Association of depression with social support and self-esteem among HIV positives

Exploring self-esteem during expressive writing about trauma predicts decreased depression in people with HIV

Self-esteem is often negatively impacted by trauma. Low self-esteem has been related to significantly worse depression in people with HIV (PWH). This study explores whether the expression of words related to self-esteem during a 4-session augmented trauma writing intervention predicted post-traumatic stress, depressive symptoms, and health outcomes 6-months later. Ninety-five PWH completed four 30-minute augmented trauma writing sessions in the intervention arm of a randomized controlled trial. One augmented session was devoted to self-esteem. Two individuals coded trauma essays for number of self-esteem words. CD4+ and viral load data were collected, and the Davidson PTSD Scale and the Hamilton Depression Rating Scale were administered at baseline, one-, and six-month follow-up. Greater total self-esteem words were related to lower depressive symptoms at 6-months, controlling for depressive symptoms at study entry, age, race, and education (t(80) = -2.235, ß = -0.239, SE = 0.283, p < 0.05, 95% CI [-1.195, -.069). Total self-esteem words were not predictive of PTSD, viral load, or CD4+ at 6-months. Exploring self-esteem when writing about and processing a traumatic event could be an important mechanism for decreasing depressive symptoms among PWH. Research is needed to test augmented expressive writing interventions that support efforts to bolster self-esteem in PWH.

Effect of psychotherapy for adult depression on self-esteem: A systematic review and meta-analysis

BACKGROUND

There is emerging evidence to suggest that Cognitive Behavioral Therapy for depression may have a secondary effect on self-esteem, but less is known about non-CBT based interventions. To examine this, we had two main aims; (1) to meta-analyze psychotherapy effects on (i) depression and (ii) self-esteem, and (2) to investigate the relationship between reductions in depression symptoms and improvements in self-esteem.

DESIGN

A systematic review and meta-analysis.

METHODS

Following the PRISMA guidelines, we conducted a meta-analysis of randomized control trials of psychotherapy for adult depression, which included a self-esteem outcome at post-treatment. Nineteen studies with a total of 3423 participants met the inclusion criteria. For each comparison between psychotherapy and a control condition, we calculated Hedges' g both for depression and self-esteem and pooled them in two separate meta-analyses. Furthermore, meta-regression was used to explore the association between the effect of psychotherapy for depression and its effect on self-esteem.

RESULTS

The effects on depression were large and significant (Hedges' g = -0.95; [95 % CI: -1.27, -0.63]). We found evidence of smaller, albeit still moderate, effects on self-esteem (Hedges'g = 0.63; [95 % CI:0.32, 0.93]), with sustained effects at 6-12 months (Hedges'g = 0.70; [95 % CI: -0.03, 1.43]). We also found a strong inverse association between the effects of psychotherapy for depression and self-esteem (β = -0.60, p < 0.001).

LIMITATIONS

Heterogeneity was very high (I² = 97 %), and out of 19 trials, only 6 trials were rated as having a low risk of bias.

CONCLUSIONS

The results suggest that psychotherapy for depression may improve self-esteem to a moderate degree.

Quality of life and associated factors among people receiving second-line anti-retroviral therapy in Johannesburg, South Africa

Background

Studies which examine quality of life (QOL) provide important insights that are needed to understand the impacts of HIV/AIDS anti-retroviral treatment (ART), comorbid conditions and other factors on the daily activities of people living with HIV/AIDS (PLH). This study aimed to determine the inter-relationships between clinical factors, behavioural, socio-demographic variables and QOL among PLH.

Methods

The secondary analysis used data collected from 293 people living with HIV/AIDS (PLH) receiving second-line ART in Johannesburg in a clinical trial which evaluated the non-inferiority of ritonavir-boosted darunavir (DRV/r 400/100 mg) compared to ritonavir-boosted lopinavir (LPV/r) over a 48 week-period. Physical functioning, cognitive and mental QOL were measured using the Aids Clinical Trial Group questionnaire. Exploratory factor analyses were used to examine the structure, the relationships between and the construct validity of QOL items. Structural equation models which tested the a priori-hypothesised inter-relationships between QOL and other variables were estimated and goodness of fit of the models to the data was assessed.

Results

Patients on darunavir presented with lower pill burden. Older patients and women were more likely to report lower QOL scores. Pill burden mediated the effects of age, sex and treatment regimen on physical functioning QOL and adverse effects; the effects of age, sex, treatment regimen and adverse effects on cognitive QOL; and the effects of sex on mental QOL.

Conclusion

QOL among PLH is associated with socio-demographic and clinical factors. Therefore, QOL could be enhanced by considering PLH characteristics, clinical factors such as regimen side-effects profile, management of comorbid conditions and mitigating risks such as potential adverse drug-to-drug interactions among patients on ART.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12879-022-07429-9.

Health-related quality of life of people living with HIV infection in Spain: a gender perspective

Studies exploring gender differences in health-related quality of life (HRQOL) of people living with HIV/AIDS (PLWHA) are scarce and contradictory. This study evaluated gender differences in HRQOL of 744 PLWHA with median (IQR) age 44 (37-48) years and HIV infection diagnosed 12 (5-20) years earlier. Results showed important differences between genders (p < .05). Better male physical health was related to being employed, not having economic worries, not receiving psychological support, not having injected drugs in past, low negative mood HIV-related, low HIV illness representation and internalized stigma, and high body image satisfaction and health behavior. For women, variables were fewer years since HIV diagnosis and low enacted stigma-personal experience of rejection. Mentally, variables in men were being employed, not having injected drugs, having a stable partner, high health behavior, use of problem-solving coping, personal autonomy and personal meaning. In women, better mental health was related to high CD4 cells, self-esteem and body image satisfaction, and negative mood HIV-related. Men and women coincided in absence of past opportunistic infections being related to better physical and mental health, and absence of side effects for physical health and low HIV-related stress and HIV illness representation for mental health. Our results highlight the need for detailed study of gender differences that identify the bio-psycho-socio inequalities that affect HRQOL.

Identifying factors associated with depression among men living with HIV/AIDS and undergoing antiretroviral therapy: a cross-sectional study in Heilongjiang, China

BACKGROUND

Depression is common among people living with HIV/AIDS; however, studies focusing on the depression of men living with HIV/AIDS are limited. Therefore, we examined the prevalence of depression and its associated factors among men living with HIV/AIDS in China.

METHODS

A cross-sectional questionnaire survey was conducted in Harbin, China between March and August in 2013. Two-hundred twenty participants completed the Burns Depression Checklist, the Berger HIV Stigma, and the SPIEGEL questionnaire. We also investigated demographics, family support, hostility, and the antiretroviral therapy side effects of men living with HIV/AIDS.

RESULTS

More than 40% of respondents had depressive symptoms and worry about the health was the major symptom of depression (40.9%). The logistic regression model indicated that bad sleep quality (OR = 3.452), hostility (OR = 1.120), perceived discrimination (OR = 1.110), and antiretroviral therapy side effects (OR = 1.083) were positively associated with depression. Family support (OR = 0.860) was negatively associated with depression for men living with HIV/AIDS. Demographic variables, HIV infection route, disease duration, and CD4+ cell count had no significant associations with depression.

CONCLUSION

Although China's work of national HIV prevention and treatment has made much progress during the past several years, the prevalence of depression among men living with patients with HIV/AIDS is still prominent. The strongest factor associated with depression among men living with HIV/AIDS was sleep quality. Future studies should explore the effects of interventions for depression among PLWHA.

Loneliness among mothers raising children under the age of 3 years and predictors with special reference to the use of SNS: a community-based cross-sectional study

BACKGROUND

Loneliness in mothers raising children can adversely impact the health of their children and lead to child abuse, depression, and deterioration of mothers' health. Few studies to date have specifically assessed the association between loneliness and social factors, including the use of social network sites (SNSs), and personal factors. This study aimed to identify predictors of loneliness in mothers raising children, with special reference to SNS use.

METHODS

This cross-sectional study involved an anonymous self-reported questionnaire survey of mothers participating in the health check-ups for their children in Nagahama City, Japan, from July 28 to September 29, 2014. The following items were assessed: revised UCLA Loneliness Scale, "Secure" subscale of the Internal Working Model Scale (IWMS-S), psychological distress scale (K6), abbreviated Lubben Social Network Scale (LSNS-6), and types of communication devices and information sources. Multiple regression analysis was performed using the Loneliness Scale score as the dependent variable.

RESULTS

Among 763 mothers attending health check-ups for children in Nagahama City, 715 were available for the survey. Among a total of 638 respondents, data from 523 mothers were analyzed (valid response rate: 73.1%). The mean Loneliness Scale score ± standard deviation was 36.1 ± 9.7. The multiple regression analysis revealed that loneliness was significantly associated with being financially worse-off (β = - 3.35, p = 0.004) and struggling (β = - 2.47, p = 0.047); having a smaller family social network (β = - 0.32, p = 0.032), having fewer friends (β = - 0.49, p = 0.001), and having a smaller SNS network (β = - 0.21, p = 0.018); a lower secure subscale score on the IWMS-S (β = - 0.56, p < 0.001); and a K6 score of ≥5 (β = 4.24, p < 0.001).

CONCLUSION

The degree of loneliness in mothers raising children was associated with a smaller social network, lower secure attachment style, and a higher possibility of psychological distress. These factors should be considered when developing effective interventions against loneliness in mothers raising children.

A study on prevalence and correlates of depression among women living with human immunodeficiency virus/acquired immune deficiency syndrome in North Karnataka

CONTEXT

Depression is the most prevalent psychiatric condition seen in human immunodeficiency virus (HIV)-positive individuals. Various biological, sociocultural, and economic factors make women more vulnerable to HIV and acquired immune deficiency syndrome (AIDS). Depression affects medication adherence and immunity against HIV thus contribute significantly to disease progression.

AIMS

The aim is to assess the prevalence, sociodemographic, and clinical correlates of depression among women living with HIV/AIDS.

SETTINGS AND DESIGN

Antiretroviral therapy (ART) centre attached to government medical college hospital in North Karnataka and cross-sectional design.

MATERIALS AND METHODS

This study was conducted among of 145 women living with HIV/AIDS, depression was assessed using Beck Depression Inventory, and social support was assessed using Lubben Social Network Scale and quality of life (QoL) using the World Health Organization QoL BREF scale.

STATISTICAL ANALYSIS USED

Data were analyzed using Statistical Package for the Social Sciences version 20.0. Chi-square test with P value less than 0.05 was taken as statistically significant.

RESULTS

Among 145 HIV-positive women, 50 (34.5%) were depressed. Depression was statistically significant in women from rural background. Significant association between depression and risk of social isolation was observed. Scores of all domains of QoL, that is, physical, psychological, social, and environmental were reducing with increase in the severity of depression indicating that QoL was decreasing with increase in severity of depression. Among the four domains, social domain was the most affected.

CONCLUSIONS

Depression among women living with HIV/AIDS which is underdiagnosed and undertreated. Depression negatively impacts adherence and immunity leading rapid progression of the infection. Therefore, early diagnosis and treatment of depression are essential.

Women living with AIDS in rural Southern India: Perspectives on mental health and lay health care worker support

In this study, focus groups were conducted with 16 rural Women Living with AIDS (WLA) from Andhra Pradesh, India who had previously participated in a clinical trial wherein 68 WLA were randomized into either an Accredited Social Health Activists (ASHA) - Life (AL) intervention or a Usual Care program. Findings are discussed in terms of: a) mental health issues, b) perceived stressors, c) individual resources for coping with mental health issues, and d) role of Asha support in coping with mental health issues. These findings highlight the salience of mental health issues in the lives of WLA and the role played by Asha in addressing some of these issues. The discussion section makes a case for increased emphasis on mental health care in future community-based interventions for this population.

Poverty indicators and mental health functioning among adults living with HIV in Delhi, India

Poor mental health functioning among persons living with HIV (PLHIV) has gained considerable attention particularly in low-income countries that disproportionately carry the global HIV/AIDS burden. Fewer studies, however, have examined the relationship between poverty indicators and mental health among PHLIV in India. Based on this cross-sectional study of 196 HIV-seropositive adults who received medical services at Shalom AIDS Project in Delhi, India, structural equation modeling and mediation analysis were employed to estimate the associations between poverty indices (household asset index, food security, unemployment, water treatment, sanitation), HIV-health factors (illness in the past 3 months, co-morbid medical conditions), and psychological distress. In the final model, ownership of fewer household assets was associated with higher levels of food insecurity, which in turn was associated with higher psychological distress. Also, the household asset index, food insecurity, and unemployment had a larger effect on psychological distress than new opportunistic infections. These findings build on increasing evidence that support concerted efforts to design, evaluate, and refine HIV mental health interventions that are mainstreamed with livelihood programming in high poverty regions in India.

Psychiatric disorders and adherence to antiretroviral therapy among a population of HIV-infected adults in Nigeria

Psychiatric disorders are common among people living with HIV in Nigeria. Adherence is necessary to optimise the outcome of antiretroviral therapy. In this study, we aimed to identify associations between antiretroviral adherence, measured by one-week and one-month self-reported missed doses, and psychiatric illness in a cohort previously assessed for psychiatric disorders using the Composite International Diagnostic Interview. The study participants comprised 151 adults with major depression, anxiety or suicidal symptoms, and 302 matched-control participants. Two controls were randomly selected for each case within the same gender and education level. We compared participants with psychiatric disorders (WPDs) and no psychiatric disorders (NPDs) on selected demographic and clinical variables, in addition to adherence. Participants with one or more missed doses in the preceding month had twice the odds of having a major depressive episode as those with no missed doses during this period (OR 2.22, 95% CI 1.03, 4.79). This association remained significant after adjusting for selected risk factors. There was no statistically significant difference between WPD and NPD groups on either one-week or one-month adherence, or on age, marital status, occupational class, HIV viral load at enrolment or current CD4 cell count. Among Nigerian adults with HIV, suboptimal antiretroviral adherence is associated with, and could be a sign of, depression. Routine self-report adherence assessments may potentially be utilised in identifying individuals at risk among this population.

Factors Influencing Quality of Life among People Living with HIV in Coastal South India

BACKGROUND

Antiretroviral therapy (ART) has increased life expectancy of HIV/AIDS patients, but the quality of life (QOL) still remains the same.

METHODS

In this cross-sectional study, 356 people living with HIV (PLHIV) were interviewed to assess their QOL using WHOQOL-HIV BREF questionnaire. The association between QOL with sociodemographic, clinical and cohabitation status of the participants was tested using ANOVA and Student t-test, and p value < .05 was considered statistically significant.

RESULTS

Physical domain of QOL showed maximum score of 16.4, while a minimum score of 12.2 was seen in social relationship domain. Participants with higher socioeconomic status (SES) and self-motivated to take ART had shown better scores across all the domains of QOL ( p < .05).

CONCLUSION

In our study, quality of life was high among males, younger patients, married participants, higher socioeconomic status, longer duration of ART, self-motivation to take ART, absence of opportunistic infection, and with higher CD₄ count.

Relationship between trusting behaviors and psychometrics associated with social network and depression among young generation: a pilot study

Maladaptive social interaction and its related psychopathology have been highlighted in psychiatry especially among younger generations. In Japan, novel expressive forms of psychiatric phenomena such as "modern-type depression" and "hikikomori" (a syndrome of severe social withdrawal lasting for at least six months) have been reported especially among young people. Economic games such as the trust game have been utilized to evaluate real-world interpersonal relationships as a novel candidate for psychiatric evaluations. To investigate the relationship between trusting behaviors and various psychometric scales, we conducted a trust game experiment with eighty-one Japanese university students as a pilot study. Participants made a risky financial decision about whether to trust each of 40 photographed partners. Participants then answered a set of questionnaires with seven scales including the Lubben Social Network Scale (LSNS)-6 and the Patient Health Questionnaire (PHQ)-9. Consistent with previous research, male participants trusted partners more than female participants. Regression analysis revealed that LSNS-family (perceived support from family) for male participants, and item 8 of PHQ-9 (subjective agitation and/or retardation) for female participants were associated with participants' trusting behaviors. Consistent with claims by social scientists, our data suggest that, for males, support from family was negatively associated with cooperative behavior toward non-family members. Females with higher subjective agitation (and/or retardation) gave less money toward males and high attractive females, but not toward low attractive females in interpersonal relationships. We believe that our data indicate the possible impact of economic games in psychiatric research and clinical practice, and validation in clinical samples including modern-type depression and hikikomori should be investigated.

Actor and partner effects of perceived HIV stigma on social network components among people living with HIV/AIDS and their caregivers

BACKGROUND

Few studies have investigated the relationship between HIV stigma and social network components at the dyadic level. The objective of this study was to examine the actor and partner effects of perceived HIV stigma by people living with HIV/AIDS (PLWHAs) and their caregivers on social network variables at the dyadic level.

METHOD

An egocentric social network study was conducted among 147 dyads consisting of one PLWHA and one caregiver (294 participants) in Nanning, China. The actor-partner interdependence model (APIM) was used to analyze the relationships between perceived HIV stigma and social network components (network relations, network structures, and network functions) at the dyadic level.

RESULTS

We found in this dyadic analysis that: (1) social network components were similar between PLWHAs and their caregivers; (2) HIV stigma perceived by PLWHAs influenced their own social network components, whereas this influence did not exist between caregivers' perceived HIV stigma and their own social network components; (3) a few significant partner effects were observed between HIV stigma and social network components among both PLWHAs and caregivers.

CONCLUSION

The interrelationships between HIV stigma and social network components were complex at the dyadic level. Future interventions programs targeting HIV stigma should focus on the interpersonal relationship at the dyadic level, beyond the intrapersonal factors.

Cognitive functioning, depression, and HIV medication adherence in India: a randomized pilot trial

Objective: India is home to the third-largest number of people living with HIV in the world, and no-cost antiretroviral therapy (ART) has been available across the country since 2004. However, rates of adherence to ART are often subpar in India, and interventions to increase adherence are warranted. Cognitive impairment and depression have been associated with ART non-adherence, and may also limit the impact of behavioral interventions designed to improve adherence. Studies have not evaluated the impact of cognitive impairment and depression on response to adherence interventions in India. Methods: Individuals new to ART (≤12 months prescribed) were recruited from a public hospital in Chandigarh, India. Participants (N = 80) were randomized to either a group medication adherence intervention (MAI) or an enhanced standard of care (ESOC) condition. The MAI consisted of three monthly gender-concordant group cognitive-behavioral sessions addressing HIV and ART, adherence, and HIV-related coping and social support. Participants were assessed at baseline for depression and cognitive functioning, and assessed monthly for adherence by pill count. Results: Adherence among participants receiving the MAI improved by about one day's dose over the course of the study, and no improvement was noted among those in the ESOC. Additionally, high rates of cognitive impairment (57%) and depression (25%) were identified among participants. There was no evidence that cognitive impairment moderated response to the intervention. However, while non-depressed participants benefitted from the intervention, depressed participants failed to show the same improvement. Conclusions: Results of this pilot study suggest that group behavioral interventions can be an effective strategy to promote ART adherence in this population, even among those demonstrating cognitive impairment. However, because of the negative impact of depression on adherence, future studies should continue to develop strategies to identify and treat it among people living with HIV in India.