Prevalence of mental health conditions among people living with HIV during the COVID-19 pandemic: A rapid systematic review and meta-analysis

Daily stigma and daily emotional well-being among people living with HIV: Testing a buffering hypothesis of social support during the COVID-19 pandemic

This study examined the relationship between daily perceived stigma and daily emotional well-being among people living with HIV/AIDS during the COVID-19 pandemic. Additionally, a buffering effect of perceived emotional support on this relationship was verified. The participants were 133 patients with a medically confirmed diagnosis of HIV infection. Data were collected using online diaries completed every evening for five consecutive weekdays in three bursts separated by 6 months. Dynamic multilevel analyses showed a significant positive autoregressive effect for daily stigma in each burst. Additionally, increased stigma predicts increased negative affect and decreased positive affect the next day. However, these effects differed across bursts. Thus, to some extent, daily HIV/AIDS stigma was found to predict a decrease in affective well-being the next day. The buffering effect of perceived emotional support reduced this decline but was also time-limited, probably because of the later established direction in these relationships at the individual level and/or because of changes in the course of the pandemic. The results provide insights on the role of daily stigma in shaping affective well-being, suggesting that it may be a significant source of short-term negative emotional consequences for PWLH.

Prevalence and Correlates of Physical Inactivity Among Individuals with HIV During the First COVID-19 Wave: A Cross-sectional Survey

Physical activity is associated with improved health outcomes among people with HIV (PWH). In the recent pandemic context, policies designed to mitigate COVID-19 transmission may result in an increase in sedentary lifestyle and decreased physical activity. In this study, we aimed to characterize self-reported physical activity and factors associated with physical inactivity during the first wave of the COVID-19 pandemic among a sample of PWH engaged in care. We also described whether psychological coping strategies measured by the Brief COPE differed based on physical activity levels. Among 260 surveyed PWH in two HIV clinics in the US Northeast, 28.5% (n = 74) met the criteria for being physically active according to the Centers for Disease Control and Prevention (CDC)'s physical activity guidelines. Receiving care in New Haven, CT, presence of a detectable HIV viral load, every day tobacco use, and unhealthy alcohol use were associated with physical inactivity. Problem-focused coping, emotion-focused coping, and avoidance-focused coping strategies were found to be protective against physical inactivity. In adjusted analysis, only problem-focused coping continued to be significantly associated with lower odds of reporting physical inactivity. Efforts are urgently needed to promote physical activity among PWH, including among those without problem-focused coping strategies.

COVID-19 pandemic stressors, familial discord, and anxiety among adolescents living with HIV in South Africa: pathways to non-adherence

Adolescents living with HIV (ALHIV) have poorer adherence to antiretroviral treatment (ART). This study investigates the interconnectivity of stressors induced by the COVID-19 pandemic, anxiety and family dynamics on adolescents' adherence to ART. A telephone survey was conducted among 196 South African ALHIV previously enrolled in support groups. Generalized structural equations modeling was used to understand how pandemic-related stressors affected ART adherence. Respondents reported experiencing life stressors since the implementation of COVID-19 restrictions, including doing worse at school (32%), loss of household income (44%) and less food available (38%). Forty-two percent reported greater verbal aggression from adults at home and 60% experienced anxiety. The structural equations model demonstrated a direct path from experiencing life stressors to increased verbal aggression from caregivers, which led to anxiety and ultimately, poorer ART adherence. Each stressor experienced increased the odds of experiencing verbal aggression by 51% (OR=1.51, 95%CI=1.14-2.00) which, in turn, increased the odds of having anxiety four-fold (OR=4.1, 95%C =2.16-7.76). Anxiety was associated with a 74% reduction in the odds of being fully ART adherent (OR=0.26, 95%CI=0.08-0.81). COVID-19-induced stressors exacerbated the mental and physical vulnerability of ALHIV. Findings elucidate how both discord at home and anxiety can result in poorer ART adherence.

Bridging internalized HIV stigma and depressive symptoms among people living with HIV in China during the COVID-19 pandemic: a network analysis

Previous research has documented that HIV-related stigma may be a significant trigger of mental health problems among people living with HIV (PLWH). However, less is known about how internalized HIV stigma is linked to depressive symptoms among PLWH during the COVID-19 pandemic. The current study sought to explore the network structure of internalized HIV stigma and depressive symptoms, along with bridge nodes, to elucidate how they co-exist. Participants were 1,197 Chinese PLWH (64.3% male, Mage = 41.52, SD = 9.20) who completed the measurements of internalized HIV stigma and depressive symptoms during the early phase of the COVID-19 outbreak (May 2020). Results revealed that "ashamed of having HIV" was identified as the most central nodes in the internalized HIV stigma network, whereas "mind wandered during tasks" ranked highest on centrality in the depressive symptoms network. Two bridge connections were exhibited within the combined internalized HIV stigma and depressive symptoms network model: "inferiority due to HIV" and "gloomy feelings" from internalized HIV stigma and depressive symptoms communities, respectively. This study is one of the first to examine the co-occurrence of internalized HIV stigma and depressive symptoms in the context of the COVID-19 pandemic using a network approach. These findings have potential clinical implications for mitigating depressive symptoms in populations facing socioeconomic disadvantage and vulnerability.

HIV Testing Disruptions and Service Adaptations During the COVID-19 Pandemic: A Systematic Literature Review

Access to treatment and care in safe clinical settings improves people's lives with HIV. The COVID-19 pandemic disrupted vital HIV programs and services, increasing the risk of adverse health outcomes for people with HIV and HIV transmission rates in the community. This systematic literature review provides a meta-analysis of HIV testing disruptions and a synthesis of HIV/AIDS services adapted during COVID-19. We searched scholarly databases from 01 January 2020 to 30 June 2022 using key terms on HIV testing rates and services during the COVID-19 pandemic. The process of how the included articles were identified, selected, appraised, and synthesised was reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We included 17 articles that reported changes in HIV testing during the COVID-19 pandemic and 22 that reported adaptations in HIV/AIDS services. We found that HIV testing decreased by 37% during the search period because of the COVID-19 pandemic. Service providers adopted novel strategies to support remote service delivery by expanding community antiretroviral therapy dispensing, setting up primary care outreach points, and instituting multi-month dispensing services to sustain client care. Therefore, service providers and policymakers should explore alternative strategies to increase HIV testing rates impacted by COVID-19 and leverage funding to continue providing the identified adapted services.

Profiles of subjective well-being among people living with HIV during the COVID-19 pandemic

BACKGROUND

The aim of our study was to examine subjective well-being (SWB) profiles and their sociodemographic and clinical correlates among people living with HIV (PLWH) during the COVID-19 pandemic.

METHODS

The participants were 663 PLWH undergoing antiretroviral treatment. Their SWB was evaluated using the Satisfaction with Life Scale and the Positive and Negative Affect Schedule. Sociodemographic and clinical covariates, together with COVID-19 distress, were assessed with a self-report survey.

RESULTS

Latent profile analysis revealed four SWB profiles: average negative, average positive, flourishing and languishing. The languishing profile was the worse in terms of values of SWB components and had a relative overrepresentation of PLWH who were single, without a university degree, and not employed for money. The pandemic-related distress was positively related to being a member of average negative and languishing profiles. Gender and age had no significant effect on either profile membership or directly on the SWB components.

CONCLUSION

It seems that in the context of chronic illness and socially shared stressful circumstances, which was the COVID-19 pandemic, the components of SWB among PLWH developed rather congruent profiles. Sociodemographic, but not clinical characteristics were found to be significant correlates of belonging to obtained SWB profiles in this sample. The most striking effect with this regards was obtained for the members of the languishing profile, defined by the co-occurrence of low positive affect, low satisfaction with life, and high negative affect.

Using All of Us data to examine the mental health change during COVID-19 pandemic among people living with HIV: A longitudinal study protocol

INTRODUCTION

The COVID-19 pandemic has negatively affected people's mental health around the globe. Such effects may be especially compounded among some vulnerable populations such as people living with HIV (PLWH). However, large-scale data on mental health outcomes among PLWH are limited. Few studies have also identified potential protective factors for mental health outcomes.

METHODS AND ANALYSIS

Guided by theories of resilience and socioecology, we will leverage multiple datasets from National Institutes of Health's Cloud-based All of Us Programme including electronic health records (EHRs), a series of COVID-19 Participant Experience (COPE) Surveys conducted from May 2020 to February 2021, and other self-reported survey data to achieve two specific aims: (1) to examine the mental health outcome changes during COVID-19 pandemic among PLWH by employing both EHR data (2018-2022) and survey data (2020-2021) in the All of Us Programme; and (2) to identify potential protective factors based on COPE Survey data for mental health outcomes at multiple socioecological levels including individual level (eg, coping strategy), interpersonal level (eg, social support) and health institutional level (eg, health service accessibility), adjusting for pre-existing health conditions including psychiatric disorders and other relevant factors (eg, COVID-19 infection). Interaction terms will be included in the multivariable analysis to identify different socially disadvantaged or stigmatised subgroups.

ETHICS AND DISSEMINATION

The study has been approved by the institutional review board at the University of South Carolina (Pro00124044). Study findings will be disseminated through presentations at academic conferences and publications in peer-reviewed journals.

Depression during the COVID-19 pandemic among people living with HIV: Are low HIV/AIDS stigma and high perceived emotional support protective resources?

This study has two objectives: first, to examine changes in depressive symptoms among people living with HIV (PLWH) during the COVID-19 pandemic and, second, to verify the role of HIV/AIDS stigma and perceived emotional support (PES) in the heterogeneity of these changes. The participants were 392 people with a medical diagnosis of HIV who have undergone antiretroviral therapy. Depression was measured at three time points with 6-month intervals using the Centre for Epidemiological Studies Depression Scale (CES-D). PES was evaluated with the Berlin Social Support Scales, and HIV/AIDS-related stigma was assessed with the Berger HIV Stigma Scale. Latent growth class modelling identified four trajectories of depression over the study period: three stable (very high, high, and very low) and one increasing. Both the very high and high stable trajectories had baseline values above the CES-D cut-off point for depression, suggesting that 57.6% of the sample was likely to be diagnosed with depression. After controlling for sociodemographic and clinical variables, stigma and PES were found to be significant covariates of the obtained trajectories; however, they did not protect against an increase in depression symptoms. There was no overall increase in depression symptoms among the PLWH participants during the pandemic, but this change in depression symptoms was heterogeneous. We observed the potential development of depression in initially well-functioning individuals despite their personal resources differing only slightly from those who remained resilient.

HIV/AIDS stigma accumulation among people living with HIV: a role of general and relative minority status

The main objective of the study was to investigate the relationship between selected sociodemographic factors (i.e. sexual orientation, gender and AIDS status), and the level of HIV/AIDS stigma among people living with HIV (PLWH). The participants were 663 adults with a medically confirmed diagnosis of HIV infection, undergoing antiretroviral treatment. Their level of HIV/AIDS stigma was assessed with the Berger HIV Stigma Scale, and relevant sociodemographic and clinical data were obtained using a self-report survey. The main effect was revealed only for sexual orientation and total stigma; those with heterosexual orientation declared higher levels of total stigma than those with other sexual orientations. For the subscales, significant results were obtained only for disclosure concerns. Namely, for the interaction of gender and sexual orientation, the highest level of disclosure stigma was declared by heterosexual women, while there was no such relationship for men. This result was further modified when AIDS diagnosis was added to the interaction. There is a cumulative effect of PLWH minority statuses, rather than main effects of each status individually. Thus, each minority status should be analysed from at least two perspectives, general (i.e., compared to the general population) and relative (i.e., compared to the population in question).

Increased prevalence of depression and anxiety among adults initiating antiretroviral therapy during the COVID-19 pandemic in Shinyanga region, Tanzania

BACKGROUND

Concerns about the interconnected relationship between HIV and mental health were heightened during the COVID-19 pandemic. This study assessed whether there were temporal changes in the mental health status of people living with HIV presenting for care in Shinyanga region, Tanzania. Specifically, we compared the prevalence of depression and anxiety before and during COVID-19, with the goal of describing the changing needs, if any, to person-centered HIV services.

METHODS

We analyzed baseline data from two randomized controlled trials of adults initiating ART in Shinyanga region, Tanzania between April-December 2018 (pre-COVID-19 period, n = 530) and May 2021-March 2022 (COVID-19 period, n = 542), respectively. We compared three mental health indicators that were similarly measured in both surveys: loss of interest in things, hopelessness about the future, and uncontrolled worrying. We also examined depression and anxiety which were measured using the Hopkins Symptom Checklist-25 in the pre-COVID-19 period and the Patient Health Questionnaire-4 in the COVID-19 period, respectively, and classified as binary indicators per each scale's threshold. We estimated prevalence differences (PD) in adverse mental health status before and during the COVID-19 pandemic, using stabilized inverse probability of treatment weighting to adjust for underlying differences in the two study populations.

RESULTS

We found significant temporal increases in the prevalence of feeling 'a lot' and 'extreme' loss of interest in things ['a lot' PD: 38, CI 34,41; 'extreme' PD: 9, CI 8,12)], hopelessness about the future [' a lot' PD: 46, CI 43,49; 'extreme' PD: 4, CI 3,6], and uncontrolled worrying [' a lot' PD: 34, CI 31,37; 'extreme' PD: 2, CI 0,4] during the COVID-19 pandemic. We also found substantially higher prevalence of depression [PD: 38, CI 34,42] and anxiety [PD: 41, CI 37,45].

CONCLUSIONS

After applying a quasi-experimental weighting approach, the prevalence of depression and anxiety symptoms among those starting ART during COVID-19 was much higher than before the pandemic. Although depression and anxiety were measured using different, validated scales, the concurrent increases in similarly measured mental health indicators lends confidence to these findings and warrants further research to assess the possible influence of COVID-19 on mental health among adults living with HIV. Trial Registration NCT03351556, registered November 24, 2017; NCT04201353, registered December 17, 2019.

Mental health and substance use screening in HIV primary care before and during the early COVID-19 pandemic

BACKGROUND

Mental health and substance use disorders disproportionately affect people with HIV (PWH), and may have been exacerbated during COVID-19. The Promoting Access to Care Engagement (PACE) trial was designed to assess the effectiveness of electronic screening for mental health and substance use in HIV primary care and enrolled PWH from October 2018 to July 2020. Our objective here was to compare screening rates and results for PWH before (October 2018 - February 2020) and early in the COVID-19 pandemic (March-July 2020).

METHODS

Adult (≥ 18 years) PWH from 3 large HIV primary care clinics in a US-based integrated healthcare system were offered electronic screening online or via in-clinic tablet computer every 6 months. Screening completion and results (for depression, suicidal ideation, anxiety, and substance use) were analyzed using logistic regression with generalized estimating equations to estimate prevalence ratios (PR) before and after the start of the regional COVID-19 shelter-in-place orders on March 17, 2020. Models adjusted for demographics (age, sex, race/ethnicity), HIV risk factors (men who have sex with men, injection drug use, heterosexual, other), medical center, and modality of screening completion (online or tablet). We conducted qualitative interviews with providers participating in the intervention to evaluate how the pandemic impacted patient care.

RESULTS

Of 8,954 eligible visits, 3,904 completed screenings (420 during COVID, 3,484 pre-COVID), with lower overall completion rates during COVID (38% vs. 44%). Patients completing screening during COVID were more likely to be White (63% vs. 55%), male (94% vs. 90%), and MSM (80% vs., 75%). Adjusted PRs comparing COVID and pre-COVID (reference) were 0.70 (95% CI), 0.92 (95% CI), and 0.54 (95% CI) for tobacco use, any substance use, and suicidal ideation, respectively. No significant differences were found by era for depression, anxiety, alcohol, or cannabis use. These results were in contrast to provider-reported impressions of increases in substance use and mental health symptoms.

CONCLUSION

Findings suggest PWH had modest declines in screening rates early in the COVID-19 pandemic which may have been affected by the shift to telemedicine. There was no evidence that mental health problems and substance use increased for PWH in primary care.

TRIAL REGISTRATION

NCT03217058 (First registration date: 7/13/2017); https://clinicaltrials.gov/ct2/show/NCT03217058.

COVID-19 and common mental health symptoms in the early phase of the pandemic: An umbrella review of the evidence

BACKGROUND

There remains uncertainty about the impact of the Coronavirus Disease 2019 (COVID-19) pandemic on mental health. This umbrella review provides a comprehensive overview of the association between the pandemic and common mental disorders. We qualitatively summarized evidence from reviews with meta-analyses of individual study-data in the general population, healthcare workers, and specific at-risk populations.

METHODS AND FINDINGS

A systematic search was carried out in 5 databases for peer-reviewed systematic reviews with meta-analyses of prevalence of depression, anxiety, and post-traumatic stress disorder (PTSD) symptoms during the pandemic published between December 31, 2019 until August 12, 2022. We identified 123 reviews of which 7 provided standardized mean differences (SMDs) either from longitudinal pre- to during pandemic study-data or from cross-sectional study-data compared to matched pre-pandemic data. Methodological quality rated with the Assessment of Multiple Systematic Reviews checklist scores (AMSTAR 2) instrument was generally low to moderate. Small but significant increases of depression, anxiety, and/or general mental health symptoms were reported in the general population, in people with preexisting physical health conditions, and in children (3 reviews; SMDs ranged from 0.11 to 0.28). Mental health and depression symptoms significantly increased during periods of social restrictions (1 review; SMDs of 0.41 and 0.83, respectively) but anxiety symptoms did not (SMD: 0.26). Increases of depression symptoms were generally larger and longer-lasting during the pandemic (3 reviews; SMDs depression ranged from 0.16 to 0.23) than those of anxiety (2 reviews: SMDs 0.12 and 0.18). Females showed a significantly larger increase in anxiety symptoms than males (1 review: SMD 0.15). In healthcare workers, people with preexisting mental disorders, any patient group, children and adolescents, and in students, no significant differences from pre- to during pandemic were found (2 reviews; SMD's ranging from -0.16 to 0.48). In 116 reviews pooled cross-sectional prevalence rates of depression, anxiety, and PTSD symptoms ranged from 9% to 48% across populations. Although heterogeneity between studies was high and largely unexplained, assessment tools and cut-offs used, age, sex or gender, and COVID-19 exposure factors were found to be moderators in some reviews. The major limitations are the inability to quantify and explain the high heterogeneity across reviews included and the shortage of within-person data from multiple longitudinal studies.

CONCLUSIONS

A small but consistent deterioration of mental health and particularly depression during early pandemic and during social restrictions has been found in the general population and in people with chronic somatic disorders. Also, associations between mental health and the pandemic were stronger in females and younger age groups than in others. Explanatory individual-level, COVID-19 exposure, and time-course factors were scarce and showed inconsistencies across reviews. For policy and research, repeated assessments of mental health in population panels including vulnerable individuals are recommended to respond to current and future health crises.

Exploring core mental health symptoms among persons living with HIV: A network analysis

CONTEXT

Persons living with HIV (PLWH) commonly experience mental health symptoms. However, little is known about the core mental health symptoms and their relationships.

OBJECTIVE

This study aimed to evaluate the prevalence of various mental health symptoms and to explore their relationships in symptom networks among PLWH.

METHODS

From April to July 2022, we recruited 518 participants through convenience sampling in Beijing, China, for this cross-sectional study. Forty mental health symptoms, including six dimensions (somatization symptoms, negative affect, cognitive function, interpersonal communication, cognitive processes, and social adaptation), were assessed through paper-based or online questionnaires. Network analysis was performed in Python 3.6.0 to explore the core mental health symptoms and describe the relationships among symptoms and clusters.

RESULTS

Of the 40 mental health symptoms, the most common symptoms were fatigue (71.2%), trouble remembering things (65.6%), and uncertainty about the future (64.0%). In the single symptom network, sadness was the most central symptom across the three centrality indices (r_S = 0.59, r_C = 0.61, r_B = 0.06), followed by feeling discouraged about the future (r_S = 0.51, r_C = 0.57, r_B = 0.04) and feelings of worthlessness (r_S = 0.54, r_C = 0.53, r_B = 0.05). In the symptom cluster network, negative affect was the most central symptom cluster across the three centrality indices (r_S = 1, r_C = 1, r_B = 0.43).

CONCLUSION

Our study provides a new perspective on the role of each mental health symptom among PLWH. To alleviate the mental health symptoms of PLWH to the greatest extent possible and comprehensively improve their mental health, we suggest that psychological professionals pay more attention to pessimistic mood and cognitive processes in PLWH. Interventions that apply positive psychology skills and cognitive behavioral therapy may be necessary components for the mental health care of PLWH.

Anxiety, depression, and sleep disturbances among people on long-term efavirenz-based treatment for HIV: a cross-sectional study in Beijing, China

BACKGROUND

Efavirenz (EFV)-induced neuropsychiatric toxicity bothers people living with HIV (PLHIV). Neuropsychiatric adverse effects of EFV may differ by length of time on EFV-based antiretroviral treatment (ART).

METHODS

A cross-sectional, single-center study was conducted at Beijing Ditan Hospital in China from June-August 2020 among ART-experienced PLHIV who were on long-term EFV-based ART. 424 eligible virological suppressed participants were enrolled and divided into four groups according to time on EFV-based ART: group A (0.5 ≤ ART < 2 year), B (2 ≤ ART < 4 year), C (4 ≤ ART < 6 year), and D (ART ≥ 6 year). The questionnaires about 12-item Short Form Health Survey (SF-12), Hospital Anxiety and Depression Scale (HADS) and Pittsburgh Sleep Quality Index (PSQI) were administered to assess neuropsychiatric adverse events of EFV among different groups.

RESULTS

Overall mental component summary scores (MCS) of SF-12 in PLHIV was 50.2, which was lower than general population. Overall prevalence of anxiety, depression and sleep disturbances was 15.6%, 15.3% and 58%, respectively. Prevalence of anxiety, depression and sleep disturbances did not vary significantly between the time-on-ART groups. Anxiety, depression, sleep disturbances had no correlation with time on EFV-based ART or CD4⁺ T cells counts.

CONCLUSIONS

In ART-experienced PLHIV in China, neuropsychiatric adverse events exist persistently and prevalence do not significantly change with prolonged time on EFV-based ART. The prevalence of sleep disturbances was high, suggesting that clinicians should pay more attention to long-standing psychiatric health to perform early and effective interventions.