Syndemic Burden in People Living with HIV: A Systematic Review and Meta-Analysis of Depression and Anxiety Across Diverse Populations

Rifki Sakinah Nompo (Department of Psychiatric Nursing, Nursing Study Program, Sekolah Tinggi Ilmu Kesehatan Papua, Sorong, Indonesia)
Dolpiana Siyoho (Department of Psychiatric Nursing, Nursing Study Program, Sekolah Tinggi Ilmu Kesehatan Papua, Sorong, Indonesia)
Meland Ibiah (Department of Psychiatric Nursing, Nursing Study Program, Sekolah Tinggi Ilmu Kesehatan Papua, Sorong, Indonesia)
Feronika Dubuaki (Department of Psychiatric Nursing, Nursing Study Program, Sekolah Tinggi Ilmu Kesehatan Papua, Sorong, Indonesia)

Scientia Psychiatrica
Vol. 7 No. 1 (2025): Scientia Psychiatrica

Introduction: People living with HIV (PLWH) experience elevated rates of depression (31%) and anxiety (28–97%), which are often embedded within broader syndemic contexts involving multiple co-occurring psychosocial stressors. However, comprehensive meta-analytic synthesis of syndemic burden across diverse populations remains limited. This review integrates evidence on the relationship between syndemic burden (cumulative psychosocial stressors) and depression/anxiety in PLWH. Methods: Systematic literature search across Scopus, PubMed/MEDLINE, and Web of Science (2000–2025). Eligible studies reported quantitative associations between psychosocial stressors and depression or anxiety in PLWH. Data were extracted independently by two reviewers. Random-effects meta-analysis using Hedges g and odds ratios (95% confidence intervals) was conducted separately for depression and anxiety. Risk of bias was assessed using the Modified Newcastle–Ottawa Scale. GRADE methodology was applied for the certainty of evidence. Results: Seven effect sizes from six studies (N≈16,598 PLWH) were included. Depression showed robust, consistent effects (k=5, SMD=0.754, 95% CI: 0.694–0.815, I²=0%, p<0.001; OR=4.12, 95% CI: 3.05–5.54), representing a moderate-to-large clinical difference (3.8–4.5 points on PHQ-9). Anxiety also demonstrated significant effects (k=2, SMD=0.671, 95% CI: 0.012–1.330, I²=82.4%, p=0.046; OR=3.88, 95% CI: 2.76–4.91), though with high heterogeneity. The pooled effect across both outcomes was SMD=0.721 (95% CI: 0.595–0.847, I²=45.3%). Effects were consistent across cross-sectional (SMD=0.730) and longitudinal (SMD=0.749) designs. All studies were rated 7–9 on the Modified NOS, indicating low risk of bias. Conclusion: Syndemic burden is substantially associated with depression and anxiety in PLWH. Depression manifests as a consistent, primary psychiatric consequence across diverse contexts, whilst anxiety severity varies by cultural and geographical factors. Integrated screening combining PHQ-9, GAD-7, and structured psychosocial stressor assessment is warranted.