities. This systematic review synthesized the current evidence on the prevalence and correlates of loneliness from empirical studies conducted in India.
Methods: Adopting the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines, eight major databases and additional sources were searched. Studies were evaluated using following criteria: peer-reviewed journal articles, published in English language, presenting any quantitative form of evidence on loneliness, and studies conducted in India among the Indian population. A meta-analysis of the prevalence studies and narrative synthesis of the overall status and factors associated with loneliness were conducted.
Results: Among 1290 studies, only 13 met our criteria. All the studies reported a high burden of loneliness among the participants. The pooled prevalence among 3169 participants was 41% (95% confidence interval [CI] 18% - 63%). The burden of loneliness was higher among the elderly participants (44%, 95% CI 5% - 83%) compared to younger participants (24%, 95% CI 22% - 27%). Factors associated with loneliness included aging, family structure, marital status, religious practices, group membership, educational attainment, source and level of income, psychological attributes, and comorbid physical and mental health conditions among the affected individuals.
Conclusion: This review identified and evaluated the status and severity of loneliness and its correlates, which may inform future studies examining complex psychopathological and social dynamics associated with loneliness. Lastly, the current evidence necessitates the development of multipronged interventions to address the risk factors and alleviate the burden of loneliness in India.
... Loneliness and substance use are more prevalent within the HIV+ population compared to the general population (Green et al., 2010;Mishra, Kiran Behera, & Jena, 2013;Moore et al., 2009). Studies involving HIV+ men suggest loneliness has been associated with a lower CD4 T-lymphocytes count, and disease progression (Hawkley & Cacioppo, 2007;Kiecolt-Glaser, et al., 1984;Straits-Tröster et al., 1994). ...
... Furthermore, stratifying by gender allowed us to examine unique differences in health behavior between the sexes. The association between loneliness and substance use within women support calls for greater emphasis of this construct in the continuum of care (Mishra et al., 2013), and this study suggests clinicians should target loneliness in HIV+ women. Future research should attempt to elucidate the underlying mechanism of our observed association. ...
Estimates suggest 30% of adults report the highest levels of loneliness. Though men are more likely than women to use illicit substances and engage in heavy drinking, the prevalence of substance use in women is growing and their escalation toward dependence occurs more rapidly. Loneliness and substance use have greater relevance within the HIV+ population, with higher rates of substance misuse than the general population. However, the association between loneliness and substance use within HIV+ individuals remains understudied. The purpose of the present study was to test the hypothesis that there would be an association between loneliness and substance moderated by gender in HIV+ older adults. A cross-sectional study was conducted between October 2013 and January 2014. Study participants included 96 HIV-positive Black/African American men and women recruited through the University of Florida Center for HIV/AIDS Research, Education and Service (UF CARES) in Jacksonville, Florida. Participants completed an interviewer-administered assessment examining mental and behavioral health. Pearson correlations examined associations between loneliness and substance use. Binary logistic regression analyses stratified by gender examined the association between loneliness and substance use while controlling for covariates. Among women, loneliness was associated with illicit drug use, AOR = 3.37, 95% CI: 1.23–9.21, p = .018 and heavy drinking, AOR = 2.47, 95% CI: 1.07–5.71, p = .033. No significant associations were found between loneliness and illicit drug use, and heavy drinking in men. Substance use among women in this population may be linked to loneliness. Interventions should be gender specific. Further research into this association is necessary as it will likely have important clinical implications for this population.
... Poverty and physical illnesses were significantly correlated with geriatric depression and other studies. [29] In our study, loneliness is found more among females compared to males similar to Mishra et al., [33] In Grover et al. [23] loneliness is found more among people with low education similar to our study. And finally, loneliness is found to be associated with dependency Similar to a study done in Bengaluru by Anil et al. [34] All these may be due to the economic burden, which is essential to manage daily routine living expenses. ...
... Loneliness is the absence of imperative social relations or lack of affection in current relationships (Rubin, 1982). It has contributed to adverse mental health in other contexts such as combat trauma (Stein & Tuval-Mashiach, 2014), depression in people living with HIV (Mishra, Behera, & Jena, 2013), and geriatric mental health (Park, Jang, Lee, Haley, & Chiriboga, 2013;Solomon, Bensimon, Greene, Horesh, & Ein-Dor, 2013). However, little is known about the mental health implications of loneliness in orthopaedic patients' caregivers. ...
... Loneliness is the absence of imperative social relations or lack of affection in current relationships (Rubin, 1982). It has contributed to adverse mental health in other contexts such as combat trauma (Stein & Tuval-Mashiach, 2014), depression in people living with HIV (Mishra, Behera, & Jena, 2013), and geriatric mental health (Park, Jang, Lee, Haley, & Chiriboga, 2013;Solomon, Bensimon, Greene, Horesh, & Ein-Dor, 2013). However, little is known about the mental health implications of loneliness in orthopaedic patients' caregivers. ...
Although research evidence indicates that loneliness is detrimental to mental health in diverse populations, impact of loneliness on psychological distress of orthopaedic patients’ caregivers has been given little research attention. The present study examined the association of loneliness with psychological health, and explored gender differences in the loneliness and psychological health association among orthopaedic patients’ caregivers. Participants were 250 patients’ caregivers drawn from a national orthopaedic hospital in eastern Nigeria. Data was collected by means of self-report measures translated into the local dialect of the caregivers. Multiple regression results showed that loneliness positively predicted psychological distress in the total sample. Loneliness did not predict psychological distress of male caregivers, but it positively predicted psychological distress of female caregivers. In order to promote orthopaedic patients caregivers’ mental health, gender-based differentials in the link between loneliness and psychological distress should be addressed by researchers and healthcare practitioners.
... Loneliness is the absence of imperative social relations or lack of affection in current relationships (Rubin, 1982). It has contributed to adverse mental health in other contexts such as combat trauma (Stein & Tuval-Mashiach, 2014), depression in people living with HIV (Mishra, Behera, & Jena, 2013), and geriatric mental health (Park, Jang, Lee, Haley, & Chiriboga, 2013;Solomon, Bensimon, Greene, Horesh, & Ein-Dor, 2013). However, little is known about the mental health implications of loneliness in orthopaedic patients' caregivers. ...
Although research evidence indicates that loneliness is detrimental to mental health in diverse populations, impact of loneliness on psychological distress of orthopaedic patients’ caregivers has been given little research attention. The present study examined the association of loneliness with psychological health, and explored gender differences in the loneliness and psychological health association among orthopaedic patients’ caregivers. Participants were 250 patients’ caregivers drawn from a national orthopaedic hospital in eastern Nigeria. Data was collected by means of self-report measures translated into the local dialect of the caregivers. Multiple regression results showed that loneliness positively predicted psychological distress in the total sample. Loneliness did not predict psychological distress of male caregivers, but it positively predicted psychological distress of female caregivers. In order to promote orthopaedic patients caregivers’ mental health, gender-based differentials in the link between loneliness and psychological distress should be addressed by researchers and healthcare practitioners.
... In a study by SK Mishra et al., in 380 HIV (Human immunodeficiency virus) patients of Andhra Pradesh (India) found that 66.57% of patients were found to be lonely and loneliness was associated with depression (71.84%) in them. He also concluded that in physical illnesses like HIV infection, the mental health indicators like loneliness and depression needs more stress in the continuum of care of patients [33]. ...
Human beings are social species which require safe and secure social surroundings to survive. Satisfying social relationships are essential
for mental and physical well beings. Impaired social relationship can lead to loneliness. Since the time of dawn, loneliness is perceived
as a global human phenomenon. Loneliness can lead to various psychiatric disorders like depression, alcohol abuse, child abuse, sleep
problems, personality disorders and Alzheimer’s disease. It also leads to various physical disorders like diabetes, autoimmune disorders
like rheumatoid arthritis, lupus and cardiovascular diseases like coronary heart disease, hypertension (HTN), obesity, physiological
aging, cancer, poor hearing and poor health. Left untended, loneliness can have serious consequences for mental and physical health
of people. Therefore it is important to intervene at the right time to prevent loneliness, so that physical and mental health of patients is
maintained.
The problem of Child Labour continues to pose a challenge
before the nation. Government has been taking various pro-active
measures to tackle this problem. However, considering the magnitude
and extent of the problem and that it is essentially a socio-economic
problem inextricably linked to poverty and illiteracy, it requires
concerted efforts from all sections of the society to make a dent in the
problem. In this regard, the aim of this article “Child Labour in India:
A study on Zone-I, Visakhapatnam” is to explain about the status of Child Labour in Zone-I, Visakhapatnam and suggest some necessary
measures to eradicate the child Labour.
The point prevalence of depressive disorders in the elderly population in India varies from 13 to 25%. Since the World Health Organization (five) Well-being Index (1998 version) is simple and easy to administer, an attempt is made to evaluate the Indian version of this instrument to identify depression in the elderly Indian community.
(1) To determine the prevalence of depression among the elderly population of rural areas of Udupi district, Karnataka, India. (2) To determine the validity and reliability of WHO (five) Well-being Index (1998 version) as a screening instrument to identify depressive disorders in elderly population in this Indian setting.
This cross-sectional study was conducted over a period of eight months (from March 1 to October 31, 2002) in the three taluks of Udupi, Kundapura, and Karkala; belonging to the Udupi district of South India. We selected 627 people in the age group of 60 years and above for the study. Simple random sampling, without replacement method, using the probability proportionate to size (PPS) technique was used. The WHO (five) well-being index (1998 version) was validated against the major International Classification of Diseases and Related Health Problems 10th Revision (ICD-10) depression inventory of mastering depression in primary care version 2.2. Proportions and their 95% confidence intervals were calculated and Kappa statistics was applied to determine the reliability of the screening instrument. P value<0.05 was considered statistically significant.
The prevalence of depression in elderly population was determined to be 21.7% (95% CI = 18.4 - 24.9). The Indian version of WHO-five well-being index (1998 version) showed a sensitivity of 97.0%, specificity of 86.4%, positive predictive value of 66.3% and an overall accuracy of 0.89. The Kappa statistics showed significantly high reliability of k = 0.71.
The Indian version of "WHO (five) Well-being Index (1998 version)" was found to be an effective instrument for identifying depression in elderly Indian community.
The aims of this study were to identify the psychosocial and health care needs of persons living with HIV/AIDS and to determine their coping strategies. The study was conducted in 3 governorates of Egypt on 153 people infected with HIV. The data were collected using a structured questionnaire and in-depth interviews. The majority of the people had been forced to change the pattern of their sexual behaviour. Fear of stigmatization and feelings of anxiety, hopelessness and depression were frequently reported, resulting in a negative psychosocial impact on the infected person. Decreasing stigma and providing psycho-social support would help people living with HIV/AIDS to utilize effective ways of coping with the negative sequelae of the infection.
A cross-sectional study was conducted on HIV-infected adults being treated with antiretroviral drugs at a reference service in Southern Brazil. Participants answered a sociodemographic questionnaire and were tested by scales assessing sociocognitive variables. Adherence to treatment was assessed by a self-report inventory developed for the study. Clinical information was obtained from the patients' records. Significance tests were conducted using univariate logistic regressions followed by multivariate logistic regression analysis. A total of 195 patients participated in the study and 56.9% of them reported > or = 95% adherence on the previous two days. In univariate analysis, the odds of adherence increased with self-efficacy (a person's conviction that he/she can successfully execute the behavior required to produce a certain desired outcome) in taking medications as prescribed (OR = 3.50, 95% CI 1.90-6.55), and decreased with perception of negative affect and physical concerns (OR = 0.71, 95% CI 0.53-0.95). The odds were lower for taking antiretroviral medications >4 times a day (OR = 0.44, 95% CI 0.20-0.94) and higher for patients with 8 years of schooling (OR = 2.28, 95% CI 1.12-4.66). In the multivariate analysis, self-efficacy (OR = 3.33, 95% CI 1.69-6.56) and taking medication >4 times a day (OR = 0.34, 95% CI 0.14-0.80) were independently associated with adherence. Self-efficacy was the most important predictor of adherence, followed by number of times antiretroviral medication was taken per day. Among sociodemographic and clinical variables, only the number of years of schooling was associated with adherence. Motivational interventions based on self-efficacy may be useful for increasing treatment adherence.
The authors examined factors associated with four dimensions of functional quality of life (physical functioning, energy/fatigue, social functioning, and role functioning) in 142 men and women living with HIV/AIDS. Participants completed the Brief COPE inventory and the Medical Outcomes Study Health Survey, with HIV-relevant items added. Greater use of maladaptive coping strategies was associated with lower levels of energy and social functioning. Pain severe enough to interfere with daily living tasks was associated with a lower level of functional quality of life on all four quality of life dimensions. Interventions aimed at developing adaptive coping strategies and improving pain management may improve functional aspects of quality of life in persons living with HIV/AIDS.
A cross-sectional study was performed among seropositive individuals who sought HIV treatment at an outpatient clinic in San Jose, Costa Rica, to determine the prevalence, predictors, and reasons for nonadherence to antiretroviral. A structured, face-to-face interview was administered to 88 patients. The primary outcome of adherence was measured as taking 100% of medications within 3 days prior to interview. A number of risk factors, including demographic information, HIV knowledge, logistics of the regimen, and management skills were assessed. Statistical analyses included logistic regression. Eighty-five percent of patients took 100% of their medications in the last 3 days. Factors that were correlated with nonadherence included difficulty in finding transportation to the clinic (odds ratio [OR] = 6.3, p = 0.01), not laying pills out as a management skill (OR = 9.9, p = 0.01), and prescription instructions to take medication on an empty stomach (OR = 6.7, p = 0.03). HIV-positive patients in this Costa Rican sample were fairly adherent to their drug regimens. To increase adherence among non-adherent individuals, interventions that increase access in remote areas and help people manage their regimens may be beneficial.
Our objective was to determine the level of adherence and reasons for non-adherence to antiretroviral therapy (ART) among HIV-positive (HIV+) people on ART in a resource-limited setting. Patients receiving ART were recruited into the cross-sectional study from three treatment centres in Kampala, Uganda. The number of missed doses over the last three days was assessed by structured patient interviews and dichotomized at +/-95% adherence. Reasons for non-adherence were assessed with both structured patient interviews and unstructured qualitative interviews. Independent predictors of non-adherence were assessed with multivariate logistic regression. In all, 304 HIV-infected persons on ART were enrolled into the study. Factors associated with non-adherence were marital status (odds ratio (OR) = 2.93, 95% confidence interval (CI) 1.32-6.50) and low monthly income <50 US$ [OR = 2.77, 95% CI 1.64-4.67]. We concluded that levels of self-reported adherence in patients receiving ART in Kampala are comparable to levels in resource-rich settings with inability to purchase and secure a stable supply as a major barrier to adherence.
As new technologies extend the lives of people living with HIV/AIDS (PHA), the need increases for services that optimize their quality-of-life cost effectively. This study of PHAs (n = 297) in Ontario, Canada, examined the prevalence of depression, and its association with quality-of-life, coping strategies, social support, and use of health and social services. Results showed that depression was widespread (54.2%) and largely unrelated to demographic characteristics, but associated with diminished health status, health-related quality-of-life, and coping strategies. Depressed PHAs used significantly more crisis health care and related services, and community-based HIV/AIDS service organizations (ASOs). Findings suggest quality-of-life of PHAs may be improved by expanding the capacity of ASO workers to recognize and address depression, including helping depressed PHA access appropriate medication and sustain medication regimes.
Racial/ethnic minorities in the United States are disproportionately affected by HIV/AIDS. In addition to having higher rates of HIV/AIDS, minorities with HIV/AIDS have higher mortality rates than others in the United States. Disparities in the care received by minorities living with HIV/AIDS contribute to these higher mortality rates. This article provides a review of HIV/AIDS health care disparities and explores providers' contributions to these disparities. An important source of provider contribution to disparities appears to be differential prescribing based on perceptions and assumptions that minority patients may have lower adherence to highly active antiretroviral therapy. Literature regarding this topic is reviewed and strategies for reducing disparities are suggested.
This article estimates the point prevalence of psychiatric disorders in a sample of HIV-positive subjects in Nigeria in comparison with normal HIV-negative controls and evaluates the possible sociodemographic and clinical correlates of psychiatric disorders in HIV-positive subjects.
HIV-positive subjects (n=88) and HIV-negative healthy controls (n=87) were assessed for their current diagnosis of DSM-IV psychiatric disorders via the Mini International Neuropsychiatric Interview. Sociodemographic and clinical details were also obtained.
The rate of psychiatric disorders in subjects with HIV was 59.1% compared to 19.5% in subjects without HIV infection [odds ratio (OR)=5.95, 95% confidence interval (CI)=3.02-11.75]. The subjects with HIV had significantly higher rates of affective disorders (OR=3.58, 95% CI=1.44-8.94), anxiety disorders (OR=3.57, 95% CI=1.65-7.72), and psychotic disorders (OR=1.10, 95% CI=1.01-1.12) than healthy controls. The factors significantly associated with psychiatric disorders include poor level of social support and stage of the disease.
Psychiatric disorders are common in our Nigerian subjects with HIV, and the rates are significantly higher when compared to the healthy general population. Proactive identification and treatment of mental disorders should be integrated into HIV intervention policies in this region.