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      Social Isolation and Mortality Among People Living with HIV in British Columbia, Canada

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          Abstract

          Social isolation, a risk factor for poor health within the general population, may be exacerbated by unique challenges faced by people living with HIV (PLHIV). This analysis examines the association between social isolation and all-cause mortality among a cohort of PLHIV experiencing multiple social vulnerabilities. The analytical sample included 936 PLHIV ≥ 19 years, living in British Columbia, Canada, and enrolled in the Longitudinal Investigation into Supportive and Ancillary Health Services (LISA) Study (2007–2010). Participants were classified as Socially Connected (SC), Minimally Isolated (MI) or Socially Isolated (SI) via latent class analysis. Cross-sectional survey data was linked to longitudinal clinical data from a provincial HIV treatment database. Mortality was assessed longitudinally up to and including December 31st, 2017. Through multivariable logistic regression, an association between SI and all-cause mortality was found (adjusted OR: 1.48; 95% CI 1.08, 2.01). These findings emphasize the need to mitigate effects of social isolation among PLHIV.

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          The online version of this article (10.1007/s10461-020-03000-2) contains supplementary material, which is available to authorized users.

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          Most cited references31

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          Social relationships and health.

          Recent scientific work has established both a theoretical basis and strong empirical evidence for a causal impact of social relationships on health. Prospective studies, which control for baseline health status, consistently show increased risk of death among persons with a low quantity, and sometimes low quality, of social relationships. Experimental and quasi-experimental studies of humans and animals also suggest that social isolation is a major risk factor for mortality from widely varying causes. The mechanisms through which social relationships affect health and the factors that promote or inhibit the development and maintenance of social relationships remain to be explored.
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            Social isolation: a predictor of mortality comparable to traditional clinical risk factors.

            We explored the relationship between social isolation and mortality in a nationally representative US sample and compared the predictive power of social isolation with that of traditional clinical risk factors.
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              Is Open Access

              Validating a Shortened Depression Scale (10 Item CES-D) among HIV-Positive People in British Columbia, Canada

              Objective To establish the reliability and validity of a shortened (10-item) depression scale used among HIV-positive patients enrolled in the Drug Treatment Program in British Columbia, Canada. Methods The 10-item CES-D (Center for Epidemiologic Studies Depression Scale) was examined among 563 participants who initiated antiretroviral therapy (ART) between August 1, 1996 and June 30, 2002. Internal consistency of the scale was measured by Cronbach’s alpha. Using the original CES-D 20 as primary criteria, comparisons were made using the Kappa statistic. Predictive accuracy of CES-D 10 was assessed by calculating sensitivity, specificity, positive predictive values and negative predictive values. Factor analysis was also performed to determine if the CES-D 10 contained the same factors of positive and negative affect found in the original development of the CES-D. Results The correlation between the original and the shortened scale is very high (Spearman correlation coefficient  = 0.97 (P<0.001). Internal consistency reliability coefficients of the CES-D 10 were satisfactory (Cronbach α = 0.88). The CES-D 10 showed comparable accuracy to the original CES-D 20 in classifying participants with depressive symptoms (Kappa = 0.82, P<0.001). Sensitivity of CES-D 10 was 91%; specificity was 92%; and positive predictive value was 92%. Factor analysis demonstrates that CES-D 10 contains the same underlying factors of positive and negative affect found in the original development of the CES-D 20. Conclusion The 10-item CES-D is a comparable tool to measure depressive symptoms among HIV-positive research participants.
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                Author and article information

                Contributors
                bobhogg@cfenet.ubc.ca
                Journal
                AIDS Behav
                AIDS Behav
                AIDS and Behavior
                Springer US (New York )
                1090-7165
                1573-3254
                14 August 2020
                : 1-12
                Affiliations
                [1 ]GRID grid.416553.0, ISNI 0000 0000 8589 2327, Epidemiology and Population Health Program, , BC Centre for Excellence in HIV/AIDS, ; 608-1081 Burrard Street, Vancouver, BC V6Z 1Y6 Canada
                [2 ]GRID grid.21729.3f, ISNI 0000000419368729, Mailman School of Public Health, , Columbia University, ; New York City, NY USA
                [3 ]GRID grid.143640.4, ISNI 0000 0004 1936 9465, Faculty of Human and Social Development, School of Public Health and Social Policy, , University of Victoria, ; Victoria, Canada
                [4 ]GRID grid.61971.38, ISNI 0000 0004 1936 7494, Faculty of Health Sciences, , Simon Fraser University, ; Burnaby, Canada
                [5 ]GRID grid.17091.3e, ISNI 0000 0001 2288 9830, Faculty of Medicine, School of Population and Public Health, , University of British Columbia, ; Vancouver, Canada
                [6 ]GRID grid.17091.3e, ISNI 0000 0001 2288 9830, Division of Infectious Diseases, Department of Medicine, Faculty of Medicine, , University of British Columbia, ; Vancouver, Canada
                Article
                3000
                10.1007/s10461-020-03000-2
                7427496
                32797358
                ebfa2647-7a76-468a-ac36-e2a04594c9e6
                © Springer Science+Business Media, LLC, part of Springer Nature 2020

                This article is made available via the PMC Open Access Subset for unrestricted research re-use and secondary analysis in any form or by any means with acknowledgement of the original source. These permissions are granted for the duration of the World Health Organization (WHO) declaration of COVID-19 as a global pandemic.

                History
                Funding
                Funded by: FundRef http://dx.doi.org/10.13039/501100000024, Canadian Institutes of Health Research;
                Award ID: 53396
                Award Recipient :
                Categories
                Original Paper

                Infectious disease & Microbiology
                social isolation,social environment,mortality,hiv,canada
                Infectious disease & Microbiology
                social isolation, social environment, mortality, hiv, canada

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