Depressive Symptoms, Quality of Life, and Worry Among People Living with HIV and Community Controls: A Cross-sectional Comparative Study in Tehran, Iran

Abstract

Background: Mental health problems are common among people living with HIV and may adversely affect treatment adherence, disease progression, and quality of life. Objectives: This study compared depressive symptoms, quality of life, and worry among adults living with HIV and community controls in Tehran, Iran. Methods: We conducted a cross-sectional comparative study of 48 adults living with HIV and 71 community controls recruited through convenience sampling in Tehran, Iran. Participants completed the Depression subscale of the Depression Anxiety Stress Scales–21, the World Health Organization Quality of Life–BREF, and the Penn State Worry Questionnaire. Between-group differences were assessed using independent-samples t tests and Pearson's chi-square tests. Binary logistic regression was used to examine cross-sectional associations of age and psychological variables with group membership (0 = HIV, 1 = community controls), with a sensitivity analysis additionally adjusting for education. Results: Compared with community controls, adults living with HIV reported significantly higher depressive symptoms (P = 0.013, Cohen's d = 0.50) and lower quality of life (P = 0.015, d = −0.50), whereas worry did not differ significantly (P = 0.355, d = 0.17). Educational attainment also differed significantly between the groups (χ2(2) = 27.50, P < 0.001). In the complete-case logistic model (n = 108), older age (odds ratio [OR] = 0.94, 95% confidence interval [CI], 0.90 - 0.98, P = 0.002) and higher depressive symptom scores (OR = 0.84, 95% CI, 0.74 - 0.96, P = 0.008) were associated with lower odds of community-control membership, corresponding to higher odds of HIV-group membership. Quality of life and worry were not independently associated with group membership. When education was added (n = 105), university-level education was strongly associated with control membership (OR = 5.63, 95% CI, 2.10 - 15.10), the depressive-symptom association was attenuated (OR = 0.86, 95% CI, 0.75 - 1.00, P = 0.047), and age was no longer significant (P = 0.069). Conclusions: In this sample, adults living with HIV reported higher depressive symptoms and lower quality of life than community controls. Depressive symptoms were the only measured psychological variable associated with group membership in the primary model, although this association was attenuated after adjustment for education. These findings support further evaluation of mental health assessment and psychosocial support within HIV care; however, causal inferences and the effectiveness of specific screening or intervention strategies require longitudinal and interventional research.