The Mediating Effect of Changes in Depression Symptoms on the Relationship between Health-Related Quality of Life and Alcohol Consumption: Findings from a Longitudinal Study among Men Living with HIV in India
Abstract
:1. Introduction
2. Materials and Methods
2.1. Study Design and Sample Participants
2.2. Measurements
2.2.1. Alcohol Use
2.2.2. Health-Related Quality of Life (HRQoL)
2.2.3. Depressive Symptoms
2.2.4. Demographic and Other Covariates
2.3. Statistical Analysis
3. Results
3.1. Characteristics of Participants
3.2. Associations between Depression Symptoms and Other Factors
3.3. Associations between Alcohol Use and Other Factors
3.4. Mediating Effects
4. Discussion
4.1. HRQoL and Alcohol Use
4.2. Depression Symptoms and Alcohol Use
4.3. Limitations
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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Alcohol Use | ||||
---|---|---|---|---|
Characteristics | Overall, n = 564 | Low, n = 354 | Hazardous, n = 210 | p-Value |
Age (in years), mean (range) | 42.0 (19.0–75.0) | 42.0 (19.0–72.0) | 42.0 (22.0–75.0) | 0.831 |
Education background, n (%) | 0.166 | |||
Illiterate | 62.0 (11.0%) | 31.0 (8.8%) | 31.0 (14.8%) | |
Primary school | 134.0 (23.8%) | 87.0 (24.6%) | 47.0 (22.4%) | |
Secondary school | 343.0 (60.8%) | 221.0 (62.4%) | 122.0 (58.1%) | |
High school and above | 25.0 (4.4%) | 15.0 (4.2%) | 10.0 (4.8%) | |
Marital status, n (%) | 0.837 | |||
Currently married | 463.0 (82.1%) | 293.0 (82.8%) | 170.0 (81.0%) | |
Never married | 49.0 (8.7%) | 29.0 (8.2%) | 20.0 (9.5%) | |
Separated/divorced/widowed | 52.0 (9.2%) | 32.0 (9.0%) | 20.0 (9.5%) | |
Religion, n (%) | 0.211 | |||
Hindu | 491.0 (87.1%) | 313.0 (88.4%) | 178.0 (84.8%) | |
Other | 73.0 (12.9%) | 41.0 (11.6%) | 32.0 (15.2%) | |
Migration, n (%) | 0.386 | |||
Born in Mumbai | 354.0 (62.8%) | 227.0 (64.1%) | 127.0 (60.5%) | |
Born outside Mumbai | 210.0 (37.2%) | 127.0 (35.9%) | 83.0 (39.5%) | |
Household income per month, n (%) | 0.819 | |||
<20,000 INR | 454.0 (80.5%) | 286.0 (80.8%) | 168.0 (80.0%) | |
≥20,000 INR | 110.0 (19.5%) | 68.0 (19.2%) | 42.0 (20.0%) | |
4-day ART adherence, n (%) | <0.001 * | |||
≥90% | 453.0 (80.3%) | 300.0 (84.7%) | 153.0 (72.9%) | |
<90% | 111.0 (19.7%) | 54.0 (15.3%) | 57.0 (27.1%) | |
Duration on ART (months), mean (SD) | 51.5 (32.8) | 51.6 (33.4) | 51.2 (31.8) | 0.952 |
CD4 count (cells/mL), mean (SD) | 469.6 (239.3) | 469.3 (235.0) | 470.0 (246.8) | 0.894 |
HIV symptoms, mean (SD) | 3.4 (3.0) | 3.1 (2.9) | 3.8 (2.9) | 0.002 * |
Family support, mean (SD) | 5.1 (3.0) | 4.7 (3.1) | 5.6 (2.8) | 0.001 * |
HIV-related stigma, mean (SD) | 42.6 (7.4) | 42.2 (7.5) | 43.3 (7.0) | 0.017 * |
Alcohol Use Risk | ||||
---|---|---|---|---|
Characteristics | Overall, n = 376 | Low, n = 295 | Hazardous, n = 81 | p-Value |
Age (in years), mean (range) | 44.3 (19.0–71.0) | 44.3 (19.0–71.0) | 44.2 (26.0–64.0) | 0.988 |
Education background, n (%) | 0.994 | |||
Illiterate | 25.0 (6.6%) | 20.0 (6.8%) | 5.0 (6.2%) | |
Primary school | 75.0 (19.9%) | 58.0 (19.7%) | 17.0 (21.0%) | |
Secondary school | 260.0 (69.1%) | 204.0 (69.2%) | 56.0 (69.1%) | |
High school and above | 16.0 (4.3%) | 13.0 (4.4%) | 3.0 (3.7%) | |
Marital status, n (%) | 0.402 | |||
Currently married | 274.0 (72.9%) | 219.0 (74.2%) | 55.0 (67.9%) | |
Never married | 53.0 (14.1%) | 41.0 (13.9%) | 12.0 (14.8%) | |
Separated/divorced/widowed | 49.0 (13.0%) | 35.0 (11.9%) | 14.0 (17.3%) | |
Religion, n (%) | 0.574 | |||
Hindu | 336.0 (89.4%) | 265.0 (89.8%) | 71.0 (87.7%) | |
Other | 40.0 (10.6%) | 30.0 (10.2%) | 10.0 (12.3%) | |
Migration, n (%) | 0.240 | |||
Born in Mumbai | 221.0 (58.8%) | 178.0 (60.3%) | 43.0 (53.1%) | |
Born outside Mumbai | 155.0 (41.2%) | 117.0 (39.7%) | 38.0 (46.9%) | |
Household income per month, n (%) | 0.331 | |||
<20,000 INR | 315.0 (83.8%) | 250.0 (84.7%) | 65.0 (80.2%) | |
≥20,000 INR | 61.0 (16.2%) | 45.0 (15.3%) | 16.0 (19.8%) | |
4-day ART adherence, n (%) | <0.001 * | |||
≥90% | 336.0 (89.4%) | 272.0 (92.2%) | 64.0 (79.0%) | |
<90% | 40.0 (10.6%) | 23.0 (7.8%) | 17.0 (21.0%) | |
Duration on ART (in months), mean (SD) | 57.9 (29.7) | 58.8 (29.4) | 54.6 (30.7) | 0.291 |
CD4 count (cells/mL), mean (SD) | 467.1 (215.0) | 468.6 (218.1) | 461.4 (204.9) | 0.983 |
HIV symptoms, mean (SD) | 2.4 (2.2) | 2.2 (2.3) | 3.2 (1.9) | <0.001 * |
Family support, mean (SD) | 2.9 (2.9) | 2.8 (2.9) | 3.3 (2.6) | 0.102 |
HIV-related stigma, mean (SD) | 36.9 (5.5) | 36.4 (5.3) | 39.1 (5.7) | <0.001 * |
Intervention Participants (n = 519) ¶ | Control Participants (n = 352) ⸸ | |||
---|---|---|---|---|
Characteristics | β (95% CI) | p-Value | β (95% CI) | p-Value |
Age (in years) | −0.073 (−0.163, 0.018) | 0.115 | −0.039 (−0.145, 0.067) | 0.466 |
Education background (ref: Illiterate) | ||||
Primary school | 0.040 (−0.068, 0.148) | 0.469 | 0.083 (−0.044, 0.210) | 0.200 |
Secondary school | −0.039 (−0.133, 0.055) | 0.415 | 0.001 (−0.104, 0.107) | 0.979 |
High school and above | 0.003 (−0.096, 0.102) | 0.952 | 0.058 (−0.061, 0.177) | 0.340 |
Marital status (ref: Never married) | ||||
Currently married | 0.051 (−0.044, 0.147) | 0.293 | −0.084 (−0.192, 0.024) | 0.128 |
Separated/divorced/widowed | −0.004 (−0.100, 0.092) | 0.934 | −0.059 (−0.172, 0.053) | 0.299 |
Religion (ref: Others) | ||||
Hindu | −0.042 (−0.129, 0.044) | 0.337 | 0.001 (−0.101, 0.098) | 0.103 |
Migration (ref: Born outside Mumbai) | ||||
Born in Mumbai | 0.046 (−0.044, 0.136) | 0.313 | 0.0530(−0.057, 0.163) | 0.348 |
Household income per month (ref: <20,000 INR) | ||||
≥20,000 INR | 0.029 (−0.058, 0.116) | 0.509 | −0.030 (−0.133, 0.074) | 0.577 |
4-day ART adherence (ref: <90%) | ||||
≥90% | 0.059 (−0.030, 0.147) | 0.193 | −0.073 (−0.176, 0.030) | 0.165 |
Duration on ART (months) | 0.055 (−0.035, 0.145) | 0.231 | 0.080 (−0.022, 0.181) | 0.124 |
CD4 count (cells/mL) | −0.085 (−0.172, 0.002) | 0.056 | −0.112 (−0.214, 0.011) | 0.030 |
HIV symptoms | −0.115 (−0.203, −0.027) | 0.011 * | −0.008 (−0.120, 0.104) | 0.889 |
Family support | −0.017 (−0.106, 0.072) | 0.712 | 0.070 (−0.043, 0.183) | 0.222 |
HIV-related stigma | 0.024 (−0.063, 0.111) | 0.583 | −0.113 (−0.220, −0.006) | 0.039 * |
Alcohol use at T1 (ref: Low risk) | ||||
Hazardous | 0.131 (0.043, 0.218) | 0.003 * | −0.066 (−0.168, 0.036) | 0.205 |
HRQoL Δ from T1-T2 | −0.111 (−0.199, −0.023) | 0.013 * | −0.341 (−0.445, −0.237) | <0.001 * |
Intervention Participants (n = 519) ¶ | Control Participants (n = 352) ⸸ | |||
---|---|---|---|---|
Characteristics | β (95% CI) | p-Value | β (95% CI) | p-Value |
Age (in years) | −0.053 (−0.137, 0.032) | 0.221 | −0.080 (−0.186, 0.027) | 0.141 |
Education background (ref: Illiterate) | ||||
Primary school | −0.065 (−0.162, 0.035) | 0.201 | 0.051 (−0.076, 0.178) | 0.432 |
Secondary school | 0.004 (−0.083, 0.091) | 0.936 | −0.081 (−0.178, 0.024) | 0.130 |
High school and above | −0.064 (−0.156, 0.027) | 0.168 | −0.004 (−0.123, 0.115) | 0.945 |
Marital status (ref: Never married) | ||||
Currently married | 0.033 (−0.055, 0.122) | 0.460 | 0.005 (−0.103, 0.114) | 0.924 |
Separated/divorced/widowed | −0.039 (−0.128, 0.050) | 0.388 | 0.052 (−0.061, 0.164) | 0.368 |
Religion (ref: Others) | ||||
Hindu | −0.067 (−0.148, 0.013) | 0.101 | 0.085 (−0.017, 0.187) | 0.101 |
Migration (ref: Born outside Mumbai) | ||||
Born in Mumbai | 0.172 (0.089, 0.256) | <0.001 * | −0.001 (−0.110, 0.110) | 0.997 |
Household income per month (ref: <20,000 INR) | ||||
≥20,000 INR | 0.063 (−0.018, 0.143) | 0.127 | 0.005 (−0.099, 0.109) | 0.923 |
4-day ART adherence (ref: <90%) | ||||
≥90% | −0.005 (−0.087, 0.077) | 0.909 | −0.038 (−0.141, 0.065) | 0.464 |
Duration on ART (months) | 0.026 (−0.057, 0.110) | 0.540 | 0.091 (−0.011, 0.193) | 0.080 |
CD4 count (cells/mL) | 0.012 (−0.069, 0.092) | 0.779 | −0.028 (−0.074, 0.131) | 0.585 |
HIV symptoms | −0.010 (−0.093, 0.072) | 0.805 | −0.161 (−0.273, −0.049) | 0.005 * |
Family support | −0.069 (−0.151, 0.014) | 0.102 | −0.047 (−0.160, 0.066) | 0.415 |
HIV-related stigma | 0.083 (0.002, 0.164) | 0.044 | −0.060 (−0.167, 0.048) | 0.276 |
Alcohol use at T1 (ref: Low risk) | ||||
Hazardous | 0.253 (0.172, 0.335) | <0.001 * | 0.330 (0.227, 0.432) | <0.001 * |
HRQoL Δ from T1-T2 | −0.122 (−0.204, −0.040) | 0.004 * | −0.107 (−0.217, 0.003) | 0.057 |
Depression Δ from T1-T2 | 0.174 (0.093, 0.256) | <0.001 * | 0.063 (−0.044, 0.171) | 0.248 |
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Ha, T.; Shi, H.; Shrestha, R.; Gaikwad, S.S.; Joshi, K.; Padiyar, R.; Schensul, S.L. The Mediating Effect of Changes in Depression Symptoms on the Relationship between Health-Related Quality of Life and Alcohol Consumption: Findings from a Longitudinal Study among Men Living with HIV in India. Int. J. Environ. Res. Public Health 2023, 20, 5567. https://doi.org/10.3390/ijerph20085567
Ha T, Shi H, Shrestha R, Gaikwad SS, Joshi K, Padiyar R, Schensul SL. The Mediating Effect of Changes in Depression Symptoms on the Relationship between Health-Related Quality of Life and Alcohol Consumption: Findings from a Longitudinal Study among Men Living with HIV in India. International Journal of Environmental Research and Public Health. 2023; 20(8):5567. https://doi.org/10.3390/ijerph20085567
Chicago/Turabian StyleHa, Toan, Hui Shi, Roman Shrestha, Sushma S Gaikwad, Kavita Joshi, Rupal Padiyar, and Stephen L. Schensul. 2023. "The Mediating Effect of Changes in Depression Symptoms on the Relationship between Health-Related Quality of Life and Alcohol Consumption: Findings from a Longitudinal Study among Men Living with HIV in India" International Journal of Environmental Research and Public Health 20, no. 8: 5567. https://doi.org/10.3390/ijerph20085567