NIH Toolbox Emotion Battery Findings Among People with HIV: Normative Comparisons and Clinical Associations

Abstract

Lilla A Brody,1,2 Lily Kamalyan,2,3 Kayle Karcher,2 Lesley A Guarena,2 Alexis A Bender,4 Benjamin S McKenna,2 Anya Umlauf,2 Donald Franklin,2 Maria J Marquine,5 Robert K Heaton2 1Division of Geriatrics and Palliative Medicine, Weill Cornell Medicine, New York, NY, USA; 2Department of Psychiatry, HIV Neurobehavioral Research Program, San Diego, CA, USA; 3Joint Doctoral Program in Clinical Psychology, San Diego State University/University of California, San Diego, CA, USA; 4Division of Geriatrics & Gerontology, Department of Medicine, Emory University, Atlanta, GA, USA; 5Division of Geriatrics, Department of Medicine, Duke University School of Medicine, Durham, NC, USACorrespondence: Robert K Heaton, Department of Psychiatry, UCSD School of Medicine, 9500 Gilman Drive, La Jolla, San Diego, CA, 92093-0603, USA, Tel [phone], Fax [phone], Email [email protected]: Depression and other aspects of emotional health in people with HIV (PWH) can affect functional independence, disease progression, and overall life quality. This study used the NIH Toolbox Emotion Battery (NIHTB-EB), which assesses many features of emotional health, to more comprehensively investigate differences among adults living with and without HIV, and to identify factors associated with emotional health for PWH.Patients and Methods: Participants (n=1451; age: M=50.19, SD=16.84; 47.90% women) included 433 PWH living in southern California seen from 2003 to 2021 (64.72% AIDS, 92.25% on antiretroviral therapy) and 1018 healthy participants from NIHTB-EB national normative cohort. Participants completed the NIHTB-EB and PWH underwent comprehensive HIV disease and psychiatric evaluations. We investigated differences in emotional health by HIV status via independent samples t-tests (continuous scores) and Chi2 tests (“problematic” emotional health scores). Multivariable linear regression models examined correlates of emotional health among PWH.Results: PWH had significantly worse emotional health than people without HIV across Social Satisfaction (Cohen’s d=0.71, p< 0.001), Psychological Well-Being (Cohen’s d=0.49, p< 0.001) and Negative Affect (Cohen’s d=0.19, p< 0.01) summary T-scores, and most component scales. PWH also had higher rates of “problematic” emotional health, particularly in Social Satisfaction (45% vs 17%, p< 0.0001). Poor emotional health among PWH was associated with lifetime Major Depressive and Substance Use Disorders, relationship status (lost relationship versus in relationship), unemployment, and cognitive difficulties and loss of functional independence.Conclusion: The NIHTB-EB identified that difficulties with multiple aspects of emotional health are common among PWH, and appear to be relatively independent of cognitive impairment as well as HIV disease and treatment history, but are strongly associated with everyday functioning. Given the cross-sectional nature of this study, longitudinal studies should be employed to evaluate causality pertaining to predictors of emotional health in PWH. These findings may inform interventions to promote emotional wellbeing in PWH.Keywords: social relationships, depression, emotional health, positive factors, HIV infection

Keywords

• social relationships
• depression
• emotional health
• positive factors
• hiv infection