The role of physical functioning and complete mental health in shaping perceived overall health among people living with HIV in Kazakhstan

Abstract

Background: People living with HIV (PLHIV) experience a wide range of physical, psychological, and social challenges that transcend viral control. Self-rated health (SRH) can be described as a measurement of overall health, which reflects both mental and physical aspects. Objective: This study investigates the relationship between SRH and complete mental health (CMH) among PLHIV in Kazakhstan using the two-continua model of mental health. Methods: This study is a secondary analysis of a cross-sectional study among PLHIV in Kazakhstan that was conducted in 2024. SRH was defined as a binary variable categorized as good/very good/excellent versus fair/poor. Complete mental health was defined as a composite variable based on measures of flourishing (Flourishing Scale) and mental illness (PHQ-2 and GAD-2) with four categories: (1) flourishing with no mental illness, (2) flourishing with mental illness, (3) not flourishing with no mental illness, and (4) not flourishing with mental illness. Multivariable logistic regression analysis was used to examine the association between SRH and CMH, controlling for the effect of socio-demographic and physical health variables. Results: Odds of good SRH were lower for ages 35-44 (AOR 0.24; 95%CI 0.07-0.81) and 45-64 (AOR 0.15; 95%CI 0.04-0.55) compared to the reference age 25-34. Participants with medium and higher educational level reported having worse SRH (AOR 0.11; 95%CI 0.02-0.63 and AOR 0.08; 95%CI 0.01-0.64 respectively), compared to those with low educational level. Chronic disease had a negative association with good SRH (AOR 0.19; 95%CI 0.08-0.50), while good physical functioning had a strong positive association (AOR 5.37; 95%CI 2.01-14.35). Complete mental health showed the strongest relationships with SRH. Odds of good SRH were higher for participants who reported flourishing, either with or without mental illness, (AOR 11.15; 95%CI 1.69-73.46 and AOR 7.28; 95%CI 1.75-30.33, respectively) compared to the reference category of languishing participants, those who were not flourishing and suffered from mental illness. Conclusion: The present study stresses the importance of both physical functioning and flourishing mental health for the perception of health among PLHIV. A biopsychosocial approach may improve the health outcomes of PLHIV by addressing both physical and mental dimensions of overall well-being.