Daniel Westreich, PhD

Disparities in depressive symptoms and resilience among reproductive-age women with and without HIV in the STAR Cohort

Teresa R. Filipowicz1, Thuy Thi Dieu Dao1, Andrew Edmonds1, Anandi N. Sheth2, Elizabeth F. Topper3, Seble G. Kassaye4, Maria L. Alcaide5, Adaora Adimora6, Aadia Rana7, Daniel Westreich1

1 UNC-Chapel Hill Gillings School of Global Public Health, Chapel Hill NC; 2 Emory University School of Medicine, Atlanta GA; 3 Johns Hopkins Bloomberg School of Public Health, Baltimore MD; 4 Georgetown University Medical Center, Washington DC; 5 University of Miami Miller School of Medicine, Miami FL; 6 UNC-Chapel Hill School of Medicine, Chapel Hill NC; 7 University of Alabama-Birmingham Heersink School of Medicine, Birmingham AL.

Health disparities are common among women with or at risk for HIV in the United States. We investigated disparities in depressive symptoms and resilience by sociodemographic, clinical, and social factors.

Using baseline data from the Study of Treatment and Reproductive Outcomes (STAR) cohort, we described disparities in depressive symptom scores and resilience by race, HIV status, poverty, and stability of health care access at baseline among reproductive-aged women with or without HIV (WWH and WwoH, respectively), with a focus on WWH. We used structured interviews to collect sociodemographic information, and validated surveys to collect information on depressive symptoms (CES-D) and resilience (Smith). We stratified by HIV, race (Black, non-Black), poverty (≤$1500/month vs. >$1500/month), and healthcare access stability (unstable, stable). We compared mean differences for continuous variables and proportion differences for binary variables, with estimates and 95% confidence intervals (CIs) generated from linear models or chi-square tests.

We studied 515 women in the STAR cohort who had baseline data collected by October 31, 2022. WWH had slightly higher levels of depressive symptoms than WwoH [difference in points] [1.4 (95% CI -0.7, 3.5)] and resilience [0.1 (-0.1, 0.2)] (p>0.05 for both). Among WWH, Black participants had higher levels of depressive symptoms [0.9 (-2.4, 4.3)] and resilience [0.1 (-0.1, 0.4)] than non-Black participants (p>0.05 for both). Among WWH, women in poverty had higher levels of depressive symptoms [4.7 (2.3, 7.2)] and lower levels of resilience [-0.3 (-0.5, -0.1)] than those not in poverty (p<0.05 for both). Finally, among WWH, those with unstable healthcare access had higher levels of depressive symptoms [6.5 (3.7, 9.4)] and lower levels of resilience [-0.3 (-0.5, -0.1)] than those with stable healthcare access (p<0.05 for both). There was minimal missingness (n<30) across all analyses.

Consideration of health disparities is a vital part of working towards health equity. We found here a suggestion that that among WWH, Black women, women in poverty, and women with unstable health care access all had higher levels of depressive symptoms. These findings, if confirmed after additional study, may help us identify particular groups that could benefit from additional intervention.

Depressive Symptoms and Associated Factors among Reproductive Age Women in the Southern United States

Thuy Thi Dieu Dao1, Teresa R. Filipowicz1, Andrew Edmonds1, Anandi N. Sheth2, Elizabeth F. Topper3, Seble G. Kassaye4, Maria L. Alcaide5, Adaora Adimora6, Aadia Rana7, Daniel Westreich1

1 UNC-Chapel Hill Gillings School of Global Public Health, Chapel Hill NC; 2 Emory University School of Medicine, Atlanta GA; 3 Johns Hopkins Bloomberg School of Public Health, Baltimore MD; 4 Georgetown University Medical Center, Washington DC; 5 University of Miami Miller School of Medicine, Miami FL; 6 UNC-Chapel Hill School of Medicine, Chapel Hill NC; 7 University of Alabama-Birmingham Heersink School of Medicine, Birmingham AL.

Growing evidence shows that depression is a critical threat to the health and well-being of women living with HIV, with implications for both survival and reproductive health outcomes. In this work we explore the prevalence of depressive symptoms among women of reproductive age with and without HIV participating in the Study of Treatment And Reproductive outcomes (STAR) cohort.

We analyzed available cross-sectional data at baseline of women enrolled in STAR, an ongoing prospective observational cohort with a focus on reproductive and mental health. Enrollment for STAR began in March 2021. We used the Center for Epidemiologic Studies Depression Scale (CES-D) to measure depressive symptoms. Chi-square tests and crude odds ratios (cORs) were used to describe depressive symptoms by sociodemographic, substance use, psychological and reproductive characteristics.

Among 350 women with HIV (WWH, mean age 36) and 164 without HIV (WwoH, mean age 33) enrolled to date in STAR, the majority were Black (83% WWH, 74% WwoH) and 40% WWH and 35% WwoH reported a CES-D score ≥ 16 (henceforth “depressive symptoms”; WWH: median 12, IQR: 5-22 and WwoH: median 10, IQR: 6-21). Hazardous alcohol use (AUDIT score ≥ 8) was associated with increased odds of depressive symptoms overall cOR=1.94 (95% CI: 1.13-3.36) and did not differ by HIV status. Among all women, the odds of depressive symptoms rose with each point increase in self-reported loneliness (cOR=2.00, 95% CI: 1.75-2.29) and lack of neighborhood safety (cOR=1.10, 95% CI: 1.05-1.16); these were similar among WWH and WwoH. We found lower odds of depressive symptoms with increasing resilience score (cOR=0.80, 95% CI: 0.76-0.84 per point) and increasing social support score (cOR=0.91, 95% CI: 0.89-0.94 per point) among women overall, and among WWH and WwoH separately. Number of children, history of pregnancy, and substance use were not associated with odds of depressive symptoms.

Depressive symptoms are common among women of reproductive age with and without HIV. Future analyses will help to confirm these initial findings, and then begin to identify targets for intervention to alleviate depressive symptoms, especially among WWH where the symptom burden is higher.