Prevalence and Determinants of Demoralization Syndrome among Middle-aged and Young Adults with HIV/AIDS: A Cross-sectional Study

Prevalence and Determinants of Demoralization Syndrome among Middle-aged and Young Adults with HIV/AIDS: A Cross-sectional Study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Prevalence and Determinants of Demoralization Syndrome among Middle-aged and Young Adults with HIV/AIDS: A Cross-sectional Study Chuntao Wu, Juan TAN, Xia Zhao, Shiping Feng, Xi Yan, Peisha Du, and 3 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8698932/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 7 You are reading this latest preprint version Abstract Objective This study aims to examine the prevalence and influencing factors of despair syndrome in middle-aged and young individuals living with HIV/AIDS at a tertiary infectious disease hospital in China. The goal is to provide a foundation for the early identification of high-risk populations and to guide the development of targeted clinical interventions. Methods A convenience sampling approach was employed to recruit 280 middle-aged and young PLWHA who met the inclusion and exclusion criteria from a tertiary infectious disease hospital in Chengdu, China, between April and October 2024. Data were collected through a general demographic questionnaire, the Chinese version of the Despair Scale, the AIDS Discrimination Perception Scale, the Simple Disease Cognition Questionnaire, and the Chinese version of the Medical Coping Modes Questionnaire. Statistical analyses, including descriptive statistics, one-way ANOVA, Spearman's correlation, and multiple stepwise regression, were performed using SPSS 27.0. Results A total of 280 participants were included in the analysis, with 88.93% aged between 31 and 59 years, and 78.21% male. Univariate analysis revealed that educational attainment, monthly income per capita, CD4 + T lymphocyte count, HIV viral load, and the presence of opportunistic infections were significantly associated with the occurrence of despair syndrome among middle-aged and young HIV/AIDS patients (P < 0.05). Spearman’s correlation analysis demonstrated significant associations between despair syndrome and perceived discrimination, disease cognition, and two coping strategies—confrontation and yielding (P < 0.05). Multiple regression analysis identified monthly income (β = -0.112, P = 0.012), CD4 + T lymphocyte count (β = -0.145, P = 0.001), and HIV viral load (β = -0.103, P = 0.020) as significant negative predictors of despair syndrome, while educational level (β = 0.267, P < 0.001), opportunistic infections (β = 0.143, P = 0.001), discrimination perception (β = 0.123, P = 0.009), cognitive appraisal (β = 0.235, P < 0.001), and yielding coping style (β = 0.232, P < 0.001) were identified as significant positive predictors. These variables together explained 48.80% of the variance in despair syndrome. Conclusion Despair syndrome in middle-aged and young PLWHA is influenced by a variety of factors. Clinicians should place greater emphasis on the psychological well-being of these individuals, implementing tailored interventions that address the identified risk factors to prevent or delay the onset of frailty. Young and middle-aged PLWHA Demoralization syndrome influencing factors Introduction Human immunodeficiency virus (HIV) / acquired immunodeficiency syndrome (AIDS) remains one of the most serious global public health challenges. According to the Joint United Nations Programme on HIV/AIDS report released in 2025, there are approximately 40.8 million people living with human immunodeficiency virus/acquired immunodeficiency syndrome(PLWHA) worldwide [1] , of whom about 1.35 million are in China, with the majority being middle-aged and young adults (15–59 years)(National Center For AlDS STD Control And Prevention, 2025). With the widespread availability of antiretroviral therapy (ART), HIV/AIDS has gradually transformed from a highly fatal disease into a chronic condition that can be effectively managed over the long term. However, the chronicity of the disease has not completely alleviated patients’ psychological distress. Under the combined impact of prolonged treatment and persistent social stressors, some individuals develop demoralization syndrome. Demoralization syndrome refers to a psychological state characterized by a persistent sense of helplessness, hopelessness, loss of meaning, and difficulty in adaptation, occurring in the context of prolonged existential distress. Its core features are not depression per se, but rather the loss of “hope” and “life meaning” (Clarke & Kissane, 2002 ). .Studies have shown that patients suffering from prolonged, incurable illnesses are more susceptible to demoralization syndrome(Fava et al., 2023 ). Among individuals with HIV/AIDS, demoralization syndrome not only undermines mental health but may also impair quality of life(Peng et al., 2021 ); in severe cases, it can even precipitate self-harm or suicide (Lin & Her, 2024 ), imposing a substantial burden on patients, their families, and society. However, research on the current status of demoralization syndrome among middle-aged and young adults with HIV/AIDS in China remains limited. Previous research suggests that various psychosocial factors may be closely associated with the onset of demoralization syndrome. Medical coping styles refer to the cognitive and behavioral response patterns individuals adopt when facing disease-related stress, commonly categorized into confrontation, avoidance, and resignation(Feifel et al., 1987). Among people living with HIV/AIDS, positive coping styles can help alleviate psychological distress, whereas negative coping styles may exacerbate feelings of helplessness and the severity of demoralization(Banerjee et al., 2022 ; Parcesepe et al., 2023 ). Moreover, cognitive patterns play a pivotal role in disease adaptation; overly negative or distorted illness perceptions may undermine patients’ self-efficacy, resulting in adaptation difficulties and heightened negative emotions(Marcil et al., 2023 ). In addition, multiple studies have confirmed that perceived discrimination can significantly impair the mental health of people living with HIV(Han et al., 2021a ). However, the combined effects of medical coping styles, perceived discrimination, and illness cognition on demoralization syndrome in middle-aged Chinese individuals with HIV/AIDS have yet to be systematically examined. This study focuses on HIV/AIDS patients of middle-aged and young adults in Sichuan Province, China. The study employs the Demoralization Syndrome Scale, Medical Coping Scale, Perceived HIV/AIDS Stigma Scale, and the Brief Illness Perception Questionnaire to investigate and analyze the current status and influencing factors of demoralization syndrome in this population. The aim of the research is to reveal the psychosocial mechanisms underlying demoralization syndrome in young and middle-aged HIV/AIDS patients, providing a theoretical foundation and practical reference for the development of targeted psychological interventions. Ultimately, this will promote the psychological well-being and quality of life of this population. Methods Study design This study is a cross-sectional investigation conducted from April 2024 to October 2024 at a specialized infectious disease hospital in Chengdu, Sichuan Province, China. Study participants and sample size Participants were recruited from both the outpatient and inpatient departments of the infectious disease hospital. Inclusion criteria: (1) confirmed HIV infection; (2) age between 18 and 59 years; (3) awareness of their own medical condition; (4) no history of significant traumatic events within the past month; (5) voluntary participation with informed consent. Exclusion criteria: (1) patients with psychiatric disorders or impaired consciousness; (2) patients with speech impairments that prevent communication or those unable to cooperate in completing the survey. A total of 280 participants were included in this study using convenience sampling. The study was approved by the hospital’s Ethics Committee (YJ-K2024-12-01), and informed consent was obtained from all participants. Study measures General Information Survey: The general information survey was independently compiled by the researchers based on a review of the literature. It includes both demographic and disease-related information. The demographic information includes: age, gender, marital status, educational level, and average monthly income. The disease-related information includes: infection duration, ART duration, CD4 + T lymphocyte count, viral load, and the presence of opportunistic infections. Demoralization Scale: The Demoralization Scale—Mandarin Version (DS-MV) was adapted and modified by Liu Peipei (Peipei et al., 2018 )based on the translated version by Hong Xiaoqi, tailored to the specific context of China. This scale is designed to assess the level of demoralization in patients and consists of 5 dimensions and 24 items, including meaninglessness, emotional disturbance, discouragement, helplessness, and failure. Each item is rated on a scale from "strongly disagree" to "strongly agree," corresponding to scores ranging from 0 to 4. A higher total score indicates more severe demoralization. The Cronbach's α of the overall scale is 0.97. Self-Stigma Scale : The Self-Stigma Scale (SSS) was developed by Mak (Mak & Cheung, 2010 )and consists of 9 items, which assess three dimensions: emotional, cognitive, and behavioral aspects. All items are positively worded and are scored on a 5-point Likert scale (1–5). Each item has five response options: "strongly disagree" (1), "disagree" (2), "slightly agree" (3), "agree" (4), and "strongly agree" (5). The total score ranges from 9 to 45, reflecting the individual's level of perceived stigma, with higher scores indicating a higher perceived level of stigma. The Cronbach's α coefficient for the scale is 0.91. Brief Illness Perception Questionnaire The Brief Illness Perception Questionnaire (BIPQ) was developed by Broadbent in 2006 as a simplified version of the revised illness cognition questionnaire, designed to assess the illness perceptions of patients with various chronic conditions (Broadbent et al., 2006 ). Items 1–8 are scored on an 11-point scale (0–10), with items 3, 4, and 7 being reverse-scored. The total score, obtained by summing the scores of all items, reflects the individual's overall illness perception. A higher total score indicates a more negative perception of the illness. Medical Coping Modes Questionnaire The Medical Coping Modes Questionnaire (MCMQ) was developed by Feifel (Feifel et al., 1987), with the Chinese version translated and revised by Shen Xiaohong (Xiaohong & Qianjin, 2000 ). This scale is used to assess patients' coping strategies when facing illness and has been well validated in China. The questionnaire consists of 20 items, with 8 items assessing the "confrontation" dimension, 7 items for the "avoidance" dimension, and 5 items for the "resignation" dimension. All items are scored on a 4-point scale, with higher scores indicating a greater tendency to adopt that coping style. Additionally, 8 items (1, 4, 9, 10, 12, 13, 18, 19) are reverse-scored. After revision, the Cronbach's α coefficients for the three dimensions were 0.69, 0.60, and 0.76, respectively. Data Collection Data were collected using paper-based questionnaires. Prior to the survey, all investigators received standardized training to ensure proficiency in the questionnaire items and administration procedures. After obtaining informed consent from eligible middle-aged and young adults living with HIV/AIDS, nurses used standardized instructions to explain the study objectives and content, as well as the procedures for completing the questionnaire. Participants were asked to complete the questionnaire independently. Nurses provided clarifications if questions arose during the process. For patients unable to complete the questionnaire on their own, nurses read the items aloud, recorded the patients’ responses, and filled in the questionnaire on their behalf. Upon completion, each questionnaire was reviewed by the nurse on site, and any missing or erroneous responses were immediately verified with the participant. Statistical Analysis Data were analyzed using SPSS version 27.0. Descriptive statistics were used to summarize the demographic and clinical characteristics of middle-aged and young adults living with HIV/AIDS, as well as the scores of each scale. Categorical variables were presented as frequencies and percentages, while continuous variables were expressed as mean ± standard deviation or as median and interquartile range, depending on data distribution. Independent-samples t tests and one-way analysis of variance (ANOVA) were performed to examine potential factors influencing demoralization syndrome among middle-aged and young living with HIV/AIDS. Pearson correlation analysis was conducted to assess the relationships between demoralization syndrome, perceived HIV-related stigma, cognitive appraisal, and medical coping. Variables with statistical significance in univariate analyses, along with those significantly correlated with demoralization syndrome, were entered into a stepwise multiple linear regression model, with the total demoralization score as the dependent variable. A p -value < 0.05 was considered statistically significant. Results Univariate Analysis of General Characteristics and Demoralization Syndrome in Middle-Aged and Young PLWHA A total of 280 patients were included in this study. Among them, 88.93% were aged 31–59 years, 78.21% were male, 54.28% reported a per capita monthly income of 3000–4500 RMB, and 67.50% had opportunistic infections. Univariate analysis indicated that educational level, per capita monthly income, CD4 + T lymphocyte count, HIV viral load, and opportunistic infections were significantly associated with demoralization syndrome in middle-aged and young PLWHA( p < 0.05).Table 1 presents the impact of general information characteristics on demoralization syndrome among middle-aged and young PLWHA. Table 1 Impact of General Information on Demoralization Syndrome in Middle-aged and Young PLWHA (n = 280) Variable Variables n (%) M(IQR) Z/H P Age(years) 18 ~ 30 31(11.07) 47(16) 3.848 0.146 31 ~ 45 150(53.57) 52(14) 46 ~ 59 99(35.36) 51(17) Sex Male 219(78.21) 51(15) -0.218 0.827 Female 61(21.79) 52(16) Marital Status Married 118(42.14) 52(15) -0.428 0.669 Unmarried/ Divorced / Widowed 162(57.86) 50(15) Education level Primary school and below 19(6.79) 39(11) 57.260 <0.001** Junior high school 58(20.71) 44(17) Senior high school 154(55.00) 52(12) Bachelor's degree and above 49(17.50) 62(16) Personal monthly income (yuan) 4500 36(12.86) 46(14) The duration of HIV diagnosis(month) ≤ 12 124(44.29) 50.50(14) -1.052 0.293 >12 156(55.71) 51.50(16) Duration of ART(month) ≤ 12 143(51.07) 52(15) -0.332 0.740 >12 137(48.93) 50(16) CD4 cell count(cells /µL) <200 171(61.07) 52(13) -3.324 20 200(71.43) 52(16) opportunistic infection Yes 189(67.50) 52(16) -4.469 <0.001** No 91(32.50) 46(14) Correlation Analysis of Demoralization Syndrome with Perceived Stigma, Cognitive Appraisal, and Medical Coping Spearman correlation analysis revealed that demoralization syndrome was significantly correlated with perceived HIV-related stigma, cognitive appraisal, medical coping–confrontation, and medical coping–yielding among middle-aged and young PLWHA( p < 0.05).Table 2 presents a detailed analysis of the correlations associated with Demoralization Syndrome. Table 2 Correlation Analysis of Demoralization Syndrome, Perceived HIV-related Stigma, Medical Coping Strategies and Cognitive Appraisal in Young and Middle-aged HIV/AIDS Patients Variable perceived HIV-related stigma confrontation avoidance yielding cognitive appraisal demoralization syndrome 0.360** − .158** 0.042 0.433** 0.532** failure 0.322** -0.102 0.046 0.413** 0.493** meaninglessness 0.289** -0.119* 0.025 0.404** 0.450** helplessness 0.350** -0.131* 0.041 0.343** 0.440** emotional disturbance 0.178** -0.056 0.008 0.241** 0.368** discouragement 0.295** -0.211** 0.058 0.343** 0.363** Multivariate Linear Regression Analysis of Factors Influencing Demoralization Syndrome Stepwise multiple linear regression analysis demonstrated that monthly income ( β = − 0.112, p = 0.012), CD4 + T lymphocyte count ( β = − 0.145, p = 0.001), and HIV viral load ( β = − 0.103, p = 0.020) were significant negative predictors of demoralization syndrome, whereas educational level ( β = 0.267, p < 0.001), opportunistic infections (β = 0.143, p = 0.001), perceived stigma ( β = 0.123, p = 0.009), cognitive appraisal ( β = 0.235, p < 0.001), and yielding coping ( β = 0.232, p < 0.001) were significant positive predictors. These variables collectively explained 48.80% of the variance in demoralization syndrome.Table 3 presents the regression analysis findings for Demoralization Syndrome. Table 3 Multivariate linear regression analysis of influencing factors of depression syndrome in young and middle-aged HIV/AIDS patients β-value Standard error Standardized regression coefficient t-value P-value (Constant) 18.924 4.826 3.921 <0.001 Education level 3.482 0.604 0.267 5.761 <0.001 Personal monthly income -1.785 0.707 -0.112 -2.526 0.012 CD4 cell count -3.071 0.926 -0.145 -3.315 0.001 Viral load -2.352 1.002 -0.103 -2.348 0.020 opportunistic infection 3.161 0.967 0.143 3.270 0.001 perceived HIV-related stigma 0.192 0.073 0.123 2.619 0.009 cognitive appraisal 0.277 0.060 0.235 4.616 <0.001 confrontation -0.024 0.162 -0.007 -0.150 0.881 yielding 0.814 0.173 0.232 4.715 <0.001 Discussion In this study, higher total scores of the demoralization syndrome were observed among people living with HIV/AIDS, which contrasts with findings from other populations. Previous research has indicated that higher educational attainment serves as a protective factor against demoralization syndrome in cancer patients, primarily because well-educated individuals tend to have better health literacy, more effective coping strategies, and greater access to health and social resources(Bjelland et al., 2008 ; Vinueza et al., 2024 ). However, in our study, educational level was positively associated with demoralization scores. This phenomenon may be related to the more pronounced social role conflicts and psychological dissonance experienced by highly educated, middle-aged PLWHA following diagnosis. Higher educational attainment often corresponds to elevated social expectations and career aspirations; upon receiving an HIV-positive diagnosis, these individuals may encounter intense social stigma, professional limitations, and self-denial, which in turn exacerbate feelings of meaninglessness, helplessness, and failure. In clinical practice, it is therefore essential to strengthen psychological assessment and targeted interventions for highly educated, middle-aged PLWHA, rather than relying solely on general screening tools. In particular, psychological counseling and social support interventions should be tailored to address their cognitive patterns, role expectations, and social adaptation challenges, with the goal of helping them reconstruct a sense of meaning and life purpose. The present findings suggest a strong association between HIV-related clinical status and levels of demoralization. Middle-aged and young adults living with HIV/AIDS who maintain CD4 + T lymphocyte counts ≥ 200 cells/µL, achieve viral suppression (< 20 copies/mL), and remain free of opportunistic infections generally exhibit lower demoralization scores. CD4 + T lymphocyte count serves as a pivotal indicator of immune competence; higher counts are typically observed during the early phase of infection or immune reconstitution under ART, when physiological functioning is relatively preserved. Prior studies have shown that individuals with CD4 + T cell counts ≤ 200 cells/µL are at substantially greater risk of AIDS-related hospitalization(Mou et al., 2025 ). For younger and middle-aged patients—who are often in critical stages of career or academic development—recurrent hospitalizations may interrupt social and occupational roles, thereby amplifying economic strain and psychological distress. Viral load, an established marker of HIV replication dynamics, reflects disease activity, with elevated levels signifying accelerated progression. Among this population, high viral load may indicate inadequate therapeutic response or the emergence of drug resistance(Swenson et al., 2014 ), often provoking fear, anxiety, pessimism, and other adverse psychological reactions that undermine hope and perceived control over life. Moreover, Middle-aged and young adults PLWHA who develop opportunistic infections bear a substantially greater economic burden than those with uncomplicated HIV infection(Bielick et al., 2024 ). Beyond the financial impact, these individuals are confronted with more complex clinical trajectories, multiple somatic manifestations, and an elevated risk of mortality(Meng et al., 2023 ; Shaw & Matin, 2022 ), factors that collectively intensify psychological distress and may further aggravate demoralization. The present study demonstrated that perceived discrimination was a significant positive predictor of demoralization among middle-aged and young PLWHA (β = 0.123, P = 0.009), indicating that greater perceived discrimination was associated with higher levels of demoralization. These findings reinforce evidence from prior research that social discrimination constitutes a critical psychosocial determinant of mental health in this population(Han et al., 2021b ). Perceived discrimination fosters experiences of social isolation and marginalization, erodes social support networks, and precipitates adverse emotional states such as helplessness and meaninglessness—hallmarks that closely parallel the defining features of demoralization(Blanco et al., 2025 ; Ninnoni et al., 2023 ). Chronic exposure to such perceptions may further undermine healthcare-seeking behavior and adherence to antiretroviral therapy(Perger et al., 2025 ; Tuot et al., 2023 ), thereby heightening the risk of disease progression and perpetuating a vicious cycle of “discrimination–psychological dysregulation–disease progression” .Accordingly, reducing perceived discrimination is pivotal in mitigating demoralization. Public health strategies should therefore prioritize community-based education and awareness campaigns to enhance scientific literacy and reduce stigma, while healthcare systems should integrate psychological counseling, peer support, and targeted anti-discrimination interventions to strengthen patients’ coping capacity and resilience. This study found that the medical coping–yielding dimension was a significant positive predictor of demoralization among middle-aged and young PLWHA (β = 0.232, P < 0.001). Specifically, greater reliance on yielding coping was associated with higher levels of demoralization. Yielding coping, defined as passive acceptance and submission to illness, indicates insufficient self-regulation and limited proactive engagement when facing health-related threats(Taylor & Stanton, 2007). Prior research in patients with cancer has similarly shown that yielding coping is closely linked to depression, anxiety, and diminished quality of life(Tang et al., 2020 ). These findings suggest that yielding coping may aggravate psychological distress by eliciting negative emotional responses, lowering self-efficacy, and hindering the effective use of social support. Among middle-aged and young PLWHA, such coping tendencies may reduce help-seeking behaviors and the acquisition of medical information, potentially delaying timely treatment, worsening disease progression, and undermining mental well-being. In addition, yielding coping may intensify negative cognitive appraisals, leading to behavioral withdrawal, a loss of social value, and poorer health outcomes. Consequently, clinical nursing and psychosocial interventions should target this maladaptive coping pattern, fostering stronger social support networks and promoting constructive interactions with healthcare professionals and peer groups to mitigate its adverse impact. Strengths and limitations With the widespread use of antiretroviral therapy, HIV/AIDS is increasingly regarded as a chronic, manageable infectious disease, prompting a growing focus on the psychological well-being of affected individuals. This study, which examines the prevalence and determinants of despair syndrome among young and middle-aged PLWHA at an infectious disease hospital in Chengdu, China, provides both theoretical insights and practical implications. The findings offer valuable guidance for healthcare professionals, family members, and society at large in early detection of despair syndrome symptoms, enabling the implementation of targeted and personalized interventions. Such measures are critical in enhancing the mental health and overall quality of life of young and middle-aged PLWHA. The participants in this study were all recruited from a single hospital, which may limit the representativeness of the sample and introduce selection bias, thus restricting the broader applicability of the findings. To enhance the generalizability of future research, it is recommended to expand the sample size and incorporate multi-center designs. This study employed a cross-sectional approach, providing a snapshot of despair syndrome levels and their influencing factors among young and middle-aged PLWHA)at a specific moment in time. However, given that despair syndrome is a dynamic psychological state, both its severity and influencing factors are likely to fluctuate over time. Therefore, to gain a more nuanced and comprehensive understanding of despair syndrome in this population, future research should consider adopting a longitudinal design to explore its evolving patterns and underlying mechanisms. Conclusion This study highlights several key factors influencing desistance syndrome in middle-aged and young individuals living with HIV/AIDS (PLWHA), including monthly income, CD4 + T lymphocyte count, HIV viral load, education level, opportunistic infections, perceived discrimination, cognitive appraisal, and yielding. In light of these findings, it is crucial that future interventions incorporate comprehensive evaluations conducted by healthcare providers. These assessments should emphasize the development of individualized and targeted care plans, potentially incorporating approaches such as cognitive-behavioral therapy and group psychotherapy. Such interventions aim to mitigate negative psychological states and improve patients' social functioning and overall adaptability. Abbreviations HIV Human immunodeficiency virus AIDS Acquired immunodeficiency syndrome ART antiretroviral therapy PLWHA people living with human immunodeficiency virus/acquired immunodeficiency syndrome Declarations Ethics approval and consent to participate The trial protocol and all amendments were approved by the Institutional Review Board of Public Health Clinical Center of Chengdu (YJ-K2024-12-01).Our study was conducted according to the principles of the Declaration of Helsinki and followed relevant guidelines and regulations. All participants provided informed consent and voluntarily participated in the study. No personal information has been used and the individual’s identity has been protected by removing any personal identifiers from the data. Codes were designated to the respondents to guarantee their anonymity. Consent for publication Not applicable. Availability of data and materials The data that support the findings of this study are available from the corresponding author upon reasonable request. Competing interests The authors declare no competing interests. Funding This research was funded by the Sichuan Institute of Social Sociology and Sex Education (Grant number:SXJYB2404) and the Chengdu Municipal Health Commission (Grant number: 2024453). Authors' contributions W.C.T., T.J., and W.B. designed this study, and the concept was proposed by W.C.T. and Z.X.; Z.X., F.S.P., Y.X. D. P.S., L.C.R., G.L.H were responsible for data collection. W.C.T. and Z.X., F.S.P., led the data analysis work. W.B. reviewed the results of the data analysis. 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Coping with loneliness and stigma associated with HIV in a resource-limited setting, making a case for mental health interventions; a sequential mixed methods study. BMC Psychiatry , 23(1), 163. http://doi.org/10.1186/s12888-023-04643-w Parcesepe, A. M., Filiatreau, L. M., Gomez, A., Ebasone, P. V., Dzudie, A., Pence, B. W., Wainberg, M., Yotebieng, M., Anastos, K., Pefura-Yone, E., Nsame, D., Ajeh, R., & Nash, D. (2023). Coping Strategies and Symptoms of Mental Health Disorders Among People with HIV Initiating HIV Care in Cameroon [Journal Article]. Aids and Behavior , 27(7), 2360-2369. http://doi.org/10.1007/s10461-022-03963-4 Peipei, L., Jin, L., Ying, D., Qigui, Q., & ZhangYulin. (2018). The correlation of demoralization syndrome and psycho- physiological statein liver cancer patients [The correlation of demoralization syndrome and psycho-physiological statein liver cancer patients]. Chinese Journal of Practical Nursing , 34(13), 966-970. Peng, H. L., Hsueh, H. W., Chang, Y. H., & Li, R. H. (2021). The Mediation and Suppression Effect of Demoralization in Breast Cancer Patients After Primary Therapy: A Structural Equation Model [Journal Article]. Journal of Nursing Research , 29(2), e144. http://doi.org/10.1097/JNR.0000000000000421 Perger, T., Davtyan, M., Foster, C., Evangeli, M., Berman, C., Kacanek, D., Puga, A. M., Sekidde, S., & Bhopal, S. (2025). Impact of HIV-Related Stigma on Antiretroviral Therapy Adherence, Engagement and Retention in HIV Care, and Transition to Adult HIV Care in Pediatric and Young Adult Populations Living With HIV: A Literature Review. Aids and Behavior , 29(2), 497-516. http://doi.org/10.1007/s10461-024-04534-5 Shaw, J., & Matin, N. (2022). Opportunistic infections in HIV. Medicine , 50(5), 294-297. http://doi.org/https://doi.org/10.1016/j.mpmed.2022.02.010 Swenson, L. C., Min, J. E., Woods, C. K., Cai, E., Li, J. Z., Montaner, J. S., Harrigan, P. R., & Gonzalez-Serna, A. (2014). HIV drug resistance detected during low-level viraemia is associated with subsequent virologic failure [Journal Article; Observational Study; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't]. Aids , 28(8), 1125-1134. http://doi.org/10.1097/QAD.0000000000000203 Tang, L., Li, Z., & Pang, Y. (2020). The differences and the relationship between demoralization and depression in Chinese cancer patients [Journal Article]. Psycho-Oncology , 29(3), 532-538. http://doi.org/10.1002/pon.5296 Taylor, S. E., & Stanton, A. L. (2007). Coping resources, coping processes, and mental health [Journal Article; Research Support, N.I.H., Extramural; Research Support, U.S. Gov't, Non-P.H.S.; Review]. Annual Review of Clinical Psychology , 3, 377-401. http://doi.org/10.1146/annurev.clinpsy.3.022806.091520 Tuot, S., Sim, J. W., Nagashima-Hayashi, M., Chhoun, P., Teo, A. K. J., Prem, K., & Yi, S. (2023). What are the determinants of antiretroviral therapy adherence among stable people living with HIV? A cross-sectional study in Cambodia. AIDS Research and Therapy , 20(1), 47. http://doi.org/10.1186/s12981-023-00544-w Vinueza, V. M., Bhatta, L., Jones, P. R., Tesli, M., Smith, G. D., Davies, N. M., Brumpton, B. M., & Næss, Ø. E. (2024). Educational attainment and mental health conditions: a within-sibship Mendelian randomization study [Journal Article; Preprint]. MedRxiv http://doi.org/10.1101/2024.08.10.24311789 Xiaohong, S., & Qianjin, J. (2000). Report on application of Chinese version of MCMQ in 701 patients. Chinese Journal of Behavioral Medical Science (01), 22-24. Additional Declarations No competing interests reported. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8698932","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":591245285,"identity":"dca48e24-4705-44ee-8bc8-77028edc146a","order_by":0,"name":"Chuntao Wu","email":"","orcid":"","institution":"Public health clinical center of chengdu","correspondingAuthor":false,"prefix":"","firstName":"Chuntao","middleName":"","lastName":"Wu","suffix":""},{"id":591245286,"identity":"ce289ced-ce41-4bdb-869a-27b41a258808","order_by":1,"name":"Juan TAN","email":"","orcid":"","institution":"Public health clinical center of chengdu","correspondingAuthor":false,"prefix":"","firstName":"Juan","middleName":"","lastName":"TAN","suffix":""},{"id":591245287,"identity":"7885198c-a304-4cc8-a66e-15671755d360","order_by":2,"name":"Xia Zhao","email":"","orcid":"","institution":"Public health clinical center of chengdu","correspondingAuthor":false,"prefix":"","firstName":"Xia","middleName":"","lastName":"Zhao","suffix":""},{"id":591245290,"identity":"c117fa8a-fe64-450e-87b8-896a625fbc96","order_by":3,"name":"Shiping Feng","email":"","orcid":"","institution":"Public health clinical center of chengdu","correspondingAuthor":false,"prefix":"","firstName":"Shiping","middleName":"","lastName":"Feng","suffix":""},{"id":591245291,"identity":"fd753379-02a0-4552-9780-6ac4ef183701","order_by":4,"name":"Xi Yan","email":"","orcid":"","institution":"Public health clinical center of chengdu","correspondingAuthor":false,"prefix":"","firstName":"Xi","middleName":"","lastName":"Yan","suffix":""},{"id":591245293,"identity":"83cd2b8f-44e9-4b57-bba8-69693f22655c","order_by":5,"name":"Peisha Du","email":"","orcid":"","institution":"Public health clinical center of chengdu","correspondingAuthor":false,"prefix":"","firstName":"Peisha","middleName":"","lastName":"Du","suffix":""},{"id":591245294,"identity":"35d2650a-caa6-4fdc-89cc-b086a55ba995","order_by":6,"name":"Chunrong Lv","email":"","orcid":"","institution":"Public health clinical center of chengdu","correspondingAuthor":false,"prefix":"","firstName":"Chunrong","middleName":"","lastName":"Lv","suffix":""},{"id":591245296,"identity":"928cc9e0-1987-493a-ad04-435b5755d4e8","order_by":7,"name":"Lihua Guo","email":"","orcid":"","institution":"Public health clinical center of chengdu","correspondingAuthor":false,"prefix":"","firstName":"Lihua","middleName":"","lastName":"Guo","suffix":""},{"id":591245297,"identity":"c861f066-1017-412c-a6f0-82d831064b3f","order_by":8,"name":"Bin Wan","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAzUlEQVRIiWNgGAWjYBACfvnnBx//Mfgnx8/eQKQWyYacZAOeggPGkj0HiNRi0JBgJsHz4UCiwYwEYrUwHEiTkDC4k2Ag+XjjDYYam2iCWswZGw9bGBg8yzOXTiu2YDiWlttASItlM0PijQQD5mLL2TlmEowNhwlrMTjGYCBxwIA5ccPNM8RqOcNgJNlgcDhxww0eIrVIzuBJNmYwSAMGMtAvCcT4hV+C/eBjhj82wKg8vPHGhxobwlpQHCmRQIpyiBZSdYyCUTAKRsHIAACZA0Dt+0zCAgAAAABJRU5ErkJggg==","orcid":"","institution":"Public health clinical center of chengdu","correspondingAuthor":true,"prefix":"","firstName":"Bin","middleName":"","lastName":"Wan","suffix":""}],"badges":[],"createdAt":"2026-01-26 09:56:39","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-8698932/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-8698932/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":102850842,"identity":"ea5939b5-0924-47d7-85b7-72dbd9a9e409","added_by":"auto","created_at":"2026-02-17 14:20:39","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":951312,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8698932/v1/3c67b548-08dd-4e34-b123-aecfb9ce14eb.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Prevalence and Determinants of Demoralization Syndrome among Middle-aged and Young Adults with HIV/AIDS: A Cross-sectional Study","fulltext":[{"header":"Introduction","content":"\u003cp\u003eHuman immunodeficiency virus (HIV) / acquired immunodeficiency syndrome (AIDS) remains one of the most serious global public health challenges. According to the Joint United Nations Programme on HIV/AIDS report released in 2025, there are approximately 40.8\u0026nbsp;million people living with human immunodeficiency virus/acquired immunodeficiency syndrome(PLWHA) worldwide\u003csup\u003e[1]\u003c/sup\u003e, of whom about 1.35\u0026nbsp;million are in China, with the majority being middle-aged and young adults (15\u0026ndash;59 years)(National Center For AlDS STD Control And Prevention, 2025). With the widespread availability of antiretroviral therapy (ART), HIV/AIDS has gradually transformed from a highly fatal disease into a chronic condition that can be effectively managed over the long term. However, the chronicity of the disease has not completely alleviated patients\u0026rsquo; psychological distress. Under the combined impact of prolonged treatment and persistent social stressors, some individuals develop demoralization syndrome.\u003c/p\u003e \u003cp\u003eDemoralization syndrome refers to a psychological state characterized by a persistent sense of helplessness, hopelessness, loss of meaning, and difficulty in adaptation, occurring in the context of prolonged existential distress. Its core features are not depression per se, but rather the loss of \u0026ldquo;hope\u0026rdquo; and \u0026ldquo;life meaning\u0026rdquo; (Clarke \u0026amp; Kissane, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e2002\u003c/span\u003e). .Studies have shown that patients suffering from prolonged, incurable illnesses are more susceptible to demoralization syndrome(Fava et al., \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e2023\u003c/span\u003e). Among individuals with HIV/AIDS, demoralization syndrome not only undermines mental health but may also impair quality of life(Peng et al., \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e2021\u003c/span\u003e); in severe cases, it can even precipitate self-harm or suicide (Lin \u0026amp; Her, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e2024\u003c/span\u003e), imposing a substantial burden on patients, their families, and society. However, research on the current status of demoralization syndrome among middle-aged and young adults with HIV/AIDS in China remains limited.\u003c/p\u003e \u003cp\u003ePrevious research suggests that various psychosocial factors may be closely associated with the onset of demoralization syndrome. Medical coping styles refer to the cognitive and behavioral response patterns individuals adopt when facing disease-related stress, commonly categorized into confrontation, avoidance, and resignation(Feifel et al., 1987). Among people living with HIV/AIDS, positive coping styles can help alleviate psychological distress, whereas negative coping styles may exacerbate feelings of helplessness and the severity of demoralization(Banerjee et al., \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2022\u003c/span\u003e; Parcesepe et al., \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e2023\u003c/span\u003e). Moreover, cognitive patterns play a pivotal role in disease adaptation; overly negative or distorted illness perceptions may undermine patients\u0026rsquo; self-efficacy, resulting in adaptation difficulties and heightened negative emotions(Marcil et al., \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e2023\u003c/span\u003e). In addition, multiple studies have confirmed that perceived discrimination can significantly impair the mental health of people living with HIV(Han et al., \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e2021a\u003c/span\u003e). However, the combined effects of medical coping styles, perceived discrimination, and illness cognition on demoralization syndrome in middle-aged Chinese individuals with HIV/AIDS have yet to be systematically examined.\u003c/p\u003e \u003cp\u003eThis study focuses on HIV/AIDS patients of middle-aged and young adults in Sichuan Province, China. The study employs the Demoralization Syndrome Scale, Medical Coping Scale, Perceived HIV/AIDS Stigma Scale, and the Brief Illness Perception Questionnaire to investigate and analyze the current status and influencing factors of demoralization syndrome in this population. The aim of the research is to reveal the psychosocial mechanisms underlying demoralization syndrome in young and middle-aged HIV/AIDS patients, providing a theoretical foundation and practical reference for the development of targeted psychological interventions. Ultimately, this will promote the psychological well-being and quality of life of this population.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy design\u003c/h2\u003e \u003cp\u003eThis study is a cross-sectional investigation conducted from April 2024 to October 2024 at a specialized infectious disease hospital in Chengdu, Sichuan Province, China.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eStudy participants and sample size\u003c/h3\u003e\n\u003cp\u003eParticipants were recruited from both the outpatient and inpatient departments of the infectious disease hospital. Inclusion criteria: (1) confirmed HIV infection; (2) age between 18 and 59 years; (3) awareness of their own medical condition; (4) no history of significant traumatic events within the past month; (5) voluntary participation with informed consent. Exclusion criteria: (1) patients with psychiatric disorders or impaired consciousness; (2) patients with speech impairments that prevent communication or those unable to cooperate in completing the survey. A total of 280 participants were included in this study using convenience sampling. The study was approved by the hospital\u0026rsquo;s Ethics Committee (YJ-K2024-12-01), and informed consent was obtained from all participants.\u003c/p\u003e\n\u003ch3\u003eStudy measures\u003c/h3\u003e\n\u003cp\u003eGeneral Information Survey: The general information survey was independently compiled by the researchers based on a review of the literature. It includes both demographic and disease-related information. The demographic information includes: age, gender, marital status, educational level, and average monthly income. The disease-related information includes: infection duration, ART duration, CD4\u0026thinsp;+\u0026thinsp;T lymphocyte count, viral load, and the presence of opportunistic infections.\u003c/p\u003e \u003cp\u003eDemoralization Scale: The Demoralization Scale\u0026mdash;Mandarin Version (DS-MV) was adapted and modified by Liu Peipei (Peipei et al., \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e2018\u003c/span\u003e)based on the translated version by Hong Xiaoqi, tailored to the specific context of China. This scale is designed to assess the level of demoralization in patients and consists of 5 dimensions and 24 items, including meaninglessness, emotional disturbance, discouragement, helplessness, and failure. Each item is rated on a scale from \"strongly disagree\" to \"strongly agree,\" corresponding to scores ranging from 0 to 4. A higher total score indicates more severe demoralization. The Cronbach's α of the overall scale is 0.97.\u003c/p\u003e \u003cp\u003e \u003cb\u003eSelf-Stigma Scale\u003c/b\u003e : The Self-Stigma Scale (SSS) was developed by Mak (Mak \u0026amp; Cheung, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e2010\u003c/span\u003e)and consists of 9 items, which assess three dimensions: emotional, cognitive, and behavioral aspects. All items are positively worded and are scored on a 5-point Likert scale (1\u0026ndash;5). Each item has five response options: \"strongly disagree\" (1), \"disagree\" (2), \"slightly agree\" (3), \"agree\" (4), and \"strongly agree\" (5). The total score ranges from 9 to 45, reflecting the individual's level of perceived stigma, with higher scores indicating a higher perceived level of stigma. The Cronbach's α coefficient for the scale is 0.91.\u003c/p\u003e \u003cp\u003e \u003cstrong\u003eBrief Illness Perception Questionnaire\u003c/strong\u003e \u003cp\u003eThe Brief Illness Perception Questionnaire (BIPQ) was developed by Broadbent in 2006 as a simplified version of the revised illness cognition questionnaire, designed to assess the illness perceptions of patients with various chronic conditions (Broadbent et al., \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e2006\u003c/span\u003e). Items 1\u0026ndash;8 are scored on an 11-point scale (0\u0026ndash;10), with items 3, 4, and 7 being reverse-scored. The total score, obtained by summing the scores of all items, reflects the individual's overall illness perception. A higher total score indicates a more negative perception of the illness.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eMedical Coping Modes Questionnaire\u003c/strong\u003e \u003cp\u003eThe Medical Coping Modes Questionnaire (MCMQ) was developed by Feifel (Feifel et al., 1987), with the Chinese version translated and revised by Shen Xiaohong (Xiaohong \u0026amp; Qianjin, \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e2000\u003c/span\u003e). This scale is used to assess patients' coping strategies when facing illness and has been well validated in China. The questionnaire consists of 20 items, with 8 items assessing the \"confrontation\" dimension, 7 items for the \"avoidance\" dimension, and 5 items for the \"resignation\" dimension. All items are scored on a 4-point scale, with higher scores indicating a greater tendency to adopt that coping style. Additionally, 8 items (1, 4, 9, 10, 12, 13, 18, 19) are reverse-scored. After revision, the Cronbach's α coefficients for the three dimensions were 0.69, 0.60, and 0.76, respectively.\u003c/p\u003e \u003c/p\u003e\n\u003ch3\u003eData Collection\u003c/h3\u003e\n\u003cp\u003eData were collected using paper-based questionnaires. Prior to the survey, all investigators received standardized training to ensure proficiency in the questionnaire items and administration procedures. After obtaining informed consent from eligible middle-aged and young adults living with HIV/AIDS, nurses used standardized instructions to explain the study objectives and content, as well as the procedures for completing the questionnaire. Participants were asked to complete the questionnaire independently. Nurses provided clarifications if questions arose during the process. For patients unable to complete the questionnaire on their own, nurses read the items aloud, recorded the patients\u0026rsquo; responses, and filled in the questionnaire on their behalf. Upon completion, each questionnaire was reviewed by the nurse on site, and any missing or erroneous responses were immediately verified with the participant.\u003c/p\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003eStatistical Analysis\u003c/h2\u003e \u003cp\u003eData were analyzed using SPSS version 27.0. Descriptive statistics were used to summarize the demographic and clinical characteristics of middle-aged and young adults living with HIV/AIDS, as well as the scores of each scale. Categorical variables were presented as frequencies and percentages, while continuous variables were expressed as mean\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation or as median and interquartile range, depending on data distribution. Independent-samples \u003cem\u003et\u003c/em\u003e tests and one-way analysis of variance (ANOVA) were performed to examine potential factors influencing demoralization syndrome among middle-aged and young living with HIV/AIDS. Pearson correlation analysis was conducted to assess the relationships between demoralization syndrome, perceived HIV-related stigma, cognitive appraisal, and medical coping. Variables with statistical significance in univariate analyses, along with those significantly correlated with demoralization syndrome, were entered into a stepwise multiple linear regression model, with the total demoralization score as the dependent variable. A \u003cem\u003ep\u003c/em\u003e-value\u0026thinsp;\u0026lt;\u0026thinsp;0.05 was considered statistically significant.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec9\" class=\"Section2\"\u003e \u003ch2\u003eUnivariate Analysis of General Characteristics and Demoralization Syndrome in Middle-Aged and Young PLWHA\u003c/h2\u003e \u003cp\u003eA total of 280 patients were included in this study. Among them, 88.93% were aged 31\u0026ndash;59 years, 78.21% were male, 54.28% reported a per capita monthly income of 3000\u0026ndash;4500 RMB, and 67.50% had opportunistic infections. Univariate analysis indicated that educational level, per capita monthly income, CD4\u0026thinsp;+\u0026thinsp;T lymphocyte count, HIV viral load, and opportunistic infections were significantly associated with demoralization syndrome in middle-aged and young PLWHA(\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05).Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e presents the impact of general information characteristics on demoralization syndrome among middle-aged and young PLWHA.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eImpact of General Information on Demoralization Syndrome in Middle-aged and Young PLWHA (n\u0026thinsp;=\u0026thinsp;280)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eVariables n (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cem\u003eM(IQR)\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003eZ/H\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge(years)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e18\u0026thinsp;~\u0026thinsp;30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e31(11.07)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e47(16)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e3.848\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.146\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e31\u0026thinsp;~\u0026thinsp;45\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e150(53.57)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e52(14)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e46\u0026thinsp;~\u0026thinsp;59\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e99(35.36)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e51(17)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSex\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e219(78.21)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e51(15)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e-0.218\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.827\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e61(21.79)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e52(16)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMarital Status\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMarried\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e118(42.14)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e52(15)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e-0.428\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.669\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUnmarried/ Divorced / Widowed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e162(57.86)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e50(15)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEducation level\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePrimary school and below\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e19(6.79)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e39(11)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e57.260\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;0.001**\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eJunior high school\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e58(20.71)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e44(17)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSenior high school\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e154(55.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e52(12)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBachelor's degree and above\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e49(17.50)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e62(16)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePersonal monthly income (yuan)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026lt;3000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e92(32.86)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e52(22)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e12.844\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.002\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e3000\u0026thinsp;~\u0026thinsp;4500\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e152(54.28)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e51.5(16)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026gt;4500\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e36(12.86)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e46(14)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eThe duration of HIV diagnosis(month)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026le;\u0026thinsp;12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e124(44.29)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e50.50(14)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e-1.052\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.293\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026gt;12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e156(55.71)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e51.50(16)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDuration of ART(month)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026le;\u0026thinsp;12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e143(51.07)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e52(15)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e-0.332\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.740\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026gt;12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e137(48.93)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e50(16)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCD4 cell count(cells /\u0026micro;L)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026lt;200\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e171(61.07)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e52(13)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e-3.324\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;0.001**\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026ge;\u0026thinsp;200\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e109(38.93)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e46(19)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eViral load(copies/ml)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026le;\u0026thinsp;20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e80(28.57)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e48(18)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e-2.483\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.013\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026gt;20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e200(71.43)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e52(16)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eopportunistic infection\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e189(67.50)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e52(16)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e-4.469\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;0.001**\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e91(32.50)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e46(14)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eCorrelation Analysis of Demoralization Syndrome with Perceived Stigma, Cognitive Appraisal, and Medical Coping\u003c/h3\u003e\n\u003cp\u003eSpearman correlation analysis revealed that demoralization syndrome was significantly correlated with perceived HIV-related stigma, cognitive appraisal, medical coping\u0026ndash;confrontation, and medical coping\u0026ndash;yielding among middle-aged and young PLWHA(\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05).Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e presents a detailed analysis of the correlations associated with Demoralization Syndrome.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eCorrelation Analysis of Demoralization Syndrome, Perceived HIV-related Stigma, Medical Coping Strategies and Cognitive Appraisal in Young and Middle-aged HIV/AIDS Patients\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eperceived HIV-related stigma\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003econfrontation\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eavoidance\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eyielding\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003ecognitive appraisal\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003edemoralization syndrome\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.360**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;.158**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.042\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.433**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.532**\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003efailure\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.322**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-0.102\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.046\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.413**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.493**\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003emeaninglessness\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.289**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-0.119*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.025\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.404**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.450**\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ehelplessness\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.350**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-0.131*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.041\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.343**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.440**\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eemotional disturbance\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.178**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-0.056\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.008\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.241**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.368**\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ediscouragement\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.295**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-0.211**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.058\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.343**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.363**\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eMultivariate Linear Regression Analysis of Factors Influencing Demoralization Syndrome\u003c/h2\u003e \u003cp\u003eStepwise multiple linear regression analysis demonstrated that monthly income (\u003cem\u003eβ\u003c/em\u003e = \u0026minus;\u0026thinsp;0.112, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.012), CD4\u0026thinsp;+\u0026thinsp;T lymphocyte count (\u003cem\u003eβ\u003c/em\u003e = \u0026minus;\u0026thinsp;0.145, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.001), and HIV viral load (\u003cem\u003eβ\u003c/em\u003e = \u0026minus;\u0026thinsp;0.103, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.020) were significant negative predictors of demoralization syndrome, whereas educational level (\u003cem\u003eβ\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.267, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001), opportunistic infections (β\u0026thinsp;=\u0026thinsp;0.143, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.001), perceived stigma (\u003cem\u003eβ\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.123, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.009), cognitive appraisal (\u003cem\u003eβ\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.235, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001), and yielding coping (\u003cem\u003eβ\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.232, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001) were significant positive predictors. These variables collectively explained 48.80% of the variance in demoralization syndrome.Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e presents the regression analysis findings for Demoralization Syndrome.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eMultivariate linear regression analysis of influencing factors of depression syndrome in young and middle-aged HIV/AIDS patients\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eβ-value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eStandard error\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eStandardized regression coefficient\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003et-value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eP-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e(Constant)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e18.924\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4.826\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e3.921\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEducation level\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3.482\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.604\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.267\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e5.761\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePersonal monthly income\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e-1.785\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.707\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e-0.112\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e-2.526\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.012\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCD4 cell count\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e-3.071\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.926\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e-0.145\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e-3.315\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eViral load\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e-2.352\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.002\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e-0.103\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e-2.348\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.020\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eopportunistic infection\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3.161\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.967\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.143\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e3.270\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eperceived HIV-related stigma\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.192\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.073\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.123\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e2.619\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.009\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ecognitive appraisal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.277\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.060\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.235\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e4.616\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003econfrontation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e-0.024\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.162\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e-0.007\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e-0.150\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.881\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eyielding\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.814\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.173\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.232\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e4.715\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eIn this study, higher total scores of the demoralization syndrome were observed among people living with HIV/AIDS, which contrasts with findings from other populations. Previous research has indicated that higher educational attainment serves as a protective factor against demoralization syndrome in cancer patients, primarily because well-educated individuals tend to have better health literacy, more effective coping strategies, and greater access to health and social resources(Bjelland et al., \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e2008\u003c/span\u003e; Vinueza et al., \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e2024\u003c/span\u003e). However, in our study, educational level was positively associated with demoralization scores. This phenomenon may be related to the more pronounced social role conflicts and psychological dissonance experienced by highly educated, middle-aged PLWHA following diagnosis. Higher educational attainment often corresponds to elevated social expectations and career aspirations; upon receiving an HIV-positive diagnosis, these individuals may encounter intense social stigma, professional limitations, and self-denial, which in turn exacerbate feelings of meaninglessness, helplessness, and failure. In clinical practice, it is therefore essential to strengthen psychological assessment and targeted interventions for highly educated, middle-aged PLWHA, rather than relying solely on general screening tools. In particular, psychological counseling and social support interventions should be tailored to address their cognitive patterns, role expectations, and social adaptation challenges, with the goal of helping them reconstruct a sense of meaning and life purpose.\u003c/p\u003e \u003cp\u003eThe present findings suggest a strong association between HIV-related clinical status and levels of demoralization. Middle-aged and young adults living with HIV/AIDS who maintain CD4\u0026thinsp;+\u0026thinsp;T lymphocyte counts\u0026thinsp;\u0026ge;\u0026thinsp;200 cells/\u0026micro;L, achieve viral suppression (\u0026lt;\u0026thinsp;20 copies/mL), and remain free of opportunistic infections generally exhibit lower demoralization scores.\u003c/p\u003e \u003cp\u003eCD4\u0026thinsp;+\u0026thinsp;T lymphocyte count serves as a pivotal indicator of immune competence; higher counts are typically observed during the early phase of infection or immune reconstitution under ART, when physiological functioning is relatively preserved. Prior studies have shown that individuals with CD4\u0026thinsp;+\u0026thinsp;T cell counts\u0026thinsp;\u0026le;\u0026thinsp;200 cells/\u0026micro;L are at substantially greater risk of AIDS-related hospitalization(Mou et al., \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e2025\u003c/span\u003e). For younger and middle-aged patients\u0026mdash;who are often in critical stages of career or academic development\u0026mdash;recurrent hospitalizations may interrupt social and occupational roles, thereby amplifying economic strain and psychological distress. Viral load, an established marker of HIV replication dynamics, reflects disease activity, with elevated levels signifying accelerated progression. Among this population, high viral load may indicate inadequate therapeutic response or the emergence of drug resistance(Swenson et al., \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e2014\u003c/span\u003e), often provoking fear, anxiety, pessimism, and other adverse psychological reactions that undermine hope and perceived control over life. Moreover, Middle-aged and young adults PLWHA who develop opportunistic infections bear a substantially greater economic burden than those with uncomplicated HIV infection(Bielick et al., \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e2024\u003c/span\u003e). Beyond the financial impact, these individuals are confronted with more complex clinical trajectories, multiple somatic manifestations, and an elevated risk of mortality(Meng et al., \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e2023\u003c/span\u003e; Shaw \u0026amp; Matin, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e2022\u003c/span\u003e), factors that collectively intensify psychological distress and may further aggravate demoralization.\u003c/p\u003e \u003cp\u003eThe present study demonstrated that perceived discrimination was a significant positive predictor of demoralization among middle-aged and young PLWHA (β\u0026thinsp;=\u0026thinsp;0.123, P\u0026thinsp;=\u0026thinsp;0.009), indicating that greater perceived discrimination was associated with higher levels of demoralization. These findings reinforce evidence from prior research that social discrimination constitutes a critical psychosocial determinant of mental health in this population(Han et al., \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e2021b\u003c/span\u003e). Perceived discrimination fosters experiences of social isolation and marginalization, erodes social support networks, and precipitates adverse emotional states such as helplessness and meaninglessness\u0026mdash;hallmarks that closely parallel the defining features of demoralization(Blanco et al., \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e2025\u003c/span\u003e; Ninnoni et al., \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e2023\u003c/span\u003e). Chronic exposure to such perceptions may further undermine healthcare-seeking behavior and adherence to antiretroviral therapy(Perger et al., \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e2025\u003c/span\u003e; Tuot et al., \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e2023\u003c/span\u003e), thereby heightening the risk of disease progression and perpetuating a vicious cycle of \u0026ldquo;discrimination\u0026ndash;psychological dysregulation\u0026ndash;disease progression\u0026rdquo; .Accordingly, reducing perceived discrimination is pivotal in mitigating demoralization. Public health strategies should therefore prioritize community-based education and awareness campaigns to enhance scientific literacy and reduce stigma, while healthcare systems should integrate psychological counseling, peer support, and targeted anti-discrimination interventions to strengthen patients\u0026rsquo; coping capacity and resilience.\u003c/p\u003e \u003cp\u003eThis study found that the medical coping\u0026ndash;yielding dimension was a significant positive predictor of demoralization among middle-aged and young PLWHA (β\u0026thinsp;=\u0026thinsp;0.232, P\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Specifically, greater reliance on yielding coping was associated with higher levels of demoralization. Yielding coping, defined as passive acceptance and submission to illness, indicates insufficient self-regulation and limited proactive engagement when facing health-related threats(Taylor \u0026amp; Stanton, 2007). Prior research in patients with cancer has similarly shown that yielding coping is closely linked to depression, anxiety, and diminished quality of life(Tang et al., \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e2020\u003c/span\u003e). These findings suggest that yielding coping may aggravate psychological distress by eliciting negative emotional responses, lowering self-efficacy, and hindering the effective use of social support. Among middle-aged and young PLWHA, such coping tendencies may reduce help-seeking behaviors and the acquisition of medical information, potentially delaying timely treatment, worsening disease progression, and undermining mental well-being. In addition, yielding coping may intensify negative cognitive appraisals, leading to behavioral withdrawal, a loss of social value, and poorer health outcomes. Consequently, clinical nursing and psychosocial interventions should target this maladaptive coping pattern, fostering stronger social support networks and promoting constructive interactions with healthcare professionals and peer groups to mitigate its adverse impact.\u003c/p\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003eStrengths and limitations\u003c/h2\u003e \u003cp\u003eWith the widespread use of antiretroviral therapy, HIV/AIDS is increasingly regarded as a chronic, manageable infectious disease, prompting a growing focus on the psychological well-being of affected individuals. This study, which examines the prevalence and determinants of despair syndrome among young and middle-aged PLWHA at an infectious disease hospital in Chengdu, China, provides both theoretical insights and practical implications. The findings offer valuable guidance for healthcare professionals, family members, and society at large in early detection of despair syndrome symptoms, enabling the implementation of targeted and personalized interventions. Such measures are critical in enhancing the mental health and overall quality of life of young and middle-aged PLWHA.\u003c/p\u003e \u003cp\u003eThe participants in this study were all recruited from a single hospital, which may limit the representativeness of the sample and introduce selection bias, thus restricting the broader applicability of the findings. To enhance the generalizability of future research, it is recommended to expand the sample size and incorporate multi-center designs. This study employed a cross-sectional approach, providing a snapshot of despair syndrome levels and their influencing factors among young and middle-aged PLWHA)at a specific moment in time. However, given that despair syndrome is a dynamic psychological state, both its severity and influencing factors are likely to fluctuate over time. Therefore, to gain a more nuanced and comprehensive understanding of despair syndrome in this population, future research should consider adopting a longitudinal design to explore its evolving patterns and underlying mechanisms.\u003c/p\u003e \u003c/div\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThis study highlights several key factors influencing desistance syndrome in middle-aged and young individuals living with HIV/AIDS (PLWHA), including monthly income, CD4\u0026thinsp;+\u0026thinsp;T lymphocyte count, HIV viral load, education level, opportunistic infections, perceived discrimination, cognitive appraisal, and yielding. In light of these findings, it is crucial that future interventions incorporate comprehensive evaluations conducted by healthcare providers. These assessments should emphasize the development of individualized and targeted care plans, potentially incorporating approaches such as cognitive-behavioral therapy and group psychotherapy. Such interventions aim to mitigate negative psychological states and improve patients' social functioning and overall adaptability.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eHIV\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eHuman immunodeficiency virus\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eAIDS\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eAcquired immunodeficiency syndrome\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eART\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eantiretroviral therapy\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003ePLWHA\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003epeople living with human immunodeficiency virus/acquired immunodeficiency syndrome\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe trial protocol and all amendments were approved by the Institutional Review Board of Public Health Clinical Center of Chengdu (YJ-K2024-12-01).Our study was conducted according to the principles of the Declaration of Helsinki and followed relevant guidelines and regulations. All participants provided informed consent and voluntarily participated in the study. No personal information has been used and the individual\u0026rsquo;s identity has been protected by removing any personal identifiers from the data. Codes were designated to the respondents to guarantee their anonymity.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe data that support the findings of this study are available from the corresponding author upon reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis research was funded by the Sichuan Institute of Social Sociology and Sex Education (Grant number:SXJYB2404) and the Chengdu Municipal Health Commission (Grant number:\u0026nbsp;2024453).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026apos; contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eW.C.T., T.J., and W.B. designed this study, and the concept was proposed by W.C.T. and Z.X.; Z.X., F.S.P., Y.X. D. P.S., L.C.R., G.L.H were responsible for data collection. W.C.T. and Z.X., F.S.P., led the data analysis work. W.B. reviewed the results of the data analysis. W.C.T. and T.J. wrote the paper, and W.B. revised and polished the paper. All authors have read and approved the final version of this paper.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThanks to all the patients who participated in this study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eClinical trial number\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;Not applicable.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003e\u003cem\u003eGlobal HIV \u0026amp; AIDS statistics \u0026mdash; Fact sheet | UNAIDS\u003c/em\u003e Retreved 2025-08-08 from /en/resources/fact-sheet\u003c/li\u003e\n \u003cli\u003eBanerjee, N., Goodman, Z. T., McIntosh, R., \u0026amp; Ironson, G. (2022). 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Coping Strategies and Symptoms of Mental Health Disorders Among People with HIV \u0026nbsp;Initiating HIV Care in Cameroon [Journal Article]. \u003cem\u003eAids and Behavior\u003c/em\u003e, 27(7), 2360-2369. http://doi.org/10.1007/s10461-022-03963-4\u003c/li\u003e\n \u003cli\u003ePeipei, L., Jin, L., Ying, D., Qigui, Q., \u0026amp; ZhangYulin. (2018). The correlation of demoralization syndrome and psycho- physiological statein liver cancer patients [The correlation of demoralization syndrome and psycho-physiological statein liver cancer patients]. \u003cem\u003eChinese Journal of Practical Nursing\u003c/em\u003e, 34(13), 966-970.\u003c/li\u003e\n \u003cli\u003ePeng, H. L., Hsueh, H. W., Chang, Y. H., \u0026amp; Li, R. H. (2021). 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E., \u0026amp; Stanton, A. L. (2007). Coping resources, coping processes, and mental health [Journal Article; Research Support, N.I.H., Extramural; Research Support, U.S. Gov\u0026apos;t, Non-P.H.S.; Review]. \u003cem\u003eAnnual Review of Clinical Psychology\u003c/em\u003e, 3, 377-401. http://doi.org/10.1146/annurev.clinpsy.3.022806.091520\u003c/li\u003e\n \u003cli\u003eTuot, S., Sim, J. W., Nagashima-Hayashi, M., Chhoun, P., Teo, A. K. J., Prem, K., \u0026amp; Yi, S. (2023). What are the determinants of antiretroviral therapy adherence among stable people living with HIV? A cross-sectional study in Cambodia. \u003cem\u003eAIDS Research and Therapy\u003c/em\u003e, 20(1), 47. http://doi.org/10.1186/s12981-023-00544-w\u003c/li\u003e\n \u003cli\u003eVinueza, V. M., Bhatta, L., Jones, P. R., Tesli, M., Smith, G. D., Davies, N. M., Brumpton, B. M., \u0026amp; N\u0026aelig;ss, \u0026Oslash;. E. (2024). 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Report on application of Chinese version of MCMQ in 701 patients. \u003cem\u003eChinese Journal of Behavioral Medical Science\u003c/em\u003e(01), 22-24.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-infectious-diseases","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"infd","sideBox":"Learn more about [BMC Infectious Diseases](http://bmcinfectdis.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/infd","title":"BMC Infectious Diseases","twitterHandle":"#bmcinfectdis","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Young and middle-aged PLWHA, Demoralization syndrome, influencing factors","lastPublishedDoi":"10.21203/rs.3.rs-8698932/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8698932/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eObjective\u003c/h2\u003e \u003cp\u003eThis study aims to examine the prevalence and influencing factors of despair syndrome in middle-aged and young individuals living with HIV/AIDS at a tertiary infectious disease hospital in China. The goal is to provide a foundation for the early identification of high-risk populations and to guide the development of targeted clinical interventions.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eA convenience sampling approach was employed to recruit 280 middle-aged and young PLWHA who met the inclusion and exclusion criteria from a tertiary infectious disease hospital in Chengdu, China, between April and October 2024. Data were collected through a general demographic questionnaire, the Chinese version of the Despair Scale, the AIDS Discrimination Perception Scale, the Simple Disease Cognition Questionnaire, and the Chinese version of the Medical Coping Modes Questionnaire. Statistical analyses, including descriptive statistics, one-way ANOVA, Spearman's correlation, and multiple stepwise regression, were performed using SPSS 27.0.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eA total of 280 participants were included in the analysis, with 88.93% aged between 31 and 59 years, and 78.21% male. Univariate analysis revealed that educational attainment, monthly income per capita, CD4\u0026thinsp;+\u0026thinsp;T lymphocyte count, HIV viral load, and the presence of opportunistic infections were significantly associated with the occurrence of despair syndrome among middle-aged and young HIV/AIDS patients (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05). Spearman\u0026rsquo;s correlation analysis demonstrated significant associations between despair syndrome and perceived discrimination, disease cognition, and two coping strategies\u0026mdash;confrontation and yielding (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05). Multiple regression analysis identified monthly income (β = -0.112, P\u0026thinsp;=\u0026thinsp;0.012), CD4\u0026thinsp;+\u0026thinsp;T lymphocyte count (β = -0.145, P\u0026thinsp;=\u0026thinsp;0.001), and HIV viral load (β = -0.103, P\u0026thinsp;=\u0026thinsp;0.020) as significant negative predictors of despair syndrome, while educational level (β\u0026thinsp;=\u0026thinsp;0.267, P\u0026thinsp;\u0026lt;\u0026thinsp;0.001), opportunistic infections (β\u0026thinsp;=\u0026thinsp;0.143, P\u0026thinsp;=\u0026thinsp;0.001), discrimination perception (β\u0026thinsp;=\u0026thinsp;0.123, P\u0026thinsp;=\u0026thinsp;0.009), cognitive appraisal (β\u0026thinsp;=\u0026thinsp;0.235, P\u0026thinsp;\u0026lt;\u0026thinsp;0.001), and yielding coping style (β\u0026thinsp;=\u0026thinsp;0.232, P\u0026thinsp;\u0026lt;\u0026thinsp;0.001) were identified as significant positive predictors. These variables together explained 48.80% of the variance in despair syndrome.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eDespair syndrome in middle-aged and young PLWHA is influenced by a variety of factors. Clinicians should place greater emphasis on the psychological well-being of these individuals, implementing tailored interventions that address the identified risk factors to prevent or delay the onset of frailty.\u003c/p\u003e","manuscriptTitle":"Prevalence and Determinants of Demoralization Syndrome among Middle-aged and Young Adults with HIV/AIDS: A Cross-sectional Study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-02-17 14:20:20","doi":"10.21203/rs.3.rs-8698932/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"editorInvitedReview","content":"","date":"2026-05-07T16:11:06+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"81432675117827627508002596752847096930","date":"2026-05-07T15:30:20+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-02-12T06:32:04+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-02-12T06:26:37+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2026-02-03T17:32:29+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-02-03T08:16:37+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Infectious Diseases","date":"2026-02-03T07:47:10+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-infectious-diseases","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"infd","sideBox":"Learn more about [BMC Infectious Diseases](http://bmcinfectdis.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/infd","title":"BMC Infectious Diseases","twitterHandle":"#bmcinfectdis","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"1bdfe9bf-9965-4e55-aa85-4b0aaab55be2","owner":[],"postedDate":"February 17th, 2026","published":true,"recentEditorialEvents":[{"type":"editorInvitedReview","content":"","date":"2026-05-07T16:11:06+00:00","index":79,"fulltext":""},{"type":"reviewerAgreed","content":"81432675117827627508002596752847096930","date":"2026-05-07T15:30:20+00:00","index":78,"fulltext":""}],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-02-17T14:20:20+00:00","versionOfRecord":[],"versionCreatedAt":"2026-02-17 14:20:20","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8698932","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8698932","identity":"rs-8698932","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}