Table_2_Loneliness as a mediation from social support leading to a decrease of health-related quality of life among PLWHIV.docx

This study focused on the mental health of people living with HIV(PLWHIV) and explored their relationship between loneliness and perceived social support, health related quality of life (HRQoL) with a method of structural equation model. We collected clinical and psychological data from consecutively enrolled PLWHIV. A total of 201 PLWHIVs were enrolled and measured with self-reporting survey instruments of UCLA Loneliness Scale, Self-Rating Depression Scale, Self-Rating Anxiety Scale, Social Support Ratio Scale and Short Form Health Survey-36. The levels of loneliness, depression, anxiety, perceived social support and HRQoL were assessed. PLWHIV enrolled were divided into two groups of loneliness and non-loneliness based on their UCLA Loneliness Scale scores. Multivariable analysis indicated that being married is a protective factor associated with loneliness (OR = 0.226; P = 0.032). We further found the loneliness group had a higher level of depression (P < 0.001) and anxiety (P < 0.001), but lower level of HRQoL (P < 0.001) than the non-loneliness group. We found there was a positive linear correlation between social support and HRQoL among the enrolled PLWHIVs (r2 = 0.0592; P = 0.0005). A structural equation model (SEM) was established to evaluate whether the loneliness played as a mediation role between social support and HRQoL. The model showed loneliness as a mediation from social support leading to a decrease of HRQoL. Our findings showed a potential psychological pathway from social support to HRQoL, suggesting the need for interventions focusing on social support may improve poor HRQoL lead by loneliness.

本研究聚焦人类免疫缺陷病毒感染者（People Living with HIV, PLWHIV）的心理健康状况，探讨孤独感、感知社会支持与健康相关生存质量（Health Related Quality of Life, HRQoL）之间的关联，采用结构方程模型（Structural Equation Model, SEM）开展分析。研究纳入连续就诊的PLWHIV，收集其临床与心理相关数据，最终共纳入201名受试者。所有受试者通过自评式问卷调查完成评估，所用工具包括UCLA孤独量表、抑郁自评量表、焦虑自评量表、社会支持比率量表以及简明健康调查问卷36项版（Short Form Health Survey-36, SF-36），以测评其孤独感、抑郁、焦虑、感知社会支持及HRQoL水平。根据UCLA孤独量表得分，将纳入的PLWHIV分为孤独组与非孤独组。多变量分析结果显示，已婚状态是孤独感的保护因素（比值比OR=0.226；P=0.032）。进一步对比两组发现，相较于非孤独组，孤独组的抑郁与焦虑水平显著更高（P均<0.001），而HRQoL水平显著更低（P<0.001）。此外，本研究发现纳入的PLWHIV中，社会支持与HRQoL呈正线性相关（决定系数r²=0.0592；P=0.0005）。本研究构建结构方程模型，以评估孤独感在社会支持与HRQoL之间是否发挥中介作用。模型结果显示，孤独感作为中介变量，介导社会支持对HRQoL的负面影响，即社会支持通过孤独感降低个体的HRQoL水平。本研究结果揭示了社会支持影响HRQoL的潜在心理通路，提示开展针对社会支持的干预措施，或可改善由孤独感引发的HRQoL受损状况。