Cited by 146HIV/AIDS Research and InterventionsHealth disparities and outcomesHealth and Well-being Studies

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Direct and indirect effects of perceived social support on health-related quality of life in persons living with HIV/AIDS

Bekele, Tsegaye, Rourke, Sean B., Tucker, Ruthann, Greene, Saara, Sobota, Michael, Koornstra, Jay, Monette, Laverne, Rueda, Sergio, Bacon, Jean, Watson, James, Hwang, Stephen W., Dunn, James, Guenter, Dale, The Positive Spaces Healthy Places Team·2013·AIDS Care

DOI 10.1080/09540121.2012.701716

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Abstract

Research has established a link between perceived social support and health-related quality of life (HRQOL) among persons living with HIV/AIDS. However, little is known about the ways through which social support influences HRQOL. This study examined the direct and indirect effects of perceived social support on physical and mental HRQOL in a sample of 602 adults living with HIV in Ontario, Canada. Participants completed the Medical Outcomes Study-HIV (MOS-HIV) health survey, the MOS-HIV Social Support Scale (MOS-HIV-SSS), and the Center for Epidemiological Studies Depression-Revised scale. Data on demographic and clinical characteristics were also collected. The direct and indirect effects of social support on the two MOS-HIV HRQOL summary measures, that is, physical health summary (PHS) and mental health summary (MHS), were estimated in multiple linear regression analyses. Perceived social support had significant direct effects on PHS (B=0.04, p<0.01) and MHS (B=0.05, p<0.01). It also had significant indirect effect on both PHS (B=0.04, p<0.01) and MHS (B=0.11, p<0.01), mediated by depressive symptoms. Interventions that enhance social support have the potential to contribute to better HRQOL either directly or indirectly by decreasing the deleterious effect of depressive symptoms on HRQOL.

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Levitt, E. B., Ainuz, B. Y., Pourmoussa, A. J., Acuna, J., Rosa, M. R. D. L., Zevallos, J., Wang, W., Rodriguez, P., Castro, G., & Sánchez, M. (2019) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph16224391 · Cited by 19
The role of personality, social economic and prevention strategy effects on health-related quality of life among people living with HIV/AIDS
Wang, X., Luo, H., Yao, E., Tang, R., Dong, W., Liu, F., Liang, J., Li, H., Xiao, M., Zhang, Z., et al. (2021) · Infectious Diseases of Poverty · doi:10.1186/s40249-021-00890-9 · Cited by 17
The Medical Outcome Study‐HIV Health Survey: A systematic review and reliability generalization meta‐analysis
Alcocer‐Bruno, C., Ferrer‐Cascales, R., Rubio‐Aparicio, M., & Ruiz‐Robledillo, N. (2020) · Research in Nursing & Health · doi:10.1002/nur.22070 · Cited by 16
Type 2 Diabetes Burden and Diabetes Distress: The Buffering Effect of Patient-centred Communication
Peimani, M., Garmaroudi, G., Stewart, A. L., Yekaninejad, M. S., Shakibazadeh, E., & Nasli‐Esfahani, E. (2021) · Canadian Journal of Diabetes · doi:10.1016/j.jcjd.2021.11.007 · Cited by 16
Associations Between Social Support and Social Media Use Among Young Adult Cisgender MSM and Transgender Women Living With HIV
Gerke, D. R., Step, M. M., Rünger, D., Fletcher, J. B., Brooks, R. A., Davis, N., Kisler, K. A., & Reback, C. J. (2020) · Health Promotion Practice · doi:10.1177/1524839920936248 · Cited by 16
Use of geofencing interventions in population health research: a scoping review
Tobin, K. E., Heidari, O., Volpi, C. R., Sodder, S., & Duncan, D. T. (2023) · BMJ Open · doi:10.1136/bmjopen-2022-069374 · Cited by 15
Let’s be healthy together: Relational motivation for physical health is more effective for women
Gore, J. S., Bowman, K. M., Grosse, C., & Justice, L. (2015) · Motivation and Emotion · doi:10.1007/s11031-015-9523-9 · Cited by 17
Development of a Clinic Screening Tool to Identify Burdensome Health-Related Issues Affecting People Living With HIV in Spain
Fuster‐RuizdeApodaca, M. J., Safreed‐Harmon, K., de la Cal, M. P., Laguía, A., Naniche, D., & Lazarus, J. V. (2021) · Frontiers in Psychology · doi:10.3389/fpsyg.2021.681058 · Cited by 14
Mediation analysis of health‐related quality of life among people living with HIV infection in C hina
Li, X., Li, L., Wang, H., Fennie, K., Chen, J., & Williams, A. B. (2014) · Nursing and Health Sciences · doi:10.1111/nhs.12181 · Cited by 14
“Consistent with other studies (Bajunirwe et al., 2009; Holzemer et al., 2009; Bekele et al., 2013), our results confirmed that high levels of HIV stigma and low levels of social support were directly associated with poor HRQOL without considering depressive symptoms.”
BackgroundResult
Early ART Initiation Improves HIV Status Disclosure and Social Support in People Living with HIV, Linked to Care Within a Universal Test and Treat Program in Rural South Africa (ANRS 12249 TasP Trial)
for the ANRS 12249 TaSP Study Group, Fiorentino, M., Nishimwe, M. L., Protopopescu, C., Iwuji, C. C., Okesola, N., Spire, B., Orne‐Gliemann, J., McGrath, N. M., Pillay, D., et al. (2020) · AIDS and Behavior · doi:10.1007/s10461-020-03101-y · Cited by 14
Health-Related Quality of Life in People with Advanced HIV Disease, from 1996 to 2021: Systematic Review and Meta-analysis
Portilla, I., Rubio‐Aparicio, M., Fuster‐RuizdeApodaca, M. J., Portilla-Tamarit, J., Reus, S., & Portilla, J. (2024) · AIDS and Behavior · doi:10.1007/s10461-024-04298-y · Cited by 18
The Role of Dimensions of Social Support in the Relationship Between Stigma and Mental Health: A Moderation Analysis
Tian, J. M. L. H., Watson, J. R., Cioppa, L., Murphy, M., Boni, A. R., Parsons, J. A., Maunder, R., & Rourke, S. B. (2024) · AIDS and Behavior · doi:10.1007/s10461-024-04506-9 · Cited by 13
“Social support has been linked to positive health outcomes for people living with HIV including improved health-related quality of life [26–28], lower levels of depression and anxiety [29, 30], increased rates of HIV testing [31], and better treatment adherence [32].”
‘The own’ and ‘the wise’ as social support for older people living with HIV in the United Kingdom
Rosenfeld, D., & Anderson, J. (2018) · Ageing and Society · doi:10.1017/s0144686x18000909 · Cited by 13
“, 2006), and Shippy and Karpiak’s (2005) early work on OPLWH’s ‘fragile’ social support have sparked a growing body of research into ageing with HIV (see e.g. Mavandadi et al., 2009; Bekele et al., 2013; Brennan-Ing et al., 2016), much of which focuses on barriers to this older group’s social support.”
Background
Sleep disturbance, associated symptoms, and quality of life in adults living with HIV in Jakarta, Indonesia
Pujasari, H., Levy, J. A., Culbert, G. J., Steffen, A. D., Carley, D. W., & Kapella, M. C. (2020) · AIDS Care · doi:10.1080/09540121.2020.1748868 · Cited by 13
Illness perception and quality of life of HIV-positive persons: mediation effects of tenacious and flexible goal pursuit
Catunda, C., Seidl, E. M. F., & Lemétayer, F. (2016) · Psychology Health & Medicine · doi:10.1080/13548506.2016.1146404 · Cited by 13
“Studies show that the QOL of PLHIV is associated with several psychosocial aspects, such as social support (Beaulieu et al., 2012; Bekele et al., 2013; Slater et al., 2013; Vyavaharkar, Moneyham, Murdaugh, & Tavakoli, 2012), coping style (Slater et al., 2013; Vyavaharkar et al., 2012; Weaver et…”
Background
HIV-specific unsupportive social interactions, health, and ethnicity in men living with HIV
Fekete, E. M., Deichert, N. T., & Williams, S. L. (2013) · Journal of Social and Personal Relationships · doi:10.1177/0265407513506796 · Cited by 12
“In men and women living with HIV, depressive symptoms explain the relationship between perceptions of social support and health-related quality of life (Bekele et al., 2013).”
BackgroundInfluential
Psychosocial Risk Factors: its Relation with Social Cognition, Emotional Regulation and Well-Being
Betancourt, Y. U., & Muñoz, J. A. C. (2019) · International journal of psychological research · doi:10.21500/20112084.3741 · Cited by 16
“Positive Peers”: Function and Content Development of a Mobile App for Engaging and Retaining Young Adults in HIV Care
Step, M. M., Smith, J. M., Kratz, J., Briggs, J., & Avery, A. (2019) · JMIR Formative Research · doi:10.2196/13495 · Cited by 11
Assessing the impact of homelessness on HIV/AIDS transmission dynamics
Bhunu, C. P. (2015) · Cogent Mathematics · doi:10.1080/23311835.2015.1021602 · Cited by 11
“Thus, housing is the greatest unmet need of people living with HIV (Bekele et al., 2013; Shubert & Bernstine, 2007).”
Background
Experiences of women aging with the human immunodeficiency virus: A qualitative study
Akhtar, N. F., Garcha, R. K., & Solomon, P. E. (2017) · Canadian Journal of Occupational Therapy · doi:10.1177/0008417417722574 · Cited by 11
Adapting an m-Health Intervention for Spanish-Speaking Latinx People Living with HIV in the Nonurban Southern United States
Flickinger, T., Sherbuk, J. E., de Guex, K. P., Añazco, D., Hilgart, M. M., McManus, K. A., Ingersoll, K. S., & Dillingham, R. (2021) · Telemedicine Reports · doi:10.1089/tmr.2020.0018 · Cited by 11
Social Network Size and its Relationship to Domains of Quality-of-life among Older Persons Living with HIV
Yoo-Jeong, M., Nguyen, A., & Waldrop, D. (2022) · AIDS Care · doi:10.1080/09540121.2022.2057907 · Cited by 13
Online Social Support Perceived by Facebook Users and Its Effects on Stress Coping
Chung, T.-Y., Yang, C., & Chen, M. (2014) · Journal of corporate governance insurance and risk management · doi:10.56578/jcgirm010212 · Cited by 11
“Bekele (2013) found that perceived social support had both direct and indirect effects on health-related quality of life in persons living with HIV/AIDS.”
Background
The Value of Support Group Participation in Influencing Adherence to Antiretroviral Treatment among People Living with Human Immunodeficiency Virus (HIV)
Tumwikirize, S., Torpey, K., Adedokun, O. A., & Badru, T. (2015) · World Journal of AIDS · doi:10.4236/wja.2015.53022 · Cited by 10
The mediating effects of functions of social support on HIV-related trauma and health-related quality of life for PLHIV in China
Anderson, J. D., Li, X., Qiao, S., Zhou, Y., & Shen, Z. (2019) · AIDS Care · doi:10.1080/09540121.2019.1622633 · Cited by 10
Pathways and Processes Linking Social Support to Health: Development of an Exploratory Model With South African Caregivers
Casale, M. (2020) · Qualitative Health Research · doi:10.1177/1049732320966584 · Cited by 10
“They also resonate with studies showing measures of mental health to mediate the relationship between social support and self-reported health or health-related quality of life, including among people living with HIV (Bekele et al., 2013; Xiaowen et al., 2018).”
BackgroundResult
Effects of Stigma on the Relationship Between Perceived Social Support and Sexual Satisfaction Among Breast Cancer Survivors
Zhang, Y., Zhao, J., Jiang, N., Wang, T., Cao, H., Wang, Q., Wei, X., Wang, J., & Yu, J. (2022) · The Journal of Sexual Medicine · doi:10.1016/j.jsxm.2022.03.617 · Cited by 9
An in-depth analysis of the relation of health and poverty in Europe
Apostu, S. A., Dimian, G. C., & Vasilescu, M. D. (2022) · Panoeconomicus · doi:10.2298/pan210622006a · Cited by 11
Rasch Analysis and Differential Item Functioning of a Social Support Measure in Jail Inmates With HIV Infection
Kim, S. J., Ouellet, L. J., Mazza, J., & Spaulding, A. C. (2016) · Evaluation & the Health Professions · doi:10.1177/0163278716644954 · Cited by 9
“Closer to our findings, Bekele and others reported that a sample of mostly lower income Canadian adults with HIV infection scored 56.6 on MOS-SSS (Bekele et al., 2013).”
ResultInfluential
Anticipated suicidal ideation among female injecting drug users who are sex workers of negative or unknown HIV status in China
Lau, J. T. F., Gu, J., Tsui, H. Y., Chen, H., Wang, Z. J., & Cao, W. (2017) · Women & Health · doi:10.1080/03630242.2017.1353571 · Cited by 9
“…and family support are important external coping resources (Overdale and Gardner 2012), which could protect PLWH from developing psychological problems and may moderate the relationship between perceived stress and psychological problems (Amiya et al. 2014; Bekele et al. 2013; Liu et al. 2013).”
Background
Effect of Social Support and HIV-Related Stigma on Depression in HIV/AIDS Patients
Umeadi, C. A. (2015) · ScholarWorks (Walden University) · Cited by 9
Improving depression and perceived social support enhances overall quality of life among myocardial infarction survivors: necessity for integrating mental health care into cardiac rehabilitation programs
Upadhyay, V. K., Bhandarı, S. S., Prasad, D., Dutta, S., Grau, P. G., & Vaddiparti, K. (2022) · The Egyptian Journal of Neurology Psychiatry and Neurosurgery · doi:10.1186/s41983-022-00521-6 · Cited by 8
“…hypothesis predicted, we found that depression mediates the effect of PSS on QoL, which is in agreement with the findings of studies performed in patients with human immunodeficiency virus infection and acquired immune deficiency syndrome [38] and elderly patients with multiple morbidities [39].”
Result
Does Type of Social Support Influence Medication Adherence Among South African Adolescents Living With HIV? A Quantitative Analysis of Pilot Data
Malo, V. F., Ritchwood, T. D., Relf, M. V., & Bekker, L. (2022) · Journal of the Association of Nurses in AIDS Care · doi:10.1097/jnc.0000000000000325 · Cited by 8
“Although some studies have examined the effect of global social support on HIV-related clinical and mental health outcomes among ALWH (Bekele et al., 2013; Casale, Carlqvist, et al., 2019;Casale et al., 2015;Kelly et al., 2014;Ncama et al., 2008; Okawa et al., 2011), few have explored the influence…”
Background
It’s all about connection: Determinants of social support and the influence on HIV treatment interruptions among people living with HIV in British Columbia, Canada
Tam, C., Wesseling, T., Wang, L., Salters, K., Moore, D. M., Dawydiuk, N., Zhu, J., Grieve, S., Bingham, B., McLinden, T., et al. (2023) · BMC Public Health · doi:10.1186/s12889-023-17416-7 · Cited by 10
“Among PLWH, higher social support has been found to be positively associated with higher measures of overall quality of life [13–16] and was also found to be associated with earlier HIV diagnosis [17], while lower social support was associated with depression [18, 19].”
Background
Ethnic differences in the links between benefit finding and psychological adjustment in people living with HIV
Fekete, E. M., Chatterton, M., Skinta, M. D., & Williams, S. L. (2016) · Journal of Behavioral Medicine · doi:10.1007/s10865-016-9715-0 · Cited by 8
Association of Supplemental Nutrition Assistance Program (SNAP) with Health Related Quality of Life and Disease State of HIV Infected Patients
Hatsu, I. E., Johnson, P., Baum, M. K., Huffman, F. G., Thomlison, B., & Campa, A. L. (2014) · AIDS and Behavior · doi:10.1007/s10461-014-0801-4 · Cited by 7
“In addition, several studies have shown that psychological and social support influences HRQOL in this population, sometimes even mediating the relationship of quality of life with symptomatology and/or treatment side effects [18–21].”
Background
Impact of Community Support Workers in Rural Ethiopia on Emotional and Psychosocial Health of Persons Living with HIV: Results of a Three-Year Randomized Community Trial
Lifson, A. R., Hailemichael, A., Workneh, S., MacLehose, R. F., Horvath, K. J., Hilk, R., Sites, A. R., & Shenie, T. (2023) · AIDS and Behavior · doi:10.1007/s10461-023-04007-1 · Cited by 7
“Social support can play a critical role in helping individuals cope with stressful life events and ongoing life strains [33, 34], and social support among PLWH can play an important role in promoting physical and mental health, and improved quality of life [7, 35, 36].”
Background
Intensity of Social Support Matters: A Latent Class Analysis to Identify Levels of Social Support Associated with Optimal Health Outcomes Among Women Living with HIV
Chandran, A., Bhondoekhan, F., Wilson, T. E., Milam, J. E., Cohen, M. H., Adimora, A. A., Adedimeji, A., Cocohoba, J. M., Parish, C. L., Holstad, M. M., et al. (2021) · AIDS and Behavior · doi:10.1007/s10461-021-03377-8 · Cited by 7
Gastrointestinal Symptom Distress is Associated With Worse Mental and Physical Health-Related Quality of Life
O’Neill, T. J., Raboud, J., Tinmouth, J., Rourke, S. B., Rueda, S., Hart, T. A., Cooper, C., Rachlis, A., Burchell, A. N., & the OHTN Cohort Study Team (2017) · JAIDS Journal of Acquired Immune Deficiency Syndromes · doi:10.1097/qai.0000000000001309 · Cited by 7
Psychosocial correlates of health-related quality of life among people living with HIV in China
Zhao, Q., Mao, Y., Li, X., Qiao, S., Zhou, Y., & Shen, Z. (2019) · AIDS · doi:10.1097/qad.0000000000002180 · Cited by 7
Emotional experiences, difficulties, and facilitators in patient care of nurses working in surgical units: a qualitative study
Şahin, Ş., & Özhanlı, Y. (2025) · BMC Nursing · doi:10.1186/s12912-025-04010-y · Cited by 8
Stigma, Social Support, and Substance Use in Diverse Men Who Have Sex With Men and Transgender Women Living with HIV in the US Southeast
Schafer, K. R., Tanner, A. E., Mann‐Jackson, L., Alonzo, J., Song, E., & Rhodes, S. D. (2022) · Southern Medical Journal · doi:10.14423/smj.0000000000001345 · Cited by 6
“Social support, including emotional, informational, and tangible support from family and friends or in the form of services from organizations, increases health-related quality of life and health outcomes among PLWH, but the role of social support is less clear within the context of substance use.(33,34) Social media…”
Background
Exploring the Longitudinal Influence of Perceived Social Support, HIV Stigma, and Future Orientation on Depressive Symptoms Among People Living with HIV in China
Yuan, G. F., Zhang, R., Qiao, S., Li, X., Shen, Z., & Zhou, Y. (2024) · AIDS and Behavior · doi:10.1007/s10461-024-04292-4 · Cited by 9
“Similarly, Bekele et al. examined the mental health of a sample of 603 PLWH in Canada and found a significant inverse association between perceived social support and depressive symptoms [17].”
Reliability and validity of the European Portuguese version of the quality of life index EUROHIS-QOL-8 in HIV-infected patients
Pereira, M., & Canavarro, M. C. (2015) · Revista Portuguesa de Saúde Pública · doi:10.1016/j.rpsp.2015.04.002 · Cited by 6

Authors: Bekele, T., Rourke, S. B., Tucker, R., Greene, S., Sobota, M., Koornstra, J., Monette, L., Rueda, S., Bacon, J., Watson, J., Hwang, S. W., Dunn, J., Guenter, D., & The Positive Spaces Healthy Places Team
Affiliations: Ontario HIV Treatment Network (CA)
St. Michael's Hospital (CA)
Positive Health Network (CA)
Fife House (CA)
AIDS Thunder Bay, Thunder Bay, Canada
Bruce House, Ottawa, Canada
Ontario Aboriginal HIV/AIDS Strategy, Toronto, Canada
McMaster University (CA)
Corresponding author: Rourke, Sean B.
ORCID: Bekele, Tsegaye
Rourke, Sean B.
Greene, Saara
Rueda, Sergio
Bacon, Jean
Hwang, Stephen W.
Dunn, James
Guenter, Dale
Venue: AIDS Care
Publisher: Informa UK Limited
Published: 2012-07-09
Volume: 25
Issue: 3
Pages: 337-346
ISSN: 0954-0121 (ISSN-L)
1360-0451
DOI: 10.1080/09540121.2012.701716
OpenAlex: W2064343532
Cited by: 146
References: 52
Citations by year: 2026: 2 · 2025: 11 · 2024: 8 · 2023: 7 · 2022: 10 · 2021: 11 · 2020: 13 · 2019: 13 · 2018: 17 · 2017: 10 · 2016: 14 · 2015: 16 · 2014: 9 · 2013: 4 · 2012: 1
FWCI: 6.63
Type: journal article
Language: en
Open access: closed
Locations: AIDS Care (publishedVersion)
PubMed (publishedVersion)
Funders: Ontario Ministry of Health and Long-Term Care
Canadian Institutes of Health Research
Topics: Health Sciences › Medicine › Infectious Diseases › HIV/AIDS Research and Interventions
Social Sciences › Health › Health disparities and outcomes
Social Sciences › Psychology › Clinical Psychology › Health and Well-being Studies
Keywords: perceived social support, health-related quality of life, HIV/AIDS, people living with HIV, depressive symptoms, mediation, physical health, mental health, MOS-HIV
MeSH terms: Acquired Immunodeficiency Syndrome, Adult, Aged, Depression, Female, Health Status, Humans, Male, Middle Aged, Ontario, Quality of Life, Social Support, HIV Infections, Outcome Assessment, Health Care, HIV Long-Term Survivors, Young Adult

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Direct and indirect effects of perceived social support on health-related quality of life in persons living with HIV/AIDS

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