Psychological resilience and social support as determinants of HIV-related stress in older adults living with HIV in China: a moderated mediation analysis

Abstract

Background: This cross-sectional study investigates the relationship between social support, psychological resilience, and HIV-related stress in older adults living with HIV in China. It further explores whether psychological resilience mediates the link between social support and stress and whether living arrangements moderate this relationship. Methods: From January to February 2024, 405 older adults aged 50 and above were selected from the outpatient Department of Infection and Immunology at Changsha Infectious Disease Hospital. Participants filled out a structured on-site questionnaire survey measuring the Chinese HIV/AIDS Stress Scale (CSS-HIV), the Connor-Davidson Resilience Scale (CD-RISC-10), and the Social Support Rating Scale (SSRS). Data were analyzed using SPSS 26.0, GraphPad Prism 10, and the PROCESS macro to test for mediation and moderation effects. Results: The mean HIV-related stress score was 24.84 ± 14.01, comprising instrumental (4.71 ± 4.74), social (14.23 ± 6.21), and emotional (5.91 ± 5.98) stress components. Social support had a significant total effect on HIV-related stress (β = -0.462, p < 0.001). The indirect effect via psychological resilience was statistically significant (β = -0.216, 95% CI [-1.044, -0.339], p < 0.001), and the direct effect remained significant (β = -0.246, p = 0.025), indicating partial mediation. Living with others showed a stronger moderating effect on psychological resilience against stress (β = -1.004, p < 0.001) than living alone (β = -0.586, p < 0.001). Conclusion: In this study, we found that psychological resilience and social support play critical roles in reducing HIV-related stress among older adults living with HIV in China. Our findings suggest that interventions designed to strengthen resilience and promote a supportive social environment have the potential to significantly improve mental health outcomes for this population. Future programs should consider the role of living arrangements by addressing privacy challenges and the dynamics of shared living, and by recognizing how these factors shape stress experiences and support needs in this vulnerable population. Trial registration: Not applicable. This study is a cross-sectional observation study and was therefore not registered as a clinical trial.