A Cross-Lagged Model of Psychiatric Problems and Health-Related Quality of Life Among a National Sample of HIV-Positive Adults

by Maria Orlando Edelen, Joan S. Tucker, Cathy D. Sherbourne, M. Audrey Burnam

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OBJECTIVES: To investigate the temporal association between symptoms of psychiatric disorder and physical aspects of health-related quality of life (HRQOL) in a sample of HIV-positive adults. METHODS: Sample included 2431 participants at baseline and the first follow-up (FU1; approximately 8 months later). Measures included 4 components of HRQOL (general health, lack of pain, physical functioning, and role functioning), and psychiatric symptoms of depressive and anxiety disorders. Covariates included demographics, and clinical and substance use-related measures. A series of regression equations was estimated to construct the cross-lagged path model. Results depicted the relationships among the 4 HRQOL components and 2 types of psychiatric symptoms over time. This model included stability effects for each measure and cross-lagged effects from both the psychiatric measures at baseline to each of the HRQOL components at FU1 and from each of the 4 HRQOL components at baseline to the psychiatric measures at FU1. RESULTS: After controlling for stability effects and covariates, symptoms of depressive disorder at FU1 were significantly predicted by baseline general health and physical functioning, whereas symptoms of anxiety disorder at FU1 were significantly predicted by baseline general health and lack of pain. Anxiety symptoms at baseline did not significantly predict FU1 HRQOL, but baseline depressive symptoms were significant predictors of general health and lack of pain at FU1. CONCLUSION: Responses from a sample of HIV-positive adults at 2 time points approximately 8 months apart provide evidence for a reciprocal relationship between symptoms of psychiatric disorder and physical aspects of HRQOL.

Originally published in: Medical Care, v. 43, no. 1, January 2005, pp. 21-27.

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