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Abstract
Background
Events associated with the COVID-19 pandemic, such as physical distancing, closure
of community services, postponement of health appointments, and loss of employment
can lead to social isolation, financial uncertainty, and interruption of antiretroviral
adherence, resulting in additional health-related challenges (disability) experienced
among adults living with chronic illness such as HIV. ‘Living strategies’ is a concept
derived from the perspective of people living with HIV, defined as behaviors, attitudes
and beliefs adopted by people living with HIV to help deal with disability associated
with HIV and multi-morbidity. Our aim was to describe disability among adults living
with HIV and self-care living strategies used during the COVID-19 pandemic.
Methods
Adults living with HIV in Toronto, Ontario, Canada, including some with pre-pandemic
HIV Disability Questionnaire (HDQ) data, completed a cross-sectional web-based survey
between June-August 2020. The survey included the HDQ and questions about self-care
living strategy use during the pandemic. We compared disability (HDQ) scores prior
to versus during the pandemic using paired t-tests. We reported the proportion of
participants who engaged in various living strategies at least ‘a few times a week’
or ‘everyday’ during the pandemic.
Results
Of the 63 respondents, 84% were men, median age 57 years, and 62% lived alone. During
the pandemic the greatest disability severity was in the uncertainty (median 30; Interquartile
range (IQR): 16, 43) and mental-emotional (25; IQR: 14, 41) domains. Among the 51
participants with pre-pandemic data, HDQ severity scores were significantly greater
(worse) during the pandemic (vs prior) in all domains. Greatest change from prior
to during the pandemic was in the mental-emotional domain for presence (17.7; p<0.001),
severity (11.4; p<0.001), and episodic nature (9.3; p<0.05) of disability. Most participants
(>60%) reported engaging a ‘few times a week’ or ‘everyday’ in self-care strategies
associated with maintaining sense of control and adopting positive attitudes and beliefs.
Conclusions
People living with HIV reported high levels of uncertainty and mental-emotional health
challenges during the pandemic. Disability increased across all HDQ dimensions, with
the greatest worsening in the mental-emotional health domain. Results provide an understanding
of disability and self-care strategy use during the COVID-19 pandemic.
The eight-item Patient Health Questionnaire depression scale (PHQ-8) is established as a valid diagnostic and severity measure for depressive disorders in large clinical studies. Our objectives were to assess the PHQ-8 as a depression measure in a large, epidemiological population-based study, and to determine the comparability of depression as defined by the PHQ-8 diagnostic algorithm vs. a PHQ-8 cutpoint > or = 10. Random-digit-dialed telephone survey of 198,678 participants in the 2006 Behavioral Risk Factor Surveillance Survey (BRFSS), a population-based survey in the United States. Current depression as defined by either the DSM-IV based diagnostic algorithm (i.e., major depressive or other depressive disorder) of the PHQ-8 or a PHQ-8 score > or = 10; respondent sociodemographic characteristics; number of days of impairment in the past 30 days in multiple domains of health-related quality of life (HRQoL). The prevalence of current depression was similar whether defined by the diagnostic algorithm or a PHQ-8 score > or = 10 (9.1% vs. 8.6%). Depressed patients had substantially more days of impairment across multiple domains of HRQoL, and the impairment was nearly identical in depressed groups defined by either method. Of the 17,040 respondents with a PHQ-8 score > or = 10, major depressive disorder was present in 49.7%, other depressive disorder in 23.9%, depressed mood or anhedonia in another 22.8%, and no evidence of depressive disorder or depressive symptoms in only 3.5%. The PHQ-8 diagnostic algorithm rather than an independent structured psychiatric interview was used as the criterion standard. The PHQ-8 is a useful depression measure for population-based studies, and either its diagnostic algorithm or a cutpoint > or = 10 can be used for defining current depression.
Authors’ contributions: KKO led the planning and implementation of the study. KKO led the conceptualisation
of the study objectives, development of the protocol, oversaw study implementation,
analysis and interpretation, and drafted the manuscript. AMB, SCC, AMD, RA, and LA
are members of the original community-based exercise study research and core analytical
team, and were involved in the conceptualisation of the study design, development
of the protocol, study implementation, analysis and interpretation and drafting the
manuscript. PS, KME, CB, RH, DAB, JHV and SH are members of the research team, were
involved in the conceptualization of the study design, development of the protocol,
interpretation of study findings and reviewing the manuscript. All authors contributed
to the review and revision, and approved the final manuscript.
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