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

Background: 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.

Method: 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.

Results: 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.

Conclusions: 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.