The impact of socio-economic factors, mental health and functional status on survival in a sample of AIDS patients

The aim of the paper is to examine the influence of socio-economic conditions, mental health and functional status on survival of a sample of people with AIDS. It is a longitudinal prospective study carried out in five infectious disease wards in Rome and Naples, Italy. Patients enrolled (total 168) are all diagnosed as having AIDS in 1992. The Functional Multidimensional Evaluation Questionnaire for people infected with HIV was administered to all subjects. It collects information on social and economic conditions, physical and mental health, self-sufficiency in Activities of Daily Living (ADLs) and on the demand for and/or utilization of a package of non-hospital care services. In the overall assessment, 11.3% of patients had inadequate socio-economic resources to cover their needs. More than half of those interviewed were partially or totally dependent on help to perform ADLs. There was a high prevalence of psychiatric symptoms (60.6%). Lower CD4 count and lower ability to perform ADLs were related to shorter survival with a mortality risk ratio by Cox regression of 1.5 (95 CI: 1.2-1.9) and 1.6 (95 CI: 1.1-2.3), respectively. A lower ADL performance level was also associated with a higher prevalence of psychiatric symptoms and reduced socio-economic circumstances. The ADL performance level could be a useful predictor of survival in people with AIDS. There was, moreover, a marked association between functional status, socio-economic resources and mental health. The results support the hypothesis that these three factors have an impact on the survival of AIDS patients.