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Article

Health-Related Quality of Life of People Living with HIV: Contributions of Emotion Regulation and Self-Compassion

by
JohnBosco Chika Chukwuorji
1,2,3,*,
Chinonso Perpetual Odi
2,
Adaeze Chike-Okoli
3,4,
Nwando Maryann Morah
2,
Oluchi Miracle Osondu
2,
Dwi Kartika Rukmi
5,
Vera Victor-Aigbodion
6,7 and
John E. Eze
2
1
CS Mottt Department of Public Health, College of Human Medicine, Michigan State University, Flint, MI 48504, USA
2
Department of Psychology, University of Nigeria Nsukka, Nsukka 410001, Nigeria
3
IVAN Research Institute, Enugu 400001, Nigeria
4
Department of Clinical Psychology, Walden University, Minneapolis, MN 55401, USA
5
Department of Nursing, Jenderal Achmad Yani Yogyakarta University, Yogyakarta 55293, Indonesia
6
Department of Educational Psychology, University of Johannesburg, Johannesburg 2006, South Africa
7
Department of Educational Psychology, University of Nigeria Nsukka, Nsukka 410001, Nigeria
*
Author to whom correspondence should be addressed.
Venereology 2024, 3(3), 136-146; https://doi.org/10.3390/venereology3030011
Submission received: 1 December 2023 / Revised: 14 August 2024 / Accepted: 30 August 2024 / Published: 3 September 2024
Versions Notes

Abstract

:
Living with chronic health conditions such as HIV has implications for health-related quality of life (HRQoL) and improving the HRQoL of people living with HIV (PLWH) is becoming increasingly important for researchers, policymakers, and health practitioners. However, there is limited research on factors that help to explain HRQoL among persons with HIV in sub-Saharan Africa. We examined the contributions of emotion regulation and self-compassion in the HRQoL of 187 PLWH (56.1% female) drawn from the HIV clinic in a specialist hospital in southeast Nigeria. They completed the Brief Version of the Difficulties in Emotion Regulation Scale (DERS-18), Self-compassion Scale, and Patient-Reported Outcome Quality of Life-HIV (PROQOL-HIV). While controlling for participants’ demographic variables, the regression results showed that self-compassion was positively associated with HRQoL. Higher difficulties in emotion regulation were not associated with HRQoL in the presence of self-compassion. The findings extend the outcomes of previous research in other parts of the world and support the notion that enhancing self-compassion interventions may shore up the HRQoL of people living with chronic health conditions. HRQoL interventions that embody culturally informed self-compassion strategies and developmental level approach are needed for the health system in sub-Saharan Africa.

1. Introduction

Human immunodeficiency virus (HIV) remains a significant global public health issue and represents a considerable burden for public health and medical care systems, with more than 39 million infected people and over 40.4 million deaths [1]. About 67 percent of people living with HIV (PLWH) are in sub-Saharan Africa, a region which is also responsible for over 40 percent of new infections and 43 percent of reported acquired immune deficiency syndrome (AIDS)-related deaths globally [2]. Nevertheless, the availability of excellent HIV prevention, diagnosis, treatment, and care has transformed HIV infection into a chronic illness that can be managed, allowing those living with the virus to live long and healthy lives [2,3]. PLWH have been found to place greater value on some components of quality of life than observed in the general population [4]. Hence, the assessment of the health-related quality of life (HRQoL) of PLWH has become a significant issue of interest for health practitioners, policy makers, and researchers, with the now-abundant data on the health requirements of persons with HIV being helpful for effectively planning interventions [5,6,7].
HRQoL, a component of the general quality of life (QoL) of a person, is an estimate of the impacts of a disease and its treatment on the patient’s ability to live a fulfilling life [8]. It is widely acknowledged as an important clinical measure of perceived well-being for individuals who are HIV+ [9]. Identifying the risk and mitigating factors for HRQoL has significant implications for enhancing the well-being of PLWH [10,11]. A recent review of research on HRQoL among PLWH highlighted the lack of research on this issue in developing nations, especially in countries with a high prevalence of HIV/AIDS [12]. Sub-Saharan African countries (e.g., Nigeria) are among such places that have a substantial burden of the HIV epidemic and other sexually transmitted infections [2,13]. While HRQoL in PLWH is widely studied, very little is known about HRQoL among PLWH in Nigeria. Nigeria has significantly reduced the number of new HIV infections and raised treatment coverage during the last decade, but the country still has the highest HIV prevalence in sub-Saharan Africa, with about 2 million PLWH [14,15].
A psychological factor that has been observed to play a potentially unifying role in diverse areas of human functioning is emotion regulation [16,17,18,19]. Emotion regulation is the process by which individuals influence which emotions they have, when they have them, and how they experience and express them [20]. It also refers to people’s responses, which can either attenuate or exacerbate negative effects, which can be either adaptive or maladaptive [21]. Adaptive emotion regulation (e.g., cognitive reappraisal, distraction, and seeking social support) includes responses that ameliorate the intensity and duration of emotional distress arising from stressful stimuli [22] or optimize and maintain positive emotions [23]. Conversely, maladaptive emotion regulation (e.g., substance abuse, rumination, and suppression) refers to ineffective attempts to decrease negative emotional experiences, which may result in some success but paradoxically brings about sustained and exacerbated negative long-term outcomes [21,24]. Individuals with more significant difficulties in regulating their emotions are more likely to engage in maladaptive responses [25]. Hence, one strategy to motivate people to adopt actions that promote health is to evaluate and promote their emotion regulation [26].
Among PLWH in Pakistan and Iran, adaptive emotion regulation was associated with increased quality of life, while maladaptive emotion regulation strategies were associated with reduced quality of life [27,28]. Greater difficulties in emotion regulation were associated with significantly lower scores on all aspects of general QoL among PLWH in the USA [29]. Similar findings have been reported among Italian dermatologic patients [30] and those with gastric ulcers [31]. In another study, emotion regulation by means of distraction and less use of behavioral disengagement and positive reinterpretation reduced the negative impact of illness perception on the general QoL of PLWH [32]. There is scarce literature on the contributions of emotion regulation in HRQoL among PLWH in sub-Saharan Africa. This is one of the gaps that the current study intends to fill. Although there are other measures of difficulties in emotion regulation, the Brief Version of the Difficulties in Emotion Regulation Scale (DERS-18) has been considered the most used self-report questionnaire to assess difficulties in emotion regulation [33]. This is the measure we adopted in this study.
Self-compassion is also a behavioral variable critical to PLWH. In addition to being a robust construct with cross-cultural relevance [34,35], self-compassion is relevant in the context of the current research because PLWH are faced with stigma and discrimination that may result to self-criticism, isolation, and avoidant behaviors [36]. Self-compassion is being kind and non-judgmental toward oneself [37,38] and being able to use self-reassurance and soothing in times of adversity [38,39]. It includes being nonjudgmental about oneself [37,40] and recognizing one’s experience as part of the human condition [36]. Based on Gilbert’s [39,41] model of compassion, self-compassionate behaviors are components of the soothing system, which is associated with the evolved attachment system, as well as a prosocial motivating system that is intended to control negative emotions and alleviate human suffering by making oneself and others feel less alone and more content [42]. Enhancing self-compassion through psychological interventions has been linked to better mental and overall well-being [43,44].
Specifically, increase in self-compassion has been found to be associated with a reduction in avoidance of emotional discomfort and a decrease in shame and self-criticism [45]. Self-compassion was positively related to general QoL among PLWH in Indonesia [46] and Portugal [47], as well as in patients with cancer [48,49], cardiac diseases [50], diabetes [51], cystic fibrosis [52], and multiple sclerosis [53]. Conversely, in a fairly large sample from five countries, self-compassion was not significantly associated with HIV symptom severity [54], and there was a non-significant relationship between self-compassion and HRQoL in 34 Americans living with HIV [55]. The inconsistent findings call for further investigations of the relationship between self-compassion and quality of life of PLWH, especially in the parts of the world where knowledge is limited. In the present study, we adopted the short form of the Self-Compassion Scale [56] to assess self-compassion. We noted the observed need for improvement in the multidimensionality, multiple populations, and cultural relevance of existing self-compassion measures [57], yet the Self-Compassion Scale remains the most widely accepted measure of self-compassion among researchers [58].
Several generic measures of HRQoL [59] fail to capture some peculiarities of HRQoL specific to PLWH, and many of the existing studies on HRQoL among PLWH in sub-Saharan Africa utilized generic measures of QoL that were not specific to HIV/AIDS [60,61]. Evaluating the construct using measures specifically tailored to a given population’s peculiar issues is essential. Hence, in the present study, we sought to assess HRQoL using a condition-specific measure of the construct [62,63]. Extensive investigations of the contributions of factors such as difficulties in emotion regulation and self-compassion in HRQoL among this vital population (PLWH) are needed in view of their possible roles in disease prevention and health promotion. This knowledge is essential to inform policies and programs to improve HRQoL for PLWH, a population already vulnerable to poor HRQoL. We hypothesized that greater difficulties in emotion regulation would be associated with reduced HRQoL of PLWH and that PLWH who report high self-compassion would evidence increased HRQoL.

2. Method

2.1. Participants and Procedure

The participants were 187 adult PLWH (male = 82, 43.9%; female = 105, 56.1%) who attended the HIV clinic in a specialist hospital located in southeast Nigeria within the months of May–July 2019. All the patients who attended the clinic within the period and met the inclusion criteria participated in the study, except 2 persons who were reluctant to complete the measures. The inclusion criteria were being an adult (minimum age of 18 years) so that they could provide valid informed consent, a minimum of 12 months since the HIV diagnosis to give adequate time for the impact of the experience in the patient’s evaluation of their HRQoL after the HIV+ diagnosis, a minimum of secondary school education so that they could read and complete the measures without assistance, and no comorbidity with another chronic illness (see Table 1 for detailed participants’ characteristics). Ethical clearance for the study was obtained from the research ethics committee of Bishop Shanahan Specialist Hospital, Nsukka, Enugu State, Nigeria. The researchers recruited and trained two research assistants (one male and one female) who assisted in administering the questionnaire to the participants. An in-person approach was adopted in administering the measures to the participants. From May to July 2019, the research assistants approached the participants on the clinic days with the facilitation of nurses on duty who verified the eligibility of the patients for the study from their hospital folders. The nurses comprised both females and males, although female nurses were on duty on most days of the study. After explaining the purpose of the study and what they were required to do, the research assistants gave the questionnaire to those who consented to participate in the study. They were encouraged to respond to the test items honestly. No need for matching of research assistant and participant sexes was observed. The response rate was 81 percent.

2.2. Measures

2.2.1. Brief Version of the Difficulties in Emotion Regulation Scale (DERS-18)

The DERS-18 [64] was used to assess the participants’ ability to identify, accept, and manage their emotional experiences. The participants responded on a 6-point Likert scale format of totally disagree (1) to totally agree (6), with reverse scoring for 3 positively worded items. Sample items included the following: “I have difficulty making sense out of my feelings”; “When I am upset, I become embarrassed for feeling that way”; “When I am upset, I believe that wallowing in it is all I can do”; etc. In five datasets, Victor and Klonsky [64] found that the DERS-18 had excellent reliability and validity and performed similarly to the original DERS [25], despite comprising half the items. It had a very high internal consistency estimate of Cronbach’s α = 0.98 [64]. For the current study, Cronbach’s α = 0.88, which was considered good. Higher scores indicate more difficulties in emotion regulation.

2.2.2. Self-Compassion Scale

The 12-item Self-Compassion Scale [56] was used to assess kindness and non-judgmental attitude to oneself. The participants responded on a 5-point Likert scale of never (1) to always (5). Negatively phrased items (5) were scored in the reverse direction such that higher scores reflected more self-compassion. Sample items included the following: “I try to be understanding and patient towards those aspects of my personality I don’t like”; “I try to see my failings as part of the human condition”; “When something upsets me, I try to keep my emotions in balance”; etc. Internal consistency for the self-compassion scale was very high (α = 0.92) with substantial evidence of validity [56]. For the current study, we obtained an α of 0.78.

2.2.3. Patient-Reported Outcome Quality of Life-HIV (PROQOL-HIV)

PROQOL-HIV [62,63] measured the physical symptoms and mental health symptoms associated with the health condition, as well as social relationships and HIV treatment impacts. Typical items on the scale are the following: “During the last two weeks, because I am HIV positive, I felt tired”; “During the last two weeks, because I am HIV positive, I have been anxious”; “During the last two weeks, because I am HIV positive, I have difficulty with my love life”; etc. The participants responded on a 5-point Likert scale of never (0) to always (4). The sum of scores on the four scales (dimensions) of PROQOL-HIV was obtained to indicate the individual’s HRQoL. Higher scores indicated higher HRQoL. Internal consistency reliabilities (Cronbach’s α) of the scales ranged from 0.81 to 0.97 [62,63]. A previous study on PLWH in Nigeria reported α of 0.77 to 0.81 [5].

2.3. Data Analyses

The analysis was primarily to determine whether difficulties in emotion regulation and self-compassion were associated with HRQoL. We, however, considered it plausible that some participants’ demographic characteristics may potentially have shared the variance in HRQoL with the major variables in the study. We therefore computed the descriptive statistics for the participants’ demographic characteristics, the major factors (difficulties in emotion regulation and self-compassion), and the outcome variable (HRQoL). Pearson’s correlation (r) analysis was conducted to inspect relationships among the participants’ demographic factors, the major factors, and the outcome variable. Hierarchical multiple linear regression was applied for hypotheses testing while controlling for the demographic variables. The α for both Pearson’s correlation and regression analyses was set at 0.05.
The values of difficulties in emotion regulation, self-compassion, and HRQoL, as well the participants’ age, years since the HIV+ diagnosis, and CD4 count, were obtained as scores and therefore treated as continuous variables. The participants’ sex, marital status, educational status, religion, and employment status were obtained from the participants on the nominal scale and therefore treated as categorical variables. As they are widely accepted and validly interpretable, we included the categorical variables in Pearson’s correlations (r) and entered them as factors in linear regression considering that each of them was on two levels. Their categories are specified under the respective tables.

3. Results

Table 1 shows that the average number of years since the participants were diagnosed HIV+ was low (M = 6.20, SD = 4.69). Their mean age was 39.58 years (SD = 12.14): reducing the mean age by the standard deviation and also adding the standard deviation to the mean age (SD ± M) indicated that by the distribution of their ages, the majority of the participants were in their early or middle adulthood. There was a slightly higher proportion of females (56.1%) than males (43.9%) in the sample. Most of them (73.3%) were married. A large proportion (64.2%) attained only secondary education (O level). The majority of them (79.7%) were employed. Most of them (86.1%) were Christians, with a few being Muslims (4.3%), Traditionalists (2.7%), or other religions (7%).
Table 2 shows the zero-order (Pearson’s r) correlations of the demographic and study variables. Difficulties in emotion regulation had a low negative correlation with self-compassion. Age, marital status, and educational status had significant correlations with HRQoL. Educational status also correlated with self-compassion and all the demographic variables. The demographic variables were therefore controlled for in the regression analysis (see results in Table 3) to test the hypotheses of this study. Religion was not included in the zero-order correlations (Table 2) and regression analysis (Table 3), because there were very few participants in other religious groups besides Christians.
The results of the hierarchical multiple linear regression to test the hypotheses of this study are shown in Table 3. The demographic factors shown in Table 2 to be related to the study variables were entered in step 1 of the regression model, and their variances were partialed out. In line with the extant literature on the precedence of self-compassion to emotion regulation [65,66,67], self-compassion was entered into step 2 of the regression model, while difficulties in emotion regulation were entered into step 3.
Table 3 shows that among the demographic factors, educational status had a significant negative association with HRQoL, indicating that those with tertiary education reported lower HRQoL compared with those with secondary (O level) education. The other demographic factors were not significantly associated with HRQoL among PLWH.
Self-compassion was positively associated with HRQoL, indicating that participants with higher self-compassion also had higher HRQoL. Self-compassion contributed significantly to explaining the variance in HRQoL, accounting for 7% of the variance (∆R [2] = 0.07; β = 0.27, t = 3.78, p < 0.001). The overall model fit improved significantly when self-compassion was added as a factor in step 2, compared with step 1 and step 3. This is evident in the increase in R2 from 0.07, explained by the demographic factors, to 0.14, and only a minor change to 0.15 when difficulties in emotion regulation were added in step 3. The F-statistic further supports the significance of self-compassion in explaining variations in HRQoL among PLWH.
Difficulties in motion regulation did not show a significant association with HRQoL. It accounted for only 1 percent of the variance in HRQoL, and the overall model fit did not significantly improve when difficulties in emotion regulation were added as a factor in step 3: ∆F(1, 177) = 2.60, ∆R [2] = 0.01, p = 0.11 (p > 0.05). It may, however, be noted that as shown in Table 2, self-compassion and difficulties in emotion regulation were correlated and thereby shared a significant degree of variance. This implied that self-compassion, which was entered into the regression model before difficulties in emotion regulation, would have accounted for much of the variance attributable to difficulties in emotion regulation. All the factors in the regression model accounted for 15 percent of the variance in HRQoL among PLWH (R [2] = 0.15).

4. Discussion

The present study aimed to examine the contributions of emotion regulation and self-compassion in HRQoL in a sample of HIV+ sub-Saharan adults. We found that difficulties in emotion regulation were not significantly associated with HRQoL, which refuted our hypothesis that greater difficulties in emotion regulation would be significantly associated with lower HRQoL among PLWH. This finding is inconsistent with past research findings on the relationship between difficulties in emotion regulation and HRQoL of PLWH [27,28,29]. These earlier studies suggest that it is beneficial to develop behaviors like accepting emotions with awareness, focusing on something other than the cause of unfavorable feelings, or rephrasing emotionally charged events by viewing them as learning experiences in life. In Africa, PLWH face a lot of stigma and discrimination. It was assumed that under such intense stigma, discrimination, and related pressures, a lot of PLWH might have significant challenges in effectively controlling their emotions, such as anger and anxiety, and thus negatively impact their HRQoL. Although affective control by means of emotion regulation would not change those negative encounters or protect PLWH from the negative experiences, it was considered to promote their ability to properly manage how they feel [68]. Effective emotion regulation was therefore considered beneficial, whereas difficulties in emotion regulation would have deleterious consequences. From our findings in this study, it seems that the relationship between difficulties in emotion regulation and HRQoL may be substantially explained by the relationship between self-compassion and HRQoL. This view is congruent with the self-compassion theory and other empirical findings [65,66,67] that conceptualize emotion regulation as part of the processes encompassed in self-compassion. Thus, as suggested in these previous studies and implied by the findings in the present study, difficulties in emotion regulation may be a secondary process to self-compassion.
Consistent with our expectation that PLWH who report high self-compassion would evidence increased HRQoL, our results indicated that higher compassionate responses were associated with higher HRQoL. Although existing research in Western cultures showed that self-compassion was positively related to HRQoL in PLWH [45,46], some other findings of null effects exist [54,55]. The core components of self-compassion, kindness to oneself, and mindfulness enable people to have a sense of shared humanity that thwarts the element of isolation, notable in depression and anxiety [69]. Kindness to oneself prevents harsh self-judgment and its seemingly excessive guilt, while mindfulness impedes over-identification with pain, loss, and suffering. When PLWH can treat themselves with kindness and accept the chronicity of their health condition, the positive disposition may lead to good relationships with others that provide social support and more successful treatment, thereby reducing the stress of living with HIV. These processes when effectively utilized would likely disable difficulties in emotion regulation.
Although it was not part of our major aim in this study, we found that educational status was negatively associated with HRQoL, indicating that PLWH who had tertiary education reported lower HRQoL compared with those who attained only secondary (O level) education. It may be noted that the zero-order correlations presented in Table 2 show that educational status was also negatively related with self-compassion, probably implying that those with tertiary education had less self-compassion. This could negatively impact their HRQoL. In addition, there were a higher number of younger than older participants with tertiary education in the sample (Table 2) considering the negative correlation between age and educational status. The negative association of educational status with HRQoL then seems to suggest that younger persons who attained tertiary education may be more sensitive to perceived limitations imposed on their potentials in life due to the expected stigma, discrimination, and other pressures related to their HIV+ status. This possibility requires further exploration. It is plausible that those who were older also had a more extended number of years since their diagnosis with the health condition to adjust to life and improve on their HRQoL. It needs to be noted that age was moderately positively correlated with years since the HIV+ diagnosis, and age had a zero-order positive correlation with HRQoL. This, however, does not mean that living with HIV for a longer time transforms to the conclusion that one is living well. Counselling interventions, especially in Nigeria, thus need to pay attention to the aspirations and needs of all categories of PLWH but consider that those who are younger but highly educated may have more intensified challenges.
Despite the strengths of the present study, there are some notable limitations. First, causal inferences are excluded due to the study’s cross-sectional design and our data measurement using self-report questionnaires. Second, participation in the study was voluntary and excluded some potential participants based on the inclusion and exclusion criteria for participation in the study. We could not ascertain if those who did not complete the survey were, for example, marked by lower HRQoL compared with their counterparts who formed part of the sample for our study. Third, the sample was drawn from only one hospital, thus limiting the generalizability of the results to the entire population of PLWH in Nigeria. Fourth, the variance explained by the regression model was low, indicating that several vital factors may be relevant to HRQoL among PLWH. Fifth, evidence has shown that emotion regulation may be a mechanism of change in how self-compassion is linked to mental health outcomes [69], implying that mediation effects are worthwhile. However, recent ideas on mediation showed that cross-sectional data are limited in establishing such pathways of influence, except when there is sufficient evidence for temporality [70]. We obtained the data for both emotion regulation and self-compassion simultaneously, so we could not conduct a mediation analysis using the current data. More research is needed, particularly in the form of longitudinal and experience-sampling studies that consider both individual and contextual factors in understanding the dynamics of HRQoL among patients. Studies with larger samples across the geopolitical zones of a diverse country such as Nigeria are worthwhile.
Notwithstanding the weaknesses, this study adds to the existing body of knowledge and theory. The findings have implications for psychological interventions aimed at promoting HRQoL of PLWH. It further contributes to the field of HIV care by bringing awareness and understanding of emotion regulation and self-compassion regarding their impact on HRQoL, which can be most beneficial to clinicians and healthcare organizations when providing therapeutic treatment. Based on the positive association of self-compassion with HRQoL in this study, culturally couched systems of deliberate rumination and self-assertions on thriving are capable of etching memorable meanings to the individuals and help in the positive application of self-compassion to improve HRQoL among PLWH. Some of such therapeutic systems have been outlined and applied in therapeutic interventions in Africa [71,72]. The application and practice of mindfulness meditation could serve as the foundation for such intervention. Ultimately, the therapeutic intervention may also improve self-compassion among PLWH for improvements in HRQoL.

Author Contributions

Conceptualization, J.C.C. and C.P.O.; methodology, C.P.O., D.K.R. and V.V.-A.; validation, C.P.O., N.M.M. and O.M.O.; formal analysis, J.C.C. and J.E.E.; writing—original draft preparation, J.C.C., C.P.O. and N.M.M.; writing—review and editing, O.M.O., A.C.-O. and J.E.E.; supervision, J.C.C. and J.E.E. All authors have read and agreed to the published version of the manuscript.

Funding

This research received no external funding.

Institutional Review Board Statement

Ethical clearance for the study was obtained from the research ethics committee of Bishop Shanahan Specialist Hospital Nsukka, Enugu State, Nigeria.

Informed Consent Statement

Informed consent was obtained from all individual participants involved in the study.

Data Availability Statement

The data presented in this study are available on request from the corresponding author.

Acknowledgments

Authors are grateful to the patients who agreed to participate in the study.

Conflicts of Interest

The authors declare no conflicts of interest.

References

  1. World Health Organisation. HIV and AIDS. 13 July 2023. Available online: https://www.who.int/news-room/fact-sheets/detail/hiv-aids (accessed on 22 November 2023).
  2. Joint United Nations Programme on HIV/AIDS, UNAIDS. Danger: UNAIDS Global AIDS Update 2022; UNAIDS: Geneva, Switzerland, 2022; Available online: https://www.unaids.org/en/resources/documents/2022/in-danger-global-aids-update (accessed on 22 November 2023).
  3. Hattoh, K.A.; Sienso, B.A.; Kuugbee, E.D. Prevalence of comorbidities and associated factors among HIV patients attending antiretroviral clinics in the Tamale metropolis, Ghana. Venereology 2023, 2, 1–15. [Google Scholar] [CrossRef]
  4. Fazeli, P.L.; Montoya, J.L.; McDavid, C.N.; Moore, D.J. Older HIV+ and HIV− adults provide similar definitions of successful aging: A mixed-methods examination. Gerontologist 2020, 60, 385–395. [Google Scholar] [CrossRef]
  5. Onu, D.U.; Ifeagwazi, C.M.; Chukwuorji, J.C. Does posttraumatic growth buffer the association between death anxiety and quality of life among people living with HIV/AIDS? J. Clin. Psychol. Med. Settings 2021, 28, 229–238. [Google Scholar] [CrossRef]
  6. Onu, D.U.; Ifeagwazi, C.M.; Orjiakor, T.C. Intensified thinking: Implications for health related quality of life among people living with HIV/AIDS. Niger. J. Psychol. Res. 2017, 13, 1–6. [Google Scholar]
  7. Ifeagwazi, C.M.; Chukwuorji, J.C.; Onu, D.O. Death anxiety as a factor in health-related quality of life among people living with HIV/AIDS. Niger. J. Psychol. Res. 2018, 14, 34–38. [Google Scholar]
  8. Nilsson, E. Aspects of Health Related Quality of Life: Associations with Psychosocial and Biological Factors, and Use as Patient-Reported Outcome in Routine Health Care; Linköping University: Linköping, Sweden, 2012. [Google Scholar]
  9. Mitchell, M.M.; Nguyen, T.Q.; Isenberg, S.R.; Maragh-Bass, A.C.; Keruly, J.; Knowlton, A.R. Psychosocial and service use correlates of health-related quality of life among a vulnerable population living with HIV/AIDS. AIDS Behav. 2017, 21, 1580–1587. [Google Scholar] [CrossRef] [PubMed]
  10. Nguyen, A.L.; McNeil, C.J.; Han, S.D.; Rhodes, S.D. Risk and protective factors for health-related quality of life among persons aging with HIV. AIDS Care 2018, 30, 518–522. [Google Scholar] [CrossRef] [PubMed]
  11. van Luenen, S.; Garnefski, N.; Spinhoven, P.; Spaan, P.; Dusseldorp, E.; Kraaij, V. The benefts of psychosocial interventions for mental health in people living with HIV: A systematic review and meta-analysis. AIDS Behav. 2018, 22, 9–42. [Google Scholar] [CrossRef]
  12. Vu, G.T.; Tran, B.X.; Hoang, C.L.; Hall, B.J.; Phan, H.T.; Ha, G.H.; Latkin, C.A.; Ho, C.S.H.; Ho, R.C.M. Global research on quality of life of patients with HIV/AIDS: Is it socio-culturally addressed? (GAPRESEARCH). Int. J. Environ. Res. Public Health 2020, 17, 2127. [Google Scholar] [CrossRef]
  13. Nzoputam, C.; Adam, V.Y.; Nzoputam, O. Knowledge, prevalence and factors associated with sexually transmitted diseases among female students of a federal university in Southern Nigeria. Venereology 2022, 1, 81–97. [Google Scholar] [CrossRef]
  14. Bassey, A.E.; Miteu, G.D. A review of current trends in HIV epidemiology, surveillance, and control in Nigeria. Ann. Med. Surg. 2023, 85, 1790–1795. [Google Scholar] [CrossRef] [PubMed]
  15. Onovo, A.A.; Adeyemi, A.; Onime, D.; Kalnoky, M.; Kagniniwa, B.; Dessie, M.; Lee, L.; Parrish, D.; Adebobola, B.; Ashefor, G.; et al. Estimation of HIV prevalence and burden in Nigeria: A Bayesian predictive modelling study. EClinicalMedicine 2023, 62, 102098. [Google Scholar] [CrossRef]
  16. Aldao, A.; Gee, D.G.; De Los Reyes, A.; Seager, I. Emotion regulation as a transdiagnostic factor in the development of internalizing and externalizing psychopathology: Current and future directions. Dev. Psychopathol. 2016, 28, 927–946. [Google Scholar] [CrossRef] [PubMed]
  17. Aaron, R.V.; Finan, P.H.; Wegener, S.T.; Keefe, F.J.; Lumley, M.A. Emotion regulation as a transdiagnostic factor underlying co-occurring chronic pain and problematic opioid use. Am. Psychol. 2020, 75, 796–810. [Google Scholar] [CrossRef] [PubMed]
  18. Chukwuorji, J.C. Mediating Roles of Respiratory Sinus Arrythmia and Emotion Regulation in the Association between Childhood Sexual Abuse and Depressive Symptoms among Psychiatric Patients. Ph.D. Thesis, Department of Psychology, University of Nigeria, Nsukka, Nigeria, 2021. [Google Scholar]
  19. Sloan, E.; Hall, K.; Moulding, R.; Bryce, S.; Mildred, H.; Staiger, P.K. Emotion regulation as a transdiagnostic treatment construct across anxiety, depression, substance, eating and borderline personality disorders: A systematic review. Clin. Psychol. Rev. 2017, 57, 141–163. [Google Scholar] [CrossRef]
  20. Gross, J.J. The emerging field of emotion regulation: An integrative review. Rev. Gen. Psychol. 1998, 2, 271–299. [Google Scholar] [CrossRef]
  21. Kovacs, M.; Rottenberg, J.; George, C. Maladaptive mood repair responses distinguish young adults with early-onset depressive disorders and predict future depression outcomes. Psychol. Med. 2009, 39, 1841–1854. [Google Scholar] [CrossRef]
  22. Gross, J.J. Antecedent-and response-focused emotion regulation: Divergent consequences for experience, expression, and physiology. J. Personal. Soc. Psychol. 1998, 74, 224. [Google Scholar] [CrossRef]
  23. Parrott, W.G. Beyond hedonism: Motives for inhibiting good moods and for maintaining bad moods. In Handbook of Mental Control; Century Psychology Series; Wegner, D.M., Pennebaker, J.W., Eds.; Prentice-Hall, Inc.: Hoboken, NJ, USA, 1993; pp. 278–305. [Google Scholar]
  24. Kovacs, M.; Yaroslavsky, I.; Rottenberg, J.; George, C.J.; Kiss, E.; Halas, K.; Dochnal, R.; Benák, I.; Baji, I.; Vetró, A.; et al. Maladaptive mood repair, atypical respiratory sinus arrhythmia, and risk of a recurrent major depressive episode among adolescents with prior major depression. Psychol. Med. 2016, 46, 2109–2119. [Google Scholar] [CrossRef]
  25. Gratz, K.L.; Roemer, L. Multidimensional assessment of emotion regulation and dysregulation: Development, factor structure, and initial validation of the difficulties in emotion regulation scale. J. Psychopathol. Behav. Assess. 2004, 26, 41–54. [Google Scholar] [CrossRef]
  26. Menefee, D.S.; Ledoux, T.; Johnston, C.A. The importance of emotional regulation in mental health. Am. J. Lifestyle Med. 2022, 16, 28–31. [Google Scholar] [CrossRef]
  27. Bhatti, R.J.; Fahd, S.; Rehman, S.U. Exploring the role of cognitive emotion regulation strategies on the quality of life of HIV patients: Role of cognitive emotion regulation strategies. Pak. J. Health Sci. 2023, 4, 248–252. [Google Scholar] [CrossRef]
  28. Seyedalinaghi, S.; MohsseniPour, M.; Aghaei, E.; Zarani, F.; Fathabadi, J.; Mohammadifirouzeh, M. The relationships between early maladaptive schemas, quality of life and self-care behaviors in a sample of persons living with HIV: The potential mediating role of cognitive emotion regulation strategies. Open AIDS J. 2020, 14, 100–107. [Google Scholar] [CrossRef]
  29. Brandt, C.P.; Jardin, C.; Sharp, C.; Lemaire, C.; Zvolensky, M.J. Main and interactive effects of emotion dysregulation and HIV symptom severity on quality of life among persons living with HIV/AIDS. AIDS Care 2017, 29, 498–506. [Google Scholar] [CrossRef] [PubMed]
  30. Ciuluvica, C.; Amerio, P.; Fulcheri, M. Emotion regulation strategies and quality of life in dermatologic patients. Procedia-Soc. Behav. Sci. 2014, 127, 661–665. [Google Scholar] [CrossRef]
  31. Muazzam, A.; Ali, N.; Niazi, Y.; Hassan, N. Emotion regulation, optimism and quality of life among Gastric Ulcer Patients. Pak. J. Med. Sci. 2021, 37, 988–992. [Google Scholar] [CrossRef]
  32. Catunda, C.; Seidl, E.M.; Lemétayer, F. Quality of life of people living with HIV/AIDS: Effects of illness perception and coping strategies. Psicol. Teor. Pesqui. 2017, 32, 1–7. [Google Scholar] [CrossRef]
  33. Raimondi, G.; Balsamo, M.; Carlucci, L.; Alivernini, F.; Lucidi, F.; Samela, T.; Innamorati, M. Meta-analysis of the Difficulties in Emotion Regulation Scale and its short forms: A two-part study. J. Clin. Psychol. 2024, 80, 1797–1820. [Google Scholar] [CrossRef] [PubMed]
  34. Agarwal, A.; Lee, N.H.; Yaroslavsky, I. Culture Moderating between Self-Compassion, Emotion Dysregulation, and Depression. In Proceedings of the 91st Annual Meeting of the Midwestern Psychological Association, Chicago, IL, USA, 11–13 April 2019. [Google Scholar]
  35. Kemppainen, J.; Johnson, M.O.; Phillips, J.C.; Sullivan, K.M.; Corless, I.B.; Reid, P.; Iipinge, S.; Chaiphibalsarisdi, P.; Sefcik, E.; Chen, W.T.; et al. A multinational study of self-compassion and human immunodeficiency virus-related anxiety. Int. Nurs. Rev. 2013, 60, 477–486. [Google Scholar] [CrossRef]
  36. Brion, J.M.; Leary, M.R.; Drabkin, A.S. Self-compassion and reactions to serious illness: The case of HIV. J. Health Psychol. 2014, 19, 218–229. [Google Scholar] [CrossRef]
  37. Neff, K.D. Self-compassion: An alternative conceptualization of a healthy attitude towards oneself. J. Self Identity 2003, 2, 85–101. [Google Scholar] [CrossRef]
  38. Neff, K.D. Development and validation of a scale to measure self-compassion. J. Self Identity 2003, 2, 223–250. [Google Scholar] [CrossRef]
  39. Gilbert, P. Introducing compassion-focused therapy. Adv. Psychiatr. Treat. 2009, 15, 199–208. [Google Scholar] [CrossRef]
  40. Gilbert, P. The Compassionate Mind; Constable: London, UK, 2009. [Google Scholar]
  41. Gilbert, P. Compassion: Conceptualisations, Research and Use in Psychotherapy; Routledge: London, UK, 2005. [Google Scholar]
  42. Gilbert, P. Explorations into the nature and function of compassion. Curr. Opin. Psychol. 2018, 28, 108–114. [Google Scholar] [CrossRef]
  43. Chinweuba, D.C.; Ifeagwazi, C.M.; Chinweuba, A.; Chukwuorji, J.C. Does self-concealment and self-compassion differentially influence substance use for male versus female adolescents? J. Subst. Use 2022, 28, 117–122. [Google Scholar] [CrossRef]
  44. Kirschner, H.; Kuyken, W.; Wright, K.; Roberts, H.; Brejcha, C.; Karl, A. Soothing your heart and feeling connected: A new experimental paradigm to study the benefits of self-compassion. Clin. Psychol. Sci. 2019, 7, 545–565. [Google Scholar] [CrossRef]
  45. Germer, C.K.; Neff, K.D. Self-compassion in clinical practice. J. Clin. Psychol. 2013, 69, 856–867. [Google Scholar] [CrossRef]
  46. Atmaja, C.T.; Kusuma, W.; Putranto, P.A. The correlation of self-compassion (202 with life quality of people with HIV/AIDS (ODHA) in KDS Solo Plus Surakarta. In Proceedings of the Youth International Conference for Global Health 2022 (YICGH 2022); Waluyo, S.U.F., Yuliandari, E., Suwandono, A., Kharisma, D.B., Eds.; Atlantis Press: Amsterdam, The Netherlands, 2023; pp. 143–151. [Google Scholar] [CrossRef]
  47. Martins, A.; Canavarro, M.; Pereira, M. The role of psychological flexibility and self-compassion in mental health and quality of life of HIV-infected adults. In Proceedings of the International AIDS Society (IAS) Conference on HIV Science, Paris, France, 23–26 July 2017. [Google Scholar] [CrossRef]
  48. Pinto-Gouveia, J.; Duarte, C.; Matos, M.; Fráguas, S. The protective role of self-compassion in relation to psychopathology symptoms and quality of life in chronic and in cancer patients. Clin. Psychol. Psychother. 2014, 21, 311–323. [Google Scholar] [CrossRef]
  49. Treaster, M. Self-Compassion and Physical Health-Related Quality of Life in Cancer: Mediating Effects of Control Beliefs and Treatment Adherence. Master’s Thesis, East Tennessee State University, Johnson City, TN, USA, 2018; p. 3495. Available online: https://dc.etsu.edu/cgi/viewcontent.cgi?article=4949&context=etd (accessed on 10 June 2023).
  50. Dowd, A.J.; Jung, M.E. Self-compassion directly and indirectly predicts dietary adherence and quality of life among adults with celiac disease. Appetite 2017, 113, 293–300. [Google Scholar] [CrossRef]
  51. Misurya, I.; Misurya, P.; Dutta, A. The effect of self-compassion on psychosocial and clinical outcomes in patients with medical conditions: A systematic review. Cureus 2020, 12, e10998. [Google Scholar] [CrossRef]
  52. Kauser, S.; Keyte, R.; Regan, A.; Nash, E.F.; Fitch, G.; Mantzios, M.; Egan, H. Exploring associations between self-compassion, self-criticism, mental health, and quality of life in adults with Cystic Fibrosis: Informing future interventions. J. Clin. Psychol. Med. Settings 2022, 29, 332–343. [Google Scholar] [CrossRef] [PubMed]
  53. Gedik, Z.; Idiman, E. Health-related quality of life in multiple sclerosis: Links to mental health, self-esteem, and self-compassion. J. Psychiatry Neurol. Sci. 2020, 33, 59–70. [Google Scholar] [CrossRef]
  54. Webel, A.R.; Wantland, D.; Rose, C.D.; Kemppainen, J.; Holzemer, W.L.; Chen, W.T.; Johnson, M.O.; Nicholas, P.; Eller, L.S.; Chaiphibalsarisdi, P.; et al. A cross-sectional relationship between social capital, self-compassion, and perceived HIV symptoms. J. Pain Symptom Manag. 2015, 50, 59–68. [Google Scholar] [CrossRef] [PubMed]
  55. Skelton, W.M.; Cardaciotto, L.; O’Hayer, C.V.; Goldbacher, E. The role of self-compassion and shame in persons living with HIV/AIDS. AIDS Care 2021, 33, 818–826. [Google Scholar] [CrossRef] [PubMed]
  56. Raes, F.; Pommier, E.; Neff, K.D.; Van Gucht, D. Construction and factorial validation of a short form of the Self-Compassion Scale. Clin. Psychol. Psychother. 2011, 18, 250–255. [Google Scholar] [CrossRef]
  57. Jiang, H.; Wang, W.; Mei1, Y.; Zhao1, Z.; Lin, B.; Zhang, Z. A scoping review of the self-reported compassion measurement tools. BMC Public Health 2023, 23, 2323. [Google Scholar] [CrossRef]
  58. Egan, S.J.; Rees, C.S.; Delalande, J.; Greene, D.; Fitzallen, G.; Brown, S.; Webb, M.; Finlay-Jones, A. A review of self-compassion as an active ingredient in the prevention and treatment of anxiety and depression in young people. Adm. Policy Ment. Health Ment. Health Serv. Res. 2022, 49, 385–403. [Google Scholar] [CrossRef]
  59. Kaplan, R.M.; Hays, R.D. Health-related quality of life measurement in public health. Annu. Rev. Public Health 2022, 43, 355–373. [Google Scholar] [CrossRef]
  60. Abera, K.; Gedif, T.; Engidawork, E.; Gebre-Mariam, T. Quality of life of people living with HIV/AIDS and on highly active antiretroviral therapy in Ethiopia. Afr. J. AIDS Res. 2010, 9, 31–40. [Google Scholar] [CrossRef] [PubMed]
  61. Olisah, V.O.; Baiyewu, O.; Sheikh, T.L. Depression underdiagnosis and the effects on quality of life in outpatients with HIV at a Nigerian university teaching hospital. Afr. J. AIDS Res. 2011, 10, 247–254. [Google Scholar] [CrossRef]
  62. Duracinsky, M.; Herrmann, S.; Berzins, B.; Armstrong, A.R.; Kohli, R.; Le Coeur, S.; Diouf, A.; Fournier, I.; Schechter, M.; Chassany, O. The development of PROQOL-HIV: An international instrument to assess the health-related quality of life of persons living with HIV/AIDS. J. Acquir. Immune Defic. Syndr. 2012, 59, 498–505. [Google Scholar] [CrossRef] [PubMed]
  63. Duracinsky, M.; Lalanne, C.; Le Coeur, S.; Herrmann, S.; Berzins, B.; Armstrong, A.R.; Lau, J.T.; Fournier, I.; Chassany, O. Psychometric validation of the PROQOL-HIV questionnaire, a new Health-Related Quality of Life Instrument-Specific to HIV disease. J. Acquir. Immune Defic. Syndr. 2012, 59, 506–515. [Google Scholar] [CrossRef] [PubMed]
  64. Victor, S.E.; Klonsky, E.D. Validation of a Brief Version of the Difficulties in Emotion Regulation Scale (DERS-18) in Five Samples. J. Psychopathol. Behav. Assess. 2016, 38, 582–589. [Google Scholar] [CrossRef]
  65. Inwood, E.; Ferrari, M. Mechanisms of change in the relationship between self-compassion, emotion regulation, and mental health: A systematic review. Appl. Psychol. Health Well-Being 2018, 10, 215–235. [Google Scholar] [CrossRef]
  66. Neff, K.D. Self-compassion: Theory, method, research, and intervention. Annu. Rev. Psychol. 2023, 74, 193–218. [Google Scholar] [CrossRef]
  67. Paucsik, M.; Nardelli, C.; Bortolon, C.; Shankland, R.; Leys, C.; Baeyens, C. Self-compassion and emotion regulation: Testing a mediation model. Cogn. Emot. 2023, 37, 49–61. [Google Scholar] [CrossRef]
  68. Capobianco, L.; Nordahl, H. A brief history of metacognitive therapy: From cognitive science to clinical practice. Cogn. Behav. Pract. 2023, 30, 45–54. [Google Scholar] [CrossRef]
  69. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, 5th ed.; American Psychiatric Publishing, Inc.: Arlington, VA, USA, 2013. [Google Scholar] [CrossRef]
  70. Hayes, A.F. Introduction to Mediation, Moderation, and Conditional Process Analysis: A Regression-Based Approach, 3rd ed.; The Guilford Press: New York, NY, USA, 2022. [Google Scholar]
  71. Clay, S.V.; Jackson, C.; Stephenson, Q. Counseling techniques supporting West African children with adverse childhood experiences: A systematic review. Front. Sociol. 2021, 6, 573115. [Google Scholar] [CrossRef]
  72. Ebigbo, P.O. Harmony Restoration Therapy: Theory and practice. Int. J. Psychother. Afr. 2017, 2, 20–35. [Google Scholar]
Table 1. Participants’ demographic characteristics and means of study variables.
Table 1. Participants’ demographic characteristics and means of study variables.
VariableDescriptionStatistic
Age (years), M (SD)Range: 18–6939.59 (12.12)
Sex, n (%)Male82 (43.9)
Female105 (56.1)
Marital status, n (%)Never married50 (26.7)
Married137 (73.3)
Educational status, n (%)Secondary education (O level)120 (64.2)
Tertiary education67 (35.8)
Religion, n (%)Christian161 (86.1)
Muslim8 (4.3)
African Traditional Religionist5 (2.7)
Others13 (7.0)
Employment, n (%)Unemployed38 (20.3)
Employed149 (79.7)
Years since HIV+ diagnosis, M (SD)Range: 1–156.20 (4.69)
CD4, M (SD)Range: 105–1120429.92 (216.25)
Difficulties in emotion regulation, M (SD)Range: 18–9656.50 (18.32)
Self-compassion, M (SD)Range: 25–6040.62 (7.01)
Health-related quality of life, M (SD)Range: 9.64–400.00287.24 (87.17)
Table 2. Zero-order (r) correlations of demographic variables, emotion regulation, self-compassion, and health-related quality of life.
Table 2. Zero-order (r) correlations of demographic variables, emotion regulation, self-compassion, and health-related quality of life.
Variables123456789
1Age1
2Sex−0.041
3Marital status0.47 ***0.121
4Education−0.20 **−0.22 **−0.25 ***1
5Employment0.28 ***0.060.15 *−0.18 *1
6Years of HIV+0.48 ***0.090.20 **−0.27 ***0.131
7CD4count0.37 ***0.120.24 ***−0.25 ***0.050.68 ***1
8Self-compassion0.070.070.15 *−0.17 *0.040.060.101
9Difficulties in ER0.01−0.040.090.05−0.05−0.01−0.02−0.30 ***1
10HRQoL0.16 *−0.050.17 *−0.21 **0.040.080.070.30 ***−0.18 *
Note: *: p < 0.05; **: p < 0.01; ***: p < 0.001; sex (0 = male; 1 = female); marital status (0 = never married; 1 = married); education (0 = O level; 1 = tertiary education); employment (0 = unemployed; 1 = employed); ER = emotion regulation; HRQoL = health-related quality of life.
Table 3. Hierarchical multiple linear regression of health-related quality of life on difficulties in emotion regulation and self-compassion, controlling for demographic factors.
Table 3. Hierarchical multiple linear regression of health-related quality of life on difficulties in emotion regulation and self-compassion, controlling for demographic factors.
FactorsStep 1Step 2Step 3
BβtBβtBβt
Age0.630.090.920.680.091.030.650.090.99
Sex−16.54−0.09−1.25−17.37−0.10−1.37−18.12−0.10−1.43
Marital status18.680.101.1212.320.060.7616.230.081.00
Educational status−35.40−0.20−2.48 *−29.05−0.16−2.10 *−28.61−0.16−2.08 *
Employment status−4.95−0.02−0.30−5.38−0.03−0.34−6.71−0.03−0.42
Years since HIV+−0.16−0.01−0.08−0.010.00−0.000.060.000.03
CD4 count−0.01−0.02−0.16−0.01−0.03−0.34−0.02−0.04−0.37
Self-compassion 3.340.273.78 ***2.880.233.11 **
Emotion regulation −0.56−0.12−1.61
R [2]0.070.140.15
∆R [2]0.070.070.01
F1.97 (7, 179)3.64 (8, 178) ***3.55 (9, 177) ***
∆F1.97 (7, 179)14.31 (1, 178) ***2.60 (1, 177)
*: p < 0.05; **: p < 0.01; ***: p < 0.001; ∆R [2] = change in R [2]; ∆F = change in F.
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Chukwuorji, J.C.; Odi, C.P.; Chike-Okoli, A.; Morah, N.M.; Osondu, O.M.; Rukmi, D.K.; Victor-Aigbodion, V.; Eze, J.E. Health-Related Quality of Life of People Living with HIV: Contributions of Emotion Regulation and Self-Compassion. Venereology 2024, 3, 136-146. https://doi.org/10.3390/venereology3030011

AMA Style

Chukwuorji JC, Odi CP, Chike-Okoli A, Morah NM, Osondu OM, Rukmi DK, Victor-Aigbodion V, Eze JE. Health-Related Quality of Life of People Living with HIV: Contributions of Emotion Regulation and Self-Compassion. Venereology. 2024; 3(3):136-146. https://doi.org/10.3390/venereology3030011

Chicago/Turabian Style

Chukwuorji, JohnBosco Chika, Chinonso Perpetual Odi, Adaeze Chike-Okoli, Nwando Maryann Morah, Oluchi Miracle Osondu, Dwi Kartika Rukmi, Vera Victor-Aigbodion, and John E. Eze. 2024. "Health-Related Quality of Life of People Living with HIV: Contributions of Emotion Regulation and Self-Compassion" Venereology 3, no. 3: 136-146. https://doi.org/10.3390/venereology3030011

APA Style

Chukwuorji, J. C., Odi, C. P., Chike-Okoli, A., Morah, N. M., Osondu, O. M., Rukmi, D. K., Victor-Aigbodion, V., & Eze, J. E. (2024). Health-Related Quality of Life of People Living with HIV: Contributions of Emotion Regulation and Self-Compassion. Venereology, 3(3), 136-146. https://doi.org/10.3390/venereology3030011

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