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People living with human immunodeficiency virus (PLHIV) are approximately twice as likely to be depressed compared with HIV-negative individuals. Depression is consistently associated with low antiretroviral therapy (ART) adherence, an important step within the HIV care continuum related to HIV disease progression and overall health. One factor that may have positive psychosocial benefits and promote ART adherence is dog ownership. Research indicates that dog ownership is associated with lower depression, and initial evidence suggests its positive impact on psychosocial outcomes for PLHIV.
The aim of our study was to expand the existing research by examining the relationship between current dog ownership and depression for a sample of PLHIV while controlling for demographic characteristics and other potential confounders.
Participants aged 18 years or older and who self-reported an HIV diagnosis were recruited via social media into
A total of 252 participants were enrolled into the study in January 2016, with a final analytic sample of 199 participants. Mean age was 49 years, 86.4% (172/199) of participants were male, and 80.4% (160/199) were white. Current dog ownership was prevalent among the sample (68.3%, 136/199). Bivariate analysis indicated that there was no significant relationship between depression and demographic characteristics (age, race, ethnicity, gender, and sexual orientation), with
Growing evidence suggests that dog ownership reduces the likelihood of depression and, therefore, may confer long-term health benefits on PLHIV. Future studies should explore whether dog-specific interventions are a feasible and efficacious intervention to improve outcomes among PLHIV.
In the United States, 1.1 million people are living with human immunodeficiency virus (HIV), with the highest burden among men who have sex with men (MSM), particularly racial and ethnic minority MSM [
Depression and depressive symptoms are consistently associated with poor ART adherence and overall HIV disease progression—even in a post-ART era [
One factor that may ameliorate depressive symptoms, promote ART adherence, and potentially assist in improving other HIV-related health outcomes is pet ownership. Pet ownership, in particular dog ownership, has been linked to multiple positive physical, psychological, and psychosocial health outcomes [
Dog-specific AAIs have been shown to benefit those living with chronic health conditions in particular. Hospitalized pediatric cancer patients who undergo animal-facilitated therapy with dogs show improved psychological health, decreased worry, and less fear [
Similar to the general population, a small body of research suggests positive benefits of pet ownership among PLHIV, including stress reduction and improvement in mood and well-being, particularly for those with less social support [
The first methodologically rigorous investigation into pet ownership in a sample of gay and bisexual men used data from the Multicenter AIDS Cohort Study, an ongoing observational study of the natural history of HIV/AIDS [
In sum, initial evidence suggests that dog ownership is associated with positive psychosocial outcomes for PLHIV. In the study described herein, we sought to update this evidence and extend it to a broad target population of PLHIV in the United States. On the basis of prior findings, we hypothesized that among PLHIV, current dog ownership would be associated with fewer depressive symptoms, controlling for demographic characteristics and other potential confounders. Given the potential for dog ownership to reflect a resilient response to stress (eg, drawing on social capital and social interaction), we also measured and included an indicator of resilience in our models to control for its potential confounding of the dog ownership and depression relationship.
The study
Participants first completed a brief set of demographic questions indicating their primary race (Asian/Pacific Islander, black/African American, white, Latino/Hispanic, other, or multiracial), ethnicity (Spanish/Hispanic/Latino/a), sex assigned at birth (male or female), current gender identity (male, female, or transgender), age, and whether or not they ever owned a pet (yes or no). Participants who reported having ever owned a dog were asked whether they currently owned a dog.
Depression was measured using the shortened Center for Epidemiologic Studies Depression Scale (CES-D10) [
Resiliency, a potential confounding variable, was measured with the Resilience Research Centre Adult Resilience Measure (RRC-ARM), an adapted version of the Child and Youth Resilience Measure (CYRM-28) [
We used descriptive statistics, including measures of central tendency and dispersion, to characterize the sample. We assessed simple associations between variables using Pearson correlations or chi-square tests, with significance level set at alpha <.05. A multivariable logistic regression analysis assessed the log odds that a participant would meet criteria for depression based on current dog ownership, controlling for age, race, ethnicity, and gender, as well as resilience. Due to low cell numbers, the race variable was dichotomized for analysis (white vs nonwhite). Data were analyzed using SPSS statistics version 24 (IBM Corporation).
In total, 356 data cases were downloaded from Qualtrics, of which 29 cases had a duplicate IP address. The data cases that were most complete were kept in the final dataset, leaving 327 unique volunteers who clicked the survey link; 15 cases that contained no data were deleted (ie, a volunteer clicked the link but did not proceed past the first screen). A total of 28 cases were deleted for not meeting eligibility criteria. Of the participants who were eligible, 32 did not enroll in the study.
A total of 252 adults living with HIV were enrolled into the study in January 2016, yielding a participation rate of 77.1% (252/327). Completion of the study survey took approximately 15 min on average. A total of 51 cases were withdrawn from analysis for largely incomplete responses. The completion rate for the survey was 79.8% (201/252). An additional 2 participants who reported transgender status were removed from the sample because of small cell size for analysis, that is, to minimize the number of variables in analytical models. The final analytic sample included 199 PLHIV.
Sample characteristics of adult people living with human immunodeficiency virus (N=199).
Characteristic | Number | ||
Age at baseline, mean (SD) | 48.72 (10.68) | ||
Age at HIV diagnosis, mean (SD) | 31.89 (9.43) | ||
Years since human immunodeficiency virus (HIV) diagnosisa, mean (SD) | 16.87 (10.05) | ||
Male, n (%) | 172 (86.4) | ||
Female, n (%) | 27 (13.6) | ||
Black/African American, n (%) | 9 (4.5) | ||
White, n (%) | 160 (80.4) | ||
Latino/Hispanic, n (%) | 9 (4.5) | ||
Asian/Pacific Islander, n (%) | 7 (3.5) | ||
Other and multiracial, n (%) | 14 (7.0) | ||
Hispanic/Spanish/Latino/a, n (%) | 18 (9.0) | ||
Not Hispanic/Spanish/Latino/a, n (%) | 181 (91.0) | ||
Homosexual/gay, n (%) | 165 (82.9) | ||
Bisexual, n (%) | 8 (4.0) | ||
Heterosexual/straight, n (%) | 23 (11.6) | ||
Other, n (%) | 3 (1.5) | ||
Yes, n (%) | 194 (97.5) | ||
No, n (%) | 5 (2.5) | ||
Yes, n (%) | 184 (92.5) | ||
No, n (%) | 15 (7.5) | ||
Before, n (%) | 57 (31.1) | ||
After, n (%) | 126 (68.9) | ||
Companion or household pet, n (%) | 168 (91.3) | ||
Therapy dog, n (%) | 14 (7.6) | ||
Official service dog, n (%) | 2 (1.1) | ||
Yes, n (%) | 136 (68.3) | ||
No, n (%) | 63 (31.7) |
aOne participant declined to answer this question.
Chi-square tests (with Fisher exact test as needed for low cell sizes) and Pearson correlations indicated that there was no significant relationship between depression and demographic characteristics (N=199): age (
Multivariable logistic regression of depression on pet ownership among people living with human immunodeficiency virus (N=199).
Predictor Variables | Beta | Standard error | Odds ratio (95% CI) | |
Age | −.026 | 0.015 | .08 | 0.974 (0.946-1.004) |
Race (white) | −.687 | 0.460 | .14 | 0.503 (0.204-1.239) |
Ethnicity (Hispanic) | −.203 | 0.605 | .74 | 0.816 (0.249-2.671) |
Gender (male) | −.508 | 0.500 | .31 | 0.602 (0.226-1.602) |
Resilience | −1.201 | 0.291 | <.001 | 0.301 (0.170-0.533) |
Current dog ownership (no) | 1.130 | 0.355 | .001 | 3.095 (1.542-6.213) |
Constant | 6.427 | 1.622 | <.001 | 618.620 |
This study explored the impact of current dog ownership on depression for a sample of adult PLHIV. It was hypothesized that among PLHIV, current dog ownership would be associated with decreased likelihood of meeting depressive criteria. Our hypothesis was supported in that noncurrent dog ownership was significantly and positively associated with depression, controlling for the potential influence of resilience and other demographic factors. Individuals who were not current dog owners had 3 times higher odds of depression compared with current dog owners. This finding adds to and updates prior findings regarding the potential positive impact of dog ownership on depression in PLHIV.
This is a notable finding as depression is the most common psychiatric disorder associated with HIV disease [
Although little research has been done on the potential mechanisms of action, dog ownership may impact depression and overall psychological health among PLHIV through bolstering social support networks. Pet dogs may act as a source of social support that can supplement existing support networks or fill network voids for vulnerable populations [
Beyond ameliorating depressive symptoms, dog ownership may also have an effect on other important factors related to health outcomes for PLHIV, including ART adherence. As noted earlier, depression is consistently associated with suboptimal ART adherence. Inadequate social support is also routinely found to be correlated with poor ART adherence [
Several limitations of this study should be noted. The data are cross-sectional in nature and therefore causality cannot be inferred. For example, we measured depressive symptoms over the past 7 days, meaning we do not have data regarding onset of depression or whether depressive symptoms preceded or followed dog companionship. Additionally, only participants with access to the Internet were able to enroll. Although the vast majority of Americans report having access to the Internet, Internet adoption is still closely dependent on income and education [
In conclusion, growing evidence suggests that dog ownership reduces the likelihood of depression and, therefore, may confer long-term health benefits on PLHIV. Given this evidence, testing of dog-specific AAIs to reduce depressive symptoms as well as to improve HIV-related health outcomes is a logical next step. Given the relatively low rate of viral suppression in PLHIV in comparison with national targets, innovative interventions are needed to reach goals established under the national HIV/AIDS strategy.
animal-assisted intervention
acquired immune deficiency syndrome
antiretroviral therapy
Center for Epidemiologic Studies
diabetic alert dog
human immunodeficiency virus
Internet Protocol
men who have sex with men
people living with HIV
Resilience Research Centre
transport layer security
The authors thank Rose Diskin for her support in the literature search.
None declared.