Depression during the COVID-19 pandemic among people living with HIV: Are low HIV/AIDS stigma and high perceived emotional support protective resources?

Mental health during and after the COVID-19 pandemic - a longitudinal study over 42 months in five European countries

Background: The mental health impact of the COVID-19 pandemic is well documented. However, only a few studies investigated mental health in later phases of the pandemic and after its official end. Moreover, little is known about people's psychological burden related to the pandemic and other global crises post-pandemic.Objective: Study's first objective was to compare mental health outcomes in the general population over the course of the pandemic and ten months post-pandemic. The second objective was to explore people's psychological burden regarding the pandemic, in comparison to current wars, climate crises, inflation, and poor government management and/or corruption in the post-pandemic era.Method: Participants from the general population of Austria, Croatia, Germany, Greece, and Portugal (68.8% female, Mage = 41.55) were assessed online up to four times between June 2020 and March 2024 (baseline sample: N = 7913). Adjustment Disorder New Module - 8 (ADNM-8), Patient Health Questionnaire (PHQ-2), and World Health Organization-Five Well-Being Index (WHO-5) were used to measure adjustment disorder, depression, and well-being. Prevalence rates were calculated and repeated measures ANOVAs applied to assess mental health at four time points. One-way repeated measures ANOVA was run to explore how the different global crises were related to participants' burden.Results: Temporal variations in mental health were evident across four assessment waves, with highest levels of probable adjustment disorder and depression in winter 2020/2021 (T2). A slight improvement of mental health was found at later time points. Current wars and inflation were the greatest sources of psychological burden at the post-pandemic assessment, revealing some cross-country differences.Conclusion: Although mental health differences in the general population were not as pronounced as in the acute phase of the pandemic, psychosocial support is still needed post-pandemic. This is likely to be due to other global crises that take a toll on people's mental health.

"Life mapping" exploring the lived experience of COVID-19 on access to HIV treatment and care in Malawi

Background

The COVID-19 pandemic in Malawi exacerbated, existing public health challenges including access to HIV treatment and care services. "Life Mapping," a component of the Citizen Science community-led project in Malawi, documented the lived experiences and perspectives of people living with HIV in the context of COVID-19.

Methods

Citizen Science Life Maps is a three-year qualitative, longitudinal project utilizing collaborative and participatory research methods through digital storytelling to document peoples' daily lives. Twenty participants living with HIV were recruited between 2022 and 2023 in two central regional districts of Malawi and two urban areas. The participants were given mobile smart phones to document the impact of COVID-19 on HIV prevention and treatment services, HIV treatment literacy, mental health and the COVID -19 vaccine. Data was analyzed using a thematic analysis approach.

Results

Access to HIV prevention and treatment slowly recovered yet introducing multi-month anti- retroviral dispensing raised concerns. In the absence of mental health care services, participants were resourceful in seeking alternative ways to deal with mental health. However, state sponsored violence in relation to COVID-19 public health measures impacted negatively not only on mental well-being but also on HIV treatment adherence. Whilst most recognized the importance of the COVID-19 vaccine, especially for people living with HIV, myths, misinformation, and conspiracy theories around the vaccine persisted especially religious themed misinformation.

Conclusions

The relationship between misinformation and COVID-19 vaccine hesitancy is complex and medical and scientific approaches may not be sufficient to prevent misinformation. Fear and misinformation are likely attributed to global uncertainty during the pandemic and the speed at which vaccines were developed with minimal opportunity to prepare global communities.

The association of changes in depression severity after the onset of the COVID-19 pandemic and viral nonsuppression among people with HIV

OBJECTIVE

This study sought to characterize changes in depressive symptom severity during the COVID-19 pandemic and the association of these changes with HIV viral nonsuppression among people with HIV (PWH).

DESIGN

A clinical cohort study.

METHODS

We included PWH in the Johns Hopkins HIV Clinical Cohort who completed the Patient Health Questionnaire 8 (PHQ-8) prepandemic (1 March 2018 to 28 February 2020) and during the COVID-era (1 September 2020 to 28 February 2022). PWH were classified according to depression severity categories prepandemic and during the COVID-era as: consistently depressed (prepandemic PHQ-8 >4 and no change in severity category); consistently nondepressed (prepandemic PHQ-8 ≤4 and no change in severity category); worsened (changed to a higher severity category) and; improved (change to a lower severity category). The association between changes in depressive symptom severity and viral nonsuppression (HIV RNA >200 copies/ml on the earliest viral load measured 7 days before to 12 months after the COVID-era PHQ-8 survey) was assessed using multivariable logistic regression.

RESULTS

Of 793 PWH, mean age was 56 (SD 10) years, 60% were male individuals and 88% were Black. After the onset of the pandemic, 60% were consistently nondepressed, 9% were consistently depressed, 15% worsened and 16% improved. PWH who worsened had 2.47 times the odds of viral nonsuppression (95% CI: 1.09-5.55) compared with the nondepressed group. Associations among other groups were not statistically significant.

CONCLUSION

Worsening depression during the COVID-era was associated with HIV viral nonsuppression. Strategies to monitor and address depression among PWH may contribute to reduced risk of viral nonsuppression.