Demographic and clinical factors correlating with high levels of psychological distress in HIV-positive women living in Ontario, Canada

Abstract

The concept of psychological distress includes a range of emotional states with symptoms of depression and anxiety and has yet to be reported in HIV-positive women living in Ontario, Canada, who are known to live with contributing factors. This study aimed to determine the prevalence, severity, and correlates of psychological distress among women accessing HIV care participating in the Ontario HIV Treatment Network Cohort Study using the Kessler Psychological Distress Scale (K10). The K10 is a 10-item, five-level response scale. K10 values range from 10 to 50 with values less than or equal to 19 categorized as not clinically significant, scores between 20 and 24 as moderate levels, 25–29 as high, and 30–50 as very high psychological distress. Correlates of psychological distress were assessed using the Pearson's chi-square test and univariate and multivariate logistic regression analysis. Moderate, high, and very high levels of psychological distress were experienced by 16.9, 10.4, and 15.1% of the 337 women in our cohort, respectively, with 57.6% reporting none. Psychological distress levels greater than 19, correlated with being unemployed (vs. employed/student/retired; AOR = 0.33, 95% CI: 0.13–0.83), living in a household without their child/children (AOR = 2.45, 95% CI: 1.33–4.52), CD4 counts < 200 cells/mm³ (AOR = 2.07, 95% CI: 0.89–4.80), and to a lesser degree an education of some college or less (vs. completed college or higher; AOR=1.71, 95% CI: 0.99–2.95). Age and ethnicity, a priori variables of interest, did not correlate with psychological distress. Findings suggest that socioeconomic factors which shape the demography of women living with HIV in Ontario, low CD4 counts, and losing the opportunity to care for their child/children has a significant relationship with psychological distress. Approaches to manage psychological distress should address and make considerations for the lived experiences of women since they can act as potential barriers to improving psychological well-being.

Keywords:

• psychological distress
• HIV
• women
• depression
• anxiety

Acknowledgements

We gratefully acknowledge all the people living with HIV who volunteered to participate in the OHTN Cohort Study and the work and support of the past and present members of the OCS Governance Committee: Adrian Betts, Anita C. Benoit, Les Bowman, Tracey Conway, Patrick Cupido (Chair), Tony Di Pede, Brian Finch, Michael J. Hamilton, Brian Huskins, Rick Kennedy, Ken King, Nathan Lachowsky, Joanne Lindsay, Shari Margolese, John McTavish, Colleen Price, Lori Stoltz, Darien Taylor, Rosie Thein, and Drs. Ahmed Bayoumi, Evan Collins, Curtis Cooper, Clemon George, Troy Grennan, Claire Kendall, and Greg Robinson. We thank all the interviewers, data collectors, research associates and coordinators, and nurses and physicians who provide support for data collection and extraction. The authors wish to thank the OHTN staff and their teams for data management and IT support (Mark Fisher, Director, IT) and study Coordinators (Kevin Challacombe, OCS Data & Brooke Ellis, OCS Research). The OHTN Cohort Study is supported by the AIDS Bureau – Ontario Ministry of Health and Long-Term Care. Two investigators are also the recipients of salary support from the Canadian Institutes of Health Research Canadian HIV Trials Network (AB) and the Canadian Institutes of Health Research (ANB).