The mediating effects of functions of social support on HIV-related trauma and health-related quality of life for PLHIV in China

Loneliness as a mediation from social support leading to a decrease of health-related quality of life among PLWHIV

This study focused on the mental health of people living with HIV(PLWHIV) and explored their relationship between loneliness and perceived social support, health related quality of life (HRQoL) with a method of structural equation model. We collected clinical and psychological data from consecutively enrolled PLWHIV. A total of 201 PLWHIVs were enrolled and measured with self-reporting survey instruments of UCLA Loneliness Scale, Self-Rating Depression Scale, Self-Rating Anxiety Scale, Social Support Ratio Scale and Short Form Health Survey-36. The levels of loneliness, depression, anxiety, perceived social support and HRQoL were assessed. PLWHIV enrolled were divided into two groups of loneliness and non-loneliness based on their UCLA Loneliness Scale scores. Multivariable analysis indicated that being married is a protective factor associated with loneliness (OR = 0.226; P = 0.032). We further found the loneliness group had a higher level of depression (P < 0.001) and anxiety (P < 0.001), but lower level of HRQoL (P < 0.001) than the non-loneliness group. We found there was a positive linear correlation between social support and HRQoL among the enrolled PLWHIVs (r2 = 0.0592; P = 0.0005). A structural equation model (SEM) was established to evaluate whether the loneliness played as a mediation role between social support and HRQoL. The model showed loneliness as a mediation from social support leading to a decrease of HRQoL. Our findings showed a potential psychological pathway from social support to HRQoL, suggesting the need for interventions focusing on social support may improve poor HRQoL lead by loneliness.

Mediating role of social capital on the association between negative life events and quality of life among adults in China: A population-based study

Objective

To evaluate whether social capital played a mediating role in the relationship between negative life events (NLE) and quality of life (QoL) among adults in China after proposed a conceptual model based on stress buffering theory.

Methods

A cross-sectional study was conducted based on baseline survey from the Chinese Multi-ethnic Cohort (CMEC) in Yunnan province. A total of 22,866 adults were recruited by multistage stratified cluster sampling. A structured questionnaire was used to collect the general demographic characteristics and the occurrence of NLE. A self-developed brief social capital scale was utilized to assess the social capital and the EQ-5D-5L scale was used to measure the QoL. The relationships among NLE, social capital and QoL were analyzed using multiple linear regression analyses. Structural equation models were used to evaluate whether social capital had a mediating effect on the relationship between NLE and QoL. The standardize coefficient (β) and it's 95% confidence intervals (CI) were calculated in this process.

Results

The mean age of participants was 52.70 years old. The mean of EQ-5D index value was 0.92 (SD = 0.12) and the mean of EQ-VAS score was 71.77 (SD = 13.80). NLE not only directly affected EQ-5D index value [β = -0.127, 95% CI (-0.144, -0.110)] but also indirectly negatively affected EQ-5D index value through social capital [β = -0.019, 95% CI (-0.023, -0.015)]. Social capital had a direct positive effect on EQ-5D index value [β = 0.114, 95% CI (0.097, 0.133)]. A similar pattern was identified for the association between NLE and EQ-VAS score. The direct effect of NLE on EQ-VAS score was negatively significant [β = -0.132, 95% CI (-0.146, -0.118)]. Moreover, the indirect effect through social capital was also negatively significant [β = -0.022, 95% CI (-0.026, -0.019)]. There was a positive direct effect of social capital on EQ-VAS score [β = 0.135, 95% CI (0.117, 0.151)].

Conclusion

Social capital played an important mediating role in the relationship between NLE and QoL, and it alleviated the negative effects of NLE on the QoL of the community residents in China. Providing reliable social capital for community residents experiencing NLE could effectively improve their quality of life.

"I just keep quiet about it and act as if everything is alright" - The cascade from trauma to disengagement among adolescents living with HIV in western Kenya

INTRODUCTION

There are approximately 1.7 million adolescents living with HIV (ALHIV, ages 10 to 19) globally, including 110,000 in Kenya. While ALHIV experience poor retention in care, limited data exist on factors underlying disengagement. We investigated the burden of trauma among disengaged ALHIV in western Kenya, and its potential role in HIV care disengagement.

METHODS

We performed in-depth qualitative interviews with ALHIV who had disengaged from care at two sites, their caregivers and healthcare workers (HCW) at 10 sites, from 2018 to 2020. Disengagement was defined as not attending clinic ≥60 days past a missed scheduled visit. ALHIV and their caregivers were traced through phone calls and home visits. Interviews ascertained barriers and facilitators to adolescent retention in HIV care. Dedicated questions elicited narratives surrounding traumatic experiences, and the ways in which these did or did not impact retention in care. Through thematic analysis, a conceptual model emerged for a cascade from adolescent experience of trauma to disengagement from HIV care.

RESULTS

Interviews were conducted with 42 disengaged ALHIV, 34 caregivers and 28 HCW. ALHIV experienced a high burden of trauma from a range of stressors, including experiences at HIV disclosure or diagnosis, the loss of parents, enacted stigma and physical or sexual violence. A confluence of factors - trauma, stigma and isolation, and lack of social support - led to hopelessness and depression. These factors compounded each other, and resulted in complex mental health burdens, poor antiretroviral adherence and care disengagement. HCW approaches aligned with the factors in this model, suggesting that these areas represent targets for intervention and provision of trauma-informed care.

CONCLUSIONS

Trauma is a major factor underlying disengagement from HIV care among Kenyan adolescents. We describe a cascade of factors representing areas for intervention to support mental health and retention in HIV care. These include not only the provision of mental healthcare, but also preventing or addressing violence, trauma and stigma, and reinforcing social and familial support surrounding vulnerable adolescents. In this conceptualization, supporting retention in HIV care requires a trauma-informed approach, both in the individualized care of ALHIV and in the development of strategies and policies to support adolescent health outcomes.

Support Network Factors Associated With Naming a Health Care Decision-Maker and Talking About Advance Care Planning Among People Living With HIV

CONTEXT

Little attention has been given to social environmental factors associated with advance care planning (ACP) among African Americans or people living with advanced HIV (PLHIV).

OBJECTIVES

The present study aimed to identify support network factors that affect the likelihood of naming a decision-maker and of talking to family/friends and doctors about ACP among vulnerable PLHIV.

METHODS

PLHIV were recruited from a large urban HIV clinic. A social support network inventory was used to calculate number of persons available for various types of support. Characteristics of network members were also collected. Multivariable logistic regression models were fit to examine associations between social network factors and ACP discussion, adjusting for age, sex, education, and total number of network members.

RESULTS

The sample (N = 370) was mostly African American (95%), male (56%), and 48% had less than a high school education. Almost half the sample (48%) had talked to their family/friends or doctor about ACP, and 34% had named a medical decision-maker. Adjusted analysis revealed that talking about ACP with family/friends was associated with female sex and a larger closer support network who provided health information and physical assistance. Talking to doctors about ACP was associated with larger support networks who provided physical assistance but lower numbers from whom emotional support was received. Naming a decision-maker was associated with greater numbers of network members who provided emotional support, health information, and medication adherence reminders.

CONCLUSION

The findings revealed aspects of family/support network structures and caregiving function associated with ACP in a population with often vital yet vulnerable networks.