Participant Characteristics and Socio-economic Aspects
A total of 600 adults (≥ 18 years old. 315 PLWH vs 285 PLWOD) were recruited for the study, after being admitted to the Hospital for the routine visits. 211 patients (35,2% of the total) refused to take part to the study: 143 patients with HIV (32,17% women) and 68 patients with oncological disease (42,65% women). Lack of time and will were the main causes of refusal. Furthermore, 65 (10,8%) questionnaires were excluded as were incomplete. Overall, 324 (54% of the total) were eligible for analyses: 167 PLWH and 157 PLWOD. PLWH were significant younger compared to PLWOD and PLWH had a significant longest history of disease compared to PLWOD (Table 1).
Additionally, from the socio-economic point of view, 153 patients (47,2%) were employed while 103 patients (31,8%) were retired. A greater number of PLWH than PLWOD were employed, while a significant greater number of PLWOD were retired (p < 0.001). At last, PLWH were significant more worried than PLWOD about economics and financial problems due to the pandemic (32,9% PLWH vs 9,56% PLWOD, p < 0.001). (Table 2).
Almost 25% of total patients referred to have a history of psychological problems without significant differences between groups. Depression was the most widespread psychological disorder among the groups. Furthermore, the majority of the patients (97,2%) reported to respect the care continuum during the pandemic. (Table S1 in supplementary materials).
Table 1
Participant Characteristics
Recruitment: n (%) | PLWH (N=315) | PLWOD (N=285) | Total (N=600) | |
Participants | 167 (51.5%) | 157 (48.5%) | 324(54%) | |
Refusal | 143 (67.8%) | 68 (32.2%) | 211(35.2%) | |
Interrupted | 5 (7.7%) | 60 (92.3%) | 65(10.8%) | |
Characteristics | Observed | Total (N=324) | p- value |
| PLWH (N=167) | PLWOD (N=157) | | |
Age: | | | | <.001* |
Year: mean (sd) | 51.0 (11.2) | 61.6 (12.5) | 56.1 (13.0) | |
Sex: n (%) | | | | < .001* |
Male | 114 (68.3%) | 73 (46.5%) | 187 (57.7%) | |
Female | 52 (31.1%) | 84 (53.5%) | 136 (42.0%) | |
Others | 1 (0.6%) | 0 (0%) | 1 (0.3%) | |
Education: | | | | |
Year: mean (sd) | 10.6 (3.9) | 10.7 (4) | 10.6 (3.9%) | .880 |
Level of education: n (%) | | | | .048* |
Primary School diploma | 17 (10.2%) | 26 (16.6%) | 43 (13.3%) | |
Middle School diploma | 74 (44.3%) | 49 (31.2%) | 123 (38.0%) | |
High School diploma | 55 (32.9%) | 65 (41.4%) | 120 (37.0%) | |
Degree | 21 (12.6%) | 17 (10.8%) | 38 (11.7%) | |
Nationality: n (%) | | | | .084 |
Italian | 156 (93.4%) | 153 (97.5%) | 309 (95.4%) | |
Foreigner | 11 (6.6%) | 4 (2.5%) | 15 (4.6%) | |
Diagnosis: n (%) | | | | < .001* |
< 5 years | 17 (10.2%) | 116 (73.9%) | 133 (41.0%) | |
≥ 5 years | 150 (89.8%) | 41 (26.1%) | 191 (59.0%) | |
Cohabitation during the interview: n (%) | | | < .001* |
Single | 48 (28.7%) | 20 (12.7%) | 68 (21.0%) | |
With someone | 119 (71.3%) | 137 (87.3%) | 256 (79.0%) | |
Cohabitation during the quarantine (first wave): n (%) | | < .001* |
Single | 42 (25.2%) | 17 (10.8%) | 59 (18.2%) | |
With someone | 125 (74.9%) | 140 (89.2%) | 265 (81.8%) | |
Note: * Significant values. |
Table 2
Characteristics | Observed | Total (N=324) | p- value |
| PLWH (N=167) | PLWOD (N=157) | | |
Employment: n (%) | | | | <. 001* |
Employed | 103 (61.7%) | 50 (31.8%) | 153 (47.2%) | |
Pensioners | 24 (14.4%) | 79 (50.3%) | 103 (31.8%) | |
Housewife | 11 (6.6%) | 17 (10.8%) | 28 (8.6%) | |
Unemployed | 21 (12.6%) | 4 (2.6%) | 25 (7.7%) | |
Other | 8 (4.8%) | 6 (3.8%) | 14 (4.3%) | |
Student | 0 (0.0%) | 1 (0.6%) | 1 (0.3%) | |
Habitation: n (%) | | | | < .001* |
Spacious house with garden | 123 (73.7%) | 146 (93.0%) | 269 (83.0%) | |
Three-room apartment | 20 (12.0%) | 9 (5.7%) | 29 (9.0%) | |
Two-room apartment | 17 (10.2%) | 2 (1.3%) | 19 (5.9%) | |
Studio apartment | 7 (4.2%) | 0 (0.0%) | 7 (2.2%) | |
Concern for economics problems: n (%) | | < .001* |
Not at all | 83 (49.7%) | 121 (77.1%) | 204 (63.0%) | |
A little | 29 (17.4%) | 21 (13.4%) | 50 (15.4%) | |
A lot | 55 (32.9%) | 15 (9.6%) | 70 (21.6%) | |
Note: * Significant values. |
Information about COVID-19
Patients’ general knowledge about important aspects of COVID-19 pandemic was analyzed (Table 3). The majority of patients (87%) reported to be alert to the COVID-19-related symptoms, such as anosmia, ageusia, fever, cough, fatigue, and dyspnoea (86,2% of PLWH vs 87,9% of PLWOD). Participants were aware about the recommended prevention methods. In particular, 150 patients (46,9%) sustained that facial masks are enough to protect from the virus while 139 patients (43,4%) reported that not only facial masks but also physical distancing and hand washing are necessary to protect from the infection.
Furthermore, the association between living with chronic disease and living during the pandemic was analyzed. When asked about living with chronic diseases while facing the risk of contracting COVID-19, most of the participants (47,7%) reported that they no longer consider themselves at higher risk than other people (53% of PLWH vs 42% of PLWOD). However, a significant greater number of PLWOD than PLWH thought to be at risk (25,9% of PLWH vs 40,8% of PLWOD, p = 0.018) and were worried about their clinical outcome (35,5% of PLWH and 52,3% of PLWOD, p = 0.007). Lastly, most of the participants (62,7%) would like to get the vaccination as soon as it was available (58,7% of PLWH vs 66,9% of PLWOD).
In sum, most of the patients were careful about the symptoms of COVID-19 and they understood the importance of protecting themselves and reducing the diffusion of the virus: PLWOD were in general more aware and worried about the outcome of the COVID-19 infection than PLWH.
The 97,2% of patients were aware of the progress of the pandemic (Table S2 in supplementary materials). Patients consulted the COVID-19-related information from different sources, the most used ones were television, internet, and social media. Most of the patients (71,9%) reported that information obtained by the doctors were useful, while information provided by politicians were confused and catastrophic. 161 patients (49,7%) checked the news every 3-5 hours and PLWOD consulted the COVID-19-related information significant more frequently than PLWH (42,5% of PLWH vs 57,3% of PLWOD, p = 0.013).
Table 3
Characteristics | Observed | Total (N=324) | p- value |
| PLWH (N=167) | PLWOD (N=157) | | |
Pay attention to Covid-19 symptoms: n (%) | | .052** |
Not at all | 5 (3.0%) | 11 (7.0%) | 16 (4.9%) | |
A little | 18 (10.8%) | 8 (5.1%) | 26 (8.1%) | |
A lot | 144 (86.2%) | 138 (87.9%) | 282 (87.0%) | |
The facial masks are enough to protect yourself: n (%) | | .421 |
N-Miss | 2 | 2 | 4 | |
Not at all | 19 (11.5%) | 12 (7.7%) | 31 (9.7%) | |
A little | 73 (44.2%) | 66 (42.6%) | 139 (43.4%) | |
A lot | 73 (44.2%) | 77 (49.7%) | 150 (46.9%) | |
Concern of being at risk: n (%) | | .018* |
N-Miss | 1 | 0 | 1 | |
Not at all | 88 (53.0%) | 66 (42.0%) | 154 (47.7%) | |
A little | 35 (21.1%) | 27 (17.2%) | 62 (19.2%) | |
A lot | 43 (25.9%) | 64 (40.8%) | 107 (33.1%) | |
Worsening of the chronic disease: n (%) | | .007* |
N-Miss | 1 | 2 | 3 | |
Not at all | 83 (50.0%) | 53 (34.2%) | 136 (42.4%) | |
A little | 24 (14.5%) | 21 (13.5%) | 45 (14.0%) | |
A lot | 59 (35.5%) | 81 (52.3%) | 140 (43.6%) | |
Vaccination: n (%) | | | | .253 |
As soon as possible | 98 (58.7%) | 105 (66.9%) | 203 (62.7%) | |
Wait to see the effects | 48 (28.7%) | 39 (24.8%) | 87 (26.9%) | |
Never | 21 (12.6%) | 13 (8.28%) | 34 (10.5%) | |
Note: * significant values. ** tendency to significant values. |
Social support and coping strategies
Social and family networks were analyzed to identify the support received (Table S3 in supplementary materials). The 81,2% of participants reported to be very helped by the family in the everyday life both for the practical, psychological and emotional aspects. They felt also protected to express their COVID-19-related concerns and thoughts to the family. Moreover, the majority of the participants (62%) reported not having feelings of solitude than usual during the quarantine. Indeed, during the pandemic, participants have managed to maintain good relationships with others, such as family and friends. Furthermore, the majority of the participants (73,6%) did not receive and search support from other patients with the same disease.
Three aspects of coping strategies were analyzed: the faith, the using of meditation techniques and the ability to take pleasure from their activities and hobbies. Only the 29,5% of patients received support by the faith (19,3% of PLWH vs 40,5% of PLWOD, p < 0.001). Most of the participants (80,5%) did not use meditation techniques while the 71,3% continued to take pleasure from their activities and hobbies. Patients reported that found new activities, such as cooking, when their previous hobbies were suspended.
Stress And Experiences
Emotional experiences of the participants were analyzed to understand the stress of the patients during the quarantine (Table 4). A greater number of PLWOD were significant calmer than PLWH (p = 0.039) and, on the other hand, a greater number of PLWH were more restless than PLWOD (p = 0.014). Overall, 254 patients (78,4%) referred to have lived peacefully (72,5% of PLWH vs 84,7% PLWOD, p = 0.026).
Regarding daily habits, a major part of the participants (65,3%) reported not to have changed the quality of sleep (59,6% of PLWH vs 71,4% PLWOD, p = 0.086). Changes in nutritional supply were also analyzed: 63 patients (19,4%) referred an increase in food intake (25,2% of PLWH vs 13,4% of PLWOD, p = 0.003). Notwithstanding, only the 22,2% of patients reported weight increase (28,7% of PLWH vs 15,3/ of PLWOD, p = 0.013). Moreover, PLWH smoked significant more than PLWOD (10,8% of PLWH vs 1,3% of PLWOD, p < 0.001).
The suicidal thoughts and the self-harming ideas were also analyzed among participants. Most of the patients (90,7%) did not experience intrusive thoughts. The introspection ability among participants was analyzed and most of patients (53,9%) reported that the quarantine was a period of personal development.
Lastly, it was asked to the PLWH group if the COVID-19 may be comparable with the HIV pandemic. Most of the patients (31,8%) referred that the two situations were not comparable.
Table 4
Characteristics | Observed | Total (N=324) | p- value |
| PLWH (N=167) | PLWOD (N=157) | | |
Feelings during the quarantine: n (%) | | |
Calm | | | | .039* |
Yes | 82 (49.1%) | 95 (60.5%) | 147 (45.4%) | |
No | 85 (50.9%) | 62 (39.5%) | 177 (54.6%) | |
Indifferent | | | | .530 |
Yes | 5 (3.0%) | 3 (1.9%) | 8 (2.5%) | |
No | 162 (97.0%) | 154 (98.1%) | 316 (97.5%) | |
Sad | | | | .207 |
Yes | 21 (12.6%) | 13 (8.3%) | 34 (10.5%) | |
No | 146 (87.4%) | 144 (91.7%) | 290 (89.5%) | |
Sense of guilty | | | | .579 |
Yes | 0 (0.0%) | 0 (0.0%) | 0 (0.0%) | |
No | 167 (100%) | 157 (100%) | 324 (100%) | |
Powerless | | | | .116 |
Yes | 23 (13.8%) | 13 (8.28%) | 36 (11.1%) | |
No | 144 (86.2%) | 144 (91.7%) | 288 (88.9%) | |
Angry | | | | .887 |
Yes | 10 (6.0%) | 10 (6.4%) | 20 (6.2%) | |
No | 157 (94.0%) | 147 (93.6%) | 304 (93.8%) | |
Nerves | | | | .435 |
Yes | 12 (7.2%) | 8 (5.1%) | 20 (6.2%) | |
No | 155 (92.8%) | 149 (94.9%) | 304 (93.8%) | |
Troubled | | | | .014* |
Yes | 20 (12.0%) | 7 (4.46%) | 27 (8.33%) | |
No | 147 (88.0%) | 150 (95.5%) | 297 (91.7%) | |
Worried | | | | .196 |
Yes | 80 (47.9%) | 64 (40.8%) | 144 (44.4%) | |
No | 87 (52.1%) | 93 (59.3%) | 180 (55.6%) | |
Anxious | | | | .209 |
Yes | 26 (15.6%) | 17 (10.8%) | 43 (13.3%) | |
No | 141 (84.4%) | 140 (89.2%) | 281 (86.7%) | |
Frightened | | | | .659 |
Yes | 38 (22.8%) | 39 (24.8%) | 77 (23.8%) | |
No | 129 (77.3%) | 118 (75.2%) | 247 (76.2%) | |
Panic | | | | .421 |
Yes | 3 (1.8%) | 5 (3.19%) | 8 (2.5%) | |
No | 164 (98.2%) | 152 (96.8%) | 316 (97.5%) | |
Isolated | | | | .957 |
Yes | 22 (13.2%) | 21 (13.4%) | 43 (13.3%) | |
No | 145 (86.8%) | 136 (86.6%) | 281 (86.7%) | |
Living with serenity the situation: n (%) | | .026* |
Not at all | 10 (5.9%) | 6 (3.8%) | 16 (4.9%) | |
A little | 36 (21.6%) | 18 (11.5%) | 54 (16.7%) | |
A lot | 121 (72.5%) | 133 (84.7%) | 254 (78.4%) | |
Feeling confident: n (%) | | .290 |
Not at all | 26 (15.6%) | 18 (11.5%) | 44 (13.6%) | |
A little | 57 (34.1%) | 47 (29.9%) | 104 (32.1%) | |
A lot | 84 (50.3%) | 92 (58.6%) | 176 (54.3%) | |
Feeling pessimist: n (%) | | .853 |
Not at all | 98 (58.7%) | 94 (59.9%) | 192 (59.3%) | |
A little | 51 (30.5%) | 44 (28.0%) | 95 (29.3%) | |
A lot | 18 (10.8%) | 19 (12.1%) | 37 (11.4%) | |
Change the quality of sleep: n (%) | | .086 |
N-Miss | 1 | 0 | 1 | |
Not at all | 99 (59.6%) | 112 (71.4%) | 211 (65.3%) | |
A little | 37 (22.3%) | 24 (15.3%) | 61 (18.9%) | |
A lot | 30 (18.1%) | 21 (13.4%) | 51 (15.8%) | |
Eating more: n (%) | | .003* |
Not at all | 88 (52.7%) | 111 (70.7%) | 199 (61.4%) | |
A little | 37 (22.2%) | 25 (15.9%) | 62 (19.1%) | |
A lot | 42 (25.2%) | 21 (13.4%) | 63 (19.4%) | |
Weight changes: n (%) | | .013* |
No | 106 (63.5%) | 121 (77.1%) | 227 (70.1%) | |
Loss weight | 13 (7.8%) | 12 (7.6%) | 25 (7.7%) | |
Gain weight | 48 (28.7%) | 24 (15.3%) | 72 (22.2%) | |
Characteristics Observed | Total (N=324) | p- value |
Smoking: n (%) | | < .001* |
Not smoke | 93 (55.7%) | 133 (84.7%) | 226 (69.8%) | |
Not at all | 44 (26.3%) | 18 (11.5%) | 62 (19.1%) | |
A little | 12 (7.2%) | 4 (2.5%) | 16 (4.9%) | |
A lot | 18 (10.8%) | 2 (1.3%) | 20 (6.2%) | |
Alcohol: n (%) | | .026* |
Not drink | 109 (65.3%) | 116 (73.9%) | 225 (69.4%) | |
Not at all | 44 (26.3%) | 39 (24.8%) | 83 (25.6%) | |
A little | 8 (4.8%) | 1 (0.6%) | 9 (2.8%) | |
A lot | 6 (3.6%) | 1 (0.6%) | 7 (2.2%) | |
Drugs: n (%) | | .011* |
Not use drugs | 155 (92.8%) | 156 (99.4%) | 311 (96.0%) | |
Not at all | 11 (6.6%) | 1 (0.6%) | 12 (3.7%) | |
A little | 1 (0.6%) | 0 (0.0%) | 1 (0.3%) | |
A lot | 0 (0.0%) | 0 (0.0%) | 0 (0.0%) | |
Mood medications: n (%) | | .627 |
Not at all | 152 (91.0%) | 141 (89.8%) | 293 (90.4%) | |
A little | 9 (5.4%) | 12 (7.6%) | 21 (6.5%) | |
A lot | 6 (3.6%) | 4 (2.5%) | 10 (3.1%) | |
Suicidal thoughts: n (%) | | .198 |
Not at all | 156 (93.4%) | 138 (87.9%) | 294 (90.7%) | |
A little | 7 (4.2%) | 14 (8.9%) | 21 (6.5%) | |
A lot | 4 (2.4%) | 5 (3.2%) | 9 (2.8%) | |
Psychological support: n (%) | | .586 |
Yes | 23 (13.8%) | 25 (15.9%) | 48 (14.8%) | |
No | 144 (86.2%) | 132 (84.1%) | 276 (85.2%) | |
Others were more scarred than the patients: n (%) | | .840 |
N-Miss | 2 | 2 | 4 | |
Not at all | 35 (21.2%) | 37 (23.9%) | 72 (22.5%) | |
A little | 42 (25.5%) | 37 (23.9%) | 79 (24.7%) | |
A lot | 88 (53.3%) | 81 (52.3%) | 169 (52.8%) | |
Period of reflection: n (%) | | .104 |
N-Miss | 0 | 1 | 1 | |
Not at all | 40 (24.0%) | 52 (33.3%) | 92 (28.5%) | |
A little | 28 (16.8%) | 29 (18.6%) | 57 (17.6%) | |
A lot | 99 (59.3%) | 75 (48.1%) | 174 (53.9%) | |
Covid-19 pandemic vs HIV pandemic: n (%) | | |
Not at all | 103 (31.8%) | - | | |
A little | 30 (9.3%) | - | | |
A lot | 32 (9.9%) | - | | |
Note: * Significant values. |
Experience in hospital ward
PLWH have been using the hospital services for significant longer time than PLWOD (15,8 vs 9,65 years, p < 0.001). Furthermore, most of participants reported that the hygiene measures against COVID-19 adopted by the Hospital were adequate (95.9%) and reported to feel protected from the infection in the clinic of origin both during the previous visits (96%) and at the moment of the interview (97,2%).
Regarding relationship with healthcare providers, 247 (77,7%) patients were not afraid about the possibility that the healthcare providers may be infected by COVID-19 and could not be reference points anymore (79,8% of PLWH vs 75,5%, NS). Moreover, 277 (86%) patients were not worried about the possibility that the medical staff could infect patients themselves. The majority of patients reported they would not have wanted to be informed about the sanitary situation of the ward before the visit (86,7%) and they felt supported by the healthcare providers during the COVID-19 pandemic (78,3%). Most of patients (90,3%) did not feel neglected by the sanitary system and they reported to be assisted as usual (Table S4 in the supplement materials).
Resilience
The resilience of the participants was investigated to study the differences between the groups in the capability to manage the critical psychological issue during the pandemic (Table S5 in the supplement materials). Participants had in general high level of resilience measured by RS (RS mean ± standard deviation: 59,7 ± 6,92). Regarding the total RS score, no significant differences were found between the groups (RS score: 59,7 in PLWH vs 59,6 in PLWOD) except in the item “I have enough energy to do what I should do” (RS10, p = 0.002) (Figure 1, item 10).
Linear Regression analysis
From the original 44 variables collected through the questionnaire, factor analysis allowed to identify latent factors defined based on the loading (Figure S1) as feeling of anger, need of attention, concern of the infection, psychological problems, anxiety/concern, coping and lockdown conditions. All the factors were included in the linear regression to test their effect on RS.
No significant differences were found between the groups in the Resilience Score (p = 0.410). However, regardless of chronic disease displayed a lower level of resilience who was unemployed (-3.52; 95% CI [-6.68 -0.35]; p = 0.029); who showed more anger feelings (-1.76; 95% CI [-2.67 -0.85]; p < 0.001), who showed more anxiety/concern (-1.56; 95% CI [-2.30 -0.82]; p < 0.001) and who had a history of psychological problems during the lockdown (-2.18; 95% CI [-3.17 -1.18]; p < 0.001). (Table S6 in the supplement materials).