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. Author manuscript; available in PMC: 2020 Jan 3.
Published in final edited form as: Psychol Health Med. 2018 Oct 8;24(3):355–361. doi: 10.1080/13548506.2018.1529327

Value of perceived support on depressive symptoms and hazardous drinking among underserved HIV+ adults 50 and older

Nicole Ennis 1, Vaughn Bryant 1, Zachary Mannes 1
PMCID: PMC6941422  NIHMSID: NIHMS1063884  PMID: 30293456

Abstract

The current study examined the association between perceived social support, depressive symptoms and alcohol use among people living with HIV (PLWH) 50 and older who identified as Black. Participants included 96 men and women ages 50 and older. Participants completed an interviewer-administered assessment examining mental and behavioral health functioning. Mediation analyses examined whether perceived support mediated the association between depressive symptoms and hazardous drinking. Depressive symptoms were significantly associated with hazardous drinking (B = .068, SE = .035, t = 1.92, p = 0.05) and negatively associated with having the desired amount of contact with a primary supporter (B = −.072, SE = .018, z = −3.96, p < 0.001). In addition, having the desired amount of contact with a confidant was negatively associated with hazardous drinking (B = −.543, SE = .208, t = −2.61, p 0 < .01). The effect of depressive symptoms on hazardous drinking when controlling for having adequate contact with a primary supporter was not significant (B = .033, SE = .04, t = .829, p = 0.41). Having a valued confidant mediated the association between depressive symptoms and hazardous drinking. Thus, social support interventions may be an effective method of reducing hazardous drinking among older PLWH.

Keywords: Perceived support, HIV, depressive symptoms & hazardous drinking

Introduction

Despite representing up to 12% of the US population, Black Americans account for 43% of all people living with HIV (CDC, 2018). Further, older adults account for approximately 17% of new HIV cases each year and those who identify as Black are disproportionately affected by the disease. Rates of HIV/AIDS among persons 50 and older were 12 times as high among blacks (51.7/100,000) than whites (CDC, 2018). The population of people living with HIV (PLWH) in the United States is aging, with 45% of the current population age 50 and older (CDC, 2017). In addition to new diagnoses, the prevalence of adults over 50 living with HIV is increasing greatly each year (High et al., 2012). Aging is a complex process physically, mentally, and socially, which takes place within social infrastructures such as the medical community, families, and intimate partnerships. This complexity increases when coping with a chronic illness such as HIV (Boeri et al., 2008; Briggs, Magnus, Lassiter, Patterson, & Smith, 2011; Grella & Lovinger, 2012; Hamilton & Grella, 2009). Both structural support which includes peer network size and frequency of contact, as well as functional support, which takes into account factors such as perceived quality and satisfaction with support aspects of social ties, are important factors to be addressed over the lifespan (Mavandadi, Zanjani, Ten Have, & Oslin, 2009).

The aging process is associated with increased social isolation and depressive symptoms (Arean et al., 2010; Chou, Mackenzie, Liang, & Sareen, 2011; Knowlton, Curry, Hua, & Wissow, 2009). Further, hazardous drinking is prevalent among older adults aging with HIV (High et al., 2012). However, perceived support has been identified as an important resource for PLWH but limited work has been done to understand the complex psychosocial factors affecting minorities aging with HIV (Whitehead, Hearn, & Burrell, 2014). Therefore, the current study sought to examine the extent to which perceived social support mediated the association between depressive symptoms and hazardous drinking among a sample of PLWH age 50 and older who identify as Black.

Methods

Participants and recruitment

Ninety-six PLWH 50 and older who self-identified as Black were recruited through the University of Florida Center for HIV/AIDS Research, Education and Service (UF CARES). UF CARES is a comprehensive HIV and AIDS medical treatment program; therefore all participants were engaged in care at the time of the survey. Data was collected using convenience sampling methods, a type of nonprobability sampling where members of the target population meeting inclusion criteria and willing to participate were included. Participants who met the eligibility criteria were approached by clinic staff, given a brief description of the study, and upon providing written informed consent, completed an interviewer-administered assessment examining mental and behavioral health functioning. This study was approved by the Institutional Review Board of the University of Florida. Eligible participants were HIV-positive, identified as Black/African American, and age 50 or older. Participants received a $25 gift card for completing the assessment.

Measures

Demographics

Sex, age, race, marital/partner status, number of children and other demographics were collected using a standard questionnaire.

Depressive symptoms

The 21-item Beck Depression Inventory-II (BDI-II) assessed the severity of depressive symptoms by respondents selecting the statements that best reflects how they have felt in the past two weeks. Sum scores range from 0–68. Depressive symptoms was analyzed as a continuous variable for the purpose of this study.

Hazardous drinking

Self-reported drinks per week were dichotomized according to whether or not individuals met the National Institute on Alcohol and Alcoholism (NIAAA) criteria for hazardous drinking (greater than 7 drinks per week for women and greater than 14 drinks per week for men) (Reid, Fiellin, & O’connor, 1999).

Perceived social support

The ENRICHD Social Support Inventory (ESSI) assesses perceived social support with six Likert-type scale items and an additional item assessing the presence or absence of a spouse or partner (Mitchell et al., 2003).

Statistical analyses

Mediation analyses using the Preacher and Hayes method (2004) was used to examine whether the perceived social support of a confidant mediated the association between depressive symptoms and hazardous drinking, followed by bootstrapping with 5,000 samples, to test the strength of the indirect effect. The covariates sex, CD4 count, and annual income were added to the model in order to control for confounding variables that may influence the association between depressive symptoms and Hazardous drinking.

Results

The mean age of the sample was 55.77 years (SD = 5.27; range: 50–76 years), and 62.9% were female (see Table 1). The majority of the sample (82.05%) reported incomes of less than 20,000 dollars/year. The average number of years since HIV diagnosis was 14.80 years (SD = 10.61; range: 0–35 years). Participants reported an average number of 6.46 (SD = 2.85) medical comorbidities, and based on medical chart abstraction, 28.6% of the sample had a detectable viral load (greater than 50 copies of viral RNA) with an average CD4 cell count of 540.81 (SD = 277.83). Participants had an average score of 11.15(M) 8.69 (SD) on the BDI. Perceived support of a valued confidant was the only aspect of social support that was significantly correlated with both depressive symptoms (r = −.337, p = 0.001) and hazardous drinking (r = −.325, p = 0.001).

Table 1.

Participant demographics (N = 96).

Sex % Female (N) 63.16% (60) Annual household income % (N)
Age M(SD) 55.78 (5.26) < 10,000 49.47% (47)
Race % Black/African-Am (N) 100% (96) 10,000–14,999 23.16% (22)
Marital Status %(N) 15,000–19,999 12.63% (12)
 Single, Never Married 50.53% (48) 20,000–24,999 2.11% (2)
 Divorced 25.26% (24) > 25,000 3.16% (3)
 Separated 6.32% (6) Declined 9.47% (9)
 Widowed 7.37% (7) HIV Related Variables M(SD)
 Married or Common Law 10.53% (10) Years since diagnosis 14.83 (10.63)
Do you have children? 75.79% (72) CD4 Count 533.15 (275.76)
Living with a Partner %(N) 14.74% (14) Detectable Viral Load 28.6%
Number of Medical Comorbidities M(SD) 6.37 (2.80) Self-reported Non-adherence %(N) 15.79% (15)
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Note. N may vary according to missing values.

To test the hypothesis that sufficient contact with a primary supporter would mediate the association between depressive symptoms and hazardous drinking, a regression model using the Preacher and Hayes approach was run. Depressive symptoms was significantly associated with hazardous drinking (B = .068, SE = .035, t = 1.92, p = 0.05) and negatively associated with having the desired amount of contact with a primary supporter (B = −.072, SE = .018, z = −3.96, p < 0.001). In addition, having the desired amount of contact with a primary supporter was negatively associated with hazardous drinking (B = −.543, SE = .208, t = −2.61, p < 0.01). The effect of depressive symptoms on hazardous drinking when controlling for having adequate contact with a primary supporter was not significant (B = .033, SE = .04, t = .829, p = 0.41). (See Figure 1).

Figure 1.

Figure 1.

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Mediation model of social support on depressive symptoms and hazardous drinking.

Note. Estimate of the indirect effect (B = .046); Bootstrapped confidence interval (95%) = [.0053 – .0998]. * p < .05, **p < .01, *** p < .001.

Discussion

Older adults living with HIV in the United States misuse alcohol at rates higher than the general population (Green et al., 2010; Moore et al., 2009). Further, PLWH 50 years and older are frailer than their chronological age indicates due to their disease status, making them more vulnerable to the consequences (i.e. greater intoxication with even lower levels of consumption) of substance misuse such as hazardous drinking (Dowling, Weiss, & Condon, 2008; Karpiak, Shippy, & Cantor, 2006; Vance, 2010). Our findings show that having enough contact with someone ‘you feel close to’ mediated the association between depressive symptoms and hazardous drinking. Hazardous drinking is associated with decreased medication adherence, decreased engagement in HIV care, greater medical comorbidities, and poorer quality of life (Eldred, 2007; Rothlind et al., 2005; Waldrop-Valverde et al., 2006; Weber et al., 2013). An important factor underscoring the significance of these findings is that depressive symptoms and substance use among older, chronically ill populations are associated with transition from informal community based care by family and friends to institutionalization (Chou et al., 2011; Kelly et al., 2012; Knowlton, 2003; Latkin, Forman, Knowlton, & Sherman, 2003). Therefore, addressing the relationship between depressive symptoms and hazardous drinking not only improves quality of life but may substantively reduce long-term healthcare costs.

Our work shows perceived social support can mitigate health risks such as substance misuse. This is critical because the burgeoning population of older adults with HIV face considerable psychosocial challenges with regard to social engagement, adequacy of informal social networks, and caregiving resources to meet their needs. Research has documented that those aging with HIV tend to have limited and/or inadequate social networks (Bohnert, Bradshaw, & Latkin, 2009; Shippy & Karpiak, 2005a, 2005b). This work provides evidence that social support interventions could address social network insufficiency among those aging with HIV and have a positive effect on reducing detrimental health behaviors such as hazardous drinking.

Strengths and limitations

While this study provides evidence for the importance of supportive relationships, there are limitations to be considered. First, the majority of the sample was women and research shows that women benefit most from social relationships mitigating negative mood states. Second, the cross-sectional design inhibits the ability to find causal relationships between constructs in this study. Although the self-report of having ‘enough contact with someone you feel close to’ mediated the association between depressive symptoms and hazardous drinking, we are unable to determine the temporality of these constructs. Third, convenience sampling methods were used to collect the data and may not be representative of PLWH 50 and older. Moreover, because the study’s population included only older PLWH who identify as black, generalizing the findings to other populations is difficult. However, despite the limitations, the results presented have direct implications for addressing hazardous drinking among PLWH 50 and older. Specifically, perceived support may serve as an important intervention point through peer support interventions to address hazardous drinking in this population. Though literature has shown that social support can have a positive impact on psychological health in PLWH, this study identifies the particular importance of having sufficient contact with a perceived confidant for older HIV-positive minority adults.

Acknowledgments

Funding

This work was supported by the National Institute of Mental Health (NIH) under grant number R25MH080665 and the National Institute on Drug Abuse under grant number K23039769-01

Footnotes

Disclosure statement

No potential conflict of interest was reported by the authors.

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