The Nature and Correlates of Psychological Adjustment in Gay Men with AIDS-Related Conditions1

This study assessed differences in the psychological adjustment of gay men who tested positive for the antibody to the human immunodeficiency virus (HIV). Twenty-one were symptomatic for AIDS, and 27 were asymptomatic. A group of 15 gay men who tested negative for the HIV was included as a comparison group. Men in the three groups were equivalent on demographic variables. Symptomatic men reported more health problems than either asymptomatic or seronegative men. Relative to men who were symptomatic, those who were asymptomatic reported more death anxiety, less optimism, and greater severity of psychological distress, and reported more frequent use of avoidance and distancing as coping strategies. The poor psychological functioning of asymptomatic subjects was attributed to the uncertainty regarding their future health status. Generally, positive psychological well-being of symptomatic and asymptomatic men was related to the infrequent use of avoidance coping strategies and high satisfaction with perceived social support.     

Psychosocial adjustment along the HIV disease continuum

Abstract

Evidence suggests that certain indices of stage of HIV disease are determinants of psychological distress, although information is lacking on how disease stage impacts on multiple domains of adjustment. The present study aimed: (1) to explore differences among clinical stages of HIV on measures of psychosocial adjustment, and (2) to explore the relationship between indices of psychosocial adjustment to HIV and self-report measures of physical health. Ninety six HIV-infected persons and 33 HIV seronegative comparison group participants were interviewed and completed self-administered scales. Participants were divided into four groups (the independent variable): a comparison group and three HIV groups, representing the three clinical indices of illness stage (asymptomatic, early symptomatic and AIDS). Three subjective health indices included number of HIV-related symptoms, global health rating, and T4 count. The dependent variables included 5 psychosocial adjustment measures. Results indicated that social and instrumental domains of adjustment were significantly associated with both clinical stage and all 3 subjective health indices. Levels of psychological distress were associated with number of physical symptoms and global health rating, but were unrelated to clinical stage and T4 count. Emotional and existential concerns were unrelated to all indices of illness stage.     

Hypnotic discontinuation in chronic insomnia: impact of psychological distress, readiness to change, and self-efficacy.

OBJECTIVE: To compare individuals who were successful in discontinuing hypnotic medications against those who were not on measures of insomnia severity, medication withdrawal symptoms, psychological symptoms, perceived health, readiness to change and self-efficacy. DESIGN: Secondary analyses of a randomized clinical trial comparing a hypnotic taper intervention with or without self-help treatment for insomnia. MAIN OUTCOME MEASURES: Self-report measures of insomnia severity, medication withdrawal symptoms, depression and anxiety symptoms, physical and mental health, stages of change, readiness to change, decisional balance, and general and situational self-efficacy. RESULTS: There were no significant differences at baseline between medication-free individuals and those still using sleep medication at the end of a taper intervention. Group differences emerged midway through the 8-week withdrawal program and were accentuated after the intervention; participants who remained medication-free during the next six months had less severe insomnia and anxiety symptoms, a more positive perception of their health and higher self-efficacy to refrain from hypnotic use in various situations. Contrary to expectations, there were no differences between drug-free and nondrug-free participants on both readiness to change and stages of change. CONCLUSIONS: Chronic users of hypnotic medications entered a taper intervention with equal levels of psychological distress, health, self-efficacy, and readiness to change. Successful hypnotic discontinuation was associated with overall improvement of insomnia, anxiety and distress symptoms, perceived health and self-efficacy. More intensive and individualized therapeutic attention may be warranted for individuals experiencing worsening of insomnia symptoms, more withdrawal symptoms and psychological distress, and lower self-efficacy during medication discontinuation.     

Evaluation of a Brief Mindfulness Program for People with Multiple Sclerosis Delivered in the Community Over Five Years

This study evaluated the effectiveness, change mechanisms, and sustainability of a brief mindfulness intervention for people with multiple sclerosis (PwMS) delivered in the community through a frontline service over five years. Participants were 126 PwMS. A single intervention condition design was used with pre-intervention, post-intervention and 2-month follow-up assessments. The primary outcome was distress. Secondary outcomes were perceived stress, quality of life (QoL) and fatigue, and the proposed change mechanisms: mindfulness, self-compassion, psychological inflexibility. Intention-to-treat analyses showed the primary outcome, distress (Cohen’s d = .25), and all secondary outcomes improved: perceived stress (d = .38), mental health QoL (d = .39), physical health QoL (d = .47), fatigue (d = .30), mindfulness (d = .29), self-compassion (d = .37), psychological flexibility (d = .44). Distress, stress and perceived stress continued to improve post-intervention to follow-up. Mindfulness emerged as a temporal mediator of perceived stress (BCa 95% CI). Self-compassion mediated concurrent improvements in distress, perceived stress, fatigue and physical health QoL, while greater psychological flexibility mediated concurrent reductions in distress (BCa 95% CI). Mindfulness home practice was unrelated to improvements on all outcomes except a marginal association with mindfulness. Of the socio-demographic and illness factors, lower disease severity predicted improvements in physical health QoL (p = .046). Improvements in outcomes were supported by qualitative feedback and participant satisfaction ratings. Twenty-one groups were offered with good participant engagement and wide geographical reach, suggesting sustained feasibility of the Mindfulness for MS program over five years. Findings support the delivery of the Mindfulness for MS program through a community-based service in partnership with a local university.

     

Posttraumatic stress disorder symptoms, psychological distress, personal resources, and quality of life in four groups of Holocaust child survivors

The objective of the present study was to inquire into the long-term effects of child survivors' Holocaust experience. To this end, 170 Holocaust survivors who were born after 1926 completed questionnaires with regard to psychological distress, Posttraumatic Stress Disorder (PTSD), Quality of Life (QoL), Self-identity, and Potency. The survivors were divided into four groups based on the setting of their experience during the Holocaust: Catholic Institutions, Christian foster families, concentration camps, and hiding in the woods and/or with partisans. Results showed that survivors who had been with foster families scored significantly higher on several of the measures of distress, whereas survivors who had been in the woods and/or with partisans scored significantly higher on several of the positive measures, QoL, potency, and self-identity. The discussion focuses on understanding the different experiences according to developmental theory and sense of control. It was concluded that there are group differences between child survivors according to their Holocaust experience.     

Disengagement and Engagement Coping with HIV/AIDS Stigma and Psychological Well-Being of People with HIV/AIDS

The stigma associated with HIV/AIDS poses a psychological challenge to people living with HIV/AIDS. We hypothesized that that the consequences of stigma-related stressors on psychological well-being would depend on how people cope with the stress of HIV/AIDS stigma. Two hundred participants with HIV/AIDS completed a self-report measure of enacted stigma and felt stigma, a measure of how they coped with HIV/AIDS stigma, and measures of depression and anxiety, and self-esteem. In general, increases in felt stigma (concerns with public attitudes, negative self-image, and disclosure concerns) coupled with how participants reported coping with stigma (by disengaging from or engaging with the stigma stressor) predicted self-reported depression, anxiety, and self-esteem. Increases in felt stigma were associated with increases in anxiety and depression among participants who reported relatively high levels of disengagement coping compared to participants who reported relatively low levels of disengagement coping. Increases in felt stigma were associated with decreased self-esteem, but this association was attenuated among participants who reported relatively high levels of engagement control coping. The data also suggested a trend that increases in enacted stigma predicted increases in anxiety, but not depression, among participants who reported using more disengagement coping. Mental health professionals working with people who are HIV positive should consider how their clients cope with HIV/AIDS stigma and consider tailoring current therapies to address the relationship between stigma, coping, and psychological well-being.     

Perceptions of stressful life events as turning points are associated with self-rated health and psychological distress

Abstract

We test the hypothesis that changes in physical and psychological health are associated with construals of stressful life events. At two points in time, approximately 10 years apart, participants (n=1038) rated their physical health and psychological distress. At the second assessment, participants also reported their most stressful life event since the first assessment and indicated whether they considered the event a turning point and/or lesson learned. Lower self-ratings of health and higher ratings of psychological distress, controlling for baseline health and distress, and relevant demographic factors, were associated with perceiving the stressful life event as a turning point, particularly a negative turning point. The two health measures were primarily unrelated to lessons learned. How individuals construe the most stressful events in their lives are associated with changes in self-rated health and distress.     

Applying Self‐Determination Theory to the Prediction of Distress and Well‐Being in Gay Men With HIV and AIDS1

Self‐determination theory (Deci & Ryan. 1985. 1991) was used to predict psychological well‐being and distress in 48 gay men with HIV. 39 AIDS patients. and 38 HIV‐negative control participants. Participants listed 10 to 15 personal strivings and identitied their reasons for engaging in each striving. Multiple regression analyses revealed that introjection (engaging in strivings because of an internal sense of obligation or necessity) was associated with increased distress. especially among HIV‐ and AIDS participants. Introjection also predicted decreased well‐being. Integration (engaging in strivings because they are personally valued and meaningful) was positively related to well‐being. Adjustment to a life‐threatening illness is influenced by individuals' feelings of autonomy; that is. the extent to which they believe themselves to be the source of their actions.     

The relationship of depression to health risk behaviors and health perceptions in Korean college students

The purpose of this study was to investigate the relationship of depression to health risk behaviors and health perceptions in Korean college students. The sample consisted of 434 students, ranging in age from 18 to 28 years, who were attending four universities in Korea. Data were collected using the Beck Depression Inventory, the Symptom Pattern Scale, and the Short Form Health Survey. Results indicate that the students were mildly depressed. The prevalence of alcohol consumption during the previous month was 84.6% and for smoking it was 33.6%. The majority of the students reported a low occurrence of symptoms of psychological distress and evaluated their health as either very good or good. The level of depression predicted alcohol consumption, symptom pattern, and physical health. Students who were more depressed reported more symptoms and perceived their health as worse compared with those who were less depressed. The students who were less depressed drank more alcohol. Depression did not predict smoking.     

Individual attitudes and perceived social norms: Reports on HIV/AIDS‐related stigma among service providers in China

This study examined HIV/AIDS‐related stigma among Chinese service providers by comparing their personal attitudes toward people living with HIV/AIDS with their perception of social norms related to people living with HIV/AIDS. We randomly selected three provincial hospitals, four city/prefecture hospitals, 10 county hospitals, 18 township health clinics, and 54 village clinics from Yunnan, China. Doctors and nurses were randomly sampled proportionally to the doctor–nurse ratio of each hospital or clinic. Lab technicians were over‐sampled in order to include an adequate representation in the analysis. A total of 1,101 service providers participated in a voluntary, anonymous survey where demographic characteristics, individual attitude and perceived social norms toward people living with HIV/AIDS, discrimination intent at work, general prejudicial attitude and knowledge on HIV/AIDS were measured. A majority of the sample demonstrated a similarity between their personal views and what they thought most people in society believe. Multiple logistic regressions revealed that participants who were younger or reported personal contact with people living with HIV/AIDS were significantly more likely to report personal attitudes toward the population that were more liberal than their perceived social norms. Holding a more liberal personal attitude toward people living with HIV/AIDS than perceived social norms was significantly and negatively related to the level of discrimination intent at work, perceived discrimination at interpersonal level and the level of general prejudicial attitude toward people living with HIV/AIDS. Results underscored the importance of understanding social norms and personal attitudes in studying HIV‐related stigma and called for the incorporation of existing human capital into future HIV stigma reduction programs.     

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.     

Depression and appearance-related distress in functioning with lipedema

Lipedema is a chronic, progressive adipose tissue disorder that may impact the quality of life of women who suffer from it. The main aim of this study was to asses the role of perceived symptom severity, physical and psychological functioning with the disease in predicting quality of life in patients with lipedema. We conducted an online study with 329 participants who responded to five questionnaires measuring quality of life (World Health Organization Quality of Life BREF), lipedema symptom severity, mobility (Lower Extremity Functional Scale), depression (Patients Health Questionnaire-9), and appearance-related distress (Derriford Appearance Scale 24). Multiple hierarchical regression analyses showed that appearance-related distress and depression explained significantly more variance in quality of life when added to the symptom severity and mobility. Lower quality of life was predicted by higher symptom severity, lower mobility, higher appearance-related distress and higher depression severity. Appearance-related distress and depression constitute important aspects of psychological functioning in women with lipedema. Considering their relationship with quality of life, their assessment should be included in lipedema treatment with appropriate interventions aimed at decreasing appearance-related distress, as well as preventing and addressing depression.     

Optimism, coping, psychological distress, and high-risk sexual behavior among men at risk for acquired immunodeficiency syndrome (AIDS).

In a cohort of gay men responding to the threat of acquired immunodeficiency syndrome (AIDS), dispositional optimism was associated with less distress, less avoidant coping, positive attitudes as a coping strategy, and fewer AIDS-related concerns. Men who knew they were seropositive for human immunodeficiency virus (HIV) were significantly more optimistic about not developing AIDS than men who knew they were seronegative for HIV. This AIDS-specific optimism was related to higher perceived control over AIDS and to active coping among seropositive men only and to health behaviors in both serostatus groups. There was no relation of optimism to risk-related sexual behavior. It is concluded that optimism is psychologically adaptive without necessarily compromising health behavior. It is also concluded that it is useful to distinguish between event-based optimistic expectations and dispositional optimism.     

Influence of religiosity on self-reported response to psychological therapies

There is a lack of research exploring the influence of religious or spiritual beliefs on response to psychological therapies. Our aims were to confirm the positive relationship between religiosity and psychological wellbeing, and investigate the potential synergistic impact of religiosity on self-reported response to psychological therapies. Participants were 118 adults (33 male, 85 female) aged 18 to 78 (M?=?40.01, SD?=?15.41); data was collected via online survey. Religious and psychological variables were assessed using a range of standard measures including the Depression, Anxiety and Stress Scale, the Warwick-Edinburgh Mental Well-being Scale, and the Daily Spiritual Experiences Scale. Atheists reported less psychological distress and increased personal wellbeing; participants with higher levels of religiosity experienced greater ongoing benefits from therapy in domains of coping and social functioning. Results suggest that mental health practitioners should consider the religious/spiritual beliefs and behaviours of their clients in their interventions.     

Perceived responsibility for disease onset affects HIV/AIDS Education

Abstract

Ninety-nine participants were assigned to one of three experimental conditions in which they viewed an AIDS education videotape that systematically manipulated whether or not the educator would be perceived as responsible for HIV infection. Participants were administered pre and post-video affect measures, and an HlV/AIDS knowledge test after watching the video. Participants who viewed the speaker who acquired HIV through a blood transfusion (perceived not responsible) and those who viewed the speaker who did not reveal mode of acquisition (control) performed significantly better on the knowledge test compared to those who viewed the speaker who acquired HIV through unprotected sexual inttrcourse (perceived responsible). In addition. male participants in the perceived responsible condition reported a significant increase in sensation-sceking after viewing the video. Finally, females experienced a significantly greater increase in anxiety as a result of seeing the video than did males. Implications of these tindings for the design and implmentation of AIDS education programs were discussed.     

Development of the HIV/AIDS Stress Scale

Development of a self-report measure of stress specific to HIV/AIDS is needed to advance our understanding of the role of stress in adaptation to HIV/AIDS; hence, the aim of this study was the development of the HIV/AIDS Stress Scale. A total of 132 homosexual/bisexual men with HIV/AIDS were interviewed and completed the HIV/AIDS Stress Scale and measures of coping strategies, appraisal, social support and adjustment (global distress, depression, social adjustment, number of HIV symptoms, and subjective health status) at three time points. Thirty-nine primary caregivers were interviewed and completed measures of stress and adjustment. Exploratory factor analyses of the HIV/AIDS Stress Scale items revealed three factors: Social, Instrumental and Emotional/Existential Stress. Factors had adequate internal reliabilities and were stable over 12 months. Construct validation data are consistent with recent stress/coping research that links higher levels of stress with more HIV symptoms, reliance on emotion-focused coping, lower social support, poorer levels of adjustment and higher levels of caregiver stress. Results extend this research by revealing new differential relations between various stress dimensions and stress/coping variables. Convergent validation data suggest that the HIV/AIDS Stress Scale shares conceptual similarity with threat appraisal, and differs from controllability and challenge appraisals. The HIV/AIDS Stress Scale shows potential for the elucidation of the role of stress in coping and adaptation to HIV/AIDS and disease progression in both research and clinical applications.     

Gender Relations and HIV Transmission in North-Central Nigeria

Nigeria’s most recent National HIV/AIDS and Reproductive Health Survey of 2012 shows a decline in the national prevalence rate from 3.6% in 2007 to 3.0% in 2012. Despite this moderate decrease, the rate for the North-central geopolitical zone: (5.7 and 3.4%, respectively) remained higher than the national average for both years. Besides, virtually all of the HIV and AIDS surveys conducted in Nigeria from 1999 till date have consistently shown higher rates among females than males. For instance, it was 4.0 and 3.5% among females; and 3.5 and 3.3% in males in 2007 and 2012 respectively. UNAIDS reported that studies on the mode of transmission in 2008 found the bulk of new infections among cohabiting and married sexual partners who are not engaged in high risk sex (42.2%) compared to casual heterosexual sex (9.1%) and sex workers (3.4%). Higher vulnerability among married females implies higher risk of parent to child transmission, yet married women are perceived as a “low risk” group. Against this backdrop, I studied some gender related socio-cultural factors that influence HIV transmission among married women in two ethnic groups in North-central Nigeria. Results of the qualitative study conducted through 24 in-depth interviews and 36 focus group discussions in six communities indicate that marital consent; women’s poor access to safe sex; double standards in marital sexual practices; gender based violence against women; among others influence the spread of HIV infection in married heterosexual couples. In conclusion, marriage does not necessarily reduce HIV vulnerability in women.     

Abuse, health locus of control, and perceived health among HIV-positive women.

This study of 230 predominantly poor Hispanic and African American women aged 25 to 61 years living with HIV/AIDS in New York City revealed high levels of both sexual (39%) and physical (44%) trauma before the age of 16. Both types of early trauma were correlated with later trauma, and all forms of trauma were significantly associated with current perceived health. In multivariate analyses controlling for relevant covariates, the Powerful Others and Internal Control subscales of the Multidimensional Health Locus of Control Scales (K. A. Wallston, B. S. Wallston, & R. DeVellis, 1978) acted as independent predictors of perceived health rather than (as hypothesized) mediators of the association between trauma and perceived health. Findings underscore the importance of addressing trauma and perceptions of control over one's physical health in the provision of health services to HIV-positive women.     

Quality of Life and Sense of Coherence in People with Arthritis

This study investigated the physical and psychological impact of arthritis on people's quality of life. A range of variables were examined in a sample of 375 participants who comprised three groups: people with arthritis receiving a support-based service from the Arthritis Foundation of Victoria, people with arthritis receiving standard treatment, and a group of people from the general population. The results revealed that the two arthritis groups reported a significantly higher level of functional impairment, pain, and negative affectivity, and lowered mood, positive affect, and Sense of Coherence, compared to the general population group. They also reported normal levels of importance, but lower levels of satisfaction on various life domains. After statistically controlling for pain however, group differences were eliminated on all variables except for functional impairment and for all satisfaction domains except health. These data are interpreted as evidence that the combination of low domain satisfaction coupled with high domain importance yields a negative psychological state. This, then suggests the possibility of a therapy based on reducing the perceived importance of health.