Institute for Global Health, University College London, London, UK.
The Mortimer Market Centre, Central and North West London NHS Foundation Trust, London, UK.
Menopause. 2022 Feb 7;29(4):421-429. doi: 10.1097/GME.0000000000001931.
We aimed to describe the prevalence of various mental health symptoms according to menopausal status (pre, peri, post) among women living with HIV ages 45-60 in England, and to identify groups of women with similar general and menopause-related mental health symptoms. We then investigated demographic predictors of group-membership and group differences in HIV-related care outcomes (antiretroviral therapy adherence, HIV clinic attendance, CD4-count, and last HIV viral load).
An analysis of cross-sectional data from the Positive Transitions through Menopause study, an observational study of the health and well-being impacts of menopause on 869 women with HIV aged 45-60 years. Self-reported data on eight mental health indicators were collected from women in pre-, peri- and post-menopausal state using validated measures. Groups (termed "classes") of women with similar mental health symptoms were derived via latent class analysis. Class membership was linked to demographic factors using nominal logistic regression, and to clinical outcomes using Wald tests.
We identified five classes: 1) few mental health symptoms (n = 501, 57.8%); 2) high current anxiety/depression (n = 120, 13.8%); 3) history of depression, with elevated current substance use (n = 40, 4.6%); 4) history of depression with current psychological menopause symptoms (n = 81, 9.3%); and 5) high previous and concurrent mental health problems (n = 125, 14.4%). University attendance, ethnicity, and longer time since HIV diagnosis predicted class membership. Antiretroviral therapy adherence was lower in classes 3 (11%), 4 (19%) and 5 (24%) compared to class 1 (4%; all P<0.001). Members of class 5 were more likely to have missed ≥1 HIV clinic appointment in the past year than those in class 1 (34% vs 17%, P = 0.005).
Women with a history of depression, current anxiety/depression, and current menopause-related mental health symptoms were more likely to have poorer clinical outcomes. Although we cannot comment on causality, our findings highlight the importance of assessing and managing menopausal symptoms and mental health to improve well-being and engagement in HIV care.
我们旨在描述英国 45-60 岁患有 HIV 的女性根据绝经状态（绝经前、围绝经期、绝经后）出现各种心理健康症状的流行率，并确定具有相似一般和绝经相关心理健康症状的女性群体。然后，我们调查了群体成员的人口统计学预测因素以及 HIV 相关护理结果（抗逆转录病毒治疗依从性、艾滋病毒诊所就诊、CD4 计数和上次 HIV 病毒载量）的组间差异。
对阳性过渡到更年期研究的横断面数据分析，这是一项观察性研究，共纳入 869 名年龄在 45-60 岁之间的 HIV 感染者的健康和幸福感受更年期影响的情况。使用经过验证的措施从处于绝经前、围绝经期和绝经后状态的女性中收集了 8 项心理健康指标的自我报告数据。通过潜在类别分析得出具有相似心理健康症状的女性群体（称为“类别”）。使用名义逻辑回归将类别成员身份与人口统计学因素联系起来，并使用 Wald 检验将类别成员身份与临床结果联系起来。
我们确定了五个类别：1）心理健康症状较少（n = 501，57.8%）；2）当前焦虑/抑郁高（n = 120，13.8%）；3）有抑郁史，当前物质使用增加（n = 40，4.6%）；4）有抑郁史，当前有心理更年期症状（n = 81，9.3%）；5）过去和当前心理健康问题较多（n = 125，14.4%）。大学入学率、种族和 HIV 诊断后时间长短预测了类别成员身份。与类别 1（4%；所有 P<0.001）相比，类别 3（11%）、4（19%）和 5（24%）的抗逆转录病毒治疗依从性较低。与类别 1（17%）相比，类别 5 的成员在过去一年中错过≥1 次艾滋病毒诊所就诊的可能性更高（34% vs 17%，P = 0.005）。
有抑郁史、当前焦虑/抑郁和当前与绝经相关的心理健康症状的女性更有可能出现较差的临床结局。尽管我们无法评论因果关系，但我们的研究结果强调了评估和管理更年期症状和心理健康以改善幸福感和参与 HIV 护理的重要性。
