Conscientiousness predicts disease progression (CD4 number and viral load) in people living with HIV.

OBJECTIVE: Psychosocial factors (e.g., depression, avoidant coping, life stress) have been related to disease progression in HIV. This study examined the relationship between the Big Five Conscientiousness factor and HIV disease progression (CD4 cell and viral load) over 1 year in 119 seropositive participants. The study also examined whether Conscientiousness effects were mediated by adherence, perceived stress, depression, or coping measures. DESIGN: In a 1-year longitudinal design, participants completed the NEO Five-Factor Inventory Conscientiousness scale (P. T. Costa & R. R. McCrae, 1992). Participants also completed psychosocial assessments and underwent blood draws at initial assessments and 1-year follow-up. MAIN OUTCOME MEASURES: Multiple hierarchical regression models were used to predict change in CD4 cell numbers and viral load log 10, controlling for demographic variables, initial disease status, and antiretroviral medications. RESULTS: Conscientiousness predicted significant increases in CD4 number and significant decreases in viral load at 1 year. Conscientiousness was related positively to medication adherence and active coping and negatively to depression and perceived stress. Only perceived stress emerged as a possible mediator. CONCLUSION: The significant relationship between Conscientiousness and medication adherence, distress, and coping suggests that an assessment of Conscientiousness in patients with HIV may help specify or target behavioral interventions to promote optimal disease management.     

Managing stress and managing illness: Survival and quality of life in chronic disease

Interest has been steadily building in the impact of stress on psychological and physiological functioning, in particular on immune system responses, furthering the concept of a strong connection between the mind and the body. Implications for prevention of disease onset or treatment of stress-induced illness or immunocompromised conditions have been explored through the implementation of stress management techniques. Cognitive behavioral stress management interventions, biofeedback, relaxation, guided imagery, hypnosis, individual and group psychotherapy, aerobic exercise, and guided self-efficacy treatment are briefly reviewed to identify possible treatment mechanisms that may affect immune function and promote quality of life. The application of behavioral techniques to reduce distress and sharpen coping skills has great promise in reducing the costs associated with chronic disease and in enhancing quality of life among those afflicted.Presented at the APA Presidential Miniconvention, To Your Health: Psychology Through the Life Span, Session VIII, Assuring a Healthy Lifestyle: Psychology Delivers. Chair: Diane J. Willis, Ph.D. The third author received partial funding through the Terry Fox Research Fellowship 5257, National Cancer Institute of Canada.     

Psychological distress and quality of life of people living with HIV/AIDS in a Nigerian teaching hospital

Presence of psychological distress and poor quality of life (QoL) may affect the outcome of HIV/AIDS. One hundred and seventeen consecutive and consenting participants were interviewed using a Socio-demographic questionnaire, Kessler Psychological Distress Scale (K10) and World Health Organization Quality of Life-HIV Bref. Fifty-six (47.9%) participants scored 20 and above on K10 Scale. QoL was significantly higher in married participants, those who perceived their state of health as being good, asymptomatic participants and those who scored well–mild on K10. The older age group scored higher on QoL Scale than the younger age group in the physical health domain while the married participants scored higher in the domains of physical health, psychological health, environment and spiritual/religion. The participants who perceived their state of health as being good scored higher than those who perceived their health as poor in all domains. There is a high level of psychological distress and poor QoL in people living with HIV/AIDS.     

Health-related quality of life among people living with hiv disease in small communities and rural areas

Abstract

While many studies have examined the life quality of HIV-infected persons in large metropolitan areas, few studies have investigated quality of life issues among persons living with HIV disease in America's small and rural communities. In the present study, 78 people living with HIV/AIDS in small and rural communities (i.e., populations <25,000) reported on their health-related quality of life. Many respondents reported decreased social, emotional, functional, and physical well-being. Results revealed that participants' emotional well-being and the quality of their relationship with their doctor were related to their overall quality of life. The majority of participants (73%) expressed interest in participating in a telephone-linked support group involving other people living with HIV designed to improve quality of life.     

Personality functioning in people living with HIV

This investigation adopted a multiple case study approach to determine the personality functioning in people living with HIV/ AIDS (PLWHA). Participants comprised a convenience sample of four PLWHA (male?=?3, female?=?1). The majority of the participants were white (n?=?3) and one was black African. Only one participant was married at the time of participation. Data on aspects such as their suicidal ideation, affect, problem solving styles, ego functioning, self-perception, and interpersonal functioning were collected using the Rorschach inkblot test and clinical interview. The data were actuarially analysed and organised under themes, namely; dominant personality style, capacity for control and stress, situational related stress, affect, interpersonal relations and self-perception. Findings revealed that participants had high levels of potential mood disorders and interpersonal difficulties for which targeted psychological services may be needed.     

Predictors of quality of life enjoyment and satisfaction in individuals living with HIV and AIDS in a resource-constrained setting in South Africa

The burden of HIV disease is concentrated in sub-Saharan Africa, particularly in South Africa (SA). Whilst there have been many studies conducted on the biomedical and socio-psychological aspects of HIV and AIDS, insufficient attention has been paid to the quality of life of those infected with the virus. The primary purpose of the study was to determine the predictors of quality of life enjoyment and satisfaction (Q-LES) among individuals infected with HIV. A battery of questionnaires, which included the Hospital Anxiety and Depression Scale (HADS) and the Quality of Life Enjoyment and Satisfaction Questionnaire (Q-LES-Q), were administered to 121 participants. Data was analysed using SPSS. Of the total sample (n = 121), 74% were females. The study found that a large proportion (49.5%) of the sample within the age group 25–49 years old experienced psychological distress. Those who were not on antiretroviral treatment (ART) were significantly affected (66%). Psychological distress was significantly prevalent among HIV positive individuals and also the strongest predictor of Q-LES among these individuals.     

Predictors of HIV-related stigma among young people living with HIV.

Enacted and perceived HIV stigma was examined among substance-using young people living with HIV (YPLH) in Los Angeles, San Francisco, and New York City (N = 147). Almost all YPLH (89%) reported perceived stigma, and 31% reported enacted experiences in the past 3 months; 64% reported experiences during their lifetime. The HIV stigma questions were characterized by factors of avoidance, social rejection, abuse, and shame. In multivariate models, enacted stigma was associated with gay or bisexual identity, symptomatic HIV or AIDS, and bartering sex. Perceived stigma was associated with female gender, symptomatic HIV or AIDS, bartering sex, lower injection drug use, and fewer friends and family knowing serostatus. Gay or bisexual YPLH who were also HIV symptomatic or AIDS diagnosed experienced more HIV stigma than their heterosexual peers.     

Internalised HIV-stigma,loneliness, depressive symptoms and sleep quality in people living with HIV

Objective: People living with HIV (PLWH) commonly report sleep disturbances which are associated with long-term health consequences, including disease progression. PLWH also experience internalised stigma as a result of their HIV status, which can be associated with increased loneliness and depression. Little attention focuses on the impact of these factors on sleep. Therefore, we examined whether internalised HIV-stigma was indirectly related to poorer sleep quality through higher levels of loneliness and depressive symptoms.

Design: 181 PLWH from across the United States completed an online survey.

Main Study Measures: Internalised HIV-stigma was assessed using the HIV-Stigma Scale, loneliness was assessed using the UCLA-Loneliness Scale-Short Form, depressive symptoms were assessed with the Center for Epidemiologic Studies–Depression Index, and Sleep Quality was assessed using the Pittsburgh Sleep Quality Index.

Results: Internalised HIV-stigma was indirectly associated with poorer global sleep quality and daytime sleep dysfunction through both loneliness and depressive symptoms.

Conclusions: PLWH who experience HIV-related stigma may experience greater feelings of loneliness, which are related to increased depressive symptoms and poorer sleep quality. Interventions focused on improving sleep in PLWH should focus on multiple factors that influence sleep, including psychosocial factors such as stigma, social isolation and depressive symptoms.     

Correlates of spirituality and well-being in a community sample of people living with HIV disease

While the past several years have witnessed an increase in the amount of research examining the spiritual perspectives of people living with HIV/AIDS, this literature is still insufficient to guide the conceptualization and development of spiritually based interventions to improve the life quality of people living with HIV illness. The present study assessed a community sample of 275 persons living with HIV disease to examine relationships among their spirituality, quality of life, perceptions of social support, and coping and adjustment efforts. This study found relationships between social support, active problem solving, life satisfaction, and gender and race with higher levels of spirituality among people living with HIV/AIDS. Mental health providers may need to routinely include assessments of spirituality and religious practices. Caregivers, faith communities, and mental health providers will need to assist in developing supportive environments that enhance the spiritual life and social well-being of people living with HIV infection. Additionally, caregiver training programs will need to focus on spiritual practices as a means of establishing a support system that increases the psychosocial well-being of people living with HIV/AIDS.     

Coping with HIV as a chronic illness: A longitudinal analysis of illness appraisals

Illness appraisals are central to understanding how individuals cope with chronic illness. An interpretive phenomenological approach to the analysis of two years of bimonthly stressful event narratives in a sample of 57 HIV?+?gay men revealed five groups that differed on how they appraised HIV and one group of individuals who changed from one type of appraisal to another over the course of the 2-year study. The ways of appraising HIV revealed in this analysis have implications for interventions and for the study of coping with HIV as a chronic illness. The repeated assessment of specific HIV-associated stressful events and a qualitative analytic approach allowed for a more in-depth understanding of the meaning of HIV for the participants. This study suggests that coping interventions may be more powerful if they are tailored to individual appraisals of HIV because different forms of coping are likely to be differentially effective depending on the meaning of HIV in the individual's life.     

The relationship of perceived self-efficacy to quality of life in chronic obstructive pulmonary disease.

From a biomedical perspective, variations in the quality of life of chronic obstructive pulmonary disease (COPD) patients may be attributed to changes in pulmonary function; thus, an increase in lung function should be correlated with an increased score on a health-related quality-of-life measure. However, inconsistent results regarding correlations between various measures of pulmonary function and quality of life have been reported in the literature. The authors evaluated a social cognitive model of quality of life among persons with COPD by analyzing relationships among biomedical measures, self-efficacy measures, and quality-of-life measures in a recursive path model. Path analysis results indicated that the association of pulmonary function and symptoms with quality of life was mediated by perceived self-efficacy for functional activities.     

Psychological predictors for health-related quality of life and disability in persons with chronic obstructive pulmonary disease (COPD)

Objective: Individuals with chronic obstructive pulmonary disease (COPD) exhibit low physical and mental health-related quality of life (HRQL) and high susceptibility to disability. We investigated the influence of psychological factors on HRQL and disability in COPD individuals recruited from the general population. In line with Leventhal’s common sense model, we expected psychological factors to be associated with HRQL and disability even after controlling for medical status.

Methods: Individuals with COPD (n = 502; 59.7 years old; GOLD grades were I: 3%, II: 17%, III: 34%, IV: 46%) were assessed through an online survey administered via COPD patient organisations in Germany. Individuals filled in the Short Form Health Survey (SF-12), COPD Assessment Test, Patient Health Questionnaire (modules: GAD-2, PHQ-15, PHQ-9), Brief Illness Perception Questionnaire, a questionnaire that assesses causal illness attributions, and the internal illness-related locus of control scale of the ‘KKG questionnaire for the assessment of control beliefs about illness and health’. Multiple linear regressions were calculated.

Results: The investigated factors explained high variances (disability = 56%, physical HRQL = 28%, mental HRQL = 63%, p ≤ .001). Better mental health, more optimistic illness perceptions, attribution to psychological causes, and stronger internal locus of control were associated with lower disability and better HRQL. Comorbid somatic symptoms contributed to high disability and low quality of life.

Conclusion: Psychological factors, such as illness perception, attribution and internal locus of control, were associated with disability and HRQL. These factors should be considered when designing treatments for individuals with COPD, and adequate interventions should be provided to enhance illness understanding and self-management skills.     

Day-to-day living with severe chronic obstructive pulmonary disease: Towards a family-based approach to the illness impacts

Objective: This study explores the perspectives of both patients and family members regarding the impact of chronic obstructive pulmonary disease (COPD) in their family life.

Design: An exploratory qualitative study was conducted with patients and their family members in the chronic phase of COPD. Individual interviews were performed to explore participants’ perspectives and submitted to thematic analysis.

Results: Six major themes emerged from patients’ perspective: (1) impact of COPD symptoms on personal and family daily life; (2) (over)protective family support; (3) difficulties in couple communication; (4) sense of identity loss; (5) fear of COPD progression; and (6) coping resources. Five main themes emerged from the family members’ perspective: (1) restrictions in family’s social life; (2) emotional distress related to COPD exacerbations; (3) tension in couple relationship; (4) financial strain of COPD; and (5) coping resources.

Conclusions: The overall findings illustrate the complex interaction between the experience of living with COPD and communication patterns, emotional states, social support and social roles within the family. The results highlight the need to develop family-based interventions to facilitate a functional adjustment to COPD. However, these interventions in COPD remain undeveloped and empirical evidence is needed.     

Anxiety,depression, and health-related quality of life in aging people living with HIV compared to diabetes patients and patients with minor health conditions: a longitudinal study

HIV infection has evolved from a fatal to a treatable condition, leading to an increase in the rate of elderly People Living with HIV (PLWH). However, little is known about the psychosocial burden of elderly PLWH. Thus, the aim of this longitudinal multi-center cohort study was to investigate whether elderly PLWH experience more anxiety and depression and reduced health related quality of life (HRQOL) compared to elderly patients with other chronic conditions. PLWH were compared to diabetes patients (DM) and patients with minor health conditions (MHC), e.g. patients with hypertension or allergic conditions. All patients were over 50 years old. Anxiety and depression (HADS) as well as HRQOL (SF-36) were assessed at baseline and after 12 months. 218 PLWH, 249 DM and 254 MHC were included. At baseline, the study groups did not differ in anxiety, depression, and physical HRQOL. However, PLWH indicated lower mental HRQOL than DM and MHC patients (p = 0.001). We did not obtain any moderating effects showing a differential effect of patient characteristics on anxiety, depression, and HRQOL in the three patient groups. At follow-up, the level of anxiety, depression, and HRQOL did not change significantly. The prevalence of anxiety ranged between 27 and 35%, and that of depression between 17 and 28%. Thus, the results of our investigation tentatively suggest that the psychosocial adaptation to HIV among elderly PLWH resembles those of other chronic diseases. There may be some subtle impairments, though, as PLWH experienced lower mental HRQOL.     

Changing self-perception: success in independent living for individuals with chronic mental illness

Rates of rehospitalization of individuals with serious and persistent mental illness were compared prior to and after they were moved into 4-bed corporate foster homes. Results showed a significant drop in the number of rehospitalizations and in the total number of days hospitalized after moving into a 4-bed home. The data suggest that living in a 4-bed home-like environment may result in significantly fewer and shorter hospitalizations for these types of mentally ill individuals.     

A developmental-contextual model of couples coping with chronic illness across the adult life span

A developmental-contextual model of couples coping with chronic illness is presented that views chronic illness as affecting the adjustment of both the patient and the spouse such that coping strategies enacted by the patient are examined in relation to those enacted by the spouse, and vice versa. The developmental model emphasizes that dyadic coping may be different at various phases of the life span, changing temporally at different stages of dealing with the illness as well as unfolding daily as spouses interact around dyadic stressors. In addition, couples engaged in dyadic coping are affected by broad sociocultural factors (culture and gender) as well as more proximal contextual factors (quality of the marital relationship and the specific demands of the chronic illness). The model provides a framework for understanding how couples coping with chronic illness may together appraise and cope with illness during adulthood and for determining when spousal involvement is beneficial or harmful to both patient and spousal adjustment. The developmental-contextual model to dyadic appraisal and coping has numerous research implications for the field, and the authors conclude with specific recommendations for future research.     

Cognitive-behavioral treatment groups for people with chronic physical illness in Hong Kong: reflections on a culturally attuned model

This study describes and evaluates a cognitive-behavioral treatment group for people with chronic physical illness in Hong Kong. We developed a group protocol based on the understanding that Chinese people generally prefer a structured group format, expect group leaders to be active and directive, and are not used to expressing opinions and emotions in groups. The experimental and waitlist control groups had 38 and 35 participants, respectively. A standardized questionnaire was administered to all participants before and after the group treatment. Results suggest that members of the experimental group showed improvements in mental health, negative automatic thoughts, and negative emotions when compared to those in the waitlist control groups, and at the end of group treatment. Implications for designing and running a culturally attuned CBT group for Chinese people are discussed.     

Influences on help-seeking pathways among people with chronic illness and disease in a rural South African community

The study sought to explore influences on help-seeking pathways followed by patients with chronic illness and disease (CID) in a rural community of the Limpopo Province, South Africa. The sample consisted of ten people with CID (female = 6; age range 42 to 96 years; sugar diabetes = 50%, and high blood pressure = 30%). The participants responded to semi-structured interviews pertaining to the influences on their choices for help-seeking pathways. The data were analysed applying Interpretative Phenomenological Analysis (IPA). Prevailing influences on help-seeking pathways with CID included presumed cause of the illness, diagnosis agent and family process, nature of preferred treatment modality, and openness to alternative and complementary medicine.     

Coping strategies of mother carers of children living with chronic illness and disease in a rural South African community

The present study explored the coping strategies used by mother carers of children living with chronic illness and disease (CID) in a rural South African community. Ten mothers (age range = 30 to 56 years) were selected through snowball sampling to participate in the present study. They provided care to their children, a majority (50%) of whom had epilepsy, followed by asthma (20%) and other conditions. Data on the coping strategies used by mothers of children living with CID were collected using semi-structured interviews and analysed thematically. The results showed that mother carers tended to use three types of coping strategies, namely: appraisal-focused, problem-focused and emotion-focused strategies. Appraisal-focused was commonly used by mother carers whose children had epilepsy, whilst mother carers of children with asthma tended to use problem-focused coping strategies. All mother carers were found to use emotion-focused strategies to varying degrees in coping with the chronic diseases of their children.