Advertisement

Quality of Life Research

, Volume 28, Issue 1, pp 57–65 | Cite as

Psychosocial predictors of quality of life among South Africa adolescents receiving antiretroviral therapy

  • A. KageeEmail author
  • B. Coetzee
  • S. Du Toit
  • M. E. Loades
Article
  • 75 Downloads

Abstract

Purpose

Minimal research has been conducted to understand how fatigue influences quality of life (QOL) among adolescents living with HIV. The purpose of the study was to examine the relationship between fatigue, sleep disturbance, depression, anxiety, pain and QOL among adolescents receiving antiretroviral therapy (ART).

Methods

Using a cross-sectional survey design, we studied 134 South African adolescents receiving an ART at community clinics.

Results

Participants in general reported low levels of fatigue, insomnia, distress and pain and non-problematic levels of QOL. In the regression model, the linear combination of these variables explained 49% of the variance in QOL, a large effect size. Insomnia, anxiety, and depression significantly predicted QOL but surprisingly fatigue and pain did not.

Conclusions

Many members of the sample experienced non-clinical levels of sleep disturbance, fatigue and psychosocial distress. Similarly, QOL was within the normal range. These findings are surprising as the commonly held assumption is that adolescents living with HIV, especially those of poorer socio-economic backgrounds, would experience lower QOL than the norm. Even though scores on the instruments measuring these variables fell in the non-clinical range, they were still robustly predictive of poor QOL. Future research may address the relationship between self-reported adherence and QOL, possibly by examining the role of viral load as a mediating variable. Further research may also focus on non-adherent adolescents to understand the ways in which fatigue and other factors such as school functioning and social interaction influence QOL.

Keywords

Quality of life Adolescents Fatigue Antiretroviral therapy 

Notes

Acknowledgements

We would like to acknowledge Stellenbosch Universities Sub-Committee A, as well as the University of Bath’s Faculty of Humanities and Social Sciences & Department of Psychology for funding this research. The funding was supported by Universiteit Stellenbosch (ZA) and University of Bath.

Funding

Dr. Loades is funded by the National Institute for Health Research (Doctoral Research Fellowship, DRF-2016-09-021). This report is independent research. The views expressed in this publication are those of the authors(s) and not necessarily those of the NHS, The National Institute for Health Research or the Department of Health. Dr. Kagee is funded by the National Research Foundation.

Compliance with ethical standards

Conflict of interest

All authors declare that they have no conflict of interest to disclose.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

References

  1. 1.
    Shisana, O., Rehle, T., Simbayi, L. C., Zuma, K., Jooste, S., Zungu, N., … Onoya, D. (2014). South African national HIV prevalence, incidence and behaviour survey, 2012. Cape Town: HSRC Press.Google Scholar
  2. 2.
    South African National AIDS Council Trust. (2015). South Africa global AIDS response progress report. Hatfield: South African National AIDS Council Trust.Google Scholar
  3. 3.
    Lifson, A. R., Grund, B., Gardner, E. M., Kaplan, R., Denning, E., Engen, N., … Emery, S. (2017). Improved quality of life with immediate versus deferred initiation of antiretroviral therapy in early asymptomatic HIV infection. AIDS, 31(7), 953–963.  https://doi.org/10.1097/QAD.0000000000001417.CrossRefGoogle Scholar
  4. 4.
    Torres, T. S., Harrison, L. J., La Rosa, A. M., Cardoso, S. W., Zheng, L., Ngongondo, M., … Hughes, M. D. (2018). Quality of life improvement in resource-limited settings after one year of second-line antiretroviral therapy use among adult men and women. AIDS.  https://doi.org/10.1097/QAD.0000000000001738.Google Scholar
  5. 5.
    The United Nations Children’s Fund (UNICEF). (2013). Towards an AIDS-free generation: Children and AIDS, sixth stocktaking report, 2013. New York, The United Nations Children’s Fund (UNICEF).Google Scholar
  6. 6.
    Mason-Jones, A. J., Sinclair, D., Mathews, C., Kagee, A., Hillman, A., & Lombard, C. (2016). School-based interventions for preventing HIV, sexually transmitted infections, and pregnancy in adolescents. Cochrane Database of Systematic Reviews.  https://doi.org/10.1002/14651858.CD006417.pub3.Google Scholar
  7. 7.
    Mbalinda, S. N., Kiwanuka, N., Kaye, D. K., & Eriksson, L. E. (2015). Reproductive health and lifestyle factors associated with health-related quality of life among perinatally HIV-infected adolescents in Uganda. Health and Quality of Life Outcomes, 13(1), 170.  https://doi.org/10.1186/s12955-015-0366-6.CrossRefGoogle Scholar
  8. 8.
    Enimil, A., Nugent, N., Amoah, C., Norman, B., Antwi, S., Ocran, J., … Barker, D. H. (2016). Quality of life among Ghanaian adolescents living with perinatally acquired HIV: A mixed methods study. AIDS Care, 28(4), 460–464.  https://doi.org/10.1080/09540121.2015.1114997.CrossRefGoogle Scholar
  9. 9.
    Tan, S. Y., Bradley-Klug, K., & Chenneville, T. (2017). Health-related quality of life and mental health indicators in adolescents with HIV compared to a community sample in the Southeastern US. AIDS Care, 29(2), 214–222.  https://doi.org/10.1080/09540121.2016.1210078.CrossRefGoogle Scholar
  10. 10.
    Voss, J. G., Portillo, C. J., Holzemer, W. L., & Dodd, M. J. (2007). Symptom cluster of fatigue and depression in HIV/AIDS. Journal of Prevention & Intervention in the Community, 33(1–2), 19–34.  https://doi.org/10.1300/J005v33n01_03.CrossRefGoogle Scholar
  11. 11.
    Shephard, R. J. (2001). Chronic fatigue syndrome: An update. Sports Medicine (Auckland, N.Z.), 31(3), 167–194.CrossRefGoogle Scholar
  12. 12.
    Varni, J. W., Burwinkle, T. M., & Szer, I. S. (2004). The PedsQL multidimensional fatigue scale in pediatric rheumatology: Reliability and validity. The Journal of Rheumatology, 31(12), 2494–2500.Google Scholar
  13. 13.
    Gold, J. I., Mahrer, N. E., Yee, J., & Palermo, T. M. (2009). Pain, fatigue, and health-related quality of life in children and adolescents with chronic pain. The Clinical Journal of Pain, 25(5), 407–412.  https://doi.org/10.1097/AJP.0b013e318192bfb1.CrossRefGoogle Scholar
  14. 14.
    Nutini, M., Karczewski, M., & Capoor, J. (2009). Fatigue in children with neurologic impairments. Physical Medicine and Rehabilitation Clinics of North America, 20(2), 339–346.  https://doi.org/10.1016/j.pmr.2008.12.004.CrossRefGoogle Scholar
  15. 15.
    Banwell, B., Ghezzi, A., Bar-Or, A., Mikaeloff, Y., & Tardieu, M. (2007). Multiple sclerosis in children: Clinical diagnosis, therapeutic strategies, and future directions. The Lancet Neurology, 6(10), 887–902.  https://doi.org/10.1016/S1474-4422(07)70242-9.CrossRefGoogle Scholar
  16. 16.
    Webel, A. R., Perazzo, J., Decker, M., Horvat-Davey, C., Sattar, A., & Voss, J. G. (2016). Physical activity is associated with reduced fatigue in adults living with HIV/AIDS. Journal of Advanced Nursing, 72(12), 3104–3112.  https://doi.org/10.1111/jan.13084.CrossRefGoogle Scholar
  17. 17.
    Weis, J., Tomaszewski, K. A., Hammerlid, E., Ignacio Arraras, J., Conroy, T., Lanceley, A., … Bottomley, A. (2017). International psychometric validation of an EORTC quality of life module measuring cancer related fatigue (EORTC QLQ-FA12). JNCI: Journal of the National Cancer Institute.  https://doi.org/10.1093/jnci/djw273.Google Scholar
  18. 18.
    Dersch, R., Sarnes, A. A., Maul, M., Hottenrott, T., Baumgartner, A., Rauer, S., & Stich, O. (2015). Quality of life, fatigue, depression and cognitive impairment in lyme neuroborreliosis. Journal of Neurology, 262(11), 2572–2577.  https://doi.org/10.1007/s00415-015-7891-4.CrossRefGoogle Scholar
  19. 19.
    Gay, C. M., Zygmunt, T., & Torres-Vázquez, J. (2011). Diverse functions for the semaphorin receptor PlexinD1 in development and disease. Developmental Biology, 349(1), 1–19.  https://doi.org/10.1016/j.ydbio.2010.09.008.CrossRefGoogle Scholar
  20. 20.
    Barroso, J., Harmon, J. L., Madison, J. L., & Pence, B. W. (2014). Intensity, chronicity, circumstances, and consequences of HIV-related fatigue. Clinical Nursing Research, 23(5), 514–528.  https://doi.org/10.1177/1054773813492998.CrossRefGoogle Scholar
  21. 21.
    Cha, K. M., Chung, Y. K., Lim, K. Y., Noh, J. S., Chun, M., Hyun, S. Y., … Kim, N. H. (2017). Depression and insomnia as mediators of the relationship between distress and quality of life in cancer patients. Journal of Affective Disorders, 217, 260–265.  https://doi.org/10.1016/j.jad.2017.04.020.CrossRefGoogle Scholar
  22. 22.
    Jain, A., Sharmab, R., Yadavc, N., Chaudhary, P., Jainc, G., & Maanju, M. (2017). Quality of life and its association with insomnia and clinical variables in type 2 diabetes. The Journal of the Egyptian Public Health Association, 92(1), 52–59.CrossRefGoogle Scholar
  23. 23.
    Quigg, M., Gharai, S., Ruland, J., Schroeder, C., Hodges, M., Ingersoll, K. S., … Ritterband, L. M. (2016). Insomnia in epilepsy is associated with continuing seizures and worse quality of life. Epilepsy Research, 122, 91–96.  https://doi.org/10.1016/j.eplepsyres.2016.02.014.CrossRefGoogle Scholar
  24. 24.
    Lichstein, K. L., Means, M. K., Noe, S. L., & Aguillard, R. N. (1997). Fatigue and sleep disorders. Behaviour Research and Therapy, 35(8), 733–740.CrossRefGoogle Scholar
  25. 25.
    Bengtson, A. M., Pence, B. W., O’Donnell, J., Thielman, N., Heine, A., Zinski, A., … Gaynes, B. (2015). Improvements in depression and changes in quality of life among HIV-infected adults. AIDS Care, 27(1), 47–53.  https://doi.org/10.1080/09540121.2014.946386.CrossRefGoogle Scholar
  26. 26.
    Parker, R., Stein, D. J., & Jelsma, J. (2014). Pain in people living with HIV/AIDS: A systematic review. Journal of the International AIDS Society, 17, 18719.CrossRefGoogle Scholar
  27. 27.
    Robinson-Papp, J. (2016). Chronic pain and HIV: Musculoskeletal pain. In J. S. Merlin, P. A. Selwyn, G. J. Treisman & A. G. Giovanniello (Eds.), Chronic pain and HIV: A practical approach (1st ed., pp. 27–37). Chichester: Wiley.  https://doi.org/10.1002/9781118777374.CrossRefGoogle Scholar
  28. 28.
    da Silva, J. G., da Rocha Morgan, D. A., Melo, F. C. M., dos Santos, I. K., de Azevedo, K. P. M., de Medeiros, H. J., & Knackfuss, M. I. (2017). Level of pain and quality of life of people living with HIV/AIDS pain and quality of life in HIV/AIDS. AIDS Care, 29(8), 1041–1048.  https://doi.org/10.1080/09540121.2016.1274013.CrossRefGoogle Scholar
  29. 29.
    Johnson, A., Condon, K. D., Mapas-Dimaya, A. C., Schrager, J., Grossberg, R., Gonzalez, R., & O’Mahony, S. (2012). Report of an HIV clinic-based pain management program and utilization of health status and health service by HIV patients. Journal of Opioid Management, 8(1), 17–27.CrossRefGoogle Scholar
  30. 30.
    Walker, K., McGown, A., Jantos, M., & Anson, J. (1997). Fatigue, depression, and quality of life in HIV-positive men. Journal of Psychosocial Nursing and Mental Health Services, 35(9), 32–40.Google Scholar
  31. 31.
    Ferrando, S., Evans, S., Goggin, K., Sewell, M., Fishman, B., & Rabkin, J. (1998). Fatigue in HIV illness: Relationship to depression, physical limitations, and disability. Psychosomatic Medicine, 60(6), 759–764.CrossRefGoogle Scholar
  32. 32.
    Conley, S., Feder, S., & Redeker, N. S. (2015). The relationship between pain, fatigue, depression and functional performance in stable heart failure. Heart & Lung: The Journal of Acute and Critical Care, 44(2), 107–112.  https://doi.org/10.1016/j.hrtlng.2014.07.008.CrossRefGoogle Scholar
  33. 33.
    Daniel, L., Kazak, A. E., Li, Y., Hobbie, W., Ginsberg, J., Butler, E., & Schwartz, L. (2016). Relationship between sleep problems and psychological outcomes in adolescent and young adult cancer survivors and controls. Supportive Care in Cancer, 24(2), 539–546.  https://doi.org/10.1007/s00520-015-2798-2.CrossRefGoogle Scholar
  34. 34.
    Amtmann, D., Askew, R. L., Kim, J., Chung, H., Ehde, D. M., Bombardier, C. H., … Johnson, K. L. (2015). Pain affects depression through anxiety, fatigue, and sleep in multiple sclerosis. Rehabilitation Psychology, 60(1), 81–90.  https://doi.org/10.1037/rep0000027.CrossRefGoogle Scholar
  35. 35.
    Degroote, S., Vogelaers, D., & Vandijck, D. M. (2014). What determines health-related quality of life among people living with HIV: An updated review of the literature. Archives of Public Health, 72(1), 40.  https://doi.org/10.1186/2049-3258-72-40.CrossRefGoogle Scholar
  36. 36.
    Cooper, V., Clatworthy, J., Harding, R., & Whetham, J. (2017). Measuring quality of life among people living with HIV: A systematic review of reviews. Health and Quality of Life Outcomes, 15(1), 220.  https://doi.org/10.1186/s12955-017-0778-6.CrossRefGoogle Scholar
  37. 37.
    Varni, J. W., Seid, M., & Rode, C. A. (1999). The PedsQL: Measurement model for the pediatric quality of life inventory. Medical Care, 37(2), 126–139.CrossRefGoogle Scholar
  38. 38.
    Chalder, T., Berelowitz, G., Pawlikowska, T., Watts, L., Wessely, S., Wright, D., & Wallace, E. P. (1993). Development of a fatigue scale. Journal of Psychosomatic Research, 37(2), 147–153.CrossRefGoogle Scholar
  39. 39.
    Hewlett, S., Chalder, T., Choy, E., Cramp, F., Davis, B., Dures, E., … Kirwan, J. (2011). Fatigue in rheumatoid arthritis: Time for a conceptual model. Rheumatology, 50(6), 1004–1006.  https://doi.org/10.1093/rheumatology/keq282.CrossRefGoogle Scholar
  40. 40.
    Chalder, T., Deary, V., Husain, K., & Walwyn, R. (2010). Family-focused cognitive behaviour therapy versus psycho-education for chronic fatigue syndrome in 11- to 18-year-olds: A randomized controlled treatment trial. Psychological Medicine, 40(08), 1269–1279.  https://doi.org/10.1017/S003329170999153X.CrossRefGoogle Scholar
  41. 41.
    Crawley, E., & Sterne, J. A. C. (2009). Association between school absence and physical function in paediatric chronic fatigue syndrome/myalgic encephalopathy. Archives of Disease in Childhood, 94(10), 752–756.  https://doi.org/10.1136/adc.2008.143537.CrossRefGoogle Scholar
  42. 42.
    Lloyd, S., Chalder, T., & Rimes, K. A. (2012). Family-focused cognitive behaviour therapy versus psycho-education for adolescents with chronic fatigue syndrome: Long-term follow-up of an RCT. Behaviour Research and Therapy, 50(11), 719–725.  https://doi.org/10.1016/j.brat.2012.08.005.CrossRefGoogle Scholar
  43. 43.
    Soldatos, C. R., Dikeos, D. G., & Paparrigopoulos, T. J. (2000). Athens insomnia scale: Validation of an instrument based on ICD-10 criteria. Journal of Psychosomatic Research, 48(6), 555–560.  https://doi.org/10.1016/S0022-3999(00)00095-7.CrossRefGoogle Scholar
  44. 44.
    de Ross, R. L., Gullone, E., & Chorpita, B. F. (2002). The revised child anxiety and depression scale: A psychometric investigation with australian youth. Behaviour Change, 19(02), 90–101.  https://doi.org/10.1375/bech.19.2.90.CrossRefGoogle Scholar
  45. 45.
    Chorpita, B. F., Moffitt, C. E., & Gray, J. (2005). Psychometric properties of the revised child anxiety and depression scale in a clinical sample. Behaviour Research and Therapy, 43(3), 309–322.  https://doi.org/10.1016/j.brat.2004.02.004.CrossRefGoogle Scholar
  46. 46.
    Chorpita, B. F., Yim, L., Moffitt, C., Umemoto, L. A., & Francis, S. E. (2000). Assessment of symptoms of DSM-IV anxiety and depression in children: A revised child anxiety and depression scale. Behaviour Research and Therapy, 38(8), 835–855.  https://doi.org/10.1016/S0005-7967(99)00130-8.CrossRefGoogle Scholar
  47. 47.
    Van Oort, F. V. A., Greaves-Lord, K., Verhulst, F. C., Ormel, J., & Huizink, A. C. (2009). The developmental course of anxiety symptoms during adolescence: The TRAILS study. Journal of Child Psychology and Psychiatry, 50(10), 1209–1217.  https://doi.org/10.1111/j.1469-7610.2009.02092.x.CrossRefGoogle Scholar
  48. 48.
    Weiss, D., & Chorpita, B. F. (2011). Revised children’s anxiety and depression scale user’s guide. New York: Guilford Press.Google Scholar
  49. 49.
    Chorpita, B. F., Ebesutani, C., & Spence, S. H. (2015). Revised children’s anxiety and depression scale user’s guide. New York: Guilford Press.Google Scholar
  50. 50.
    McCormack, H. M., David, J. D., & Sheather, S. (1988). Clinical applications of visual analogue scales: A critical review. Psychological Medicine, 18(04), 1007.  https://doi.org/10.1017/S0033291700009934.CrossRefGoogle Scholar
  51. 51.
    Huang, I.-C., Thompson, L. A., Chi, Y.-Y., Knapp, C. A., Revicki, D. A., Seid, M., & Shenkman, E. A. (2009). The linkage between pediatric quality of life and health conditions: Establishing clinically meaningful cutoff scores for the PedsQL. Value in Health, 12(5), 773–781.  https://doi.org/10.1111/j.1524-4733.2008.00487.x.CrossRefGoogle Scholar
  52. 52.
    Cella, M., & Chalder, T. (2010). Measuring fatigue in clinical and community settings. Journal of Psychosomatic Research, 69(1), 17–22.  https://doi.org/10.1016/j.jpsychores.2009.10.007.CrossRefGoogle Scholar
  53. 53.
    Chung, K.-F., Kan, K. K.-K., & Yeung, W.-F. (2011). Assessing insomnia in adolescents: Comparison of insomnia severity index, Athens insomnia scale and sleep quality index. Sleep Medicine, 12(5), 463–470.  https://doi.org/10.1016/j.sleep.2010.09.019.CrossRefGoogle Scholar
  54. 54.
    Jensen, M. P., Chen, C., & Brugger, A. M. (2003). Interpretation of visual analog scale ratings and change scores: A reanalysis of two clinical trials of postoperative pain. The Journal of Pain: Official Journal of the American Pain Society, 4(7), 407–414.CrossRefGoogle Scholar
  55. 55.
    Cohen, J. (1988). Statistical power analysis for the behavioral sciences (2nd ed.). New York: Routledge.Google Scholar
  56. 56.
    Lam, P. K., Naar-King, S., & Wright, K. (2007). Social support and disclosure as predictors of mental health in HIV-positive youth. AIDS Patient Care and STDs, 21(1), 20–29.  https://doi.org/10.1089/apc.2006.005.CrossRefGoogle Scholar
  57. 57.
    Naar-King, S., Templin, T., Wright, K., Frey, M., Parsons, J. T., & Lam, P. (2006). Psychosocial factors and medication adherence in HIV-positive youth. AIDS Patient Care and STDs, 20(1), 44–47.  https://doi.org/10.1089/apc.2006.20.44.CrossRefGoogle Scholar
  58. 58.
    Pao, M., Lyon, M., D’Angelo, L. J., Schuman, W. B., Tipnis, T., & Mrazek, D. A. (2000). Psychiatric diagnoses in adolescents seropositive for the human immunodeficiency virus. Archives of Pediatrics & Adolescent Medicine, 154(3), 240–244.CrossRefGoogle Scholar
  59. 59.
    Marcellin, F., Préau, M., Ravaux, I., Dellamonica, P., Spire, B., & Carrieri, M. P. (2007). Self-reported fatigue and depressive symptoms as main indicators of the quality of life (QOL) of patients living with HIV and hepatitis C: Implications for clinical management and future research. HIV Clinical Trials, 8(5), 320–327.  https://doi.org/10.1310/hct0805-320.CrossRefGoogle Scholar
  60. 60.
    Crane, H. M., Nance, R. M., Delaney, J. A. C., Fredericksen, R. J., Church, A., Simoni, J. M., … Kitahata, M. M. (2017). A comparison of adherence timeframes using missed dose items and their associations with viral load in routine clinical care: Is longer better? AIDS and Behavior, 21(2), 470–480.  https://doi.org/10.1007/s10461-016-1566-8.CrossRefGoogle Scholar
  61. 61.
    Kelley, C. F., Barbour, J. D., & Hecht, F. M. (2007). The relation between symptoms, viral load, and viral load set point in primary HIV infection. JAIDS Journal of Acquired Immune Deficiency Syndromes, 45(4), 445–448.  https://doi.org/10.1097/QAI.0b013e318074ef6e.CrossRefGoogle Scholar
  62. 62.
    Loades, M. E., Coetzee, B., Du Toit, S., & Kagee, A. (2018). ‘… But i’m still tired’: The experience of fatigue among South African adolescents receiving antiretroviral therapy. AIDS Care, 30(6), 746–750.  https://doi.org/10.1080/09540121.2017.1394433.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2018

Authors and Affiliations

  1. 1.Department of PsychologyStellenbosch UniversityStellenboschSouth Africa
  2. 2.Department of PsychologyUniversity of BathBathUK

Personalised recommendations