Gender disparities in depression severity and coping among people living with HIV/AIDS in Kolkata, India

HIV Social-network intervention more effective in older populations in Kenya

US President's Emergency Plan for HIV/AIDS has been credited with saving 25 million lives in sub-Sahara Africa and, as such, constitutes a preeminent US foreign policy achievement of the twenty-first century. However, the implementation of effective HIV/AIDS pharmacological interventions remains a challenge in rural Kenyan communities. Of particular importance are patient retention and care engagement and their interaction with age disparities that are sensitive to different socioeconomic contexts, as well as time-in-treatment. For the first time, we perform an intermediation and triple interaction intent-to-treat secondary analysis on a social network-based randomized controlled trial. We hypothesize that the temporal interactions of critical demographic features with a treatment/control indicator variable may significantly explain patient retention and that these results are intermediated by social network phenomena. We find that not only does extended time-in-treatment significantly improve primary outcomes, but the threefold interaction along with age and treatment itself is sufficiently flexible to fit the data remarkably well without unnecessary elaboration, an effect that is mediated via internalized stigma. This strongly suggests that patient retention varies by age group. Rather than deploying one-size-fits-all solutions, foreign and public policymakers should invest in research that considers how interventions might be optimized for different ages.Trial registration Clinical Trial Number. NCT02474992 (note: the main trial report was published here https://doi.org/10.1371/journal.pone.0255945 .) Date of submission: June 6, 2015.

Labor Pains: Work-Related Barriers to Access to Health Care for People Living with HIV in Hyderabad, India

To explore themes regarding work-related barriers to access to health care, we conducted 32 interviews, 16 with third gender people and 16 with cisgender women, all of whom were all living with HIV in Hyderabad, India. Most respondents were members of Dalit castes and had been living with HIV for several years at the time of the interview. Using thematic content analysis, interviews were coded by two researchers using a social determinants of health conceptual framework. Themes highlighted in this study include the burden of taking time off from work, the loss of pay associated with missing work, and the interruption of gendered care work responsibilities that respondents faced when seeking treatment. Findings from this study support the claim that equitable work policies and practices for marginalized laborers can increase access to medical care for people living with HIV.

The link between anticipated and internalized stigma and depression: A systematic review

Stigmatized groups may experience psychological distress. Yet, some studies show no significant relation between stigma and mental health outcomes. This systematic review investigates the link between anticipated and internalized stigma, and one mental health outcome, depression. We aimed to (1) determine whether anticipated and internalized stigma predict levels of depression, and (2) review the quality of evidence for this link. We searched PsycInfo, PubMed and EMBASE databases. Eighty-three studies (N = 34,705) met our inclusion criteria, across five stigma categories: Sexual and gender minorities; HIV/AIDS; Illness or disability-related (non-HIV); Weight, and Other. We reviewed evidence within each category and study design and developed a narrative synthesis. Sixty studies (72.3%) supported the proposed link, which varied across categories from 53.6% to 100%. Using the NIH quality assessment tool, most studies were of fair quality. Most cross-sectional studies (76.7%) straightforwardly supported the positive relation between internalized and/or anticipated stigma and depression, while only 40% of longitudinal studies did. Implications for the study of stigma and mental health outcomes are discussed.

Toward a Prognostic Model for Mortality Risk in Older People Living With HIV: A Prospective Cohort Study From Southwestern China

OBJECTIVE

The existing prognostic models for mortality risk in people living with HIV (PLWH) may not be applicable for older PLWH because the risk factors were confined to biomarkers and clinical variables. We developed and validated a nomogram for the prognosis of all-cause mortality in older PLWH based on comprehensive predictors.

DESIGN

Prospective cohort study.

SETTING AND PARTICIPANTS

We included 824 participants aged ≥50 years (mean age, 64.0 ± 7.6 years) from 30 study sites in Sichuan, China, and followed up from Nov 2018 to Mar 2021.

METHODS

Data on demographics, biomarkers, and clinical indicators were extracted from the registry; mental and social factors were assessed by a survey. Elastic net was used to select predictors. A nomogram was developed based on Cox proportional hazards regression model to visualize the relative effect size (points) of the selected predictors. The prognostic index (PI) was calculated by summing points of all predictors to quantify mortality risk.

RESULTS

Predictive performance of PI from the nomogram was good, with area under the curve of 0.76 for the training set, and 0.77 for the validation set. Change in CD4 count, virological failure in antiretroviral therapy, and living with comorbidities were robust predictors. Depressive symptoms were an important predictor in men, those aged ≥65 years, and those with time of diagnosis <1 year; low social capital was an additional predictor in people aged <65. Mortality risk increased approximately 10-fold among participants whose PI was in the fourth quartile compared with those in the first quartile (hazard ratio, 9.5; 95% CI, 2.9-31.5).

CONCLUSION AND IMPLICATIONS

Although biological and clinical factors are crucial predictors, mental and social predictors are essential for specific groups. The developed nomogram is useful for identifying risk factors and groups at risk of mortality in older PLWH.

Longitudinal Analysis of the Relationship Between Internalized HIV Stigma, Perceived Social Support, Resilience, and Depressive Symptoms Among People Living with HIV in China: A Four-Wave Model

Depression is one of the most common mental health problems among people living with HIV (PLWH). However, the longitudinal psychological mechanism underlying the link of internalized HIV stigma and depressive symptoms remains a research gap. This study attempted to articulate how and to what extent perceived social support and resilience mediate the longitudinal associations between internalized HIV stigma and depressive symptoms. A sample consisting of 1,098 Chinese PLWH (Mage = 38.63, SD = 9.20; 63.9% male) with a six-month interval and four waves of follow-up was used in the current study. Participants were asked to complete self-report questionnaires. The associations among main study variables were examined via a complete longitudinal mediation approach. Results indicated that the linkage between internalized HIV stigma at T1 and depressive symptoms at T4 was serially mediated by perceived social support at T2 and resilience at T3, and perceived social support at T2 and depressive symptoms at T3 serially mediated the relationship between resilience at T1 and internalized HIV stigma at T4. Depressive symptoms at a previous time point consistently predicted the levels of internalized HIV stigma at subsequent time points. The study highlights the complex interplay between internalized HIV stigma, mental health problems, and protective factors in a longitudinal context. The findings suggest the need to incorporate interventions aimed at enhancing social support and resilience in mental health programs for PLWH, as these factors may interrupt the pathway from internalized HIV stigma to depressive symptoms and potentially improve the overall psychological well-being of this population.

"I hope I die. That is what I hope for": Qualitative study of lived experiences of mental health of Indian women living with HIV experiencing intersectional stigma

Poor mental health due to stigma and discrimination has been well documented among women living with HIV. Although they often have other marginalized and stigmatized identities, little is known about their mental health as a result of experiencing multiple stigmas. Current narratives of mental health as a result of HIV-related stigma center on common mental health disorders such as anxiety and depression. However, biomedical diagnostic categories may not be as well known in all cultural and social contexts, and people may choose to express their distress in their own language. It is therefore important to listen to how women express their mental health concerns in their own language-their lived experiences-in order to best support them. To fill this research gap, semi-structured interviews were conducted in Kolkata, India, with 31 women living with HIV and 16 key informants. Data were coded and analyzed using thematic network analysis. The results showed that women suffered from poor mental health, which in turn affected their physical health. This happened through reduced adherence to medication, lowered CD4 counts, and the physical effects of stress, which could be perceived as prolonged. Participants described women's mental health concerns as worry, sadness, hopelessness, and fear, but biomedical diagnostic labels were rarely used. This allowed women to avoid additional stigmatization due to mental illness, which can attract some risk in this social context. As many women living with HIV experience poor mental health, they should be supported with a combination of psychosocial and psychological interventions. These include screening all women for mental illness and offering them mental health first aid. Those requiring additional support should be offered specialist psychotherapeutic and pharmacological care. This must be accompanied by stigma reduction interventions if they are to be successful in addressing the mental health needs of women living with HIV.

Analysis of Factors Influencing Depression in Elderly People Living with HIV/AIDS Based on Structural Equation Model: A Cross-Sectional Study in Guangxi, China

Purpose

The purpose of our study is to understand the current status of depression and medical social support in elderly HIV/AIDS, as well as the role of social support on depression, so as to provide a certain reference for reducing the occurrence of depression in the population.

Methods

A total of 115 participants with PLWHA (people living with HIV/AIDS) aged 50 years or older were collected in Guilin from December 2021 to July 2022. Depression and medical social support were assessed using the Center for Streaming Depression Scale (CES-D) and the Medical Social Support Scale (MOS-SSS). The structural equation model was used to examine the relationship between medical social support and depression.

Results

Sixty-one of 115 participants developed depressive symptoms with a prevalence of 53.0%. The results of univariate analysis showed that ethnicity, health status, mean monthly income, antiviral treatment status, and medical social support influenced PLWHA depression (P<0.05). Simple linear regression showed that health status (95% CI: -9.901~-2.635), and antiviral treatment status (95% CI: -12.969~-3.394) influent depression (P<0.05). There were associations between total medical social support, practical support dimension, message and emotional support dimension, social interactive cooperation dimension, emotional support dimension and depression (unadjusted and adjusted for contextual factors) (P < 0.05). Using multiple linear regression analyses, we found that medical-social support was negatively associated with depression with a standardized effect value of -0.223. PLWHA with higher medical social support had lower prevalence of depression.

Conclusion

The results indicate that the prevalence of depression among HIV/AIDS patients in Guilin is high. So the joint efforts of individuals, families, and society are needed to improve the physical and mental health of the PLWHA.

The role of self-efficacy and parental communication in the association between cyber victimization and depression among adolescents and young adults: a structural equation model

BACKGROUND

With the rapid advancement and revolutionization of information and communication technologies, adolescents and young adults use smartphones, the internet, and social networking services more frequently, as a result, the problem of cyber-bullying sharply increases, and eventually it causes psychological issues and negative thoughts in the victims. This study aimed to examine the role of self-efficacy and parental communication in the relationship between cyber victimization and depression among adolescents and young adults in India.

METHODS

Secondary data analysis was performed on a cross-sectional dataset obtained from the Understanding the Lives of Adolescents and Young Adults (UDAYA) wave 2 survey. The sample included 16,292 adolescent and young adult boys and girls aged 12-23 years. Karl Pearson Correlation coefficient analysis was done to examine the correlation between outcome variable (depressive symptoms), mediator variables (self-efficacy and parental communication) and key explanatory variable (cyber victimization). Further, structural equation modeling technique was applied to examine the hypothesized pathways.

RESULTS

Adolescents and young adults being victims of cyber-bullying [β = 0.1357, p < 0.001] and those witnessed inter-parental violence were positively [β = 0.0026, p < 0.001] correlated with depressive symptoms. Self-efficacy and parental communication were negatively related to depressive symptoms among adolescents and young adults. There was a significant positive relationship between cyber victimization [β = 0.258, p < 0.001] and depressive symptoms. Cyber victimization was positively related to self-efficacy [β = 0.043, p < 0.001] among adolescents and young adults. Self-efficacy [β= -0.150, p < 0.001] and parental communication [β=-0.261, p < 0.001] reduced depressive symptoms among the participants.

CONCLUSIONS

The findings suggest that adolescents and young adults who are victims of cyber-bully may have depressive symptoms and their mental health can be improved through the enhancement of self-efficacy and increased parental communication. Improved peer attitudes and familial support for empowering cyber victims should be taken into account while framing programs and interventions.

Psychological Distress Increases 30-Fold Among People with HIV in the First Year on ART in Nigeria-a Call for Integrated Mental Health Services

BACKGROUND

Few studies have longitudinally assessed psychological distress among people with HIV (PWH) initiating ART in resource-limited settings.

METHOD

Baseline, 6-month, and 12-month psychological distress were measured in a Nigerian cohort newly initiating therapy; the relationship between baseline factors and psychological distress at 12 months was assessed; and the association between psychological distress at 12 months and care retention or immunologic failure was determined.

RESULTS

Among 563 patients, median age was 38 years (IQR: 33-46 years), 62% were female, and 51% were married. Psychological distress increased from 3% at baseline to 34% at 12 months. Age (aOR 1.28, 95% CI 1.06-1.56), female sex (aOR 2.89, 95% CI 1.93-4.33), lack of disclosure (aOR 4.32, 95% CI 2.48-7.51), and time on ART (6 months [aOR 6.91, 95% CI 3.14-15.18] and 12 months [aOR 32.63, 95% CI 16.54-64.36]) were associated with psychological distress while being married (OR 0.42, 95% CI 0.30-0.61) was associated with reduced odds. Tweve-month psychological distress was associated with increased risk of immunologic failure (aOR 2.22, 95% CI 1.31-3.82).

CONCLUSION

The risk of psychological distress increased 30-fold in the first year on therapy in PWH in Nigeria.

The Well-Being of the German Adult Population Measured with the WHO-5 over Different Phases of the COVID-19 Pandemic: An Analysis within the COVID-19 Snapshot Monitoring Study (COSMO)

The aim of this study is to evaluate factors associated with the subjective well-being (SWB) and suspected depression measured with WHO-5 among German adults during different phases of the COVID-19 pandemic. Survey data were analyzed from the COVID-19 Snapshot Monitoring (COSMO) study, which collected data from 972, 1013, and 973 participants in time point 1 (19–20 May 2020), time point 2 (15–16 September 2020), and time point 3 (21–22 December 2020), respectively. Descriptive analyses and logistic regression analyses to identify the factors associated with suspected depression (WHO-5 ≤ 50) were conducted. Data showed that the mean WHO-5 scores in three time points were 56.17, 57.27, and 53.93, respectively. The risk of suspected depression was increased by about 1.5 times for females, 2.5–3 times among 18–24 year-olds compared to ages above 65 years, 1.5 times for singles, 2 times for those with chronic illnesses, and 2–3 times for people living in poverty. The main study findings show that German adult SWB is lower than pre-pandemic reference values. Special focus should be placed on vulnerable groups, such as females, younger persons, and people living in poverty who are most prone to a reduction in SWB and therefore suspected depression.

Factors Associated with Depression and Anxiety in Adults ≥60 Years Old during the COVID-19 Pandemic: A Systematic Review

COVID-19 represents a threat to public health and the mental health of the aged population. Prevalence and risk factors of depression and anxiety have been reported in previous reviews in other populations; however, a systematic review on the factors associated with depression and anxiety in older adults is not currently present in the literature. We searched PubMed, Embase, Scopus, ProQuest Psychology Database, Science Direct, Cochrane Library and SciELO databases (23 February 2021). The results were obtained by entering a combination of MeSH or Emtree terms with keywords related to COVID-19, elderly, depression and anxiety in the databases. A total of 11 studies were included in the systematic review. Female gender, loneliness, poor sleep quality and poor motor function were identified as factors associated with both depression and anxiety. Aspects related to having a stable and high monthly income represent protective factors for both depression and anxiety, and exercising was described as protective for depression. This study synthesised information and analysed the main factors associated with depression and anxiety in the older population during the COVID-19 pandemic. However, the cross-sectional design of most of the included studies does not allow a causal relationship between the factors analysed and depression or anxiety.

Factors associated with psychological distress during the coronavirus disease 2019 (COVID-19) pandemic on the predominantly general population: A systematic review and meta-analysis

BACKGROUND

The Coronavirus Disease 2019 (COVID-19) outbreak has escalated the burden of psychological distress. We aimed to evaluate factors associated with psychological distress among the predominantly general population during the COVID-19 pandemic.

METHODS

We searched PubMed, EMBASE, Scopus, Cochrane Library, PsycINFO, and World Health Organization COVID-19 databases (Dec 2019-15 July 2020). We included cross-sectional studies that reported factors associated with psychological distress during the COVID-19 pandemic. Primary outcomes were self-reported symptoms of anxiety and depression. Random-effects models were used to pool odds ratios (OR) and 95% confidence intervals (CI). The protocol was registered in PROSPERO (#CRD42020186735).

FINDINGS

We included 68 studies comprising 288,830 participants from 19 countries. The prevalence of anxiety and depression was 33% (95% CI: 28%-39%) and 30% (26%-36%). Women versus men (OR: 1.48 [95% CI: 1.29-1.71; I2 = 90.8%]), younger versus older (< versus ≥35 years) adults (1.20 [1.13-1.26]; I2 = 91.7%), living in rural versus urban areas (1.13 [1.00-1.29]; I2 = 82.9%), lower versus higher socioeconomic status (e.g. lower versus higher income: 1.45 [1.24-1.69; I2 = 82.3%]) were associated with higher anxiety odds. These factors (except for residential area) were also associated with higher depression odds. Furthermore, higher COVID-19 infection risk (suspected/confirmed cases, living in hard-hit areas, having pre-existing physical or mental conditions) and longer media exposure were associated with higher odds of anxiety and depression.

INTERPRETATION

One in three adults in the predominantly general population have COVID-19 related psychological distress. Concerted efforts are urgently needed for interventions in high-risk populations to reduce urban-rural, socioeconomic and gender disparities in COVID-19 related psychological distress.

A pilot randomized controlled trial (RCT) of daily versus weekly interactive voice response calls to support adherence among antiretroviral treatment patients in India

BACKGROUND

There are more than two million people living with HIV (PLH) in India, with more than 30% on antiretroviral treatment (ART) estimated to be non-adherent. This study aimed to (I) document adherence rates and related factors among ART patients in a large ART clinic in India, and (II) pilot test daily and weekly interactive voice response (IVR) calls to improve ART adherence and related outcomes.

METHODS

ART patients reporting missing at least one dose in prior 6 months (N=362) were enrolled and assessed via self-report and medical record review. Participants were randomized to one of two conditions: (I) twice-daily IVR call reminders with self-management support messaging, plus a weekly IVR adherence assessment; or (II) an attention control, with only weekly IVR adherence assessment. Participants completed study assessments at baseline, 2-, 4-, and 6-months with high retention (88% to 96%).

RESULTS

Intention-to-treat analyses found limited support for intervention effects for improving or maintaining ART adherence or CD4 counts between the two study arms over 6-months follow-up. Adherence increased significantly in the six months prior to baseline from about 65% to >95% with perfect adherence based on pill counts from medical records and consistent with patient self-report measures, which presented ceiling effects for detecting improvements in ART adherence in response to IVR intervention exposure. There was also limited support for intervention effects on secondary, self-management outcomes.

CONCLUSIONS

High levels of adherence were sustained throughout the 6-month RCT. IVR regulation changes in India delayed study launch for 6 months, which likely allowed mobilization of improved adherence at the clinic, provider and patient levels in anticipation of the study launch. Therefore, ceiling effects limited inferences on intervention effects to improve adherence. Results suggest that clinic-level adherence monitoring may be sufficient to mobilize adherence improvements by providers and patients.

TRIAL REGISTRATION

ClinicalTrials.gov registration #NCT02118454.

Immediate psychological distress in quarantined patients with COVID-19 and its association with peripheral inflammation: A mixed-method study

Since the end of 2019, Corona Virus Disease 2019 (COVID-19) has been the cause of a worldwide pandemic. The mental status of patients with COVID-19 who have been quarantined and the interactions between their psychological distress and physiological levels of inflammation have yet to be analyzed. Using a mixed-method triangulation design (QUAN + QUAL), this study investigated and compared the mental status and inflammatory markers of 103 patients who, while hospitalized with mild symptoms, tested positive with COVID-19 and 103 matched controls that were COVID-19 negative. The severity of depression, anxiety, and post-traumatic stress symptoms (PTSS) was measured via an on-line survey. Using a convenience sampling technique, qualitative data were collected until the point of data saturation. In addition, a semi-structured interview was conducted among five patients with COVID-19. Peripheral inflammatory markers were also collected in patients, both at baseline and within ± three days of completing the on-line survey. Results revealed that COVID-19 patients, when compared to non-COVID controls, manifested higher levels of depression (P < 0.001), anxiety (P < 0.001), and post-traumatic stress symptoms (P < 0.001). A gender effect was observed in the score of "Perceived Helplessness", the subscale of PSS-10, with female patients showing higher scores compared to male patients (Z = 2.56, P = 0.010), female (Z = 2.37, P = 0.018) and male controls (Z = 2.87, P = 0.004). Levels of CRP, a peripheral inflammatory indicator, correlated positively with the PHQ-9 total score (R = 0.37, P = 0.003, Spearman's correlation) of patients who presented symptoms of depression. Moreover, the change of CRP level from baseline inversely correlated with the PHQ-9 total score (R = -0.31, P = 0.002), indicative of improvement of depression symptoms. Qualitative analysis revealed similar results with respect to patient reports of negative feelings, including fear, guilt, and helplessness. Stigma and uncertainty of viral disease progression were two main concerns expressed by COVID-19 patients. Our results indicate that significant psychological distress was experienced by hospitalized COVID-19 patients and that levels of depressive features may be related to the inflammation markers in these patients. Thus, we recommend that necessary measures should be provided to address depression and other psychiatric symptoms for COVID-19 patients and attention should be paid to patient perceived stigma and coping strategies when delivering psychological interventions.

Dopaminergic impact of cART and anti-depressants on HIV neuropathogenesis in older adults

The success of combination antiretroviral therapy (cART) has transformed HIV infection into a chronic condition, resulting in an increase in the number of older, cART-treated adults living with HIV. This has increased the incidence of age-related, non-AIDS comorbidities in this population. One of the most common comorbidities is depression, which is also associated with cognitive impairment and a number of neuropathologies. In older people living with HIV, treating these overlapping disorders is complex, often creating pill burden or adverse drug-drug interactions that can exacerbate these neurologic disorders. Depression, NeuroHIV and many of the neuropsychiatric therapeutics used to treat them impact the dopaminergic system, suggesting that dopaminergic dysfunction may be a common factor in the development of these disorders. Further, changes in dopamine can influence the development of inflammation and the regulation of immune function, which are also implicated in the progression of NeuroHIV and depression. Little is known about the optimal clinical management of drug-drug interactions between cART drugs and antidepressants, particularly in regard to dopamine in older people living with HIV. This review will discuss those interactions, first examining the etiology of NeuroHIV and depression in older adults, then discussing the interrelated effects of dopamine and inflammation on these disorders, and finally reviewing the activity and interactions of cART drugs and antidepressants on each of these factors. Developing better strategies to manage these comorbidities is critical to the health of the aging, HIV-infected population, as the older population may be particularly vulnerable to drug-drug interactions affecting dopamine.