Depressive and Anxiety Symptoms Predict Sustained Quality of Life Deficits in HIV-Positive Ugandan Adults Despite Antiretroviral Therapy: A Prospective Cohort Study.
Depressive and Anxiety Symptoms Predict Sustained Quality of Life Deficits in HIV-Positive Ugandan Adults Despite Antiretroviral Therapy: A Prospective Cohort Study.
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尽管抗逆转录病毒疗法，但抑郁症状和焦虑症状可以预测HIV阳性乌干达成年人的持续质量生活缺陷：一项前瞻性队列研究。
DOI：
10.1097/md.0000000000002525
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发表时间：
2016-03
期刊：
影响因子：
1.6
通讯作者：
Smith Fawzi MC
中科院分区：
文献类型：
--
作者：
Ezeamama AE;Woolfork MN;Guwatudde D;Bagenda D;Manabe YC;Fawzi WW;Smith Fawzi MC
在资源有限的环境中，抗逆转录病毒治疗开始时的心理社会状态对接受高效抗逆转录病毒治疗（HAART）的成年人生活质量（QOL）和主观评定健康（SRH）变化的影响尚不清楚。因此，我们评估耻辱，焦虑，抑郁和社会支持之间的关联，并在18个月期间艾滋病毒感染的乌干达成年人的生活质量和性健康和生殖健康的变化。在入组时使用结构化问卷对心理社会指标进行评估。在第0、6、12和18个月时使用医学结局调查-HIV评估QOL和SRH指标。线性混合模型确定的风险估计差异生活质量和SRH的四分位数的每个心理状态指标。采用重复测量广义估计方程模型评估随访期间SRH改善与未改善的可能性差异。在18个月内，所有参与者的QOL评分和SRH均显著改善（P <0.0001）。 随着基线抑郁症状（时间与抑郁相比P <0.001）和焦虑水平（时间与焦虑相比P <0.001）的下降，QOL的增加呈剂量依赖性。 较低的社会支持与基线时较差的QOL相关（P = 0.0005），但随访期间QOL的改善不依赖于基线社会支持水平（时间-社会支持P = 0.8943）或污名化经历的数量（时间-污名化P = 0.8662）。 在这项研究中，心理社会决定因素并不能预测SRH的变化。高水平的抑郁和焦虑症状在HAART启动预测较低的收益在生活质量的艾滋病毒阳性患者长达18个月。通过实施心理社会干预措施，减少HIV感染者的抑郁和焦虑，可以提高HIV感染者的长期生活质量。
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.