this descriptive cross - sectional study was conducted at a large 1200-bedded tertiary care hospital at pune .
a total of 50 consecutive adult hiv seropositive individuals were included in the study after obtaining informed consent .
the minimum age was 24 years , and the maximum age recorded was 73 years hiv seropositivity was confirmed by two different enzyme - linked immunosorbent assay ( elisa ) methods .
staging of hiv seropositive case was carried out as per centers for disease control ( cdc ) classification .
subjects more than 18 years of age with confirmed hiv seropositivity who were physically asymptomatic in stage ii or iii of cdc .
subjects with past history of head injury with loss of consciousness , central nervous system ( cns ) disorders , psychiatric illness and those who qualify for aids defining criteria were excluded .
the questionnaire was divided into several parts like patient 's particulars , details of hiv status and high - risk behavior , questions on family support and discrimination .
personal particulars included questions on age , sex , occupation , residence ( rural / urban ) , education , income , marital status , years of marriage , and number of children .
details on hiv status like the reason , time and place of diagnosis and immediate reaction of the individual after knowing about his illness were included .
questions on high - risk behavior like the mode of transmission , status of disclosure , and knowledge about the sources of infection were asked .
further , the reactions received on disclosure at home and workplace along with the support levels was interrogated to assess the family support and discrimination .
the ghq is a self - administered screening test , which is sensitive to the presence of psychiatric disorders in individuals presenting in primary care settings and non - psychiatric clinical settings .
the ghq is not designed to detect symptoms that occur with specific psychiatric diagnose rather ; it provides a measure of overall psychological health or wellness .
retest reliability and both content validity and construct validity . in the present study , the shorter version containing 12 items 
the ghq has been translated into 38 languages and used in diverse cultural groups . as it is primarily concerned with the detection of  psychological illness , 
the items appear to have cross - cultural relevance despite cultural variations in the expression of mental illness .
the hads was developed as a self - report questionnaire to detect adverse anxiety and depressive states .
an analysis of scores on the two sub scales supported the differentiation of each mood state into four ranges :  mild cases 
( scores 8 - 10 ) ,  moderate cases  ( scores 11 - 15 ) , and  severe cases  ( scores 16 or higher ) .
the who-5 well - being index is a short , self - administered questionnaire covering 5 positively worded items , related to positive mood ( good spirits , relaxation ) , vitality ( being active and waking up fresh and rested ) , and general interests ( being interested in things ) .
it has shown to be a reliable measure of emotional functioning and a good screener for depression .
each of the five items is rated on a 6-point likert scale from 0 (= not present ) to 5 (= constantly present ) .
then the scores are transformed to 0 - 100 by multiplying by 4 , with higher scores meaning better well - being .
a score of 50 or below is indicative for low mood , though not necessarily depression .
the scoring of the tests was done as per the test booklet of each scale .
a total of 50 consecutive adult hiv seropositive individuals were included in the study after obtaining informed consent .
the minimum age was 24 years , and the maximum age recorded was 73 years hiv seropositivity was confirmed by two different enzyme - linked immunosorbent assay ( elisa ) methods .
staging of hiv seropositive case was carried out as per centers for disease control ( cdc ) classification .
subjects more than 18 years of age with confirmed hiv seropositivity who were physically asymptomatic in stage ii or iii of cdc .
subjects with past history of head injury with loss of consciousness , central nervous system ( cns ) disorders , psychiatric illness and those who qualify for aids defining criteria were excluded .
the questionnaire was divided into several parts like patient 's particulars , details of hiv status and high - risk behavior , questions on family support and discrimination .
personal particulars included questions on age , sex , occupation , residence ( rural / urban ) , education , income , marital status , years of marriage , and number of children .
details on hiv status like the reason , time and place of diagnosis and immediate reaction of the individual after knowing about his illness were included .
questions on high - risk behavior like the mode of transmission , status of disclosure , and knowledge about the sources of infection were asked .
further , the reactions received on disclosure at home and workplace along with the support levels was interrogated to assess the family support and discrimination .
the ghq is a self - administered screening test , which is sensitive to the presence of psychiatric disorders in individuals presenting in primary care settings and non - psychiatric clinical settings .
the ghq is not designed to detect symptoms that occur with specific psychiatric diagnose rather ; it provides a measure of overall psychological health or wellness .
retest reliability and both content validity and construct validity . in the present study , the shorter version containing 12 items 
the ghq has been translated into 38 languages and used in diverse cultural groups . as it is primarily concerned with the detection of  psychological illness , 
the items appear to have cross - cultural relevance despite cultural variations in the expression of mental illness .
the hads was developed as a self - report questionnaire to detect adverse anxiety and depressive states .
an analysis of scores on the two sub scales supported the differentiation of each mood state into four ranges :  mild cases 
( scores 8 - 10 ) ,  moderate cases  ( scores 11 - 15 ) , and  severe cases  ( scores 16 or higher ) .
the who-5 well - being index is a short , self - administered questionnaire covering 5 positively worded items , related to positive mood ( good spirits , relaxation ) , vitality ( being active and waking up fresh and rested ) , and general interests ( being interested in things ) .
it has shown to be a reliable measure of emotional functioning and a good screener for depression . administering the who-5 well - being index takes 2 - 3 min .
each of the five items is rated on a 6-point likert scale from 0 (= not present ) to 5 (= constantly present ) .
then the scores are transformed to 0 - 100 by multiplying by 4 , with higher scores meaning better well - being .
a score of 50 or below is indicative for low mood , though not necessarily depression .
the scoring of the tests was done as per the test booklet of each scale .
the mean age of the subjects was found out to be 37.92 ( 9.41 ) years .
66% individuals belonged to rural background as opposed to 34% who belonged to urban background .
100% cases were males . around 74% people interviewed in the study were army personnel out of which 62% were working , and 12% were ex - servicemen .
16% were farmers and 10% were of other occupations like banker , goldsmith , teacher etc .
demographic characteristics of the 50 hiv seropositive cases most of them were diagnosed hiv positive after getting a blood test carried out for some other disease [ table 2 ] . in this study , on being asked about the immediate emotional reaction on knowing about the disease status , 30% of the study group felt sad , and 16% reported hopelessness [ table 3 ] .
the influence of knowledge about mode of transmission on high - risk behavior is a moot question .
although the knowledge about modes of transmission of hiv illness was present in 52% of the sample , the disease had already affected them , through high - risk sexual behavior that was reported by 28% of the study group
. however , the awareness seems to have reduced the high - risk behavior in the remaining study group [ tables 4 and 5 ] .
it is interesting to observe that study group had disclosed their seropositive status , most of whom received support and cooperation from their family members .
the maximum status of disclosure was to spouses and less to parents and children of the diseased .
most of the individuals had disclosed their status in their workplace , 50% of whom were of the opinion that they had faced discrimination after disclosure [ tables 69 ] .
fifty - four percent individuals were suffering from anxiety with 26% people with severe anxiety .
a relationship was found out between anxiety and depression levels by using the pearson correlation .
the value was calculated as 0.682 , which shows a significant correlation between anxiety and depression [ tables 10 and 11 ] .
the ghq revealed that most individuals did not suffer from any psychological morbidity [ table 12 ] .
the who well - being index also showed consistent findings as most of the affected individuals had a good score [ table 13 ] .
reason of getting tested for hiv in the sample population immediate reaction after knowing the hiv positive status details of knowledge about the disease before contracting it details of the mode of transmission of the disease status of disclosure in home reaction received on disclosure at home support received from parents , spouse and children on disclosure status of disclosure and discrimination faced in the workplace anxiety and depression levels mean scores on anxiety and depression scale interpretation of general health questionnaire interpretation of world health organization well - being index among psychosocial variables stigma remains the major area of concern .
most researches emphasize that social support is an extremely important indicator of psychological well - being of an individual . in one of the studies , individuals in receipt of
quantitatively different levels of support were found to differ in measures of depression , stress , coping efficacy , and self - esteem , while individuals in receipt of deficient levels of support were found to be more depressed .
findings of the present study revealed internal consistency in respect of scores on ghq and who well - being scale .
in the present study , the majority of the subjects ( 72% ) were tested for hiv at the first instance for investigation of some other disease ; 6% were screened during routine medical examination and 8% were found to be seropositive on blood donation ; 14% were tested for other reasons like after their wife 's hiv positive status getting revealed on antental care ( anc ) examination , etc .
, primarily because of ignorance 32% of people felt no emotion on being told the positive result .
another large number of people felt sorrow ( 30% ) , hopelessness ( 16% ) , disbelief ( 14% ) , and anger ( 2% ) after knowing about it .
studies suggest that while some individuals may experience psychiatric disorders , the emotional responses to illness ( shock , disbelief , grief , sadness , anger , despair , fear , guilt , hopelessness , numbness , panic ) are considered normal and appropriate reactions . a total of 52% people knew about the disease before contracting it whereas 48% did not .
38% people accounted for heterosexual transmission as a cause of their illness of which 28% felt it was not from their spouses .
others said the cause was accidental inoculation ( 26% ) , parental blood transfusion ( 16% ) and iv drug abuse ( 6% ) .
the remaining did not disclose due to sheer neglect or fear of adverse reaction from their family members . on disclosure , maximum people got family support and cooperation ( 72% ) .
however , 8% felt they faced isolation and neglect from family , and another 10% said they did not get any response , which can be attributed to lack of knowledge and ignorance .
the patients had disclosed their status , mostly to their spouses ( 80% ) and less to their children ( 40% ) and parents ( 58% ) .
majority of the cases had disclosed their seropositive status in their workplace ( 64% ) . however , 50% of those who had disclosed were of the opinion that they were facing discrimination .
in the present study , 54% of the individuals suffered from anxiety out of which 26% had severe anxiety .
findings of the present study are in concurrence with the available literature . according to an indian study ,
the authors found anxiety disorders manifesting throughout the course of hiv infection , with a general trend for increased prevalence of these disorders as the illness progresses .
researchers have reported a prevalence range of 29 - 38% depending upon the stage of illness .
the study states that in comparison to the western studies , the number of individuals diagnosed as having anxiety disorders in an indian study was higher , however , the sample in the study differed from that in the western studies in terms of recruiting greater number of individuals symptomatic ( 55% of the total sample ) for hiv infection . according to this study , physical suffering ,
cultural factors like stigma , relative lack of appropriate treatments facilities , poor access to the health - care , and low educational level could have significantly contributed .
it further emphasized that since the individuals were assessed for anxiety soon after revelation of hiv status ( within 2 - 3 months ) , it could also account for the higher incidence of anxiety disorders .
in addition , pain , concurrent alcohol abuse / dependence , poor family support , and presence of aids in the spouse accounted for 57% of the total variance in the level of anxiety .
in our study , 30% individuals suffered from depression . furthermore , a significant correlation was seen in people having anxiety and depression .
many studies state depression , anxiety , and suicidal tendencies have been found to be quite prevalent among hiv - positive individuals . in particular , depression is quoted as the most common psychiatric disorder in hiv - infected patients and pharmacological intervention may be warranted .
rates of depression in hiv seropositive patients from the west have ranged from 5% to 25% . in earlier indian studies ,
majority ( 90% ) of the patients who had depressive symptoms also had prominent anxiety symptoms and fulfilled the icd-10 criteria for generalized anxiety disorder .
the relatively lower prevalence of depression in the present study could be due to the fact that they were evaluated soon after testing positive .
though the figures appear alarming , this could give us insight into concerns of patients .
early reports based on clinical observation or medical record reviews indicated high rates of distress and depressive symptoms among those infected with hiv or who had aids .
later studies , however , used structured psychiatric evaluations and community samples with hiv - negative comparison groups and showed rates of psychiatric disorder to be largely equivalent between hiv - positive and negative people .
the study carried out by bing et al . assessed a national probability sample of nearly 3,000 adults receiving care for hiv infection and found that more than a third screened positive for clinical depression , the most common disorder identified during study . in this study
, 56% individuals do not show any morbidity in ghq and 54% show a good well - being status in who well - being index .
these figures throw a light on the importance of social support being an important factor of quality of life .
most of the studies support the notion that social support is an essential determinant of the well - being of an infected individual .
individuals in receipt of quantitatively different levels of support were found to differ on measures of depression , stress , coping efficacy , and self - esteem , while individuals in receipt of deficient levels of support were found to be more depressed .
aspects of psychological well - being were related to each of the adherence measures . it was suggested that people who feel well cared for are more likely to be adherent .
the effect of repeated hiv - related bereavements upon an individual 's social network and the emotional , social , and physical sequel of bereavement have implications for hiv quality of life research as well .
quality of survival time has become a paramount issue in the context of hiv spectrum disease .
in the present study , 54% of the individuals suffered from anxiety out of which 26% had severe anxiety .
findings of the present study are in concurrence with the available literature . according to an indian study ,
the authors found anxiety disorders manifesting throughout the course of hiv infection , with a general trend for increased prevalence of these disorders as the illness progresses .
researchers have reported a prevalence range of 29 - 38% depending upon the stage of illness .
the study states that in comparison to the western studies , the number of individuals diagnosed as having anxiety disorders in an indian study was higher , however , the sample in the study differed from that in the western studies in terms of recruiting greater number of individuals symptomatic ( 55% of the total sample ) for hiv infection .
according to this study , physical suffering , cultural factors like stigma , relative lack of appropriate treatments facilities , poor access to the health - care , and low educational level could have significantly contributed .
it further emphasized that since the individuals were assessed for anxiety soon after revelation of hiv status ( within 2 - 3 months ) , it could also account for the higher incidence of anxiety disorders .
in addition , pain , concurrent alcohol abuse / dependence , poor family support , and presence of aids in the spouse accounted for 57% of the total variance in the level of anxiety . in our study , 30% individuals suffered from depression .
many studies state depression , anxiety , and suicidal tendencies have been found to be quite prevalent among hiv - positive individuals . in particular , depression is quoted as the most common psychiatric disorder in hiv - infected patients and pharmacological intervention may be warranted .
rates of depression in hiv seropositive patients from the west have ranged from 5% to 25% . in earlier indian studies , prevalence rates of depression among hiv seropositive individuals
have ranged from 10% to 40% . majority ( 90% ) of the patients who had depressive symptoms also had prominent anxiety symptoms and fulfilled the icd-10 criteria for generalized anxiety disorder .
the relatively lower prevalence of depression in the present study could be due to the fact that they were evaluated soon after testing positive .
though the figures appear alarming , this could give us insight into concerns of patients .
early reports based on clinical observation or medical record reviews indicated high rates of distress and depressive symptoms among those infected with hiv or who had aids .
later studies , however , used structured psychiatric evaluations and community samples with hiv - negative comparison groups and showed rates of psychiatric disorder to be largely equivalent between hiv - positive and negative people .
the study carried out by bing et al . assessed a national probability sample of nearly 3,000 adults receiving care for hiv infection and found that more than a third screened positive for clinical depression , the most common disorder identified during study . in this study
, 56% individuals do not show any morbidity in ghq and 54% show a good well - being status in who well - being index .
these figures throw a light on the importance of social support being an important factor of quality of life .
most of the studies support the notion that social support is an essential determinant of the well - being of an infected individual .
individuals in receipt of quantitatively different levels of support were found to differ on measures of depression , stress , coping efficacy , and self - esteem , while individuals in receipt of deficient levels of support were found to be more depressed .
aspects of psychological well - being were related to each of the adherence measures . it was suggested that people who feel well cared for are more likely to be adherent .
the effect of repeated hiv - related bereavements upon an individual 's social network and the emotional , social , and physical sequel of bereavement have implications for hiv quality of life research as well .
quality of survival time has become a paramount issue in the context of hiv spectrum disease .
studies have reported depression being the most common psychiatric morbidity among the afflicted individuals . however , in this study , anxiety was found to be more prevalent as compared to depression .
 background : reactions of people to a diagnosis of hiv and its effect on well - being vary greatly . 
 there is paucity of indian studies in this area.aim:to assess the level of anxiety , depression and quality of life in hiv seropositive individuals.materials and methods : it was a descriptive cross - sectional study with a sample size of 50 seropositive individuals . 
 they were assessed using a specially prepared proforma containing several questions pertaining to their demographic profile , details of hiv status and high - risk behavior , questions on family support and discrimination . in addition , all subjects were evaluated with who well - being index , general health questionnaire ( ghq ) , and hospital anxiety , and depression scale.results:anxiety was noted in 54% of the individuals whereas only 30% suffered from depression . 
 ghq showed psychological morbidity in 44% individuals . who well - being index noted poor psychological well - being in 46% of individuals.conclusion:the high level of anxiety and depression in hiv seropositive subjects reiterates the importance of psychological counseling in hiv afflicted individuals in conjunction with suitable pharmacotherapy . 
MATERIALS AND METHODS
Sample
Inclusion criteria
Exclusion criteria
Data collection
General Health Questionnaire
Hospital anxiety and depression scale
World Health Organization well-being index
RESULTS
DISCUSSION
Psychosocial variables
CONCLUSION