Predicting health-related quality of life in people living with HIV in Nepal: mental health disorders and substance use determinants

ABSTRACT

HIV-positive people often experience mental health disorders and engage in substance use. Such conditions tend to impair their health-related quality of life (QOL). Evidence, however, is limited about the influence of mental health disorders and substance use on QOL by gender. Also, little is known about the influences of anxiety and high levels of stress on QOL. We recruited 682 HIV-positive people in Nepal and measured their depression, anxiety, stress levels, substance use, and QOL. Multiple linear regressions assessed the association of mental health disorders and substance use with QOL. Presence of depressive symptoms was negatively associated with all domains of QOL including the physical (men: β = -0.68, p = 0.037; women: β = −1.37, p < 0.001) and the psychological (men: β = −1.08, p <  0.001; women: β = −1.13, p <  0.001). Those who experienced anxiety had lower scores in the physical (β = −0.89, p = 0.027) and psychological (β = −1.75, p = 0.018) QOL domains among men and in the spiritual QOL domain (β = −0.061, p = 0.043) among women. High stress levels were associated with lower scores across all QOL domains including the physical (men: β = −0.16, p < 0.001; women: β = −0.14, p <  0.001) and the psychological (men: β = −0.09, p < 0.001; women: β = −0.10, p < 0.001). Substance-using men were more likely to have lower scores in physical (β = −0.70, p = 0.039) and psychological (β = −0.073, p = 0.002) domains. Among women, meanwhile, substance use was negatively associated with the psychological domain only (β = −0.77, p = 0.005). In conclusion, mental health disorders and substance use had negative associations with QOL. Attention should be given to addressing the mental health care needs of HIV-positive people to improve their QOL.

KEYWORDS:

• Mental health
• substance use
• HIV
• quality of life
• Nepal

Acknowledgments

The authors gratefully acknowledge Mr. Sanjeev Raj Neupane of Save the Children, Nepal who provided an essential support and required information for fieldwork. We are also grateful to several helping hands from selected NGOs for their contribution in all aspects of data collection. Additionally, we are thankful to Dr. Rachel Amiya for her generous support in editing English. Finally, our big thanks go to those HIV-positive people who actively participated in this study.

Disclosure statement

No potential conflict of interest was reported by the authors.