The Role of Illness, Resources, Appraisal, and Coping Strategies in Adjustment to HIV/AIDS: The Direct and Buffering Effects

This study examined the utility of a stress and coping model of adjustment to HIV/AIDS. A total of 114 HIV-infected gay or bisexual men were interviewed and they completed self-administered scales. Predictors included illness variables (disease stage and number of symptoms), coping resources (optimism and social support), appraisal (threat, challenge, and controllability), and coping strategies (problem- and emotion-focused). Adjustment outcomes were depression, global distress, social adjustment, and subjective health status. Results from hierarchical regression analyses indicated that better adjustment was related to an asymptomatic illness stage, fewer HIV-related symptoms, greater social support, challenge and controllability appraisals, problem-focused coping, and lower threat appraisals and reliance on emotion-focused coping. There was limited support for the stress-buffering effects of optimism. Findings support the utility of a stress and coping model of adjustment to HIV/AIDS.     

Predicting fatigue and depression in HIV-positive gay men

HIV-related fatigue is a prevalent and troubling symptom for HIV-positive people. The purpose of the study was to develop a model for predicting fatigue and depression among HIV-positive gay men as a function of history of fatigue and depression in the previous year and to determine whether psychological and psychosocial variables or physiologic variables better predict fatigue. Data from 96 HIV-positive gay men followed longitudinally for up to 7.5 years were used to develop logistic regression models for predicting fatigue and depression. Fatigue was predicted by both physiologic and psychological risk factors, whereas depression was predicted by only psychological risk factors.     

Cigarette Smoking among HIV+ Men and Women: Examining Health,Substance Use,and Psychosocial Correlates across the Smoking Spectrum

The prevalence of cigarette smoking among HIV+ individuals is greater than that found in the general population. However, factors related to smoking within this population are not well understood. This study examined the associations between smoking and demographic, medical, substance use, and psychosocial factors in a clinic-based sample of HIV+ men and women. Two hundred twelve participants completed self-report measures of tobacco use, HIV-related symptoms, viral load, CD4, alcohol and illicit drug use, depression, and social support. Multinomial logistic regression (MLR) analyses modeled the independent associations of the cross-sectional set of predictors with smoking status. Results indicated that 74% of the sample smoked at least one cigarette per day; using standard definitions, 23% of the sample were light smokers, 22% were moderate smokers, and 29% smoked heavily. Smoking was associated with more HIV-related symptoms, greater alcohol and marijuana use, and less social support. Light smoking was related to minority race/ethnicity and less income; moderate smoking was associated with less education; and heavy smoking was related to less education and younger age. Viral load, CD4 count, and depression were not associated with smoking status. Psychosocial interventions targeting this population should consider the relationships between biopsychosocial factors and smoking behavior.     

Psychological sequelae of hate-crime victimization among lesbian, gay, and bisexual adults

Questionnaire data about criminal victimization experiences were collected from 2,259 Sacramento-area lesbians, gay men, and bisexuals (N = 1,170 women, 1,089 men). Approximately 1/5 of the women and 1/4 of the men had experienced victimization because of their adult sexual orientation. Hate crimes were less likely than nonbias crimes to have been reported to police. Compared with other recent crime victims, lesbian and gay hate-crime survivors manifested significantly more symptoms of depression, anger, anxiety, and posttraumatic stress. They also displayed significantly more crime-related fears and beliefs, lower sense of mastery, and more attributions of their personal setbacks to sexual prejudice than did nonbias crime victims and nonvictims. Comparable differences were not observed among bisexuals. The findings highlight the importance of recognizing hate-crime survivors' special needs in clinical settings and in public policy.     

广州市区男同性恋者性别角色与精神健康状况

目的:了解男同性恋人群性别角色与精神健康的关系。方法:采用同伴推动抽样法收集男同性恋样本,调查采用自填问卷一对一的方式进行。按年龄、性别和受教育程度1:1配对对照组,最终收回有效样本420对。结果:χ~2检验结果显示,男同性恋组与对照组在生活满意度、耻辱感、自尊感、社会支持、男性化、女性化、现在是否有固定伴侣、过去6个月内是否有过临时伴侣、过去12个月是否有性病史、抑郁、焦虑、应激、亲密关系暴力、自杀意念等各项指标差异均有统计学意义;420名男同性恋者当中,抑郁、焦虑、应激水平较高,29.3%在过去1年内有过自杀的想法,36.5%遭遇过亲密关系暴力。控制了其他变量后,性别角色是男同性恋者抑郁、焦虑、应激、自杀及遭遇亲密关系暴力的危险因素。结论:性别角色是男同性恋人群精神健康的一个重要影响因素,在进行心理危机干预过程中有必要考虑其性别角色。     

A Longitudinal Examination of Social Support,Agreeableness and Depressive Symptoms in Chronic Kidney Disease

Research examining the role of social support in patient adjustment to chronic illness has been inconsistent suggesting that patient individual differences play a moderating role. This study examined the hypothesis that the relationship between social support and depressive symptoms would differ as a function of individual differences in trait Agreeableness. Fifty-nine patients with chronic kidney disease were assessed using the Social Provisions Scale, Beck Depression Inventory and NEO-Five-Factor Inventory and were followed-up a year and a half later. After controlling for baseline depressive symptoms and clinical characteristics, regression analyses revealed a significant interaction between social support and Agreeableness predicting change in depressive symptoms. Greater social support among individuals high in Agreeableness was associated with a decrease in depressive symptoms over time, while support had little effect on depression change for individuals low in Agreeableness. These findings underscore the importance of individual difference variables in understanding adjustment to chronic illness.     

The associations of gender, sexual identity and competing needs with healthcare utilization among people with HIV/AIDS

Studies report gender differences in medical service utilization among persons with HIV, although most compare women to heterogeneous groups of men. Competing needs for medical care of women may contribute to those differences. We examined prospectively the role that competing social, economic and health needs, such as caring for others, play in gender differences in hospital, ambulatory and emergency room (ER) visits. We considered sexual identity to study women, gay/bisexual men and heterosexual men in the most recent wave (n = 1,385) of the HCSUS, a nationally representative sample of persons with HIV/AIDS in care in the United States. We considered gay/bisexual men and heterosexual men separately because their different resources and social networks may lead to disparate service utilization. Multivariate regression showed that women were more likely than gay/bisexual men to be hospitalized, while women and gay/bisexual men were more likely than heterosexual men to use the ER without subsequent hospitalization. Controlling for competing needs eliminated neither difference but predicted hospitalization and ER use. Findings suggest that addressing competing needs could reduce unnecessary hospitalization and ER use for both genders. Furthermore, examinations of gender differences in service use should include sexual identity.     

Stigma, concealment and symptoms of depression as explanations for sexually transmitted infections among gay men

This study examined how perceived sociocultural factors influenced the relationship between psychosocial variables and sexually transmitted infections (STIs) among gay men. A cross-sectional brief street-intercept survey was administered to 594 gay men. Analyses examined how well stigma, concealment and symptoms of depression explained variation in participants' histories of STIs. Results suggested that concealment partially mediated the relationship between stigma and depression and depression partially mediated the relationship between concealment and STIs. Controlling for sociodemographic factors, symptoms of depression explained more varied histories of STIs; however, concealment was negatively related to STIs. Implications for STI and HIV interventions are discussed.     

Social support,psychiatric symptoms,and housing: A causal analysis

This study used structural equation modeling to examine the causal relationship between social support and each of three outcome variables: depression, psychotic symptoms, and stable housing. Two measures of social support were included in the models: natural support (family and friends) and professional support. Nearly 4,000 individuals from 18 cities in the United States provided data for this study. All participants were homeless at baseline and suffered from severe mental illness. Data were collected at baseline, 3 months, and 1 year. A reciprocal effects model best explained the causal relationship between social support and psychiatric symptoms. The social causation model best explained the relationship between social support and stable housing, such that increases in social support led to increases in stable housing. © 2002 Wiley Periodicals, Inc.     

The diverse older HIV-positive population: a national profile of economic circumstances,social support,and quality of life

The objectives of this study were to provide a national profile of socioeconomic circumstances of the middle-aged and older population living with HIV and to evaluate variations in social support and quality of life (QOL) across age and socioeconomic subgroups, controlling for indicators of disease progression. The design used was a cross-sectional analysis of nationally representative interview data on HIV-infected individuals collected in the HIV Cost and Services Utilization Study. Multiple measures of social support and QOL were used. Bivariate comparisons of outcomes across categories of age and exposure category were performed; multivariate analyses to isolate the effect of older age on outcomes within exposure categories were performed, controlling for socioeconomic and clinical co-variates. Study results indicate that older gay men with HIV/AIDS are a predominantly white population and more likely to have health insurance than their younger counterparts; 38% were employed and 48% reported incomes of more than $25,000. Older injection drug users (IDUs) with HIV/AIDS are a predominantly black population with a particularly high concentration of disadvantages; only 11% were employed and 74% reported incomes of less than $10,000. Older IDUs reported especially low levels of physical functioning and emotional support in comparison with their younger counterparts, whereas older gay men did not significantly differ from younger gay men in these respects. The authors conclude that characteristics and care needs of the older HIV-positive population are very diverse and vary sharply by exposure route. Interventions need to be tailored to the needs of these distinct subpopulations, with an emphasis on development of supportive care interventions for older IDUs.     

Distress,denial, and low adherence to behavioral interventions predict faster disease progression in gay men infected with human immunodeficiency virus

This study examined psychological predictors of 2-year disease progression in gay men after finding out their human immunodeficiency virus (HIV) serostatus. Psychological and immune status of asymptomatic gay men who did not know their HIV serostatus was monitored during the 5 weeks before and after serostatus notification. The men were randomly assigned to an exercise, cognitive-behavioral stress-management intervention, or control group. At 2-year follow-up for the 23 men who turned out to be seropositive, 9 had developed symptoms, including 5 with acquired immune deficiency syndrome—4 of whom died. Distress at diagnosis, denial (5 weeks postdiagnosis minus pre-diagnosis), and low adherence during interventions were significant predictors of 2-year disease progression. Denial and adherence remained significant predictors of disease progression even after controlling for CD4 number at entry. Furthermore, change in denial was significantly correlated with immune status 1 year later; 1-year immune status was significantly correlated with 2-year disease progression. The present study therefore demonstrates significant relations between psychological variables on the one hand and both immune measures and IIIV-1 disease progression on the other. We conclude that distress, denial, and low protocol compliance predict subsequent disease progression. This research was supported by National Institute of Menial Health Grants P50-MH4355, PO1-MH49548, and T32-MH18917.     

Internalized heterosexism among HIV-positive, gay-identified men: implications for HIV prevention and care

Internalized heterosexism (IH), or the internalization of societal antihomosexual attitudes, has been consistently linked to depression and low self-esteem among gay men, and it has been inconclusively associated with substance use and sexual risk in gay and bisexual men. Using structural equation modeling, the authors tested a model framed in social action theory (C. K. Ewart, 1991, 2004) in which IH is associated with HIV transmission risk and poor adherence to HIV antiretroviral therapy (ART) through the mechanisms of negative affect and stimulant use. Data from a sample of 465 gay-identified men interviewed as part of an HIV risk reduction behavioral trial were used to test the fit of the model. Results support the hypothesized model in which IH was associated with unprotected receptive (but not insertive) anal intercourse with HIV-negative or unknown HIV status partners, and with ART nonadherence indirectly via increased negative affect and more regular stimulant use. The model accounted for 15% of the variance in unprotected receptive anal intercourse and 17% of the variance in ART nonadherence. Findings support the potential utility of addressing IH in HIV prevention and treatment with HIV-positive gay men.     

Improving Self-Help E-Therapy for Depression and Anxiety Among Sexual Minorities: An Analysis of Focus Groups With Lesbians and Gay Men

BackgroundE-therapies for depression and anxiety rarely account for lesbian and gay users. This is despite lesbians and gay men being at heightened risk of mood disorders and likely to benefit from having access to tailored self-help resources.ObjectiveWe sought to determine how e-therapies for depression and anxiety could be improved to address the therapeutic needs of lesbians and gay men.MethodsWe conducted eight focus groups with lesbians and gay men aged 18 years and older. Focus groups were presented with key modules from the popular e-therapy “MoodGYM”. They were asked to evaluate the inclusiveness and relevance of these modules for lesbians and gay men and to think about ways that e-therapies in general could be modified. The focus groups were analyzed qualitatively using a thematic analysis approach to identify major themes.ResultsThe focus groups indicated that some but not all aspects of MoodGYM were suitable, and suggested ways of improving e-therapies for lesbian and gay users. Suggestions included avoiding language or examples that assumed or implied users were heterosexual, improving inclusiveness by representing non-heterosexual relationships, providing referrals to specialized support services and addressing stigma-related stress, such as “coming out” and experiences of discrimination and harassment. Focus group participants suggested that dedicated e-therapies for lesbians and gay men should be developed or general e-therapies be made more inclusive by using adaptive logic to deliver content appropriate for a user’s sexual identity.ConclusionsFindings from this study offer in-depth guidance for developing e-therapies that more effectively address mental health problems among lesbians and gay men.     

Hopelessness as a mediator of the association between social support and depressive symptoms: findings of a study of men with HIV.

Data from a prospective longitudinal study were used to investigate whether hopelessness mediates the association between social support and depression, as hypothesized by L. Y. Abramson, G. I. Metalsky, and L. B. Alloy (1989). Measures of hopelessness, social support, and depression were administered to 103 HIV-infected men and readministered 6 months later. Findings indicated that low baseline social support predicted increases in hopelessness and depression. Increases in hopelessness predicted increases in depression after controlling for baseline social support. Low baseline social support did not predict increased depression when hopelessness was controlled statistically.     

Focus group interviews with risk-taking gay men: appraisal of AIDS prevention activities,explanations for sexual risk-taking,and needs for support

Recently, several findings demonstrated an increase in high-risk sexual behaviour among gay men. This study conducted focus groups with gay men who engaged in'risk-taking behaviour with casual partners. Three issues were addressed: appraisal of current AIDS prevention activities, explanations for sexual risk-taking, and needs for support. The results show that participants criticize current prevention efforts. The explanations for risk-taking behaviour contribute to a better understanding of the underlying processes related to sexual risk-taking. Participants' needs include unequivocal information on HIV and AIDS, more insight into the rationality behind safe sex directives, and more opportunities to discuss their difficulties regarding safe sex behaviour with peers.     

HIV-related shame and health-related quality of life among older,HIV-positive adults

This study investigated how HIV-related shame is associated with health-related quality of life (HRQoL) in older people living with HIV (PLHIV). Structural equation modeling tested whether HIV-related shame was associated with three dimensions of HRQoL (physical, emotional, and social well-being) and whether there were significant indirect associations of HIV-related shame with the three HRQoL dimensions via depression and loneliness in a sample of 299 PLHIV ≥50 years old. Results showed that depression and loneliness were key mechanisms, with depression at least partially accounting for the association between HIV-related shame and both emotional and physical well-being, respectively, and loneliness accounting for the association between HIV-related shame and social well-being. HIV-related shame appears to be an important correlate of HRQoL in older PLHIV and may provide a promising leveraging point by which to improve HRQoL in older PLHIV.     

The health-related functions of social support

Social support research has been hampered by a lack of clarity both in the definitions of social support and in the conceptualization of its effects on health outcomes. The present study compared social network size and three types of perceived social support—tangible, emotional, and informational —in relation to stressful life events, psychological symptoms and morale, and physical health status in a sample of 100 persons 45–64 years old. Social network size was empirically separable from, though correlated with, perceived social support and had a weaker overall relationship to outcomes than did support. Low tangible support and emotional support, in addition to certain life events, were independently related to depression and negative morale; informational support was associated with positive morale. Neither social support nor stressful life events were associated with physical health. It was concluded that social support research would benefit from attention to the multidimensionality of support and greater specificity in hypotheses about the relationship between types of support and adaptational outcomes.Writing of this paper was supported in part by National Institute on Aging Research Grant AG 00799 and Public Health Service Training Grant MH 13561.     

Progression to AIDS: the effects of stress, depressive symptoms, and social support.

OBJECTIVE: We examined the effects of stress, depressive symptoms, and social support on the progression of HIV infection. METHODS: Eighty-two HIV-infected gay men without symptoms or AIDS at baseline were followed up every 6 months for up to 5.5 years. Men were recruited from rural and urban areas in North Carolina as part of the Coping in Health and Illness Project. Disease progression was defined using criteria for AIDS (CD4+ lymphocyte count of <200/microl and/or an AIDS-indicator condition). RESULTS: We used Cox regression models with time-dependent covariates, adjusting for age, education, race, baseline CD4+ count, tobacco use, and number of antiretroviral medications. Faster progression to AIDS was associated with more cumulative stressful life events (p = .002), more cumulative depressive symptoms (p = .008), and less cumulative social support (p = .0002). When all three variables were analyzed together, stress and social support remained significant in the model. At 5.5 years, the probability of getting AIDS was about two to three times as high among those above the median on stress or below the median on social support compared with those below the median on stress or above the median on support, respectively. CONCLUSIONS: These data are among the first to demonstrate that more stress and less social support may accelerate the course of HIV disease progression. Additional study will be necessary to elucidate the mechanisms that underlie these relationships and to determine whether interventions that address stress and social support can alter the course of HIV infection.     

Social support and its relationship to psychological,physical health,and immune variables in HIV-infection

The purpose of this review is to examine how social support is related to measures of psychological adjustment, physical health, and immune function among HIV-infected gay men. Within this population, recent literature has demonstrated clear links (both positive and negative) between measures of social support and psychological functioning. In contrast, studies looking at the relationship between social support and both measures of physical health and immune function have yielded inconsistent and inconclusive findings. This article synthesizes and reviews what is currently known about the effects of social support on the psychological, physical health, and immune functioning in HIV-infected gay men. Both beneficial and detrimental effects of social support on health are examined, highlighting those aspects of social support that may be enhanced or discouraged in the context of psychotherapeutic interventions.     

Network financial support and conflict as predictors of depressive symptoms among a highly disadvantaged population

The study examined multiple dimensions of social support as predictors of depressive symptoms among a highly vulnerable population. Social network analysis was used to assess perceived and enacted dimensions of support (emotional, financial, instrumental), network conflict, closeness, and composition. Participants were 393 current and former injection drug users who were 72% ≤ poverty level, 96% African American, 39% HIV seropositive. At baseline, 37% had high depression scores (CES‐D ≥ 16). Adjusted logistic regression indicated that for every additional network member providing financial support, the odds of probable depression 1 year later decreased by 23%, and for every additional conflictive network tie the odds of depression increased by 57%. Findings suggest the greater importance to this population's psychological well‐being of received support specific to environmental demands, rather than support perceived potentially available. The findings suggest potential directions for intervention. © 2007 Wiley Periodicals, Inc.