The impact of a livelihood program on depressive symptoms among people living with HIV in Cambodia

Figures & data

Fig. 1 Study participant flowchart.

Table 1 Background characteristics of study participants

Characteristic	Intervention group n=357 (%)	Comparison group n=328 (%)	Total n=685 (%)	p
Age (in years; range: 18–73)
Mean (SD)	44.5 (7.9)	43.4 (8.7)	44.0 (8.3)	0.095
<44	177 (49.6)	166 (50.6)	343 (50.7)	0.820
≥44	180 (50.4)	146 (49.4)	342 (49.3)
Gender
Men	94 (26.3)	123 (37.5)	217 (31.7)	0.002
Women	263 (73.7)	205 (62.5)	468 (68.3)
Formal education
No	71 (19.9)	68 (20.7)	139 (20.3)	0.784
Yes	286 (80.1)	260 (79.3)	546 (79.7)
Marital status
Divorced/separated/widowed/single	154 (43.1)	123 (37.5)	277 (40.4)	0.133
Married/cohabitating	203 (56.9)	205 (62.5)	408 (59.6)
Monthly household income per capita^a (in USD; range: 0–926)
Median (IQR)	21.6 (10.4, 37.0)	18.5 (7.9, 34.6)	20.6 (9.9, 37.0)	0.056
<20.6	174 (48.7)	172 (52.6)	340 (50.6)	0.313
≥20.6	183 (51.3)	158 (47.4)	344 (49.4)
Debt in the past 12 months
No	91 (25.5)	92 (28.1)	183 (26.7)	0.450
Yes	266 (74.5)	236 (71.9)	502 (73.3)
Food assistance
No	221 (61.9)	177 (54.0)	398 (58.1)	0.035
Yes	136 (38.1)	151 (46.0)	287 (41.9)
ART status
Not receiving ART	8 (2.2)	7 (2.1)	15 (2.2)	0.924
Receiving ART	349 (97.8)	321 (97.9)	670 (97.8)
Time since HIV seropositive diagnosis^a (in years; range: 1–22)
Median (IQR)	8 (6, 10)	8 (5, 10)	8 (5, 10)	0.575
<8	152 (42.7)	151 (46.0)	303 (44.3)	0.380
≥8	204 (57.3)	177 (54.0)	381 (55.7)
Internalized HIV-related stigma^b (range: 0–6)
Median (IQR)	3 (1, 4)	3 (2, 4)	3 (2, 4)	0.056
Low (IA-RSS score 0–2)	147 (41.4)	128 (39.0)	275 (40.3)	0.526
High (IA-RSS score 3–6)	208 (58.6)	200 (61.0)	408 (59.7)
Self-esteem score^c (range: 15–38)
Mean (SD)	28.7 (3.3)	28.6 (3.5)	28.7 (3.4)	0.740
Low (RSES score<28.7)	162 (45.6)	159 (48.8)	321 (47.1)	0.412
High (RSES score≥28.7)	193 (54.4)	167 (51.2)	360 (52.9)
Household food insecurity^b
Food secure	30 (8.4)	17 (5.2)	47 (6.9)	0.096
Food insecure	326 (91.6)	310 (94.8)	636 (93.1)
Depressive symptoms (HSCL-25)^a (range: 1–3.73)
Median (IQR)	1.87 (1.47, 2.27)	1.93 (1.60, 2.40)	1.93 (1.53, 2.33)	0.046
No (scores for depressive symptoms≤1.75)	157 (44.0)	122 (37.3)	279 (40.8)	0.076
Yes (scores for depressive symptoms>1.75)	200 (56.0)	205 (62.7)	405 (59.2)
Length of program participation (in years; range: 1–4)
Median (IQR)	2 (1, 2)
1 to <2	167 (46.8)
2 to <3	126 (35.3)
≥3	64 (17.9)
Participation in the program activities
Village savings and loan association	347 (97.2)
Skills training	176 (49.3)
Small cash grant	117 (32.8)

IQR, interquartile range; SD, standard deviation; ART, antiretroviral therapy; HSCL-25, 25-item Hopkins Symptom Checklist; IA-RSS, Internalized AIDS-Related Stigma Scale; RSES, Rosenberg Self-Esteem Scale. Bold denotes statistically significant p-value at 5% level.

^aOne participant did not respond to this item.

^bTwo participants did not respond to this item.

^cFour participants did not respond to this item.

Table 2 Factors associated with depressive symptoms (n=674)

Variable	AOR (95% CI)	p
Program participation status
Non-participants (ref.)	1.00
Participants	0.68 (0.52–0.88)	0.003
Age (in years; mean=44)
<44 (ref.)	1.00
≥44	0.87 (0.59–1.28)	0.483
Gender
Men (ref.)	1.00
Women	2.80 (1.92–4.07)	<0.001
Formal education
No (ref.)	1.00	0.635
Yes	0.93 (0.69–1.26)
Marital status
Divorced/separated/widowed/single (ref.)	1.00
Married/cohabitating	0.82 (0.54–1.23)	0.332
Monthly household income per capita (in USD; median=20.6)
<20.6 (ref.)	1.00
≥20.6	0.98 (0.97–0.99)	<0.001
Debt in the past 12 months
No (ref.)	1.00
Yes	0.98 (0.68–1.40)	0.893
ART status
Not receiving ART (ref.)	1.00
Receiving ART	0.49 (0.04–5.75)	0.569
Time since HIV seropositive diagnosis (in years; median=8)
<8 (ref.)	1.00
≥8	0.71 (0.38–1.32)	0.281
Food assistance
No (ref.)	1.00
Yes	0.67 (0.37–1.21)	0.181
Internalized HIV-related stigma (median=3)
Low (IA-RSS score 0–2) (ref.)	1.00
High (IA-RSS score 3–6)	4.00 (2.77–5.76)	<0.001
Self-esteem (mean=28.7)
Low (RSES score<28.7) (ref.)	1.00
High (RSES score≥28.7)	0.40 (0.26–0.62)	<0.001
Household food insecurity
No (ref.)	1.00
Yes	3.44 (2.00–5.93)	<0.001

AOR, adjusted odds ratio; CI, confidence interval; ART, antiretroviral therapy; IA-RSS, Internalized AIDS-related Stigma Scale; RSES, Rosenberg Self-Esteem Scale. Bold denotes statistically significant AOR and p-value at 5% level.

Table 3 Average treatment effect on the treated using propensity score matching

	Intervention group (n=356)	Comparison group (n=326)	Difference	SE	T-statistic
Unmatched	0.5618	0.6258	−0.0640	0.0376	−1.70
ATT	0.5618	0.6387	−0.0770	0.0387	−1.99

ATT, average treatment effect on the treated; SE, standard error.

Table 4 Comparison of balance between the intervention and comparison groups before and after propensity score matching for depressive symptoms (n=682)

		Mean
Variable		Intervention group	Comparison group	% bias^a	Reduction in % bias^a	p
Age (in years; ≥44)	Unmatched	0.506	0.497	1.7		0.821
	Matched	0.506	0.502	0.7	60.2	0.927
Gender (women)	Unmatched	0.736	0.623	24.4		0.001
	Matched	0.736	0.717	4.2	82.9	0.562
Formal education (yes)	Unmatched	0.801	0.794	1.5		0.844
	Matched	0.801	0.800	0.1	93.1	0.989
Marital status (married/cohabitating)	Unmatched	0.567	0.629	−12.5		0.103
	Matched	0.567	0.596	−5.9	53.1	0.437
Monthly household income per capita	Unmatched	10.589	9.795	7.7		0.315
(in USD; ≥20.6)	Matched	10.589	10.685	−0.9	88.0	0.901
Debt in the past 12 months (yes)	Unmatched	0.744	0.718	6.0		0.434
	Matched	0.744	0.744	0.2	96.9	0.980
ART status (receiving ART)	Unmatched	0.978	0.979	−0.7		0.929
	Matched	0.978	0.980	−1.8	−163.3	0.808
Time since HIV seropositive diagnosis	Unmatched	0.573	0.537	7.3		0.342
(in years; ≥8)	Matched	0.573	0.569	0.8	89.2	0.916
Food assistance (yes)	Unmatched	0.379	0.463	−17.0		0.026
	Matched	0.379	0.374	0.9	94.8	0.904

ART, antiretroviral therapy.

^aStandardized percentage bias: percentage of difference in sample means between the treated and non-treated sub-samples.

Table 5 Bias before and after propensity score matching

	Pseudo R^2	LR χ ^2a	p	Mean bias	Median bias	Rubin's B^b	Rubin's R^c
Unmatched	0.022	20.82	0.013	8.8	7.3	35.2	0.98
Matched	0.001	0.88	1.000	1.7	0.9	7.0	1.24

^aLikelihood-ratio chi-square test.

^bRubin's B: the absolute standardized difference of the means of the linear index of the propensity score between the treated and (matched) non-treated group.

^cRubin's R: the ratio of treated to (matched) non-treated variances in propensity score index.