Negative affectivity,coping, immune status,and disease progression in hiv iwected individuals

Abstract

The primary goal of the study was to assess the relationship between personality dispositions, coping styles, immune markers, clinical status, and subjective somatic symptoms in a mixed sample of HIV positive individuals. Specifically, the prognostic value of psychological and immunological measures in HIV progression was emphasized. Subjects (n = 104) were recruited from a cohort of 422 HIV positive individuals enrolled in the Oslo HIV Cohort Study. The partkipants were given self-administered questionnaires assessing behavioral, psychological, and psychdal variables. Clinical assessment and immunological tests were performed at regular follow-up visits. Clinical status was assessed according to the Centers for Disurse Control criteria. The immune markers used were CD4 T cell counts, beta2-microglobulin concentration, sewn levels of HIV-1 p24 core protein, and levels of antibodies to core protein. In addition, subjective somatic symptoms were assessed.

The results showed that measure-s of negative affectivity (NA; e.g. anxiety, distress, tension) were consistently related to subjective somatic symptoms and passivedefensive coping style. However, no amistent association between NA measures and immune markers was found. Individuals who developed AIDS in the study period had significantly lower initial CD4 cell counts as well as lower scores on measures of active-pmblem related wping (e.g. Positive reappraisal, Seeking social support) and passivedefensive coping (i.e. Escape-Avoidance, Self-control).

The results suggest (1) that coping styles may merit a specific focus in future research of psychological factors and medical outcomes in HIV infection, and (2) because of associations of NA measures with symptom reports studies of the relationship between e.g. stress, depression and HIV outcome should consider these variables as confounders.     

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.     

Cross-sectional and Longitudinal associations in coping strategies and physical health outcomes among HIV-Positive youth

This study assessed whether coping styles had an influence on physical health outcomes either concurrently or longitudinally in a sample of HIV-positive youth. Coping styles were characterized as positive, passive, depressive withdrawal, and escapist. A cross-sectional latent variable analysis (N = 279) assessed associations among environmental stress, self-esteem, social support, coping styles, AIDS symptoms, and CD4 count. A more restricted longitudinal analysis (N = 174) tested associations among earlier environmental stress, self-esteem, coping styles, and AIDS symptoms at follow-up. CD4 count was not associated with coping styles in the cross-sectional analysis. Concurrent AIDS symptoms were significantly predicted by depressive withdrawal and environmental stress. A passive coping style modestly predicted more AIDS symptoms longitudinally. Correlates of perceived health and well-being of persons with HIV/AIDS are important to investigate in addition to more objective measures such as CD4 count that may not be amenable to change through coping style interventions alone.     

Mentoring Relationship Quality and Maltreated Children's Coping

Coping strategies are believed to protect against the harmful effects of maltreatment on children's psychosocial outcomes. Caregivers are thought to be critical in helping children develop adaptive coping strategies, yet many maltreated children have poor and/or insecure relationships with their parents. A quality relationship with a caring, non‐parental adult (e.g., a mentor), however, may be one strategy to promote healthy coping among maltreated children. Children (N = 154) in this study participated in a mentoring and skill‐based program for maltreated preadolescents placed in foster care. Hierarchical regression was used to assess the association between children's reports of their relationship with their mentor at the end of the intervention and four coping strategies (i.e., Active, Support‐seeking, Avoidance, and Distraction) 6 months following the intervention, while accounting for baseline coping strategies and other demographic factors. Above and beyond the covariates, better mentoring relationship quality was associated with children's greater use of Active and Distraction coping 6‐month post‐intervention. Mentoring relationship quality was not significantly associated with children's Avoidance or Support‐seeking coping. The findings suggest that mentoring programs may be a fruitful approach to improving vulnerable children's coping skills. Healthy coping is hypothesized to protect against the harmful effects of maltreatment and to promote resilience in the face of multiple stressors (Banyard & Williams, 2007 ; Boxer & Sloan‐Power, 2013; Cicchetti & Rogosch, 2009). It remains unclear, however, how best to promote positive coping among maltreated children, who are disproportionately exposed to numerous adverse childhood experiences (Raviv, Taussig, Culhane & Garrido, 2010). Theories of coping emphasize the importance of coping socialization through quality parent–child relationships (Kliewer et al., 2006; Skinner & Wellborn, 1994 ). Unfortunately, many maltreated children are exposed to poor quality and/or inadequate caregiving (Baer & Martinez, 2006), which may place them at risk for engaging in unhealthy or inappropriate forms of coping. It is reasonable to expect that positive relationships with other non‐parental adults (e.g., mentors) would affect coping behaviors given the positive impact that quality relationships have on a myriad of emotional and behavioral child outcomes (DuBois, Portillo, Rhodes, Silverthorn & Valentine, 2011; Keller & Pryce, 2012; Thomson & Zand, 2010 ). Because children in foster care often transition in and out of schools and home environments, a quality relationship with a mentor (a consistent presence in the child's life) may be well suited to promote healthy coping strategies.     

Characterization and sociocultural predictors of neuropsychological test performance in HIV+ Hispanic individuals

Hispanic individuals in the U.S. have been disproportionately impacted by HIV/AIDS, yet little is known regarding the neuropsychological sequelae of HIV within the Hispanic population. This study characterized neuropsychological (NP) test performance of HIV+ English-speaking Hispanic participants (n = 51) and investigated the combined roles of sociocultural factors (e.g., ethnicity, socioeconomic status [SES] proxy, and reading level) on NP test performance among our HIV+ Hispanic and non-Hispanic White participants (n = 49). Results revealed that the pattern of NP impairment in HIV+ Hispanic participants is consistent with the frontal-striatal pattern observed in HIV-associated CNS sequelae, and the overall prevalence of global NP impairment was high compared to previous reports with more ethnically homogeneous, non-Hispanic White cohorts. Multivariate prediction models that considered both sociocultural factors and CD4 count revealed that reading level was the only unique predictor of global NP functioning, learning, and attention/working memory. In contrast, ethnicity was the only unique predictor of abstraction/executive functioning. This study provides support for the use of neuropsychological evaluation in detecting HIV-associated NP impairment among HIV+ Hispanic participants and adds to the growing literature regarding the importance of considering sociocultural factors in the interpretation of NP test performance.     

Avoidance as a predictor of the biological course of HIV infection over a 7-year period in gay men.

The present study prospectively investigated the relation between avoidance coping and active cognitive and behavioral coping and the progression of HIV infection over 7 years in 181 gay men. Findings revealed that for a number of medical and behavioral factors, (a) avoidance coping predicted a lower rate of decline in CD4 cells, (b) the proportional hazard (PH) attributable to avoidance of developing a syncytium-inducing HIV variant was 0.72 (95% confidence interval [CI]: 0.53 - 0.99, p < .05), and (c) the PH attributable to avoidance of dropping below 200 CD4 cells/microl was 0.66 (95% CI: 0.50 - 0.89, p < .01). Avoidance coping was not related to the development of AIDS-defining clinical symptoms. Active cognitive and behavioral coping was not related to the outcome measures.     

Spécificité des stratégies de coping des patients en rémission de la maladie de Crohn : une étude qualitative

IntroductionCrohn's disease (CD), a chronic inflammatory bowel disease, has strong psychological and social repercussions related to the specificity of the symptomatology. To better understand how patients cope with the disease, coping strategies have been studied but without taking into account the specificity of the CD experience.ObjectiveOur objective is to identify the perceived coping strategies used by patients in relation to their illness experience.MethodUsing a qualitative approach, semi-structured interviews and thematic content analysis with 33 CD patients in remission were conducted.ResultsOur results highlight that some of the coping strategies used are not taken into account by the coping scales frequently used in the literature. Indeed, the illness experience appears to be fundamental in the establishment of new strategies based on the experiential knowledge patients use to reduce the stress induced by a potential relapse. Moreover, coping strategies based on positive emotions are also implemented, and they enable patients to make sense of the disease.ConclusionThe coping strategies, i.e., “experiential knowledge” and “positive emotions”, may shed more light on the complexity of the illness experience of CD patients and allow us to make recommendations concerning the psychological support of patients.     

Role of thought-related beliefs and coping strategies in the escalation of intrusive thoughts: an analog to obsessive-compulsive disorder

Cognitive-behavioral models of obsessive-compulsive disorder (OCD) assume that obsessions have their origin in normal intrusive thoughts. These models propose that certain beliefs, such as thought-action fusion (TAF) beliefs, combined with the use of ineffective coping strategies, such as thought suppression, lead to the development of OCD. The purpose of the current study was to examine the relationship between these variables in a non-clinical sample in addition to exploring the effects of an alternative, acceptance-based coping strategy. This study explored the relationship between TAF beliefs, thought suppression, and OC-consistent symptoms via mediational analyses. Results showed that thought suppression mediated the relationship between TAF beliefs and OC-consistent symptoms. This study also experimentally examined the effects of various coping strategies (suppression, acceptance, or monitor-only) on the frequency of a distressing intrusion and appraisal ratings (e.g., anxiety, guilt, responsibility) after a TAF induction. Spontaneous suppression in the monitor-only group made comparisons of the experimental data difficult. However, analyses provided preliminary evidence suggesting that thought suppression is related to more intrusions, higher levels of anxiety, and negative appraisals, whereas an acceptance-based approach may be a useful alternative. Additional findings, limitations of the current study, and directions for future research are discussed.     

Goal adjustment capacities, coping, and subjective well-being: the sample case of caregiving for a family member with mental illness

This study examined the associations between goal adjustment capacities, coping, and indicators of subjective well-being in 2 waves of data from individuals who provide care for a family member with mental illness. We hypothesized that goal adjustment capacities would predict higher levels of subjective well-being by facilitating coping with caregiving stress. Results showed that goal disengagement was associated with effective care-specific coping (e.g., less self-blame and substance use). Goal reengagement was also associated with effective care-specific coping (e.g., positive reframing), but at the same time it predicted the use of less effective strategies (e.g., venting and self-distraction). Moreover, goal disengagement predicted lower levels of caregiver burden and depressive symptoms and buffered the longitudinal effect of caregiver burden on increases in depressive symptoms. Goal reengagement, by contrast, predicted higher levels of caregiver burden and purpose in life and buffered the cross-sectional association between caregiver burden and depressive symptoms. Finally, effective (and less useful) care-specific coping statistically explained the adaptive (and maladaptive) effects of goal adjustment capacities on participants' well-being.     

Enacting support within church communities for people living with HIV or AIDS

Social support is important in managing HIV and AIDS. Some people living with HIV or AIDS (PLWHA) have sought support from churches, despite their reputation for stigmatising PLWHA. Semi-structured interviews were conducted with 21 PLWHA and 21 church leaders to identify ways that churches can effectively enact support for PLWHA through improved communication about HIV, AIDS, and related issues. Church leaders also were asked about the institutional barriers to enacting support for PLWHA. Implementing these strategies consistently and holistically will require intentional efforts to address the barriers within church organisations to create environments that are welcoming to and supportive of PLWHA.     

Coping and physical health during caregiving: the roles of positive and negative affect

The associations among coping, mood, and health variables were examined prospectively over 2 years in 86 HIV positive (HIV+) and 167 HIV negative (HIV-) gay men undergoing the stress of AIDS-related caregiving. Path models suggested that including both positive and negative mood and the men's associated coping strategies increases understanding of why some people suffer adverse health effects during times of stress. Among the HIV- caregivers, higher levels of social coping predicted increases in positive affect, which in turn resulted in lower levels of physical symptoms. In contrast, higher levels of cognitive avoidance predicted increases in negative affect, which in turn resulted in higher levels of physical symptoms. Self-injurious forms of avoidance coping predicted higher levels of physical symptoms independent of mood among the HIV+ caregivers.     

Self-critical perfectionism and daily affect: dispositional and situational influences on stress and coping

This study of university students (64 men and 99 women) examined both dispositional and situational influences of self-critical (SC) perfectionism on stress and coping, which explain its association with high negative affect and low positive affect. Participants completed questionnaires at the end of the day for 7 consecutive days. Structural equation modeling indicated that the relation between SC perfectionism and daily affect could be explained by several maladaptive tendencies associated with SC perfectionism (e.g., hassles, avoidant coping, low perceived social support). Multilevel modeling indicated that SC perfectionists were emotionally reactive to stressors that imply possible failure, loss of control, and criticism from others. As well, certain coping strategies (e.g., problem-focused coping) were ineffective for high-SC perfectionists relative to low-SC perfectionists.     

Stress and Coping in Single-Handed Round-the-World Ocean Sailing

The present study sought to examine the various stressors faced, and associated coping strategies employed, by five single-handed sailors entered into the 2006/2007 Velux 5 Oceans round-the-world race. Interviews conducted with the skippers were transcribed and then deductively and inductively content analyzed. Skippers revealed organizational (e.g., environmental conditions, isolation, sleep deprivation), competitive (e.g., lack of progress, yacht-related problems), and personal (e.g., family-related issues) stressors. Strategies used to deal with these demands included problem- (e.g., prioritized sequential thinking), appraisal- (e.g., rationalizing situations), emotion- (e.g., using available communications), and approach-focused coping (e.g., “what if” scenario planning). The present study proposes that future research should examine more closely the stressor-coping strategy relationship to guide the development of successful coping interventions.     

Integration of the pleasant events and activity restriction models: development and validation of a "PEAR" model of negative outcomes in Alzheimer's caregivers

This study examined an activity restriction/pleasurable activities mismatch model for psychosocial and health-related outcomes. A total of 108 spousal caregivers of patients with Alzheimer's Disease (AD) were assessed for their experience of social and recreational activities over the past month as well as their perception of how restricted they were for engaging in social and recreational activities. Participants were divided into three groups based on their reported activities and activity restriction: HPLR = High Pleasant Events + Low Activity Restriction (i.e., reference group; N = 28); HPHR/LPLR = Either High Pleasant Events + High Activity Restriction or Low Pleasant Events + Low Activity Restriction (N = 43); LPHR = Low Pleasant Events + High Activity Restriction (N = 37). We hypothesized that participants reporting low pleasant events combined with high activity restriction (LPHR) would demonstrate greater disturbance relative to other two groups in multiple outcome domains, including: (a) greater mood disturbance, (b) greater use of negative coping factors, (c) reduced use of positive coping strategies, (d) reduced report of psychological resource factors (e.g., personal mastery, self-efficacy), and (e) increased report of subjective health difficulties (e.g., sleep disturbance). Results generally supported our hypotheses, suggesting that assessment of both constructs is important for best predicting quality of well-being in AD caregivers, and potentially for establishing maximal effect in behavior therapy for caregivers.     

Self regard and concealment of homosexuality as predictors of CD4+ cell count over time among hiv seropositive gay men

Living with HIV can challenge core features of a person’s sense of identity and ultimately lead to a diminished sense of self regard. Self-regard has been defined as the extent to which a person experiences an integrated sense of identity. Gay men with HIV may also face struggles related to their identity in deciding whether to disclose or conceal their homosexuality. This study examined whether concealment of homosexuality and a person’s sense of self regard would be associated with CD4+ cell count over time among HIV seropositive gay men. 53 HIV seropositive gay men completed questionnaires at one time point. CD4+ cell counts were measured at the time of questionnaire completion and 24 months later. Greater self regard at baseline was associated with higher CD4+ counts at 24 months. The association between baseline self regard and CD4+ count at 24 months was strongest among persons with less concealment of homosexuality.     

I fear your envy, I rejoice in your coveting: on the ambivalent experience of being envied by others

We present 2 studies on being envied. Study 1 used an emotional narrative methodology. We asked 44 Spanish (23 women, 21 men) and 48 European American (36 women, 12 men) participants to tell us about a recent experience in which others envied them. We classified the antecedents, relationship context, markers of envy, coping strategies, and positive and negative implications of being envied. In Study 2, 174 Spanish (88 women, 86 men) and 205 European American (106 women, 99 men) participants responded to a situation in which they had something someone else wanted. We manipulated the object of desire (academic achievement or having "a better life"). We measured individual differences in orientation to achievement (i.e., vertical individualism), cooperation and interpersonal harmony (i.e., horizontal collectivism), a zero-sum view of success, beliefs that success begets hostile coveting, fear of success, and dispositional envy. We also measured participants' appraisals, positive and negative emotions, and coping strategies. The findings from both studies indicate that being envied has both positive (e.g., increased self-confidence) and negative consequences (e.g., fear of ill will from others). Being envied had more positive and more negative psychological and relational consequences among those participants who were achievement oriented (European Americans) than among participants who were oriented to cooperation and interpersonal harmony (Spanish).     

Adaptive Coping Reduces the Impact of Community Violence Exposure on Violent Behavior among African American and Latino Male Adolescents

This study examined whether coping moderated the impact of community violence exposure (CVE) on violent behavior among 285 urban African American and Latino adolescent males assessed annually across 5 years. Composites indicating overall CVE (having knowledge of others’ victimization, witnessing violence, direct victimization) and approach to coping with CVE were created by averaging across years 1–3 (Time 1; mean ages 14–16). Adolescents classified as coping effectively tended to respond to CVE in beneficial ways (e.g., developing long-term solutions, engaging in positive reappraisal). Violent behavior was examined across years 1–3 (Time 1) and years 4–5 (Time 2; mean ages 18–19). CVE was longitudinally associated with greater violent behavior, adjusting for Time 1 levels of violent behavior. This association was significant only among adolescents with less effective coping strategies. Interventions targeting the enhancement of coping skills may be an effective method of reducing the impact of CVE on adolescent violent behavior. Sonya S. Brady is now an Assistant Professor in the Division of Epidemiology and Community Health, School of Public Health at the University of Minnesota (1300 South Second Street, Suite 300, Minneapolis, MN 55454-1015, USA; Tel.: +1-612-6241818; Fax: +1-612-6240315.     

The effects of stressful life events,coping, and cortisol on HIV infection

What is the role of stress and coping in changes in immunologic and clinical indicators of human immunodeficiency virus disease progression? There is substantial evidence that stressful life events and passive coping strategies, such as denial, may have a detrimental effect on HIV disease progression. Given the harmful effects of stress and passive coping, the author reviews the limited research testing the efficacy of interventions, such as cognitive-behavioral therapies for HIV-infected persons. Finally, in trying to understand psychoimmune relationships in HIV, the evidence is examined for the mediating and direct effects of cortisol, a hormone associated with stress, on HIV disease progression. Delineating the role of psychosocial factors and cortisol on HIV disease progression may aid in the development of new interventions for this devastating disease.     

CD4 Count and Physical Symptoms Among Urban African American Mothers with HIV: An Examination of the Role of Optimism and Depressive Symptoms

The current study examined the link between immune functioning (CD4 count) and physical symptoms, as well as the moderating role of optimism and depressive symptoms, in a sample of 99 low income, inner city African American women with HIV. Although there was no main effect of CD4 count on physical symptoms, depressive symptoms moderated the association between CD4 count and physical symptoms. More compromised immune functioning (lower CD4 count) was associated with more physical symptoms under conditions of higher levels of depressive symptoms, but not lower levels of depressive symptoms. This finding was observed using both a self-report measure and a clinician-rating of women’s depressive symptoms. There were no main or interactive effects for optimism. Clinical implications and future research directions are presented.     

An exploration of the influence of dispositional traits and appraisal on coping strategies in African American college students

This study explored the correlates of self-reported coping strategies from both an appraisal (e.g., severity, impact, desirability of the event, as well as perceived stress) and a dispositional (e.g., preferred/typical coping style, self-concept clarity, self-esteem, emotion regulation, problem-solving style, anxiety) perspective. Participants were 211 African American undergraduate and graduate students from diverse socioeconomic backgrounds. The results indicated that dispositional traits (especially problem-solving style) are associated uniquely with preferred/typical coping styles. The results also provided modest evidence that dispositional traits and subjects' appraisals (e.g., challenge, harm/threat, impact) are predictive of subjects' coping strategies in specific ongoing stressful situations. The general findings from this study appear to mirror research on Caucasian subjects.