Psychological Impairment, Coping Strategies, and Associated Factors among Adults Living with HIV Receiving Antiretroviral Therapy in Western Area Urban, Sierra Leone: An Analytical Cross-sectional Study

Living with HIV is no longer the sentence it once was. Thanks to modern medicine, the virus can be managed effectively, allowing people to live long, healthy lives. However, the journey involves more than just taking daily pills to suppress the virus. The diagnosis itself, along with the social stigma and financial worries that often accompany it, can weigh heavily on a person's mind. This mental burden, known as psychological impairment, includes feelings of deep sadness, constant worry, and anxiety. While doctors have become experts at treating the physical virus, the emotional toll is often overlooked, even though it can make it harder for patients to stick to their treatment and stay healthy. Understanding how people cope with these invisible struggles is essential for building a complete system of care that supports the whole person, not just the disease.

In the bustling urban district of Western Area in Sierra Leone, a team of researchers set out to understand this hidden challenge. They focused on adults who were already receiving treatment for HIV at three major government hospitals: Connaught, Rokupa, and Lumley. Between August and October 2024, the team spoke directly with 422 patients. They did not just ask about their medication; they used carefully designed questionnaires to measure how often patients felt anxious or depressed. They also asked how these individuals handled their stress, looking for the specific thoughts and actions they used to get through difficult days. The goal was to paint a clear picture of the mental landscape of people living with HIV in this region, identifying who was struggling the most and what tools they were using to survive.

The results revealed a significant gap in care. While the physical treatment was working, the mental health of many patients was suffering. Nearly half of the participants reported feeling mild anxiety, and more than one in five experienced symptoms severe enough to be considered symptomatic anxiety. The picture for depression was even more striking. Over half of the patients reported mild depression, and almost two out of every five were dealing with symptomatic depression. This means that for a vast number of people in these clinics, the daily reality of living with HIV is shadowed by persistent emotional distress that goes unaddressed.

The study also uncovered who is most vulnerable to these feelings. Women were found to be at a much higher risk than men, with female participants being significantly more likely to experience both anxiety and depression. This aligns with the broader reality that women often face additional layers of pressure, such as caregiving duties and economic dependence. Age also played a role; younger adults between the ages of 18 and 29 were more likely to struggle with depression compared to those in their 30s and 40s. The researchers noted that younger people often face greater uncertainty about their future, their relationships, and their place in society after a diagnosis. Interestingly, having a higher level of education was linked to higher rates of anxiety, suggesting that being more aware of the potential complications and social consequences of the disease can sometimes increase worry. Unemployment was another major factor, with those without jobs facing the highest odds of anxiety.

Despite these heavy burdens, the patients were not without resources. The researchers found that people were actively trying to manage their stress, often turning to constructive methods. The most common ways of coping included using humor to lighten the mood, making plans for the future, leaning on their religious faith, and accepting their situation. Many also sought out information and support from others. These are considered adaptive strategies, meaning they help a person adjust and move forward. However, the study also found that some people were relying on less helpful methods. A portion of the group admitted to using denial, avoiding the problem, or turning to substances like alcohol and drugs to cope. These maladaptive responses can make it harder to stay healthy and stick to medical advice.

The researchers concluded that while Sierra Leone has made great strides in providing life-saving medication, the system needs to evolve to include mental health support as a standard part of care. They suggest that routine screening for anxiety and depression should happen at every clinic visit, just like checking blood pressure. By identifying those who are struggling early and connecting them with counseling or peer support groups, healthcare providers can help patients build resilience. The study highlights that treating the virus is only half the battle; supporting the mind is equally critical for ensuring that people living with HIV can truly thrive.