Role of psychosocial status in predicting health-related quality of life at 1-year follow-up among newly diagnosed people living with HIV

Autoři: Yunxiang Huang aff001;  Dan Luo aff001;  Xi Chen aff002;  Dexing Zhang aff003;  Zhulin Huang aff004;  Shuiyuan Xiao aff001
Působiště autorů: Department of Social Medicine and Health Management, Xiangya School of Public Health, Central South University, Changsha, Hunan, People’s Republic of China aff001;  Hunan Provincial Center for Disease Prevention and Control, Changsha, Hunan, People’s Republic of China aff002;  The Jockey Club School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong, People’s Republic of China aff003;  Changsha Center for Disease Prevention and Control, Changsha, Hunan, People’s Republic of China aff004
Vyšlo v časopise: PLoS ONE 14(10)
Kategorie: Research Article



Psychosocial problems are common among people living with HIV (PLWH) and have been cross-sectionally associated with health-related quality of life (HRQoL). We evaluated the longitudinal relationship between psychosocial status and HRQoL among PLWH during the first year after diagnosis.


A consecutive sample of newly diagnosed PLWH was recruited from Changsha Center for Disease Control and Prevention in Hunan Province, China. Assessments were conducted at baseline and 1 year later. The measures used in this study included the Medical Outcomes Study HIV Survey (MOS-HIV), the 9-item Patient Health Questionnaire (PHQ-9), the HIV/AIDS Stress Scale (SS-HIV) and the Social Support Rating Scale (SSRS). The trajectories of depression from baseline to 1-year follow-up were categorized into four groups: never (PHQ-9 < 10 at two time points), new-onset (PHQ-9 < 10 at baseline & PHQ-9 ≥ 10 at follow-up), recovered (PHQ-9 ≥ 10 at baseline & PHQ-9 < 10 at follow-up) and persistent depression (PHQ-9 ≥ 10 at two time points). In addition, the trajectories of stress and social support were classified by calculating the proportions of participants whose stress and social support scores changed between baseline and 1-year follow-up by more than 0.5 effect size in either direction. Generalized linear models were used to examine the potential role of baseline and changes in psychosocial status in predicting the HRQoL at 1 year, after adjusting for socio-demographic and clinical characteristics.


A total of 410 participants completed both the baseline and 1-year follow-up surveys. Higher stress levels at baseline predicted a lower HRQoL at 1 year, while baseline depression status and social support did not predict 1-year HRQoL scores. Compared to those who were never depressed at both baseline and follow-up, participants who experienced new-onset or persistent depression had lower HRQoL at 1 year. Additionally, the 1-year HRQoL score of participants who recovered from depression by follow-up was comparable to that of participants who were never depressed. Moreover, participants who experienced increases in stress levels by follow-up had lower HRQoL scores at 1 year than those with decreases in stress levels. Changes in social support did not predict 1-year HRQoL scores in this study.


Assessing psychosocial status regularly and implementing effective interventions targeted at psychosocial problems may be particularly important for PLWH to improve their HRQoL. Among PLWH, special attention should be given to those with new-onset or persistent depression and those with high stress levels at the time of diagnosis and increased stress levels 1 year after the new HIV diagnosis.

Klíčová slova:

Depression – HIV diagnosis and management – HIV infections – Psychological and psychosocial issues – Psychological stress – Surveys – HIV clinical manifestations


1. Michaels SH, Clark R, Kissinger P. Declining morbidity and mortality among patients with advanced human immunodeficiency virus infection. The New England journal of medicine. 1998;339(6):405–6. doi: 10.1056/NEJM199808063390612 MEDLINE:9696654. 9696654

2. Samji H, Cescon A, Hogg RS, Modur SP, Althoff KN, Buchacz K, et al. Closing the Gap: Increases in Life Expectancy among Treated HIV-Positive Individuals in the United States and Canada. PLoS One. 2013;8(12). doi: 10.1371/journal.pone.0081355 WOS:000328740300004. 24367482

3. Carpenter CCJ, Cooper DA, Fischl MA, Gatell JM, Gazzard BG, Hammer SM, et al. Antiretroviral therapy in adults—Updated recommendations of the International AIDS Society-USA Panel. Jama-Journal of the American Medical Association. 2000;283(3):381–90. doi: 10.1001/jama.283.3.381 WOS:000084732400031. 10647802

4. Pozniak A. Quality of life in chronic HIV infection. Lancet HIV. 2014;1(1):e6–7. Epub 2015/10/02. doi: 10.1016/S2352-3018(14)70003-7 26423817.

5. Heywood W, Lyons A. HIV and Elevated Mental Health Problems: Diagnostic, Treatment, and Risk Patterns for Symptoms of Depression, Anxiety, and Stress in a National Community-Based Cohort of Gay Men Living with HIV. AIDS Behav. 2016;20(8):1632–45. Epub 2016/02/15. doi: 10.1007/s10461-016-1324-y 26874848.

6. Martinez J, Lemos D, Hosek S, Adolescent Med Trials N. Stressors and Sources of Support: The Perceptions and Experiences of Newly Diagnosed Latino Youth Living with HIV. AIDS Patient Care STDS. 2012;26(5):281–90. doi: 10.1089/apc.2011.0317 WOS:000303435800006. 22536931

7. Garrido-Hernansaiz H, Alonso-Tapia J. Associations Among Resilience, Posttraumatic Growth, Anxiety, and Depression and Their Prediction From Stress in Newly Diagnosed People Living With HIV. Janac-Journal of the Association of Nurses in Aids Care. 2017;28(2):289–94. doi: 10.1016/j.jana.2016.12.005 WOS:000396440700010. 28109699

8. Ciesla JA, Roberts JE. Meta-analysis of the relationship between HIV infection and risk for depressive disorders. Am J Psychiatry. 2001;158(5):725–30. doi: 10.1176/appi.ajp.158.5.725 WOS:000168479000011. 11329393

9. Pichon LC, Rossi KR, Ogg SA, Krull LJ, Griffin DY. Social Support, Stigma and Disclosure: Examining the Relationship with HIV Medication Adherence among Ryan White Program Clients in the Mid-South USA. Int J Environ Res Public Health. 2015;12(6):7073–84. doi: 10.3390/ijerph120607073 WOS:000357268500084. 26103592

10. Friedland J, Renwick R, Mccoll M. Coping and social support as determinants of quality of life in HIV/AIDS. AIDS Care. 1996;8(1):15–31. doi: 10.1080/09540129650125966 MEDLINE:8664366. 8664366

11. Au A, Chan I, Li P, Chung R, Po LM, Yu P. Stress and health-related quality of life among HIV-infected persons in Hong Kong. AIDS Behav. 2004;8(2):119–29. doi: 10.1023/B:AIBE.0000030243.50415.c0 WOS:000221882600002. 15187474

12. Reis RK, Haas VJ, Dos Santos CB, Teles SA, Gimenez Galvao MT, Gir E. Symptoms of depression and quality of life of people living with HIV/AIDS. Rev Lat Am Enfermagem. 2011;19(4):874–81. WOS:000293983500004. doi: 10.1590/s0104-11692011000400004 21876938

13. Degroote S, Vogelaers DP, Vermeir P, Mariman A, De Rick A, Van Der Gucht B, et al. Socio-economic, behavioural, (neuro)psychological and clinical determinants of HRQoL in people living with HIV in Belgium: a pilot study. J Int AIDS Soc. 2013;16. doi: 10.7448/ias.16.1.18643 WOS:000328696300001. 24331754

14. Briongos Figuero LS, Bachiller Luque P, Palacios Martin T, Gonzalez Sagrado M, Eiros Bouza JM. Assessment of factors influencing health-related quality of life in HIV-infected patients. HIV Med. 2011;12(1):22–30. doi: 10.1111/j.1468-1293.2010.00844.x WOS:000284963200004. 20497251

15. Perez IR, Rodriguez-Bano J, Ruz MaL, Jimenez AD, Prados MC, Liano JP, et al. Health-related quality of life of patients with HIV: Impact of sociodemographic, clinical and psychosocial factors. Qual Life Res. 2005;14(5):1301–10. doi: 10.1007/s11136-004-4715-x WOS:000229642000010. 16047505

16. Neigh GN, Rhodes ST, Valdez A, Jovanovic T. PTSD co-morbid with HIV: Separate but equal, or two parts of a whole? Neurobiol Dis. 2016;92(Pt B):116–23. Epub 2015/11/26. doi: 10.1016/j.nbd.2015.11.012 26592355; PubMed Central PMCID: PMC5673262.

17. Feigin R, Sapir Y, Patinkin N, Turner D. Breaking Through the Silence: The Experience of Living With HIV-Positive Serostatus, and Its Implications on Disclosure. Soc Work Health Care. 2013;52(9):826–45. doi: 10.1080/00981389.2013.827143 WOS:000325788900003. 24117031

18. Tao J, Vermund SH, Lu H, Ruan Y, Shepherd BE, Kipp AM, et al. Impact of Depression and Anxiety on Initiation of Antiretroviral Therapy Among Men Who Have Sex with Men with Newly Diagnosed HIV Infections in China. AIDS Patient Care STDS. 2017;31(2):96–104. doi: 10.1089/apc.2016.0214 WOS:000394343800006. 28170305

19. Garrido-Hernansaiz H, Alonso-Tapia J. Social Support in Newly Diagnosed People living With HIV: Expectations and Satisfaction Along Time, Predictors, and Mental Health Correlates. Janac-Journal of the Association of Nurses in Aids Care. 2017;28(6):849–61. doi: 10.1016/j.jana.2017.06.007 WOS:000414218900003. 28705757

20. Rzeszutek M. A longitudinal analysis of posttraumatic growth and affective well-being among people living with HIV: The moderating role of received and provided social support. PLoS One. 2018;13(8):e0201641. Epub 2018/08/07. doi: 10.1371/journal.pone.0201641 30080882; PubMed Central PMCID: PMC6078301.

21. Nightingale VR, Sher TG, Hansen NB. The impact of receiving an HIV diagnosis and cognitive processing on psychological distress and posttraumatic growth. J Trauma Stress. 2010;23(4):452–60. Epub 2010/07/22. doi: 10.1002/jts.20554 20648562; PubMed Central PMCID: PMC3629914.

22. Huang YX, Luo D, Chen X, Zhang DX, Wang M, Qiu YY, et al. Changes and determinants of health-related quality of life among people newly diagnosed with HIV in China: a 1-year follow-up study. Qual Life Res. 2019;28(1):35–46. doi: 10.1007/s11136-018-1998-x WOS:000456282400003. 30206817

23. Wu AW, Revicki DA, Jacobson D, Malitz FE. Evidence for reliability, validity and usefulness of the Medical Outcomes Study HIV Health Survey (MOS-HIV). Qual Life Res. 1997;6(6):481–93. Epub 1997/08/01. 9330549.

24. Huang Z-J, Tian M, Dai S-Y, Ye D-Q. Feasibility, reliability and validity of the Chinese simplified version of the MOS-HIV health survey among AIDS patients in China. Qual Life Res. 2013;22(2):403–7. doi: 10.1007/s11136-012-0148-0 WOS:000315279500018. 22392524

25. Kroenke K, Spitzer RL, Williams JBW. The PHQ-9—Validity of a brief depression severity measure. J Gen Intern Med. 2001;16(9):606–13. doi: 10.1046/j.1525-1497.2001.016009606.x WOS:000171184700005. 11556941

26. Kroenke K, Spitzer RL, Williams JBW, Loewe B. The Patient Health Questionnaire Somatic, Anxiety, and Depressive Symptom Scales: a systematic review. Gen Hosp Psychiatry. 2010;32(4):345–59. doi: 10.1016/j.genhosppsych.2010.03.006 WOS:000280389800001. 20633738

27. Manea L, Gilbody S, Mcmillan D. A diagnostic meta-analysis of the Patient Health Questionnaire-9 (PHQ-9) algorithm scoring method as a screen for depression. Gen Hosp Psychiatry. 2015;37(1):67–75. doi: 10.1016/j.genhosppsych.2014.09.009 WOS:000348042700015. 25439733

28. Wang W, Bian Q, Zhao Y, Li X, Wang W, Du J, et al. Reliability and validity of the Chinese version of the Patient Health Questionnaire (PHQ-9) in the general population. Gen Hosp Psychiatry. 2014;36(5):539–44. Epub 2014/07/16. doi: 10.1016/j.genhosppsych.2014.05.021 25023953.

29. Pakenham KI, Rinaldis M. Development of the HIV/AIDS stress scale. Psychol Health. 2002;17(2):203–19. doi: 10.1080/08870440290013680 WOS:000176007300005.

30. Niu L, Qiu Y, Luo D, Chen X, Wang M, Pakenham KI, et al. Cross-Culture Validation of the HIV/AIDS Stress Scale: The Development of a Revised Chinese Version. PLoS One. 2016;11(4). doi: 10.1371/journal.pone.0152990 WOS:000373592100059. 27043134

31. Xiao S. The theory basis and application of the Social Support Rating Scale. Journal of Clinical Psychiatry Medicine. 1997;4(2):98–100.

32. Cai W-P, Pan Y, Zhang S-M, Wei C, Dong W, Deng G-H. Relationship between cognitive emotion regulation, social support, resilience and acute stress responses in Chinese soldiers: Exploring multiple mediation model. Psychiatry Res. 2017;256:71–8. doi: 10.1016/j.psychres.2017.06.018 WOS:000412787700011. 28624675

33. Du J, Shao S, Jin G-H, Qian C-G, Xu W, Lu X-Q. Factors associated with health-related quality of life among family caregivers of disabled older adults: a cross-sectional study from Beijing. Medicine. 2017;96(44). doi: 10.1097/md.0000000000008489 WOS:000415106800059. 29095308

34. Wu H, Wu S, Wu H, Xia Q, Li N. Living Arrangements and Health-Related Quality of Life in Chinese Adolescents Who Migrate from Rural to Urban Schools: Mediating Effect of Social Support. Int J Environ Res Public Health. 2017;14(10). doi: 10.3390/ijerph14101249 WOS:000414763200158. 29048382

35. Cohen J, Cohen Ja, Cohen L, Cohen Jj, Cohen Jw, Cohen Ds, et al. Statistical Power Analysis for the Behavioral Science. New York: Academic Press; 1977.

36. Kazis LE, Anderson JJ, Meenan RF. Effect sizes for interpreting changes in health status. Med Care. 1989;27(3 Suppl):S178–89. doi: 10.1097/00005650-198903001-00015 MEDLINE:2646488. 2646488

37. Pokhrel KN, Sharma VD, Shibanuma A, Pokhrel KG, Mlunde LB, Jimba M. Predicting health-related quality of life in people living with HIV in Nepal: mental health disorders and substance use determinants. Aids Care-Psychological and Socio-Medical Aspects of Aids/Hiv. 2017;29(9):1137–43. doi: 10.1080/09540121.2017.1332331 WOS:000405565900010. 28547996

38. Scott-Sheldon LaJ, Kalichman SC, Carey MP, Fielder RL. Stress management interventions for HIV+ adults: A meta-analysis of Randomized controlled trials, 1989 to 2006. Health Psychol. 2008;27(2):129–39. doi: 10.1037/0278-6133.27.2.129 WOS:000254659800001. 18377131

39. Ezeamama AE, Woolfork MN, Guwatudde D, Bagenda D, Manabe YC, Fawzi WW, et al. Depressive and Anxiety Symptoms Predict Sustained Quality of Life Deficits in HIV-Positive Ugandan Adults Despite Antiretroviral Therapy A Prospective Cohort Study. Medicine. 2016;95(9). doi: 10.1097/md.0000000000002525 WOS:000375208900025. 26945347

40. Kim S-Y, Kim S-W, Shin I-S, Park M-H, Yoon J-H, Yoon J-S, et al. Changes in depression status during the year after breast cancer surgery and impact on quality of life and functioning. Gen Hosp Psychiatry. 2018;50:33–7. doi: 10.1016/j.genhosppsych.2017.09.009 WOS:000424343000005. 28987920

41. Jia HG, Uphold CR, Wu S, Chen GJ, Duncan PW. Predictors of changes in health-related quality of life among men with HIV infection in the HAART era. AIDS Patient Care STDS. 2005;19(6):395–405. doi: 10.1089/apc.2005.19.395 WOS:000230459000006. 15989435

42. Burgoyne R, Renwick R. Social support and quality of life over time among adults living with HIV in the HAART era. Soc Sci Med. 2004;58(7):1353–66. doi: 10.1016/S0277-9536(03)00314-9 WOS:000220271300011. 14759681

43. Bekele T, Rourke SB, Tucker R, Greene S, Sobota M, Koornstra J, et al. Direct and indirect effects of perceived social support on health-related quality of life in persons living with HIV/AIDS. Aids Care-Psychological and Socio-Medical Aspects of Aids/Hiv. 2013;25(3):337–46. doi: 10.1080/09540121.2012.701716 WOS:000314964600010. 22774876

44. Shrestha R, Copenhaver M, Bazazi AR, Huedo-Medina TB, Krishnan A, Altice FL. A Moderated Mediation Model of HIV-Related Stigma, Depression, and Social Support on Health-Related Quality of Life among Incarcerated Malaysian Men with HIV and Opioid Dependence. AIDS Behav. 2017;21(4):1059–69. Epub 2017/01/22. doi: 10.1007/s10461-017-1693-x 28108877; PubMed Central PMCID: PMC5344717.

45. Jia H, Uphold CR, Zheng Y, Wu S, Chen GJ, Findley K, et al. A further investigation of health-related quality of life over time among men with HIV infection in the HAART era. Qual Life Res. 2007;16(6):961–8. Epub 2007/05/01. doi: 10.1007/s11136-007-9214-4 17468942.

46. Revicki DA, Sorensen S, Wu AW. Reliability and validity of physical and mental health summary scores from the Medical Outcomes Study HIV Health Survey. Med Care. 1998;36(2):126–37. Epub 1998/02/25. doi: 10.1097/00005650-199802000-00003 9475468.

Článek vyšel v časopise


2019 Číslo 10
Nejčtenější tento týden