If PLWHAs and healthy population perceive the meaning of the items of studied questionnaires in the same way, it can be concluded that the symptoms of depression and anxiety are not misinterpreted as the symptoms of the disease or medication side effects. Hence, it is of critical importance to investigate the measurement invariance of depression/anxiety questionnaires in PLWHA samples. Furthermore, pioneer researchers pointed out that in some subpopulations of chronic patients including HIV/AIDS, disentangling symptoms such as fatigue, sleep difficulties, and pain that are attributable to depression and anxiety as opposed to those that are owing to the disease or medication side effects is a challenging issue and segregation of their origin is onerous. When measurement invariance does not hold, it is not clear whether the observed disparity in depression and anxiety scores between PLWHAs and healthy population is a real difference in the underlying construct of interest, or it is due to an artificial effect of different interpretations of items by PLWHAs and healthy individuals. Measurement invariance means that different respondents from different groups perceive the meaning of the items in a given questionnaire similarly. However, the validity of such cross-group comparisons depends on an important assumption which is known as measurement invariance. As shown in previous studies, compared to the healthy population, PLWHAs had significantly higher depression and anxiety scores. In addition to depression and anxiety diagnosis, researchers often use such measures to compare mean level of depression and anxiety between PLWHAs and other subpopulations, especially healthy population. In recent years, a number of questionnaires have been introduced to assess these aforementioned psychological disorders in PLWHAs. Using Self-administered questionnaires is the most common method to measure depression and anxiety in the clinical and research settings. This diversity in prevalence rates can be contributed to various populations of patients with HIV/AIDS in different studies, research settings and more importantly the methods and criteria used for the assessment and diagnosis of depression and anxiety. In general, the prevalence rate of depression and anxiety has been estimated from 3.2 to 45% and from 1.27 to 53% among PLWHAs, respectively. The importance of this issue is underlined by the fact that the underdiagnosis and undertreatment of these psychological disorders usher in lower quality of life, poor adherence to HIV medications, faster disease progression, deterioration in immunological function, suicidal ideation, greater sexual risk behaviors, and marital conflict. The diagnosis and treatment of depression and anxiety in PLWHAs has received special attention in the past decade. Accordingly, it is not surprising that depression and anxiety are highly prevalent among PLWHAs. It is highly recommended that health professionals develop therapeutic interventions and psychological supports to promote the mental health of PLWHAs which alleviate their depressive symptoms.Ī growing body of literature has highlighted that people living with HIV/AIDS (PLWHAs) experience a wide variety of distressing events such as complicated therapeutic regimes, disease exacerbation, shortened life expectancy, presence of pain, poor social and family support, financial burden as well as fear of disclosure and stigma. Therefore, in comparison to healthy individuals, higher depression score of PLWHAs is a real difference. The current study suggests that the BAI and CESD-10 are invariant measures across PLWHAs and healthy people which can be used for meaningful cross-group comparison. In addition, although depression scores were significantly higher in PLWHAs as opposed to the healthy individuals, no significant difference was observed in anxiety scores of these two groups. Our findings revealed that PLWHAs and healthy individuals perceived the meaning of all the items in the BAI and CESD-10 questionnaires similarly. Multi-group multiple-indicators multiple-causes model (MG-MIMIC) was used to assess measurement invariance across PLWHAs and healthy people. One hundred and fifty PLWHAs and 500 healthy individuals filled out the Persian version of the BAI and CESD-10 questionnaires. This study aims to assess the measurement invariance of the Beck Anxiety Inventory (BAI) and 10-item Centre for Epidemiological Studies Depression Scale (CESD-10) questionnaires across PLWHAs and healthy individuals. However, no single study has been carried out to investigate whether this disparity is a real difference or it happens due to lack of measurement invariance. Recently, extensive research has been reported the higher rate of depression and anxiety among people living with HIV/AIDS (PLWHAs) as compared to the general population.
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