Negative attitudes toward aging mediated the association between HIV status and depression among older people in...

In China, people living with HIV (PLWH) are aging. The study compared prevalence of probable depression between older PLWH and their HIV-negative counterparts, and tested the hypothesis that the between-group difference in depressive symptoms would be mediated by attitudes toward aging.

With informed consent, a cross-sectional survey was conducted via anonymous face-to-face interviews to 337 and 363 HIV-positive and HIV-negative people aged ≥50, respectively, in Yongzhou City, Hunan, China from December 2017 to August 2018. Depression was measured by the Center for Epidemiologic Studies Depression (CES-D) scale. Attitudes toward aging were measured by the Attitudes to Aging Questionnaire (subdomains: psychosocial loss, physical change, psychological growth). Bootstrapping analyses were performed to test the mediation hypothesis.

The prevalence of probable depression (CES-D ≥ 16) was significantly higher in the HIV-positive group than the HIV-negative group (44.8% versus 20.4%). The HIV-positive participants presented more negative attitudes toward aging (in psychosocial loss and physical change) than their HIV-negative counterparts. Negative attitudes toward aging were associated with more depressive symptoms. Overall attitudes toward aging (effect size=41.3%) and the subdomains of psychosocial loss (effect size=38.5%) and physical change (effect size=16.3%) partially mediated the association between HIV status and depressive symptoms, respectively.

The cross-sectional design limited the ability of causal inference. Selection bias, information bias, and confounding bias might exist.

Older PLWH might be more depressed than their HIV-negative counterparts in mainland China, partially because they possessed more negative attitudes toward aging. Interventions for depression may include components of improving attitudes toward aging.