Prof. Qilian He
School of Nursing, Dali University, China
Title: Global prevalence and correlates of psychological distress among people living with HIV/AIDS: A Systematic Review and Comprehensive Meta-Analysis
Abstract:
Background The scale-up of antiretroviral therapy (ART) has transformed HIV/AIDS into a manageable chronic condition. However, widespread social stigma and HIV-related stressors impose lasting psychosocial pressure on people living with HIV/AIDS (PLWHA). Psychological distress (PD) remains highly prevalent in this population, adversely affecting treatment adherence and quality of life. This study reviews the prevalence and factors associated with PD among PLWHA to inform early identification of high-risk groups and intervention design.
Methods Following PRISMA 2020 guidelines, we systematically searched seven electronic databases (PubMed, Web of Science, Embase, Cochrane Library, CINAHL, PsycInfo, and CNKI) for observational studies investigating PD prevalence and associated factors among PLWHA from database inception to June 20, 2025. Meta-analyses used Stata 18.0 with GLMM. Guided by BPS and TMSC frameworks, subgroup analyses, sensitivity analyses, and meta-regression were performed to investigate heterogeneity sources and elucidate the mechanisms of PD.
Results Sixteen studies (n=10,204 PLWHA) were included. The pooled prevalence of PD was 39.0% (95% CI: 28.0–52.0%, I² =96.25%). Subgroup analysis indicated that PD measurement tools and population were significant heterogeneity sources. Sensitivity analyses confirmed robustness. Meta-regression did not identify significant moderators. Egger’s and Begg’s tests indicated no evidence of substantial publication bias. Meta-analysis of factors associated with PD showed that poor ART adherence (OR = 4.55, 95% CI: 1.96–10.54), low CD4 count (OR = 2.59, 95% CI: 1.62–4.13), non-disclosure of HIV status (OR = 4.95, 95% CI: 3.23–7.58), and female sex (OR = 2.18, 95% CI: 1.73–2.75) were significantly associated with an increased risk of PD, while being married was protective (OR = 0.36, 95% CI: 0.28–0.46).
Conclusion Over one-third of PLWHA experience PD influenced by multifaceted biological, social, and psychological factors. Routine PD screening and targeted interventions for high-risk groups are recommended. Integrating disclosure support and ART adherence management into standardized care pathways is essential to reduce PD and improve quality of life, and integrating mental health services with HIV care is crucial to advance the WHO's 2030 goals.
PROSPERO registration number CRD420251089847.
Keywords People living with HIV, Psychological distress, Prevalence, Associated factors, Systematic review, Meta-analysis
Biography:
Qilian He,RN,MSN, Ph.D.,Professor of School of Nursing, Dali University, Dali, Yunnan, China. Dr. He is a Tibetan nursing researcher mainly focus on the transcultural nursing, nursing education and health management of infectious disease. Dr. He had been awarded the scholarship by Chinese Medical Board (CMB) and Chinese Scholarship Council (CSC) for visiting California State University, San Bernardino (CSUSB) in the United States 3 times during 2013-2025. She is also a collaborator of her home university and CSUSB, also a community volunteer when she stay in the US. Dr. He published over 30 papers including 8 SCI journals, host/participate 30 scientific projects and 27 nursing education projects.