Determinants of quality of life in HIV-infected patients receiving highly active antiretroviral treatment at a medical college ART center in Kolkata, India.
01 Jul 2013-Journal of the International Association of Providers of AIDS Care (SAGE Publications)-Vol. 12, Iss: 4, pp 284-290
TL;DR: Health-related quality of life (QOL) has become a high priority of long-term management of HIV-infected individuals and presence of depression and high neuroticism score in the personality profile of HIV patients are significantly associated with poorer QOL.
Abstract: Health-related quality of life (QOL) has become a high priority of long-term management of HIV-infected individuals. The newly diagnosed HIV cases were assessed to obtain sociodemographic and clinical findings. Eyesenk Personality Questionnaire (EPQ), World Health Organization Quality of Life Brief (WHOQOL-BREF) for HIV-infected patients, and Beck Depression Inventory (BDI) were used to get data regarding personality traits, QOL, and depression scores. A total of 175 patients were included in the study, 128 (73.1%) men and 47 (26.9%) women. Overall 56% of patients screened positive for depression. Presence of depression and high neuroticism score in the personality profile of HIV-infected patients are significantly associated with poorer QOL. High neuroticism score was a strong predictor of poorer QOL in psychological and spiritual domain. Management of HIV-infected patients therefore needs to address these psychological issues.
Citations
More filters
TL;DR: The epidemiology and the main clinical features of depression in HIV-infected patients, the causal pathways linking depression and HIV infection, the validity of screening tools, and the efficacy of different treatment approaches are discussed.
Abstract: Depression is the most common neuropsychiatric complication in HIV-infected patients and may occur in all phases of the infection. Accurately, diagnosing major depressive disorder in the context of HIV is an ongoing challenge to clinicians and researchers, being complicated by the complex biological, psychological, and social factors associated with the HIV illness. Evidences exist to support the importance of improving the identification of depressive symptoms and their adequate treatment. Depression has long been recognized as a predictor of negative clinical outcomes in HIV-infected patients, such as reducing medication adherence, quality of life, and treatment outcome, and possibly worsening the progression of the illness and increasing mortality. By analyzing the most relevant studies (MEDLINE, EMBASE, PsycLit, Cochrane Library), the review discusses the epidemiology and the main clinical features of depression in HIV-infected patients, the causal pathways linking depression and HIV infection, the validity of screening tools, and the efficacy of different treatment approaches, including psychosocial interventions, psychopharmacology as well as HIV-specific health psychology health service models.
354 citations
05 May 2016
TL;DR: The prevalence of depression and anxiety in people living with HIV/AIDS (PLWHA) ranges from 7.2% to 71.9% and 4.5% to 82.3%, respectively.
Abstract: The prevalence of depression and anxiety in people living with HIV/AIDS (PLWHA) ranges from 7.2% to 71.9% and 4.5% to 82.3%, respectively. This wide variation is attributed to differences in sample size and characteristics, and methodology for assessment of anxiety and depression. Moreover, anxiety and depression increase the morbidity of HIV by poor adherence to treatment and various other significant mechanisms. Early identification and effec - tive management of these disorders is associated with improved antiretroviral adherence and improved quality of life in PLWHA. Different treatment modalities, including pharmacological and nonpharmacological therapies, are used for the management of anxiety and depression in PLWHA. Benzodiazepines are indicated for short periods of time. Clonazepam and lorazepam are safe in terms of drug-drug interactions and may be preferred. Selective serotonin reuptake inhibitors are safer than tricyclic antidepressants. Though the different selective serotonin reuptake inhibitors are supposed to be equally effective, to avoid interactions with antiretrovirals, the better options are sertraline, citalopram, and escitalopram. Various nonpharmacological therapies, including cognitive behavior therapy, interpersonal therapy, supportive psycho- therapy, cognitive-behavioral-oriented group psychotherapy, experiential group psychotherapy, cognitive-behavioral stress management, stress management interventions, cognitive remediation therapy, mindfulness-based therapy, and aerobic and resistance exercise have been reported to be useful in treating depression among PLWHA. However, definitive evidence to decide which nonpharmacological intervention is most beneficial for the management of anxiety and depres - sion in PLWHA is still required.
32 citations
TL;DR: A systematic review of the literature on spirituality among Indian PC patients illustrated that spirituality can be an ethical challenge and that more ethical reflection on provision of spiritual care is needed.
Abstract: Objective: Spiritual care is recognized as an essential component of palliative care (PC). However, patients' experience of spirituality is heavily context dependent. In addition, Western definitions and findings regarding spirituality may not be applicable to patients of non-Western origin, such as Indian PC patients. Given the particular sociocultural, religious, and economic conditions in which PC programs in India operate, we decided to undertake a systematic review of the literature on spirituality among Indian PC patients. We intended to assess how spirituality has been interpreted and operationalized in studies of this population, to determine which dimensions of spirituality are important for patients, and to analyze its ethical implications. Method: In January of 2015, we searched five databases (ATLA, CINAHL, EMBASE, PsycINFO, and PubMed) using a combination of controlled and noncontrolled vocabulary. A content analysis of all selected reports was undertaken to assess the interpretation and dimensions of spirituality. Data extraction from empirical studies was done using a data-extraction sheet. Results: A total of 39 empirical studies (12 qualitative, 21 quantitative, and 6 mixed-methods) and 18 others (10 reviews, 4 opinion articles, and 4 case studies) were retrieved. To date, no systematic review on spirituality in Indian PC has been published. Spirituality was the main focus of only six empirical studies. The content analysis revealed three dimensions of spirituality: (1) the relational dimension, (2) the existential dimension, and (3) the values dimension. Religion is prominent in all these dimensions. Patients' experiences of spirituality are determined by the specifically Indian context, which leads to particular ethical issues. Significance of results: Since spiritual well-being greatly impacts quality of life, and because of the substantial presence of people of Indian origin living outside the subcontinent, the findings of our review have international relevance. Moreover, our review illustrates that spirituality can be an ethical challenge and that more ethical reflection on provision of spiritual care is needed.
21 citations
Cites background from "Determinants of quality of life in ..."
...It has most often been studied as an aspect or domain of quality of life (Chandra et al., 1998; 2006; 2009; Chaturvedi, 1991; 2003; WHOQoL HIV Group, 2004; Mahalakshmy et al., 2011; Marashi et al., 2009; Kandasamy et al., 2011; Bele et al., 2012; Pakseresht et al., 2011; Pandey et al., 2005; Skevington, 2012; Talukdar et al., 2013; Vidhubala et al., 2005; Peter et al., 2014; Arora & Shukla, 2014), as one of the coping mechanisms used by pa-...
[...]
...…al., 2011; Lewis et al., 2013; Mahalakshmy et al., 2011; Marashi et al., 2009; Pakseresht et al., 2011; Pandey et al., 2003; 2005; Skevington, 2012; Talukdar et al., 2013; Thomas et al., 2002; Vidhubala et al., 2005; WHOQoL HIV Group, 2004; Lewis et al., 2014; Peter et al., 2014; Arora & Shukla,…...
[...]
...…et al., 2011; Marashi et al., 2009; Kandasamy et al., 2011; Bele et al., 2012; Pakseresht et al., 2011; Pandey et al., 2005; Skevington, 2012; Talukdar et al., 2013; Vidhubala et al., 2005; Peter et al., 2014; Arora & Shukla, 2014), as one of the coping mechanisms used by patients…...
[...]
...…questions Spirituality domain in WHOQoL–HIV 120 544 HIV-positive persons Older participants tended to have better spiritual quality of life† Talukdar et al. 2013 Quantitative: intervieweradministered questionnaire with closed-ended questions Domain VI spirituality of the WHOQoL–HIV BREF…...
[...]
..., 2014), 21 quantitative (Banerjee et al., 2007; Bele et al., 2012; Chandra et al., 1998; 2006; 2009; Chaturvedi, 1991; 2003; Kandasamy et al., 2011; Lewis et al., 2013; Mahalakshmy et al., 2011; Marashi et al., 2009; Pakseresht et al., 2011; Pandey et al., 2003; 2005; Skevington, 2012; Talukdar et al., 2013; Thomas et al., 2002; Vidhubala et al., 2005; WHOQoL HIV Group, 2004; Lewis et al., 2014; Peter et al., 2014; Arora & Shukla, 2014), and 6 mixedmethods studies (Jagannathan & Juvva, 2009; Mishra et al....
[...]
TL;DR: Depression and internalized stigma are highly correlated among PLHIV entering into HIV care in southern India and may provide targets for policymakers seeking to improve HIV–related outcomes in India.
Abstract: Background In India, which has the third largest HIV epidemic in the world, depression and HIV-related stigma may contribute to high rates of poor HIV-related outcomes such as loss to care and lack of virologic suppression. Methods We analyzed data from a large HIV treatment center in southern India to estimate the burden of depressive symptoms and internalized stigma among Indian people living with HIV (PLHIV) entering into HIV care and to test the hypothesis that probable depression was associated with internalized stigma. We fitted modified Poisson regression models, adjusted for sociodemographic variables, with probable depression (PHQ-9 score ≥10 or recent suicidal thoughts) as the outcome variable and the Internalized AIDS-Related Stigma Scale (IARSS) score as the explanatory variable. Findings 521 persons (304 men and 217 women) entering into HIV care between January 2015 and May 2016 were included in the analyses. The prevalence of probable depression was 10% and the mean IARSS score was 2.4 (out of 6), with 82% of participants endorsing at least one item on the IARSS. There was a nearly two times higher risk of probable depression for every additional point on the IARSS score (Adjusted Risk Ratio: 1.83; 95% confidence interval, 1.56-2.14). Conclusions Depression and internalized stigma are highly correlated among PLHIV entering into HIV care in southern India and may provide targets for policymakers seeking to improve HIV-related outcomes in India.
13 citations
TL;DR: The development of a questionnaire offering promising prospects for the study of spirituality among palliative care patients in India is described and its psychometric characteristics are explained.
Abstract: Introduction: There are only a few studies on spirituality among palliative care patients in India. This gap in research may be caused by the absence of relevant questionnaires and scales specifically designed for Indian palliative care populations. In this study, we describe the development of such a questionnaire and explain its psychometric characteristics.
Methods: We designed a questionnaire on the basis of a systematic review of the literature. After a review of the questionnaire by specialists and a subsequent pilot study, the questionnaire was amended. The final questionnaire consisted of a list of 36 spirituality items. It was administered to a sample of 300 cancer patients attending the pain clinic of a tertiary hospital in New Delhi.
Results: A factor analysis led to four factors explaining 54.6% of variance: Shifting moral and religious values (Factor 1), support from religious relationship (Factor 2), existential blame (Factor 3), and spiritual trust (Factor 4). The skewness and kurtosis for Factors 1, 3, and 4 were within a tolerable range for assuming a normal distribution, but Factor 2 was skewed. The alphas showed that the four factors have an acceptable internal consistency. Statistically significant associations were observed for age and Factor 3 (P = 0.004), gender and Factor 4 (P = 0.014), marital status and Factors 3 (P = 0.002) and 4 (P = 0.001), educational level and Factors 3 (P < 0.001) and 4 (P < 0.001), and pain scores and Factors 1 (P < 0.001), 2 (P < 0.001), and 3 (P = 0.001).
Conclusion: The questionnaire offers promising prospects for the study of spirituality among palliative care patients in India.
10 citations
References
More filters
TL;DR: The WHOQOL-Bas discussed by the authors as discussed by the authors is an abbreviated version of the WHOQol-100 quality of life assessment, which produces scores for four domains: physical health, psychological, social relationships and environment.
Abstract: Background. The paper reports on the development of the WHOQOL-BREF, an abbreviated version of the WHOQOL-100 quality of life assessment. Method. The WHOQOL-BREF was derived from data collected using the WHOQOL-100. It produces scores for four domains related to quality of life: physical health, psychological, social relationships and environment. It also includes one facet on overall quality of life and general health. Results. Domain scores produced by the WHOQOL-BREF correlate highly (0.89 or above) with WHOQOL-100 domain scores (calculated on a four domain structure). WHOQOL-BREF domain scores demonstrated good discriminant validity, content validity, internal consistency and test-retest reliability. Conclusion. These data suggest that the WHOQOL-BREF provides a valid and reliable alternative to the assessment of domain profiles using the WHOQOL-100. It is envisaged that the WHOQOL-BREF will be most useful in studies that require a brief assessment of quality of life, for example, in large epidemiological studies and clinical trials where quality of life is of interest. In addition, the WHOQOL-BREF may be of use to health professionals in the assessment and evaluation of treatment efficacy. [References: 9]
4,897 citations
Journal Article•
TL;DR: It is envisaged that the WHOQOL-BREF will be most useful in studies that require a brief assessment of quality oflife, for example, in large epidemiological studies and clinical trials where quality of life is of interest.
Abstract: Background. The paper reports on the development of the WHOQOL-BREF, an abbreviated version of the WHOQOL-100 quality of life assessment. Method. The WHOQOL-BREF was derived from data collected using the WHOQOL-100. It produces scores for four domains related to quality of life: physical health, psychological, social relationships and environment. It also includes one facet on overall quality of life and general health. Results. Domain scores produced by the WHOQOL-BREF correlate highly (0.89 or above) with WHOQOL-100 domain scores (calculated on a four domain structure). WHOQOL-BREF domain scores demonstrated good discriminant validity, content validity, internal consistency and test-retest reliability. Conclusion. These data suggest that the WHOQOL-BREF provides a valid and reliable alternative to the assessment of domain profiles using the WHOQOL-100. It is envisaged that the WHOQOL-BREF will be most useful in studies that require a brief assessment of quality of life, for example, in large epidemiological studies and clinical trials where quality of life is of interest. In addition, the WHOQOL-BREF may be of use to health professionals in the assessment and evaluation of treatment efficacy. [References: 9]
4,347 citations
"Determinants of quality of life in ..." refers methods in this paper
...This is a 31-item short form of WHOQOL100.(13) In the present study, the Hindi version of the WHOQOL-BREF has been translated to Bengali and retranslated to Hindi by 2 different persons who were conversant in both the languages and a third bilingual person compared the original with the translated version....
[...]
...This is a 31-item short form of WHOQOL100....
[...]
TL;DR: Substantial and consistent evidence is found that chronic depression, stressful events, and trauma may negatively affect HIV disease progression in terms of decreases in CD4 T lymphocytes, increases in viral load, and greater risk for clinical decline and mortality.
Abstract: Despite advances in HIV treatment, there continues to be great variability in the progression of this disease This paper reviews the evidence that depression, stressful life events, and trauma account for some of the variation in HIV disease course Longitudinal studies both before and after the advent of highly active antiretroviral therapies (HAART) are reviewed To ensure a complete review, PubMed was searched for all English language articles from January 1990 to July 2007 We found substantial and consistent evidence that chronic depression, stressful events, and trauma may negatively affect HIV disease progression in terms of decreases in CD4 T lymphocytes, increases in viral load, and greater risk for clinical decline and mortality More research is warranted to investigate biological and behavioral mediators of these psychoimmune relationships, and the types of interventions that might mitigate the negative health impact of chronic depression and trauma Given the high rates of depression and past trauma in persons living with HIV/AIDS, it is important for healthcare providers to address these problems as part of standard HIV care
603 citations
"Determinants of quality of life in ..." refers background in this paper
...Depression not only affects adherence but also results in decreased CD4 count, increased viral load, and increased mortality.(17) In general, depression in HIV-infected patients leads to a decrease in HAART adherence....
[...]
TL;DR: Psychiatric illness is common in HIV infected individuals, and underlines the importance for screening not only for cognitive impairment but also for co morbid mental disease in HIV-positive patients.
Abstract: Objective: To review the clinical features and current knowledge on the treatment of psychiatric symptoms and disorders in patients with human immunodeficiency virus (HIV) infection. Method: We searched the PubMed database combining HIV/AIDS with different keywords for psychiatric diagnoses and symptoms (e.g. depression, mania, anxiety, psychosis, dementia, substance abuse) and for psychopharmacological treatment. The years covered by these searches included 1980 to 2008. Results: Patients with HIV infection are at an increased risk of psychiatric illness. Major depressive disorder and subsyndromal depressive symptoms, as well as anxiety disorder and substance abuse are more prevalent among HIV infected individuals than among the general population. HIV-associated neurocognitive disorders (HAND) are common among HIV patients, and HIV-associated dementia (HAD) is a serious condition during the acquired immune deficiency syndrome (AIDS) stage of HIV disease. Secondary mania and psychosis might be the first clinical symptom of HIV dementia. The introduction of highly active anti-retroviral therapy (HAART) has resulted in significant decreases in morbidity and mortality for HIV infected patients. HAART has also decreased the incidence of HAD, but does not give complete protection from this condition. The utility of psychotropic medications in HIV patients has not been studied sufficiently as a basis for guidelines, and more controlled trials are needed. Conclusion: Psychiatric illness is common in HIV infected individuals, and underlines the importance for screening not only for cognitive impairment but also for co morbid mental disease in HIV-positive patients. Further studies of the neuropsychiatric complications during HIV disease and the use of psychotropics under these circumstances are clearly needed. A better understanding of the pathogenesis of HAD is essential to identify additional therapeutic strategies for prevention and treatment of this neurodegenerative disease. Studies are also needed for optimizing effective utilization of antiretrovirals into the CNS. Mania and psychosis secondary to HAD may be used as an indicator to initiate HAART, irrespective of CD4 count. Further research on the utility of HAART in the treatment of such acute neuropsychiatric symptoms associated with HIV infection should be initiated.
182 citations
"Determinants of quality of life in ..." refers background in this paper
...Therefore, detecting and treating depression in HIV-positive individuals is even more important.(18) Longer duration of specialized HIV care predicted better QOL, particularly in the social relationship domain....
[...]
TL;DR: It is suggested that social and, particularly, psychological factors are important in their influence on quality of life in women with HIV infection and the need for interventions which address such factors is suggested.
Abstract: The purpose of this study was to evaluate the relative importance of social (social support, material resources, disclosure, and family functioning) and psychological factors (stigma, emotional distress, intrusion, avoidance, and fatalism) as predictors of the quality of life of women infected with HIV. The cross-sectional data were drawn from interviews of a sample of 264 women recruited from 8 HIV/AIDS treatment sites in a south-eastern state. Variance in quality of life variables, included limited daily functioning, general anxiety, and HIV symptoms was analyzed using ANOVA, correlations, and hierarchical multiple regression analysis. Limited daily functioning was predicted by stigma, fatalism, employment status, and stage of disease (R2 = 0.179). General anxiety was predicted by emotional distress, intrusion, and marital status (R2 = 0.503). Reported HIV symptoms were predicted by material resources, disclosure, intrusion, age, employment status, and race (R2 = 0.294). The results of this stu...
144 citations
"Determinants of quality of life in ..." refers background in this paper
...Quality of life is a multidimensional construct generally defined as a subjective evaluation of one’s functioning and well-being.(1) Because individual lifestyle, social norms, cultural practices, and belief systems vary between different population groups, it is imperative to have a deeper understanding of the experiences of HIV-infected Indians while assessing their QOL....
[...]