The Relationship between Religiosity/Spirituality and Mental Health among a Cohort of Women with HIV

Background: Low mental health status, specifically depression, poses a significant challenge to the management of HIV, as it interferes with treatment adherence and contributes to health decline for individuals with HIV. This burden is particularly pronounced among women with HIV, who often experience a higher prevalence of depression compared to men. Several individual-level, psychosocial factors, including religiosity, spirituality and resilience, have been identified as factors that may mitigate challenges with adherence. We sought, primarily, to understand the relationship between religiosity/spirituality and mental health status, and, secondarily, the relationship between religiosity/ spirituality and adherence to HIV care. Methods: This cross-sectional study analyzed the association between self-reported religiosity/spirituality and depression and religiosity/spirituality and suppression of HIV viral load, a marker for adherence, among a cohort of (N=54) women with a recent history of HIV care non-adherence. HIV viral load and HIV visit history were extracted from the medical record. Participants receiving care from a South Florida HIV care clinic completed the PHQ-9, which assesses depressive symptoms, and the Connor-Davidson Resilience Scale (CD-RISC-25), which measures individual-level resilience. Religiosity/Spirituality was operationalized using one item of the CD-RISC-25 and dichotomized into Religious/Spiritual and Non-Religious/Spiritual groups. T-tests examined group differences. Statistical models measured the association between religiosity/ spirituality and depression, as well as the relationship between religiosity/ spirituality and HIV viral load suppression. Results: Religious/Spiritual participants had significantly lower PHQ-9 scores (mean = 5.02, SD = 5.53), compared to Non-Religious/Spiritual participants (mean = 11.29, SD = 6.21; p = 0.0188). A significant, negative correlation was found between religiosity/spirituality and PHQ-9 scores (r = –0.357, p = 0.007), with religiosity/spirituality explaining 12.8% of the variance in depression severity. Among Hispanic participants, the difference in PHQ-9 scores by religiosity/spirituality approached significance (p = 0.0574). Conclusion: Self-reported religiosity/spirituality was associated with significantly lower depressive symptoms among women with HIV, suggesting that spirituality may be a meaningful psychosocial resource. There was a trend toward HIV viral load suppression for participants who were Religious/Spiritual; the relationship, however, was not significant. Faith-based and spiritually-oriented interventions should be further explored as culturally relevant strategies to support mental health and care adherence for women with HIV; however, further study is needed.