title: Depressive and Anxiety Symptoms Predict Sustained Quality of Life Deficits in HIV-Positive Ugandan Adults Despite Antiretroviral Therapy: A Prospective Cohort Study.
abstract: 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 highly active antiretroviral therapy (HAART) 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 nonimproved SRH during follow-up.QOL scores 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.
authors.affiliation: From the Department of Epidemiology and Biostatistics (AEE), Department of Health Promotion and Behaviour, The University of Georgia, Athens, GA, USA (MNW); School of Public Health (DG, DB); Infectious Diseases Institute, Makerere University College of Health Sciences, Kampala, Uganda (YCM); Division of Infectious Diseases, Department of Medicine, John Hopkins University, Baltimore, MD (YCM); Department of Epidemiology (WWF); Department of Global Health and Population (DB, WWF); Department of Nutrition, Harvard School of Public Health (WWF); Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA (MCSF); and Department of Epidemiology, College of Public Health, University of Nebraska Medical Center, Omaha, NE, USA (DB).
authors.forename: Amara E
authors.initials: AE
authors.lastname: Ezeamama
authors.forename: Makhabele N
authors.initials: MN
authors.lastname: Woolfork
authors.forename: David
authors.initials: D
authors.lastname: Guwatudde
authors.forename: Danstan
authors.initials: D
authors.lastname: Bagenda
authors.forename: Yukari C
authors.initials: YC
authors.lastname: Manabe
authors.forename: Wafaie W
authors.initials: WW
authors.lastname: Fawzi
authors.forename: Mary C
authors.initials: MC
authors.lastname: Smith Fawzi
mesh_terms: D000328:Adult; D023241:Antiretroviral Therapy, Highly Active / Q000379:methods / Q000523:psychology; D001007:Anxiety / Q000175:diagnosis / Q000503:physiopathology; D015331:Cohort Studies; D003863:Depression / Q000175:diagnosis / Q000503:physiopathology; D005260:Female; D015658:HIV Infections / Q000188:drug therapy / Q000523:psychology; D006801:Humans; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D011446:Prospective Studies; D011580:Psychological Techniques; D011584:Psychology; D011788:Quality of Life; D057545:Social Stigma; D012944:Social Support; D011795:Surveys and Questionnaires; D014454:Uganda / Q000453:epidemiology