Chronic Pain, Mental Health, and Sense of Purpose in Life Among Women Living with HIV Compared to HIV-Negative Women in the British Columbia CARMA-CHIWOS Collaboration (BCC3) Study.

Abstract

Chronic pain and mental health conditions are common among women living with HIV (WLWH) and can negatively impact the HIV care continuum, decrease quality of life, and negatively affect aging trajectories. A strong sense of purpose in life, while potentially being protective, can also be attenuated or accentuated by varying sociobehavioral-structural correlates. However, less is known about how these factors intersect. This cross-sectional analysis of the British Columbia CARMA-CHIWOS Collaboration Study examines the prevalence of self-reported mental health conditions, differences in purpose in life, as measured by the Oregon Brief Purpose Measure, and associated correlates in 176 WLWH and 273 HIV-negative controls (median age 48, 41% white). Depression (38%), anxiety (37%), post-traumatic stress disorder (24%), substance use disorder (13%) and attention deficit hyperactivity disorder (12%) were most prevalent, and the burden of mental health diagnoses was greatest among women with chronic pain, compared to those without, independent of HIV. Higher scores on measures of resilience, purpose in life, and social support were associated with upwards of 43% (95% CI 29-54%) fewer mental health diagnoses, whereas histories of childhood violence and higher perceived sexism scores were associated with upwards of 96% (95% CI 40-274%) more diagnoses. Purpose in life scores were altogether comparable across groups, with post-hoc comparisons showing no statistically significant difference in women with concurrent HIV and chronic pain relative to others. In adjusted regressions, resilience emerged as the strongest predictor of a greater sense of purpose in life (ß = 3.50, 95% CI 2.78-4.22), with employment (ß = 1.14, 95% CI 0.43-1.96) and caring for dependents (ß = 1.01, 95% CI 0.24-1.78) also contributing. Programs and activities that promote a greater sense of purpose in life may help women living with HIV and chronic pain.