Profiles of Longitudinal Trajectories of Depressive Symptoms in HIV Positive Women: The Role of Family Support and Loneliness

Background and Purpose:

Although evidence suggests that women with HIV positive suffer from poor mental health, the issue has not received much attention.  The prevalence of depression among HIV positive women, ranging from 20% to 50%, is much higher than their seronegative female counterparts; this is concerning not only because of the suffering but because depression is often associated with poor adherence to antiretroviral therapy and other therapeutic efforts.  The purpose of the study was to examine trajectories of depressive symptoms among HIV positive women.  Research questions included: (1) What are the profiles of longitudinal trajectories of depressive symptoms among HIV positive women? and (2) What is the role of family support and loneliness in predicting these longitudinal trajectories?

Methods:

Data for the study were derived from a 3-year-longitudianl study of HIV positive women. Participants were interviewed and answered questionnaires every 6 months for 3 years, yielding 7 data points.  Of 125 participants, the current study included the 119 with less than 20% missing values.  After examining descriptive statistics, trajectories of depressive symptoms were classified using semiparametric group-based modeling (Proc Traj in SAS).  Two time-varying independent variables (family support and loneliness) were included in identifying latent subgroups of depression trajectory profiles.

Results:

The average age was 37.9 (SD = 9.4), 54.6% had lower than high school education, and 67% were not married.  A majority of participants were African Americans (69.7%), followed by non-Hispanic Whites (24.4%) and Hispanics (5.9%).  Overall, depressive symptoms demonstrated a stable trend over three years (ranging from 20.1 to 22.6 out of possible maximum score of 60).  From the array of potential models, we selected a three-class model based on fit criteria: (1) none/low depressed (n = 37); (2) moderately depressed (n = 59); and (3) severely depressed (n = 23).  Feeling lonely was associated with higher levels of depressive symptoms within all three groups.  Family support significantly reduced depressive symptoms only in the moderately depressed group.   

Conclusions and Implications:

Using the longitudinal data on HIV positive women, the current study identified three distinct classes of depression trajectories.  The cross-group influence of loneliness on depressive symptoms may indicate that alleviating a sense of social isolation would improve the psychological well-being of these women.  The finding on family support suggests that moderately depressive women with HIV positive may collect greatest benefits from having a supportive family.  Considering that women living with HIV tend to be socially isolated and social support helps them cope with the long HIV disease process, interventions should address social connectedness of these women.