TY - JOUR
T1 - Depressive and anxiety symptoms predict sustained quality of life deficits in HIV-positive ugandan adults despite antiretroviral therapy
T2 - A prospective cohort study
AU - Ezeamama, Amara E.
AU - Woolfork, Makhabele N.
AU - Guwatudde, David
AU - Bagenda, Danstan
AU - Manabe, Yukari C.
AU - Fawzi, Wafaie W.
AU - Smith Fawzi, Mary C.
N1 - Publisher Copyright:
Copyright © 2016 Wolters Kluwer Health, Inc. All rights reserved.
PY - 2016/3/4
Y1 - 2016/3/4
N2 - The impact of psychosocial status at onset of antiretroviral therapy on changes in quality of life (QOL) and subjectively rated health (SRH) among adults on ART in resource-limited settings is poorly understood. Therefore, we evaluate the association between stigma, anxiety, depression, and social support and change in QOL and SRH in HIV-infected Ugandan adults during an 18-month period. Psychosocial indicators were assessed at enrollment using structured questionnaires. QOL and SRH measures were assessed at months 0, 6, 12, and 18 using the Medical Outcomes Survey-HIV. Linear mixed models determined risk estimated differences in QOL and SRH in relation to quartiles of each psychosocial status indicator. Repeated measures generalized estimating equations modeling was implemented to assess differences in likelihood of improved versus nonimprovedSRHduring follow-up. QOLscores and SRH improved significantly for all participants over 18 months (P<0.0001). The gain in QOL increased dose-dependently as baseline depressive symptoms (time -depression P<0.001) and anxiety levels (time-anxiety P<0.001) declined. Lower social support was associated with worse QOL at baseline (P=0.0005) but QOL improvement during follow-up was not dependent on baseline level of social support (time-social support P=0.8943) or number of stigmatizing experiences (time-stigma P=0.8662). Psychosocial determinants did not predict changes in SRH in this study. High levels of depression and anxiety symptoms at HAART initiation predicts lower gains in QOL for HIV-positive patients for as long as 18 months. Long-term QOL improvements in HIV-infected adults may be enhanced by implementation of psychosocial interventions to reduce depression and anxiety in HIV-infected adults.
AB - The impact of psychosocial status at onset of antiretroviral therapy on changes in quality of life (QOL) and subjectively rated health (SRH) among adults on ART in resource-limited settings is poorly understood. Therefore, we evaluate the association between stigma, anxiety, depression, and social support and change in QOL and SRH in HIV-infected Ugandan adults during an 18-month period. Psychosocial indicators were assessed at enrollment using structured questionnaires. QOL and SRH measures were assessed at months 0, 6, 12, and 18 using the Medical Outcomes Survey-HIV. Linear mixed models determined risk estimated differences in QOL and SRH in relation to quartiles of each psychosocial status indicator. Repeated measures generalized estimating equations modeling was implemented to assess differences in likelihood of improved versus nonimprovedSRHduring follow-up. QOLscores and SRH improved significantly for all participants over 18 months (P<0.0001). The gain in QOL increased dose-dependently as baseline depressive symptoms (time -depression P<0.001) and anxiety levels (time-anxiety P<0.001) declined. Lower social support was associated with worse QOL at baseline (P=0.0005) but QOL improvement during follow-up was not dependent on baseline level of social support (time-social support P=0.8943) or number of stigmatizing experiences (time-stigma P=0.8662). Psychosocial determinants did not predict changes in SRH in this study. High levels of depression and anxiety symptoms at HAART initiation predicts lower gains in QOL for HIV-positive patients for as long as 18 months. Long-term QOL improvements in HIV-infected adults may be enhanced by implementation of psychosocial interventions to reduce depression and anxiety in HIV-infected adults.
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U2 - 10.1097/MD.0000000000002525
DO - 10.1097/MD.0000000000002525
M3 - Article
C2 - 26945347
AN - SCOPUS:84962590151
SN - 0025-7974
VL - 95
JO - Medicine (United States)
JF - Medicine (United States)
IS - 9
M1 - e2525
ER -