A cross-sectional survey investigating the burden of, and psychosocial factors related to, psychological distress among people living with HIV in central Tanzania

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BACKGROUND: Psychological distress is a transdiagnostic factor associated with various mental health conditions which are highly prevalent among people living with HIV (PLWH). The aim of this study was to identify the burden of, and psychosocial factors related to, psychological distress among PLWH in Dodoma, Tanzania. METHODS: A cross-sectional study was conducted among PLWH aged ≥ 18 years recruited consecutively from two healthcare facilities, in person (currently in care) and by phone (lost to care). A questionnaire was interviewer-administered comprising the Kessler Psychological Distress 6 Scale (K6) and questions regarding psychosocial factors including physical health, money/finances, employment/work, family/friends, stigma/disclosure and other HIV-related factors. Logistic regression was used to calculate adjusted odds ratios (aOR) of distress for key sub-groups using evidence-based thresholds from the K6. Differences in psychosocial factors related to distress were investigated using multivariate regression. Regressions were adjusted for age, sex, tribe, employment status, education level, relationship status, residential type (urban/rural), care status, number of children, duration of living with HIV and study site. RESULTS: 461 PLWH participated in the study; 67% were aged ≥ 36 years, 71% were female and 58% were currently in care. More than half of PLWH (n = 270; 59%) were experiencing mild to severe distress; with 52% mildly distressed. PLWH employed by someone and PLWH self-employed had lower odds of distress compared to unemployed PLWH (aORs of 0.30, 95% CI 0.14-0.65 and 0.32, 95% CI 0.16-0.64, respectively). PLWH in a relationship also had lower odds of distress compared to PLWH not in a relationship (aOR 0.43, 95% CI 0.28-0.67). PLWH diagnosed > ten years ago had significantly higher odds of having psychological distress compared to PLWH diagnosed < five years prior (aOR 1.97, 95% CI 1.14-3.41). Physical health, money/finances and family/friends were associated with distress; however, factors differed between study sites, age, residential type, employment, relationship status and care status. CONCLUSIONS: A concerningly high proportion of PLWH are suffering from mild to severe distress which can manifest into depression, anxiety, substance misuse or other mental health conditions. Further investigations are needed to understand the interaction between psychosocial factors and distress and how distress can be prevented and reduced.

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