Prevalence and correlates of psychological distress of middle-aged and older women living with HIV

The aims of this study were to examine the prevalence and correlates of psychological distress among older women living with HIV in comparison to their male counterparts and younger women and to identify the sociodemographic and disease-related factors associated with psychological distress. The sample consisted of 508 HIV-infected patients (65 older women, 323 women aged below 50 years, and 120 older men) recruited from 10 Portuguese hospitals. Data regarding psychological distress were collected using the Brief Symptom Inventory (BSI). Seven older women (10.8%), eight older men (6.7%), and 61 younger women (18.9%) reported a T-score ≥ 63 for global severity index (GSI), indicative of a need for further psychological evaluation. Overall, younger women reported significantly higher psychological distress than older men. The odds of having clinically significant psychological distress score were significantly lower for older women reporting sexual transmission, while for younger women, having other co-infections was a significant correlate of higher psychological distress. Younger women were 2.67 (95% CI: 1.22–5.84) times more likely to report psychological distress than were older men. The odds were not significantly different from older women. This study shows that older women do not differ substantially from younger women and older men in terms of psychological distress. The results reinforce, however, that mental health interventions should be tailored to reflect individuals’ circumstances as well as developmental contexts. Moreover, they draw attention to the importance of examining resilience characteristics in older adults to understand the mechanisms behind ‘successful ageing’ while living with HIV.     

Differential Associations Between Perceived and Objective Measurement of Distress Tolerance in Relation to Antiretroviral Treatment Adherence and Response Among HIV-Positive Individuals

The present study sought to extend prior work, showing an association between self-reported distress tolerance and self-reported antiretroviral treatment (ART) adherence, by conducting a multimethod test of the association between distress tolerance and objective measures of ART adherence among a sample of 140 individuals (23.6% female) with human immunodeficiency virus (HIV). Findings indicated that, after accounting for negative affectivity and ART side-effect severity, distress tolerance was significantly associated with pill count adherence as well as viral load. Specifically, a differential association was observed whereby self-reported distress tolerance was associated with pill count adherence, whereas behavioral distress tolerance was associated with viral load. Importantly, no associations were observed between either measure of distress tolerance and CD4 count. Findings are discussed in terms of the importance of both behavioral and perceived distress tolerance assessment among patients with HIV as well as potential clinical implications related to the integration of distress tolerance-focused treatments into existing interventions for individuals with HIV.     

Psychological Distress and Associated Factors Among a Sample of Pregnant Women in South Africa

We sought to identify the prevalence of psychological distress and associated factors among pregnant women who were patients at antenatal primary care clinics in a South Africa district. A cross-sectional study using systematic sampling was conducted among 1497 pregnant women (age range=18 to 47 years; mean age=26.6 years, SD=6.1; Black African=98%), with a mean gestational age of 6.5 months (SD=1.6). They completed the Kessler Psychological Distress Scale, a measure of psychological distress. Results showed high rates of severe psychological distress (26.5%). Increased distress was in multivariate analysis associated with having had an STI (other than HIV), being unhappy about current pregnancy, and HIV positive. Identification of pregnant women with psychological distress in public health clinics is crucial for effective and appropriate targeted interventions.     

Testing the health promotion model for adherence and quality of life in individuals with multiple sclerosis

The nature of multiple sclerosis (MS) presents challenges to health-promoting behaviors (e.g. adherence) and quality of life. The Health Promotion Model (HPM) proposes that these outcomes are explained by individual characteristics (i.e. biological, social, psychological) and behavior-specific cognitions (e.g. self-efficacy). The current study sought to test the HPM in explaining self-reported adherence and MS quality of life among 121 MS patients receiving care in an MS clinic in the southeastern United States. Hierarchical regression models partially supported the HPM for adherence (R² = .27) and more fully for quality of life (QoL) (R² = .64). Depression and stigma were among the variables most strongly related to both adherence and QoL; contrary to HPM theory, self-efficacy was not significantly related to adherence but was to QoL. Thus, the HPM may help to guide strategies used to improve QoL among individuals living with MS; however, the model may need further refinement to be used with adherence.     

The Multilevel Relationships of HIV‐Related Stigma to Child and Caregiver Mental Health among HIV‐Affected Households in South Africa

HIV/AIDS‐related (HAR) stigma is still a prevalent problem in Sub‐Saharan Africa, and has been found to be related to mental health of HIV‐positive individuals. However, no studies in the Sub‐Saharan African context have yet examined the relationship between HAR stigma and mental health among HIV‐negative, HIV‐affected adults and families; nor have any studies in this context yet examined stigma as an ecological construct predicting mental health outcomes through supra‐individual (setting level) and individual levels of influence. Multilevel modeling was used to examine multilevel, ecological relationships between HAR stigma and mental health among child and caregiver pairs from a systematic, community‐representative sample of 508 HIV‐affected households nested within 24 communities in KwaZulu‐Natal, South Africa. Two distinct dimensions of HAR stigma were measured: individual stigmatizing attitudes, and perceptions of community normative stigma. Findings suggest that individual‐level HAR stigma significantly predicts individual mental health (depression and anxiety) among HIV‐affected adults; and that community‐level HAR stigma significantly predicts both individual‐level mental health outcomes (anxiety) among HIV‐affected adults, and mental health outcomes (PTSD and externalizing behavior scores) among HIV‐affected children. Differentiated patterns of relationships were found using the two different stigma measures. These findings of unique relationships identified when utilizing two conceptually distinct stigma measures, at two levels of analysis (individual and community) suggest that HAR stigma in this context should be conceptualized as a multilevel, multidimensional construct. These findings have important implications both for mental health interventions and for interventions to reduce HAR stigma in this context.     

Stress management interventions for HIV+ adults: a meta-analysis of randomized controlled trials, 1989 to 2006.

OBJECTIVE: Numerous studies document that stress accelerates disease processes in a variety of diseases including HIV. As a result, investigators have developed and evaluated interventions to reduce stress as a means to improve health among persons living with HIV. Therefore, the current meta-analysis examines the impact of stress-management interventions at improving psychological, immunological, hormonal, and other behavioral health outcomes among HIV+ adults. DESIGN: This meta-analytic review integrated the results of 35 randomized controlled trials examining the efficacy of 46 separate stress management interventions for HIV+ adults (N=3,077). MAIN OUTCOME MEASURES: Effect sizes were calculated for stress processes (coping and social support), psychological/psychosocial (anxiety, depression, distress, and quality of life), immunological (CD4+ counts and viral load), hormonal (cortisol, dehydroepiandrosterone sulfate [DHEA-S], cortisol/DHEA-S ratio, and testosterone) and other behavioral health outcomes (fatigue). RESULTS: Compared to controls, stress-management interventions reduce anxiety, depression, distress, and fatigue and improve quality of life (d+s=0.16 to 0.38). Stress-management interventions do not appear to improve CD4+ counts, viral load, or hormonal outcomes compared with controls. CONCLUSION: Overall, stress-management interventions for HIV+ adults significantly improve mental health and quality of life but do not alter immunological or hormonal processes. The absence of immunological or hormonal benefits may reflect the studies' limited assessment period (measured typically within 1-week postintervention), participants' advanced stage of HIV (HIV+ status known for an average of 5 years), and/or sample characteristics (predominately male and White participants). Future research might test these hypotheses and refine our understanding of stress processes and their amelioration.     

Life hassles, experiential avoidance and distressing delusional experiences

Life hassles have been implicated in both the formation and maintenance of psychosis symptoms. However, little is understood about the mechanism through which these stressors impact on psychosis. The current study proposed experiential avoidance (EA), a psychological coping style that is a central focus for change in Acceptance and Commitment Therapy (ACT), as a potential mediator of the link between life hassles and both the emergence and maintenance of delusional ideation. Participants were recruited to a non-clinical sample (N = 133) and a clinical sample of psychosis patients (N = 100). All participants completed a self-report questionnaire including a measure of delusions and delusional distress (Peters Delusions Inventory), life hassles (Survey of Recent Life Experiences) and EA (Acceptance and Action Questionnaire-II). Mediation testing (bootstrapping) indicated a significant mediation effect of EA in the relationship between life hassles and both delusions and delusional distress, in both clinical and non-clinical samples. The findings suggest that individuals (irrespective of their diagnostic status) with a tendency to suppress or avoid unwanted thoughts are significantly more likely to experience distressing delusions in response to stressful life occurrences. The use of ACT and Cognitive Behavioural Therapy to reduce EA in those at risk of emerging delusions and in patients with an already established psychosis is discussed.     

The Relation Between Emotional Dysregulation and Anxiety and Depressive Symptoms, Pain-Related Anxiety, and HIV-Symptom Distress Among Adults with HIV/AIDS

The current study investigated the relations between emotional dysregulation and anxiety and depressive symptoms, pain-related anxiety, and HIV-symptom distress among individuals living with HIV/AIDS. This research is important in its explanatory value regarding the unique effects of emotional dysregulation as it relates to psychological and disease-specific distress given high rates of distress specific to HIV infection (e.g. medicatin side-effects, stigma). Participants included 164 adults (17.1 % female, Mage = 48.40, SD?=?9.57) with HIV/AIDS. Results indicated that emotional dysregulation was significantly and positively related to anxiety and depressive symptoms, pain-related anxiety, and HIV-symptom distress. All emotional dyregulation effects were evidenced above and beyond the variance accounted for by demographic and HIV-specific characteristics, and the main effects of anxiety sensitivity and distress intolerance. Findings are discussed in terms of the importance of emotional dysregulation in negative affective experiences within the HIV/AIDS population.     

The association between biopsychosocial factors and disability in a national health survey in South Africa

The association between psychosocial factors and disability is less clear. This study investigated the biological and psychosocial (employment and psychological distress) factors associated with level of disability in an adult sample in South Africa. Data were analysed from a cross-sectional survey among adults aged 18–64 (n = 4974). Multiple linear regression was used to investigate the associations of the selected variables with disability. The mean percentage score on the WHODAS scale of disability was 5.31% (95% CI: 4.74–5.88). Age (p < 0.001) and race (p = 0.0002) were significantly associated with disability, and history of stroke (β = 7.19, 95% CI: 3.19–11.20) and heart-related conditions (β = 2.08, 95% CI: [0.23–3.93) showed positive associations. Of the psychosocial variables, psychological distress (β = 10.49 [8.63–12.35]) showed a strong positive association while employment (?1.62 [?2.36 to ?0.88]) showed a negative association with disability. The association between demographic factors, medical conditions and increased disability confirms the findings in the literature. The finding that psychological distress is associated with increased disability has not been frequently reported. This study highlights specific psychosocial targets that may be usefully addressed by health policies and interventions in order to improve disability management.     

Formal Employment and Health-Related Quality of Life among People Living with HIV in South Africa

This study examined the link between formal employment and characteristics of the workplace (especially awareness of workplace HIV policies and HIV status disclosure to work colleagues) and health-related quality of life (HRQoL) among people living with HIV (PLHIV). The study analysed medical treatment and employment history since first being diagnosed as HIV-positive among 554 adults, 55 % females, who had been on HIV treatment for at least 2 years in South Africa. Additional cross-sectional data on HRQoL were collected using the Medical Outcomes Study 36-Item Short Form (SF-36) (QualityMetric Incorporated). Two hundred and forty four (44 %) of the study participants (39 % and 49 % among males and females, respectively) were formally employed at the study interview. Formally employed study participants reported higher HRQoL than those not formally employed, as reflected in mean scores in the physical and mental component summaries of the SF-36 instrument. HRQoL was unrelated to study participants’ CD4 count, viral load and duration since HIV diagnosis. Among the formally employed study participants, 27.9 % reported awareness of workplace HIV policies in their organisations, while 50.8 % said they had disclosed their HIV status to work colleagues. The awareness of workplace HIV policies was associated with higher mental component summary scores after controlling for study participants’ socio-demographic characteristics, but had no significant association with the physical component summary scores. The disclosure of HIV status to work colleagues was associated with neither mental nor physical component summary scores. The finding of a positive association between formal employment and HRQoL among PLHIV suggest the need for facilitative interventions for employment entry and continuation among PLHIV for their wellbeing.     

Does Posttraumatic Growth Buffer the Association Between Death Anxiety and Quality of Life Among People living with HIV/AIDS?

People living with HIV (PLWH) may experience death anxiety (DA), which can be detrimental to quality of life. Posttraumatic growth (PTG), however, is antithetical to DA, with its positive attributes at odds with negative psychosocial outcomes. Previous research has not examined the buffering effect of PTG on the association between DA and quality of life. Therefore, in addition to the direct effects of DA and PTG on health-related quality of life (HRQoL), we investigated the moderating role of PTG on the relationship between DA and HRQoL among people living with HIV/AIDS (PLWH) in Nigeria. Using cross-sectional design and availability sampling method, we selected 201 outpatients (men, n?=?63, 31.3%, women, n?=?138, 68.7%, mean age?=?40.1, SD?=?10.5) managed for HIV/AIDS in a Nigerian tertiary healthcare institution. Death Anxiety Inventory-Revised, Posttraumatic Growth Inventory-Short Form, and Patient-Reported Outcome Quality of Life-HIV were used to access DA, PTG and HRQoL, respectively. Results showed that while adjusting for socio-demographic factors (age, gender, time since diagnosis and educational status), DA was associated with physical health, mental health and social relationships domains of HRQoL as well as overall HRQoL. In contrast, PTG did not evidence significant association with HRQoL dimensions and overall HRQoL. The moderation effect of PTG on the association between DA and HRQoL was not supported. Independent of PTG, alleviating DA may be an important target in terms of therapeutic intervention towards improving quality life of PLWH.

     

Global Maladaptive Schemas, Negative Life Events, and Psychological Distress

The relationship between maladaptive self-schemas, negative life events, and psychological distress was assessed. The model tested was based on Young's (J. Young, 1990) diathesis–stress conceptualization of maladaptive schemas, which are believed to represent the cognitive diathesis underlying Axis II personality pathology. Young's model predicts that schemas are chronically activated in individuals with maladaptive schemas. Therefore, the experience of salient negative life events is less likely to exacerbate the level of distress experienced by those having maladaptive schemas. A nonclinical sample (N = 93) was assessed using the Schema Questionnaire (SQ), a measure of maladaptive self-schemas, a measure of negative life events, and several measures of psychological distress. Support was found for this prediction indicated by a Schema × Negative Life Events interaction in which the distress level of High SQ participants was less affected by negative life events compared to Low SQ participants.     

Changes in sleep quality and levels of psychological distress during the adaptation to university: The role of childhood adversity

Stress-related sleep disturbances are common, and poor sleep quality can negatively affect health. Previous work indicates that early-life adversity is associated with compromised sleep quality later in life, but it is unknown whether it predicts greater declines in sleep quality during stressful life transitions. We propose and test a conceptual model whereby individuals who reported experiencing greater levels of child maltreatment would experience greater psychological distress during a stressful life transition, which in turn would contribute to greater declines in sleep quality, relative to their quality of sleep before the stressful transition. Controlling for potential confounding variables (e.g., age, gender), structural equation modelling demonstrated that psychological distress experienced during a stressful transition (i.e., beginning life at university) mediated the relationship between childhood emotional neglect and changes in sleep quality. The hypothesized model demonstrated a good overall fit to the data, χ ² (15) = 17.69, p = .279, CFI = .99, TLI = .97, SRMR = .04, RMSEA = .04 (90% CI <0.001–0.09). Emotional neglect (β = .22) was positively associated with psychological distress which in turn was positively associated with poor sleep quality (β = .31) during a stressful transition. Future research should aim to understand the specific stressors in the university environment that are most challenging to individuals who faced early-life emotional maltreatment. These findings will help inform interventions to facilitate adaptation to a new environment and improve sleep quality for these university students.     

Meaning in life,emotional distress,suicidal ideation,and life functioning in an active duty military sample

The present study examined the relationship of meaning in life with emotional distress, suicidal ideation, and life functioning in a sample of 273 active duty Security Forces personnel assigned to two US Air Force bases. Results of regression analyses indicated that stronger meaning in life was significantly associated with less severe emotional distress (p?<?0.001, ΔR ²?=?0.047) and suicidal ideation (p?=?0.043, ΔR ²?=?0.017), and better functioning at work and in intimate relationships, nonfamily relationships, and recreational activities (p?<?0.001, ΔR ²?=?0.073). Meaning in life showed stronger associations with outcomes relative to other predictors and covariates and explained the relationship between belonging and life functioning. Findings suggest that meaning in life is associated with less emotional distress and suicide risk, and greater success and performance across multiple domains in life among military personnel.     

Rates and Correlates of DSM-IV Diagnoses in Women Newly Diagnosed with Breast Cancer

Although the presence of psychological distress has been documented in women with breast cancer, previous studies have not established rates of DSM-IV diagnoses in this population, nor have prior investigations compared the utility of diagnostic interviewing vs. symptom checklists to assess distress. DSM-IV diagnoses of anxiety disorders and major depression, symptoms of anxiety and depression, and quality of life were examined in 207 women with newly diagnosed breast cancer. Eighteen percent of breast cancer patients met criteria for a current DSM-IV anxiety or depressive disorder and 54% met criteria for a disorder at some point in their lifetime. These rates are comparable to those found in recent community epidemiological studies (e.g., R. C. Kessler, K. A. McGonagle, S. Zhao, C. B. Nelson, M. Hughes, S. Esheman, et al., 1994). Sensitivity, specificity, and positive predictive value for anxiety and depression symptoms as predictors of DSM disorders were relatively poor. However, after accounting for demographic, treatment, and cancer variables, self-reported anxiety symptoms were significantly related to the presence of an anxiety disorder and self-reported depressive symptoms were significantly related to a diagnosis of a depressive disorder. Symptoms of anxiety and depression contributed significantly and uniquely to physical, medical, and sexual quality of life; DSM-IV diagnoses were not significantly related to quality of life after controlling for symptoms of depression and anxiety. The importance of measuring both symptoms of distress and psychiatric diagnoses in cancer patients and the clinical practice implications of the results are discussed.     

Mental health correlates of HIV risk behaviour and STIs/HIV infection among university students from 22 low,middle and high income countries

The aim of this study was to determine mental health correlates of HIV risk behaviour and self-reported STIs/HIV infection among university students in 22 low, middle and high income countries. Data on mental health and HIV risk were collected from 16 567 undergraduate university students (mean age 20.9, SD = 2.9) from 23 universities in 22 countries across Asia, Africa and the Americas. Results indicate that overall 16.8% of the students had two or more sexual partners in the past 12 months, and among the sexually active, 73.7% had inconsistently used a condom in the past three months with their primary sexual partner, 3.2% had ever been diagnosed with a sexually transmitted infection (STI) and 0.6% had been diagnosed with HIV. In multivariate logistic regression poorer mental health and child abuse (physical and sexual) were associated with HIV risk behaviour, and child abuse (physical and sexual) was associated with STI and HIV positive diagnoses.     

Psychological Effects of a Life Review Intervention for Persons With HIV Disease

The purpose of this study was to evaluate a life review intervention for persons with HIV disease. Twenty-seven adults with HIV disease (16 had been diagnosed with AIDS) were randomly assigned to 1 of 3 conditions: a group life review intervention (n = 8), a traditional support group (n = 9), or a waiting list (n = 10). Using a pre-post design, participants were compared on psychological measures of optimism, self-esteem, purpose in life, coping ability, psychological distress, and death anxiety. Although analyses revealed no significant differences between the interventions, statistical trends and participants' written evaluations favored the life review intervention. Attrition was a significant problem. Discussion focuses on the special problems encountered in conducting psychological intervention research with an HIV-positive population.     

Why is the receipt of social support associated with increased psychological distress? an examination of three hypotheses

Abstract

Although there is a great deal of research linking social support with favourable psychological well-being outcomes a number of contradictory findings have been published showing support to be associated with increased psychological distress. These contrary findings arise when social support is measured as the receipt of supportive behavior rather than perceptions of support availability and quality. This paper examines three hypotheses that have been advanced to explain why the receipt of support is associated with distress. The first of these hypotheses (the support mobilisation hypothesis) argues that the relationship is a spurious one, and that it is a product of distressing circumstances which increase both support receipt and psychological distress. The other two hypotheses (the inequity hypothesis and the esteem threat hypothesis) both argue that receiving support actually causes distress. We tested these hypotheses in two samples. One sample was a group of individuals who reported having some form of disability (N = 106). the other sample was a 'healthy' comparison group (N = 134). Our analyses showed that in both groups the receipt of support was significantly and positively related to reports of anxiety, but not to reports of depression. Among the 'healthy' sample, controlling for subjects' sex largely explained the positive association between support receipt and anxiety. This was not the case among the 'disabled sample, where the inequity hypothesis received the strongest support. The implications of these findings for interventions based around the provision of social support are examined.     

Sexual orientation and HIV risk among youth in South Africa: a brief report

This study investigated the prevalence of homosexual orientation and HIV risk in a population-based survey among youth in South Africa. A cross-sectional population-based household survey was conducted using a multi-stage stratified cluster sampling approach. The total sample included 1859 sexually experienced youth, aged 18–24, from four provinces (Eastern Cape, Gauteng, KwaZulu-Natal and Mpumalanga). Results indicate that 128 (4.9%) had had a homosexual experience. In a multivariate analysis, peer pressure and, for men, having been circumcised as an adult were associated with having had a homosexual experience. Having had a homosexual experience increased, but not significantly, HIV risk and HIV positive status.