Loneliness as a mediation from social support leading to a decrease of health-related quality of life among PLWHIV

Abstract

This study focused on the mental health of people living with HIV(PLWHIV) and explored their relationship between loneliness and perceived social support, health related quality of life (HRQoL) with a method of structural equation model. We collected clinical and psychological data from consecutively enrolled PLWHIV. A total of 201 PLWHIVs were enrolled and measured with self-reporting survey instruments of UCLA Loneliness Scale, Self-Rating Depression Scale, Self-Rating Anxiety Scale, Social Support Ratio Scale and Short Form Health Survey-36. The levels of loneliness, depression, anxiety, perceived social support and HRQoL were assessed. PLWHIV enrolled were divided into two groups of loneliness and non-loneliness based on their UCLA Loneliness Scale scores. Multivariable analysis indicated that being married is a protective factor associated with loneliness (OR = 0.226; P = 0.032). We further found the loneliness group had a higher level of depression (P < 0.001) and anxiety (P < 0.001), but lower level of HRQoL (P < 0.001) than the non-loneliness group. We found there was a positive linear correlation between social support and HRQoL among the enrolled PLWHIVs (r² = 0.0592; P = 0.0005). A structural equation model (SEM) was established to evaluate whether the loneliness played as a mediation role between social support and HRQoL. The model showed loneliness as a mediation from social support leading to a decrease of HRQoL. Our findings showed a potential psychological pathway from social support to HRQoL, suggesting the need for interventions focusing on social support may improve poor HRQoL lead by loneliness.

Keywords: health related quality of life; loneliness; mediation; mental health; people living with HIV; social support.

Figure 1

Levels of depression and anxiety in the loneliness and non–loneliness groups. (A) The depression score of PLWHIV with loneliness were 57.10 ± 10.12, significantly higher than in that without loneliness 46.02 ± 10.50 (P < 0.001). (B) The depression score of PLWHIV with loneliness were 52.85 ± 8.61, significantly higher than in that without loneliness 42.75 ± 6.79 (P < 0.001). (C) The proportion of diagnosed with depression was significantly higher in PLWHIV with loneliness than that without loneliness. (D) The proportion of diagnosed with anxiety was significantly higher in PLWHIV with loneliness than that without loneliness. (E) The relationships between SDS Scores and UCLA Loneliness Scale Scores. (F) The relationships between SDS Scores and UCLA Loneliness Scale Scores. SAS, Self–Rating Anxiety Scale; SDS, Self–Rating Depression Scale; UCLA, The University of California, Los Angeles.

Figure 2

The relationships between SSRS scores and SF−36 scores. (A) The relationship between SSRS Scores and SF−36 Scores on Mental health. (B) The relationship between SSRS Scores and SF−36 scores on Physical health. (C) The relationship between SSRS Scores and total SF−36 scores. (D) The relationship between SSRS Scores on Objective Support and SF−36 scores on Mental health. (E) The relationship between SSRS Scores on Subjective Support and SF−36 scores on Mental health. (F) The relationship between SSRS Scores on Utilization of Support and SF−36 scores on Mental health. (G) The relationship between SSRS Scores on Objective Support and SF−36 scores on Physical health. (H) The relationship between SSRS Scores on Subjective Support and SF−36 scores on Physical health. (I) The relationship between SSRS Scores on Utilization of Support and SF−36 scores on Physical health.

Figure 3

Aspects of HRQoL in the loneliness and non–loneliness groups. (A) The SF−36 Scale score on physical health of PLWHIV with loneliness were 336.85 ± 33.52, significantly higher than that without loneliness 300.70 ± 57.36 (P < 0.001). (B) The SF−36 Scale score on mental health of PLWHIV with loneliness were 335.95 ± 51.38, significantly higher than that without loneliness 267.44 ± 68.69 (P < 0.001). (C) The SF−36 Scale score on physical health was significantly and negatively co–related with UCLA Loneliness Scale scores. (D) The SF−36 Scale score on mental health was significantly and negatively co–related with UCLA Loneliness Scale scores. (E) Eight aspects of SF−36 Scale scores in two groups. *P < 0.001; **P < 0.05; ***P > 0.05. Non–loneliness group vs. non–loneliness group: Mean ± SD. PF: 96.31 ± 6.67 vs. 90.96 ± 14.26; RP: 94.39 ± 20.98 vs. 79.26 ± 39.93; BP: 93.23 ± 11.95 vs. 87.52 ± 11.31; GH: 52.91 ± 14.64 vs. 42.96 ± 12.97; VT: 74.63 ± 12.32 vs. 56.70 ± 15.96; SF: 108.18 ± 18.34 vs. 90.82 ± 22.98; RE: 82.87 ± 31.51 vs. 65.96 ± 41.47; MH: 70.28 ± 14.90 vs. 53.96 ± 13.72; HT: 55.53 ± 25.11 vs. 48.67 ± 27.28. SF−36, 36–Item Short Form Survey Instrument; UCLA, The University of California, Los Angeles; PF, Physical Function; RP, Role Physical; BP, Bodily Pain; GH, General Health; VT, Vitality; SF, Social Functioning; RE, Role Emotional; MH, Mental Health; HT, Reported Health Transition.

Figure 4

Structural equation model for the mediation mechanism of loneliness with standardized beta weights and significant level. ***P < 0.001; **P < 0.01; Fit statistics: CMIN:20.721; DF:16; CMIN/DF: 1.295; GFI: 0.975; NFI: 0.969; IFI: 0.993; TLI: 0.987; CFI: 0.993; RMSEA: 0.038; HOELTER: 254. HRQoL, Health Related Quality of Life.