Predictors of depression, anxiety, and overall psychological distress in people living with HIV/AIDS: analyses from the <i>Stigma Index Brazil 2.0</i>

Wendt, Guilherme Welter; Costa, Angelo Brandelli

doi:10.1590/0102-311XEN021925

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ARTICLE • Cad. Saúde Pública 41 (10) • 2025 • https://doi.org/10.1590/0102-311XEN021925 linkcopy

Predictors of depression, anxiety, and overall psychological distress in people living with HIV/AIDS: analyses from the Stigma Index Brazil 2.0

Preditores de depressão, ansiedade e sofrimento psicológico em geral entre pessoas vivendo com HIV/aids: análises do Índice de Estigma Brasil 2.0

Factores predictores de depresión, ansiedad y malestar psicológico general en personas que viven con VIH/SIDA: análisis del Stigma Index Brasil 2.0

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstracts

Internalized stigma has been strongly linked to mental health issues in people living with HIV/AIDS (PLHA), particularly depression. Nonetheless, the overlap between depressive symptoms and other psychopathologies is well-known among specialists. This study aimed to examine the factors predicting depressive and anxiety symptoms in PLHA. This is a community-based study (Stigma Index Brazil 2.0) that involved 1,784 PLHA recruited from seven Brazilian state capitals. Outcomes of interest were derived from the Patient Health Questionnaire (PHQ), and covariates included factors previously linked to poor mental health outcomes, such as social vulnerability, treatment adherence, internalized stigma, among others identified in the Stigma Index study. Internalized stigma was significantly associated with worse mental health outcomes across all models (i.e., depression, anxiety, and total PHQ-4 score). Moreover, other variables were differentially associated with each outcome, possibly indicating distinct pathways with which healthcare professionals might address the burden of mental suffering in PLHA. Clear implications for public policies are equally outlined.

Keywords:
Depression; Anxiety; Risk Factors

Parameter	1	2	3	4	5	6	7	8	9	10	11	12	13
1. Age
rho	-
p-value	-
2. Years living with HIV
rho	0.560	-
p-value	< 0.001	-
3. Education
rho	-0.196	-0.125	-
p-value	< 0.001	< 0.001	-
4. ART non-adherence
rho	- 0.118	- 0.016	-0.014	-
p-value	< 0.001	0.508	0.563	-
5. ART
rho	-0.050	-0.037	-0.034	0.021	-
p-value	0.037	0.121	0.155	0.384	-
6. Hardship in the previous year
rho	0.047	0.069	-0.269	0.102	0.023	-
p-value	0.048	0.004	< 0.001	< 0.001	0.334	-
7. Ethnic minority
rho	-0.091	-0.060	-0.001	-0.016	0.018	0.037	-
p-value	< 0.001	0.012	0.992	0.497	0.452	0.122	-
8. Religion minority
rho	0.061	0.040	-0.091	0.018	-0.017	0.104	0.204	-
p-value	0.011	0.094	< 0.001	0.463	0.486	< 0.001	< 0.001	-
9. HIV “key population”
rho	-0.249	-0.214	0.308	-0.013	-0.029	-0.126	0.057	-0.038	-
p-value	< 0.001	< 0.001	< 0.001	0.583	0.227	< 0.001	0.017	0.109	-
10. Internalized stigma
rho	-0.119	-0.160	-0.156	0.227	0.044	0.148	-0.003	0.022	-0.053	-
p-value	< 0.001	< 0.001	< 0.001	< 0.001	0.066	< 0.001	0.913	0.361	0.027	-
11. Depression
rho	-0.066	< 0.001	-0.120	0.127	0.079	0.282	0.028	0.031	-0.009	0.342	-
p-value	0.005	0.986	< 0.001	< 0.001	< 0.001	< 0.001	0.250	0.202	0.696	< 0.001	-
12. Anxiety
rho	-0.016	0.019	-0.137	0.152	0.077	0.247	0.016	0.056	-0.036	0.320	0.606	-
p-value	0.494	0.426	< 0.001	< 0.001	0.001	< 0.001	0.495	0.021	0.131	< 0.001	< 0.001	-
13. PHQ-4
rho	-0.046	0.012	-0.148	0.154	0.085	0.295	0.025	0.046	-0.027	0.366	0.887	0.899	-
p-value	0.055	0.630	< 0.001	< 0.001	< 0.001	< 0.001	0.296	0.056	0.250	< 0.001	< 0.001	< 0.001	-

	B	SE	95%CI	β	p-value	B0	SE	95%CI
Anxiety
Internalized stigma	0.300	0.030	0.240; 0.350	0.27	< 0.001	0.300	0.030	0.240; 0.350
Hardships in the past year (yes)	0.650	0.090	0.480; 0.820	0.17	< 0.001	0.650	0.090	0.480; 0.820
ART non-adherence	0.280	0.100	0.090; 0.480	0.07	0.005	0.280	0.100	0.090; 0.470
Currently not on ART	0.990	0.380	0.250; 1.740	0.06	0.009	0.990	0.390	0.200; 1.720
Years living with HIV	0.009	0.005	-0.003; 0.020	0.04	0.057	0.009	0.005	-0.002; 0.020
Depression
Internalized stigma	0.350	0.030	0.300; 0.400	0.32	< 0.001	0.350	0.030	0.290; 0.390
Hardships in the past year (yes)	0.820	0.090	0.650; 0.990	0.22	< 0.001	0.820	0.080	0.660; 0.990
Currently not on ART	0.860	0.370	0.140; 1.590	0.05	0.020	0.860	0.440	-0.050; 1.720
Years living with HIV	0.020	0.006	0.005; 0.030	0.08	0.005	0.020	0.006	0.005; 0.030
Age	-0.009	0.004	-0.020; -0.001	-0.06	0.020	-0.080	0.004	-0.020; 0.001
Key group (yes)	0.130	0.090	0.050; 0.310	0.03	0.153	0.130	0.090	-0.060; 0.310
PHQ-4
Internalized stigma	0.630	0.050	0.540; 0.720	0.32	< 0.001	0.630	0.050	0.540; 0.720
Hardships in the past year (yes)	1.450	0.150	1.150; 1.750	0.22	< 0.001	1.450	0.150	1.150; 1.750
Currently not on ART	1.840	0.660	0.550; 3.120	0.06	0.005	1.840	0.750	0.270; 3.250
ART non-adherence	0.370	0.170	0.030; 0.720	0.05	0.032	0.370	0.170	0.040; 0.710
Years living with HIV	0.030	0.010	0.006; 0.050	0.07	0.010	0.030	0.010	0.006; 0.050
Age	-0.010	0.007	-0.030; 0.001	0.05	0.076	-0.010	0.007	-0.030; 0.001

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Escola Nacional de Saúde Pública Sergio Arouca, Fundação Oswaldo Cruz Rua Leopoldo Bulhões, 1480 , 21041-210 Rio de Janeiro RJ Brazil, Tel.:+55 21 2598-2511, Fax: +55 21 2598-2737 / +55 21 2598-2514 - Rio de Janeiro - RJ - Brazil
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[TFN1] ART: antiretroviral therapy; PHQ-4: Patient Health Questionnaire.