Depression and anxiety mediate perceived social support to predict health-related quality of life in pregnant women living with HIV

ABSTRACT

Pregnant women living with HIV represent one of the most high-priority groups for HIV treatment and health assessment. Although social support has been shown to be a protective factor for improved health-related quality of life (HRQoL), and depression and anxiety have been identified as two major causes of psychological distress among people living with HIV, it is still unclear how social support, anxiety, and depression interact to influence HRQoL. The objective of our study was to demonstrate the nature of predictors, direct effects and mediator effects among social support, anxiety, depression symptoms and HRQoL in pregnant women living with HIV. We investigated a total of 101 pregnant women living with HIV in Yunnan province in China from April 2016 to June 2016. All participants completed the Social Support Rating Scale (SSRS), the Chinese version of the Hospital Anxiety and Depression Scales (HADS) and Quality of Life instruments (EuroQoL Five Dimensions Questionnaire, EQ-5D). The relationships between the variables were examined by Pearson's or Spearman's correlation analysis. Predictor effects were tested using separate multiple regressions, controlling for demographic variables and HIV diagnosis variables. Direct and mediation effects of social support on HRQoL were tested using a structural equation model (SEM). Anxiety and depression symptoms were negatively correlated with subjective social support, support utilization, social support and HRQoL. Social support significantly predicted better HRQoL, and anxiety and depression symptoms significantly predicted poorer HRQoL. Anxiety and depression symptoms partially mediated the associations between social support and HRQoL. Anxiety and depression symptoms completely mediated the associations of objective support and support utilization with HRQoL. Interventions to improve HRQoL in pregnant women living with HIV must consider the mediation effect of anxiety and depression symptoms on the association between social support and HRQoL. Social support interventions are valid only when anxiety and depression symptoms are managed effectively.

KEYWORDS:

• Health-related quality of life
• social support
• anxiety and depression
• mediator
• pregnant women living with HIV

Acknowledgements

We thank Tan Ting, Yu Jun, Zhou Qunbo, Li Qi and Zhao Hongjuan in Kunming Medical University helped do the investigation. We thank all the individuals in the study for their participation.

Disclosure statement

No potential conflict of interest was reported by the authors.

Ethic approval and consent to participate

All patients were informed about the study objectives, and they were assured of confidentiality. They were asked to indicate their agreement and understanding with a signed informed consent form before the investigation. The study was approved by the ethics research committee of Kunming Medical University, China (Reference number: 2016-026-KJ-QT).

Consent for publication

Not applicable.

Contributors

All authors were involved in the study's conception and design, as well as data collection, sorting, analysis or interpretation. All authors critically reviewed the report for important intellectual and practical content. Wang Xiaowen and Zheng Jiarui did the statistical analysis. Liang Xiumin, Li Zhaoqin, Luo Hongzhuan, Yang Yuyan and Yang Liyuan did the field investigation organization. Guo Guangping and Zhou Ling provided administrative, technical or material support. Lu Lin supervised the study.

Additional information

Funding

This work was supported by Doctoral Innovation and Science Foundation of Kunming Medical University [grant number 2017B001]. The funding organization had no role in the development of study design, collection, analysis, and interpretation of data, the writing of the report, or the final decision to submit the manuscript for publication.