Relationships Between Neighborhood Stressors, Mental Health Exist in PWH

The neighborhood environment can have major implications on mental health and coping in people living with HIV (PWH) according to a study published in AIDS and Behavior.¹ Factors such as feeling safe in their current location and alcohol outlets could have mental health implications in PWH.

Around the globe, socioeconomic status (SES) can affect timing of diagnosis of HIV, as well as adherence to antiretroviral therapy and disparate mortality related to HIV.² Previous studies have found that PWH living in census tracts with higher poverty had a decreased likelihood of viral suppression and uptake of ART. Neighborhood environments have been shaped by racism in US policy, which can affect the number of alcohol outlets and vacant lots in a neighborhood, therefore affecting the general health of the population. This study used daily diary measures and spatial exposures to examine the relationship between real-time Global Positioning System (GPS) spatial measures and daily diary measures as well as understand how daily violence exposure can change daily mood and coping in PWH.

Neighborhood stressors and mental health were connected in people living with HIV | Image credit: artegorov3@gmail - stock.adobe.com

All participants were residents of New Orleans, Louisiana; all of them were diagnosed with HIV. Patients were excluded if they had an acute illness within the previous 6 weeks, were pregnant, or had acute intoxication. All participants were recruited from the parent study which conducted geographic momentary assessment. Participants were eligible if they were using ART, provided consent, and had a self-reported personal history of violence or lived in a neighborhood of high violence. Interested participants were invited to enroll.

Surveys were conducted to collect baseline data and daily diaries were conducted 3 times a day through a smart phone. These diaries were distributed for 14 days and took approximately 5 minutes to complete. A GPS tracking application was used to collect geospatial data over the course of those 14 days.

Baseline data were collected from all participants, including adverse childhood experiences, intimate partner violence (IPV), demographics, alcohol consumption, and symptoms of anxiety, depression, or post-traumatic stress. Daily diaries collected data on location perception, mood, and coping.

There were 89 participants enrolled in the study, of which 83% completed at least 1 daily diary and 11% who completed all daily diaries, with a mean (SD) of 40 (11.4) daily diaries completed per person. Most of the daily diaries were completed on weekdays. GPS tracking recorded 114,077 point locations. A total of 84% of the participants identified as Black and 86.5% had an income of less than $20,000. IPV was reported by 56% of the population, 27.0% presented symptoms of post-traumatic stress, 37.1% presented with symptoms of anxiety, 24.7% presented with symptoms of depression.

The mean PTSD symptom score was 1.83 (3.01) out of a possible 25 but reported a mean of 1.21 (0.44) out of 2 for daily levels of stress. When scoring safety, with 2 being the highest possible safety, most participants felt safe with a mean score of 1.77 (0.48). Patients also scored a 1.27 (0.83) in ease of accessing alcohol, with 2 representing highest ease. A mean of 1.97 (1.75) for positive emotions was also found in the participants.

Maladaptive coping was less common compared with adaptive coping (mean, 0.05 [0.13] vs 0.15 [0.20]), which equaled a ratio of adaptive to maladaptive coping of 1.12 (0.99). Mean yearly violence counts (80.83 [51.69]), reported vacant lots (179.58 [135.05]), and alcohol outlet counts (8.05 [8.79]) were environmental stressors within a half mile of diary points.

Feeling safe was negatively correlated with all community exposures but was weaker with offsite alcohol (–0.09) and onsite alcohol (–0.16). The correlation magnitudes were stronger for violent crime (–0.27) and vacant lots (–0.22). The relationship between ease of obtaining alcohol and vacant lots (0.13) or violent crime (0.07) was weak and positive. Violent crime (0.15), offsite alcohol outlets (0.17), vacant lots (0.20), and onsite alcohol outlets (0.20) were all correlated with ease of obtaining drugs. The perception of substance use was correlated with vacant lots (0.12) and onsite alcohol outlets (0.09). Participants also reported significantly fewer positive emotions on days with activity space violence exposure that was higher than average.

There were some limitations to this study. The analysis was preliminary and were only controlled for age, sex, and education. The sample size was also smaller. The study was temporarily suspended due to Hurricane Ida, which made landfall in August 2021. A total of 69.1% of the daily diaries were performed at a participant’s home, which reduced variability and reduced the ability to perform a complex analysis. There were some inconsistencies in the measures, including the larger buffers increasing variability and spatial data having inaccuracies in location of point data.

The researchers concluded that complex relationships existed between neighborhood stressors and mental health in PWH. The results of the study highlight the disparities that PWH live with due to disadvantages in SES and should encourage addressing those disadvantages.

References

1. Gasik RE, Smith EA, Skeen SJ, et al. Using geographic momentary assessment to explore spatial environment influences on wellbeing in people with HIV. AIDS Behav. Published online October 28, 2024. doi:10.1007/s10461-024-04527-4
2. Burch LS, Smith CJ, Anderson J, et al. Socioeconomic status and treatment outcomes for individuals with HIV on antiretroviral treatment in the UK: cross-sectional and longitudinal analyses. Lancet Public Health. 2016;1(1):e26-e36. doi:10.1016/S2468-2667(16)30002-0