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Dodds S, Nuehring EM, Blaney NT, Blakley T, Lizzotte JM, Lopez M, Potter JE, O'Sullivan MJ. Integrating Mental Health Services into Primary HIV Care for Women: The Whole Life Project. Public Health Rep 2016; 119:48-59. [PMID: 15147649 PMCID: PMC1502259 DOI: 10.1177/003335490411900111] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The high rate of mental health problems in HIV-infected women jeopardizes the health of this vulnerable population, and constitutes a mandate for integrating mental health services into HIV primary care. The Whole Life project—a collaboration of the departments of Psychiatry and Obstetrics/Gynecology at the University of Miami School of Medicine—successfully integrated mental health services into primary HIV care for women. This article describes the conceptual framework of the integration, implementation strategies, effects of the service integration, and lessons learned. Funded by the Health Resources and Services Administration (HRSA) as a Special Program of National Significance (SPNS), Whole Life efforts have been sustained beyond the demonstration funding period as a result of the changes brought about in organizational structures, service delivery, and the providers' conceptualization of health for HIV-infected women.
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Affiliation(s)
- Sally Dodds
- Department of Psychiatry and Behavioral Sciences, University of Miami School of Medicine, Miami, FL 33101, USA.
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Liboro RM, Walsh RTG. Understanding the Irony: Canadian Gay Men Living with HIV/AIDS, Their Catholic Devotion, and Greater Well-being. JOURNAL OF RELIGION AND HEALTH 2016; 55:650-670. [PMID: 26160146 DOI: 10.1007/s10943-015-0087-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Nine Canadian Catholic HIV-positive gay men were interviewed to obtain a better understanding of why and how they were able to persevere in their faith despite their religion's teachings against homosexuality and contributions to the stigmatization of HIV/AIDS. By examining the lived experiences and personal perspectives of the participants, the study aimed to explore and elucidate the significant role of Catholicism and the Catholic Church both as a continued source of marginalization and oppression, as well as strength and support, for Canadian gay men living with HIV/AIDS today.
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Affiliation(s)
- Renato M Liboro
- Community Psychology Program, Faculty of Science, Wilfrid Laurier University, 75 University Avenue West, Waterloo, ON, N2L 3C5, Canada.
| | - Richard T G Walsh
- Community Psychology Program, Faculty of Science, Wilfrid Laurier University, 75 University Avenue West, Waterloo, ON, N2L 3C5, Canada
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Hoyt MA, Stanton AL, Bower JE, Thomas KS, Litwin MS, Breen EC, Irwin MR. Inflammatory biomarkers and emotional approach coping in men with prostate cancer. Brain Behav Immun 2013; 32:173-9. [PMID: 23624266 PMCID: PMC3706095 DOI: 10.1016/j.bbi.2013.04.008] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2013] [Revised: 04/11/2013] [Accepted: 04/18/2013] [Indexed: 01/22/2023] Open
Abstract
OBJECTIVE Emotion-regulating coping is associated with improvements in psychological and physical health outcomes. Yet in the context of prostate cancer-related stressors, limited research has characterized associations of emotion-regulating coping processes (emotional expression, emotional processing) and inflammatory processes that are related to disease risk. This investigation examined the relation of Emotional Approach Coping (EAC) with markers of inflammation to test the hypothesis that higher EAC scores at study entry (T1) would be associated with lower proinflammatory markers four months later (T2), specifically sTNF-RII, CRP, and IL-6. METHODS Forty-one men (M age=66.62 years; SD=9.62) who had undergone radical prostatectomy or radiation therapy for localized prostate cancer within two years completed questionnaires, including assessments of EAC, at T1, and provided blood samples for immune assessments at T2. RESULTS When controlling for relevant biobehavioral controls, emotional processing predicted lower IL-6 (B=-.66, p<.01), sTNF-RII (B=-.43, p<.05), and CRP (B=-.43, p<.10), whereas emotional expression was significantly associated with higher levels of sTNF-RII (B=.55, p<.05). Associations of emotional expression and IL-6 (B=.38, p<.10), and CRP (B=.44, p<.10) approached significance. Probing interactions of emotional processing and expression (though only approaching significance) suggested that expression of emotion is associated with higher inflammation (CRP and sTNF-RII) only in the context of low emotional processing. CONCLUSIONS Attempts at emotion regulation via emotional processing appear to modulate inflammatory processes. Understanding, making meaning of, and working through emotional experience may be a promising target of intervention to reduce inflammation with potential effects on psychological and cancer outcomes in men with prostate cancer.
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Affiliation(s)
- Michael A Hoyt
- Department of Psychology, Hunter College, City University of New York, New York, NY 10065, USA.
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Steglitz J, Ng R, Mosha JS, Kershaw T. Divinity and distress: the impact of religion and spirituality on the mental health of HIV-positive adults in Tanzania. AIDS Behav 2012; 16:2392-8. [PMID: 22797930 DOI: 10.1007/s10461-012-0261-7] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
This study examined the relationship between religiosity, spirituality and mental health in the context of a stress-coping framework. Participants were 135 rural, low-income HIV-positive adults in Iringa, Tanzania. The relationships between religiosity, spirituality, coping responses, social support, and psychological distress (depression, anxiety, and stress) were examined using structural equation modeling. Religiosity was related to decreased avoidant coping and increased social support, which in turn were related to psychological distress. Spirituality was positively related to active coping and social support. Results suggest that coping strategies and social support may mediate the relationship between religiosity and spirituality and psychological distress. Interventions to reduce psychological distress among HIV-positive individuals in Tanzania might incorporate strategies to reduce avoidant coping and increase social support. According to the present findings, this may be accomplished through faith-based approaches that incorporate religious and spiritual activities into HIV prevention programs.
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Vassend O, Eskild A. Psychological Distress, Coping, and Disease Progression in HIV-positive Homosexual Men. J Health Psychol 2012; 3:243-57. [PMID: 22021363 DOI: 10.1177/135910539800300208] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
The objectives of the study were (1) to examine the role of coping styles in disease progression in models controlling for initial CD4+ cell counts, distress, and health behavior in a sample of HIV- positive homosexual men (n = 65), and (2) to investigate the relationship between coping styles and distress (e.g. depression, anxiety, negative ruminations). A consistent association between planful problem-solving coping and disease progression was demonstrated. Distress was positively correlated with indicators of passive-defensive coping style (e.g. self- controlling, escape-avoidance), and negatively correlated with planful problem-solving and positive reappraisal. The results suggest that coping styles may merit a specific focus in future research of psychological factors in HIV infection, particularly as they may relate both to medical outcome and to the social/emotional aspects of being HIV-infected.
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Affiliation(s)
- O Vassend
- Institute of Community Dentistry, University of Oslo, Norway
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Wise EA, Streiner DL. A comparison of the millon behavioral medical diagnostic and millon behavioral health inventory with medical populations. J Clin Psychol 2010; 66:1281-91. [PMID: 20715021 DOI: 10.1002/jclp.20725] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
There is a lack of normative data on broadband omnibus types of personality tests with medical populations. In fact, the only two tests normed on medical populations are the Millon Behavioral Medicine Diagnostic (MBMD) and the Millon Behavioral Health Inventory (MBHI). The internal consistency, test-retest reliabilities, and validity studies of these instruments are reviewed and compared in an effort to aid clinicians in discerning their relative psychometric strengths and weaknesses. Due to the lack of validity studies with the MBMD and the fact that reliability limits the ceiling of validity coefficients, the MBMD has yet to meet the challenges it was designed to meet. Implications for practice are addressed.
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Affiliation(s)
- Edward A Wise
- Mental Health Resources, PLLC, Memphis, TN 38119, USA.
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Fekete E, Geaghan TR, Druley JA. Affective and behavioural reactions to positive and negative health-related social control in HIV+men. Psychol Health 2010; 24:501-15. [PMID: 20205008 DOI: 10.1080/08870440801894674] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
We examined associations between the receipt of positive and negative health-related social control (i.e. influence) from a primary network member, affective and behavioural reactions (i.e. behaviour change) to social control, and psychosocial well-being in a cross-sectional study of 91 HIV+ men living with HIV (MLWH). Receiving positive control was associated with more self-care behaviours, more active coping efforts, and fewer depressive symptoms. In contrast, receiving negative control was associated with fewer self-care behaviours and more depressive symptoms. Negative affective reactions to control mediated the associations between positive and negative control and depressive symptoms, and between positive control and active coping efforts. Behaviour change only mediated the association between positive control and self-care behaviours. Post-hoc analyses further revealed that men who were not at risk for clinical depression engaged in more behaviour change as a result of receiving negative control. Social control that elicits behaviour change and does not arouse negative affect is effective in promoting better self-care behaviours and psychosocial well-being in MLWH.
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Affiliation(s)
- Erin Fekete
- University of Miami, Psychology, Coral Gables, 33146, USA.
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Coker AL, Hopenhayn C, DeSimone CP, Bush HM, Crofford L. Violence against Women Raises Risk of Cervical Cancer. J Womens Health (Larchmt) 2009; 18:1179-85. [PMID: 19630537 DOI: 10.1089/jwh.2008.1048] [Citation(s) in RCA: 81] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND An emerging literature suggests that violence against women (VAW), particularly sexual violence, may increase the risk of acquiring a sexually transmitted infection (STI) and, therefore, may be associated with cervical cancer development. The purpose of this cross-sectional analysis was to determine if women who had experienced violence had higher prevalence rates of invasive cervical cancer. METHODS Women aged 18-88 who joined the Kentucky Women's Health Registry (2006-2007) and completed a questionnaire were included in the sample. Multivariate logistic regression analyses were used to adjust odds ratio (OR) for confounders (e.g., age, education, current marital status, lifetime illegal drug use, and pack-years of cigarette smoking). RESULTS Of 4732 participants with no missing data on violence, cervical cancer, or demographic factors, 103 (2.1%) reported ever having cervical cancer. Adjusting for demographic factors, smoking, and illegal drug use, experiencing VAW was associated with an increased prevalence of invasive cervical cancer (adjusted OR [aOR] = 2.6, 95% CI = 1.7-3.9). This association remained significant when looking at three specific types of VAW: intimate partner violence (IPV) (aOR = 2.7, 95% CI = 1.8-4.0), adult exposure to forced sex (aOR = 2.6, 95% CI = 1.6-4.3), and child exposure to sexual abuse (aOR = 2.4, 95% CI = 1.4-4.0). CONCLUSIONS Rates of cervical cancer were highest for those experiencing all three types of VAW relative to those never experiencing VAW. Because VAW is common and has gynecological health effects, asking about VAW in healthcare settings and using this information to provide tailored healthcare may improve women's health outcomes.
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Affiliation(s)
- Ann L Coker
- Department of Obstetrics and Gynecology, University of Kentucky, Lexington, KY 40536-0293, USA.
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Flynn SM, Schipper LJ, Roach AR, Segerstrom SC. Gender differences in delayed-type hypersensitivity response: effects of stress and coping in first-year law students. Brain Behav Immun 2009; 23:672-6. [PMID: 19162169 PMCID: PMC2765871 DOI: 10.1016/j.bbi.2008.12.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2008] [Revised: 12/29/2008] [Accepted: 12/31/2008] [Indexed: 11/17/2022] Open
Abstract
Law students show significant deficits in emotional and physical well-being compared with groups of students in other areas of higher education. Furthermore, evidence suggests that these effects may be worse for women than for men. The use of active coping can positively affect immunity under stress, but this may be most true for men in the context of law school. The current study examined the delayed-type hypersensitivity (DTH) skin responses of first-year law students (n=121) and a comparison group (n=30). Students' health behaviors, self-evaluative emotions, and coping strategies were also reported. Male law students had larger DTH responses than females, but this gender effect was not present in the comparison group. Endorsement of perseverance under stress (n=19), an active coping strategy, moderated the gender effect on immunity. Perseverance associated with larger DTH responses and more positive self-evaluative emotion, but only among men. These results indicate that active coping may be less efficacious for women than for men in law school, which in turn may limit women's opportunities to attenuate negative effects of law school.
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Abstract
Adding to a traditional stress perspective, behavioral medicine has been focusing increasingly on investigating the potential impact of positive psychosocial factors on disease course in HIV. Dispositional optimism, active coping, and spirituality show the most evidence for predicting slower disease progression, although the data are not entirely consistent. Findings for the role of social support are mixed, although indications are that it may be particularly helpful at later stages of illness. Many of the other constructs (positive affect, finding meaning, emotional expression/processing, openness, extraversion, conscientiousness, altruism, and self-efficacy) have only been examined in one or two studies; results are preliminary but suggestive of protective effects. Plausible behavioral and biological mechanisms are discussed (including health behaviors, neurohormones, and immune measures) as well as suggestions for clinicians, limitations, future directions, and a discussion of whether these constructs can be changed. In conclusion, investigating the importance and usefulness of positive psychosocial factors in predicting disease progression in HIV is in its beginning scientific stages and shows good initial evidence and future promise.
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McCain NL, Gray DP, Elswick RK, Robins JW, Tuck I, Walter JM, Rausch SM, Ketchum JM. A randomized clinical trial of alternative stress management interventions in persons with HIV infection. J Consult Clin Psychol 2008; 76:431-41. [PMID: 18540736 PMCID: PMC4629773 DOI: 10.1037/0022-006x.76.3.431] [Citation(s) in RCA: 90] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Research in psychoneuroimmunology suggests that immunosuppression associated with perceived stress may contribute to disease progression in persons with HIV infection. While stress management interventions may enhance immune function, few alternative approaches have yet been tested. This randomized clinical trial was conducted to test effects of three 10-week stress management approaches--cognitive-behavioral relaxation training (RLXN), focused tai chi training (TCHI), and spiritual growth groups (SPRT)--in comparison to a wait-listed control group (CTRL) among 252 individuals with HIV infection. Using repeated measures mixed modeling, the authors found that in comparison to the CTRL group, (a) both the RLXN and TCHI groups used less emotion-focused coping, and (b) all treatment groups had augmented lymphocyte proliferative function. Despite modest effects of the interventions on psychosocial functioning, robust findings of improved immune function have important clinical implications, particularly for persons with immune-mediated illnesses.
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Affiliation(s)
- Nancy L McCain
- School of Nursing, Virginia Commonwealth University, Richmond, VA 23298, USA.
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Deichert NT, Fekete EM, Boarts JM, Druley JA, Delahanty DL. Emotional support and affect: associations with health behaviors and active coping efforts in men living with HIV. AIDS Behav 2008; 12:139-45. [PMID: 17334940 DOI: 10.1007/s10461-007-9214-y] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2006] [Accepted: 01/29/2007] [Indexed: 11/29/2022]
Abstract
The present study represents a cross-sectional examination of the relationship between affect, social support and illness adjustment in men diagnosed with HIV/AIDS. Positive and negative affect were examined as separate mediators of the relationship between emotional support received from a primary support provider and illness adjustment in 105 men living with HIV. Results suggested that depressive symptoms emerged as a mediator between emotional support and engaging in healthy lifestyle behaviors (assessed by summary index). In contrast, positive affect emerged as the primary mediator between emotional support and greater amounts of active coping. Overall, findings suggested that emotional support from close others was indirectly associated with health behaviors and coping through recipients' affective states, and that these positive and negative affective states had differential relationships with multiple aspects of illness adjustment in men living with HIV.
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Burns MJ, Feaster DJ, Mitrani VB, Ow C, Szapocznik J. Stress processes in HIV-positive African American mothers: moderating effects of drug abuse history. ANXIETY, STRESS, AND COPING 2008; 21:95-116. [PMID: 18027126 PMCID: PMC2474797 DOI: 10.1080/10615800701695131] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
This study examined the mechanism by which stressors, dissatisfaction with family, perceived control, social support, and coping were related to psychological distress in a sample of HIV-positive African American mothers. Additional analyses explored whether women who had a history of a drug abuse or dependence diagnosis differed either on levels of the study variables or the model pathways. The results indicated that HIV-positive African American mothers who had higher levels of stressors perceived their stressors as a whole to be less controllable. Coping resources, available social support and perceived control, were positively associated with active coping and negatively associated with psychological distress. Avoidant coping was the most important predictor of psychological distress. Furthermore, the effect of avoidant coping on psychological distress was stronger for mothers with a history of drug diagnosis. The implications of these findings for targeting interventions are discussed.
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Affiliation(s)
- Myron J Burns
- Department of Psychology, Nevada State College, Henderson, NV 89002, USA.
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Uchino BN. Social Support and Health: A Review of Physiological Processes Potentially Underlying Links to Disease Outcomes. J Behav Med 2006; 29:377-87. [PMID: 16758315 DOI: 10.1007/s10865-006-9056-5] [Citation(s) in RCA: 1214] [Impact Index Per Article: 67.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/07/2006] [Indexed: 10/24/2022]
Abstract
Social support has been reliably related to lower rates of morbidity and mortality. An important issue concerns the physiological mechanisms by which support influences such health endpoints. In this review, I examine evidence linking social support to changes in cardiovascular, neuroendocrine, and immune function. Consistent with epidemiological evidence, social support appears to be related to more positive "biological profiles" across these disease-relevant systems. Recent research on immune-mediated inflammatory processes is also starting to provide data on more integrative physiological mechanisms potentially linking social support to health. The implications of these links, along with future research directions are discussed.
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Affiliation(s)
- Bert N Uchino
- Department of Psychology and Health Psychology Program, University of Utah, 380 S. 1530 E., Rm. 502, Salt Lake City, 84112 Utah, USA.
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Ashton E, Vosvick M, Chesney M, Gore-Felton C, Koopman C, O'Shea K, Maldonado J, Bachmann MH, Israelski D, Flamm J, Spiegel D. Social support and maladaptive coping as predictors of the change in physical health symptoms among persons living with HIV/AIDS. AIDS Patient Care STDS 2005; 19:587-98. [PMID: 16164385 DOI: 10.1089/apc.2005.19.587] [Citation(s) in RCA: 102] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
This study examined social support and maladaptive coping as predictors of HIV-related health symptoms. Sixty-five men and women living with HIV/AIDS completed baseline measures assessing coping strategies, social support, and HIV-related health symptoms. The sample was primarily low-income and diverse with respect to gender, ethnicity, and sexual orientation. Three, 6, and 12 months after completing baseline assessments, physical health symptoms associated with HIV disease were assessed. After controlling for demographic characteristics, CD4 T-cell count, and baseline HIV-related health symptoms, individuals reporting lower increase in HIV-related health symptoms used less venting (expressing emotional distress) as a strategy for coping with HIV. However, when satisfaction with social support was added to the model, the use of this coping strategy was no longer significant, and individuals reporting more satisfying social support were more likely to report lower increase in their HIV-related health symptoms, suggesting that social support is a robust predictor of health outcomes over time independent of coping style and baseline medical status. These findings provide further evidence that social support can buffer deleterious health outcomes among individuals with a chronic illness. Future research needs to examine mediating pathways that can explain this relationship.
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Affiliation(s)
- Eric Ashton
- Stanford University School of Medicine, Department of Psychiatry and Behavioral Sciences, Stanford, California 94305-5718, USA
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Martin SC, Wolters PL, Klaas PA, Perez L, Wood LV. Coping styles among families of children with HIV infection. AIDS Care 2004; 16:283-92. [PMID: 15203422 DOI: 10.1080/09540120410001665295] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
The primary aim of this study was to examine coping strategies among families of HIV-infected children and how they relate to medical, central nervous system (CNS) and family environment factors. Caregivers of HIV-positive children (N=52) completed a family coping measure (F-COPES) and provided information regarding family environment. Data regarding medical and CNS status were obtained from patient records. Results indicated that families' passive coping and spiritual support were among the coping techniques used most often, and social support was used least often. Medical variables were unrelated to any coping styles. Families of children with CNS impairment endorsed more passive coping techniques than families of children with no apparent deficits. A trend was found for non-biological caregivers to seek out more community resources and support than biological caregivers. Findings suggest the need to target families least likely to utilize resources, and to teach them to effectively seek out and benefit from social and community supports.
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Affiliation(s)
- S C Martin
- HIV and AIDS Malignancy Branch, National Cancer Institute, Bethesda, MD 20892, USA.
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Prado G, Feaster DJ, Schwartz SJ, Pratt IA, Smith L, Szapocznik J. Religious involvement, coping, social support, and psychological distress in HIV-seropositive African American mothers. AIDS Behav 2004; 8:221-35. [PMID: 15475672 PMCID: PMC1480649 DOI: 10.1023/b:aibe.0000044071.27130.46] [Citation(s) in RCA: 67] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
This study used a cross-sectional design to examine the role of religious involvement within a stress-process framework. Participants were 252 urban, low-income HIV-seropositive African American mothers. The relationships among religious involvement, stress, coping responses, social support, and psychological distress were examined using structural equation modeling. The number of stressors reported by the mother was related to greater religious involvement, which in turn was negatively related to psychological distress. Furthermore, the results suggest that social support, active coping, and avoidant coping responses mediated the relationship between religious involvement and psychological distress. According to the present results, interventions to attenuate psychological distress in HIV-seropositive African American mothers might focus on increasing social support, promoting active coping, and decreasing avoidant coping. The present findings suggest that this may be accomplished, in part, by promoting involvement in religious institutions and practices. However, in light of the cross-sectional design used in the present study, and given that religion may have both positive and negative consequences, further research is needed to determine the extent to which promoting religiosity may increase or alleviate distress.
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Affiliation(s)
- Guillermo Prado
- Department of Psychiatry and Behavioral Sciences, Center for Family Studies, University of Miami School of Medicine, Miami, Florida 33136, USA.
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Ohira H. Social support and salivary secretory immunoglobulin A response in women to stress of making a public speech. Percept Mot Skills 2004; 98:1241-50. [PMID: 15291211 DOI: 10.2466/pms.98.3c.1241-1250] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Acute experimental stressors transiently increase volume of secretory immunoglobulin A (s-IgA) in saliva. The present study examined buffering effects of social support on response of s-IgA to a brief psychological stress (giving a public speech). 24 women were divided at random into three groups, an emotional support group, an informational support group and a no-support group (control). For each group, s-IgA measures were obtained from each person under baseline conditions, during preparation of a speech when social support or no support was given, immediately after the speech and during a 'recovery' period. Level of s-IgA in the control group significantly elevated during preparation for the speech and just after the speech compared to baseline, suggesting that the speech task stimulated secretory immune function. On the other hand, the subjects in the emotional support group showed increased s-IgA during the preparation period but secretion of s-IgA rapidly returned to the baseline after the speech task. Secretion of s-IgA in the informational social support group was unchanged at any measurement point. These results suggest that social support attenuates the affect of a stressor on somatic state.
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Affiliation(s)
- Hideki Ohira
- Department of Psychology Nagoya University, Japan.
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Segerstrom SC, Miller GE. Psychological stress and the human immune system: a meta-analytic study of 30 years of inquiry. Psychol Bull 2004. [PMID: 15250815 DOI: 10.1037/0033‐2909.130.4.601] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The present report meta-analyzes more than 300 empirical articles describing a relationship between psychological stress and parameters of the immune system in human participants. Acute stressors (lasting minutes) were associated with potentially adaptive upregulation of some parameters of natural immunity and downregulation of some functions of specific immunity. Brief naturalistic stressors (such as exams) tended to suppress cellular immunity while preserving humoral immunity. Chronic stressors were associated with suppression of both cellular and humoral measures. Effects of event sequences varied according to the kind of event (trauma vs. loss). Subjective reports of stress generally did not associate with immune change. In some cases, physical vulnerability as a function of age or disease also increased vulnerability to immune change during stressors.
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Segerstrom SC, Miller GE. Psychological stress and the human immune system: a meta-analytic study of 30 years of inquiry. Psychol Bull 2004; 130:601-30. [PMID: 15250815 PMCID: PMC1361287 DOI: 10.1037/0033-2909.130.4.601] [Citation(s) in RCA: 1685] [Impact Index Per Article: 84.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The present report meta-analyzes more than 300 empirical articles describing a relationship between psychological stress and parameters of the immune system in human participants. Acute stressors (lasting minutes) were associated with potentially adaptive upregulation of some parameters of natural immunity and downregulation of some functions of specific immunity. Brief naturalistic stressors (such as exams) tended to suppress cellular immunity while preserving humoral immunity. Chronic stressors were associated with suppression of both cellular and humoral measures. Effects of event sequences varied according to the kind of event (trauma vs. loss). Subjective reports of stress generally did not associate with immune change. In some cases, physical vulnerability as a function of age or disease also increased vulnerability to immune change during stressors.
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OHIRA HIDEKI. SOCIAL SUPPORT AND SALIVARY SECRETORY IMMUNOGLOBULIN A RESPONSE IN WOMEN TO STRESS OF MAKING A PUBLIC SPEECH. Percept Mot Skills 2004. [DOI: 10.2466/pms.98.3.1241-1250] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Robinson FP, Mathews HL, Witek-Janusek L. Psycho-Endocrine-Immune Response to Mindfulness-Based Stress Reduction in Individuals Infected with the Human Immunodeficiency Virus: A Quasiexperimental Study. J Altern Complement Med 2003; 9:683-94. [PMID: 14629846 DOI: 10.1089/107555303322524535] [Citation(s) in RCA: 122] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES The purpose of this study was to examine the effects of a structured, 8-week, Mindfulness-Based Stress Reduction (MBSR) program on perceived stress, mood, endocrine function, immunity, and functional health outcomes in individuals infected with the human immunodeficiency virus (HIV). DESIGN This study used a quasiexperimental, nonrandomized design. METHODS Subjects were specifically recruited (nonrandom) for intervention (MBSR) or comparison group. Data were collected at pretest and post-test in the MBSR group and at matched times in the comparison group. t Tests where performed to determine within-group changes and between-group differences. RESULTS Natural killer cell activity and number increased significantly in the MBSR group compared to the comparison group. No significant changes or differences were found for psychological, endocrine, or functional health variables. CONCLUSIONS These results provide tentative evidence that MBSR may assist in improving immunity in individuals infected with HIV.
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Affiliation(s)
- F Patrick Robinson
- College of Nursing, University of Illinois at Chicago, Chicago, IL 60612-7350, USA.
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25
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Fang CY, Miller SM, Mills M, Mangan CE, Belch R, Campbell DE, Douglas SD. The effects of avoidance on cytotoxic/suppressor T cells in women with cervical lesions. Psychooncology 2003; 12:590-8. [PMID: 12923799 DOI: 10.1002/pon.680] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The purpose of this study was to examine the relationship between avoidant and intrusive ideation about cancer risk and immune responses among women with mild cervical dysplasia. Participants were 54 women undergoing diagnostic follow-up (i.e. colposcopy) for an abnormal Pap smear test result. Baseline assessments, collected prior to the colposcopy appointment, included demographic and medical history, levels of depression, and the intrusion and avoidance subscales of the Revised Impact of Events Scale. In addition, a sample of blood was obtained at baseline and 6-month follow-up for immune assessments. Hierarchical regression analyses revealed that higher levels of cognitive and behavioral avoidance at baseline predicted a significantly lower percentage of circulating cytotoxic/suppressor T cells (CD3(+)/CD8(+)) at 6-month follow-up, after controlling for baseline levels of cytotoxic/suppressor T cells and potential confounding variables (e.g. age, smoking status). Baseline intrusive ideation was unrelated to changes in percentage of cytotoxic/suppressor T cells. Avoidant ideation, but not intrusive ideation or depression, appears to be associated with alterations in immunologic measures in women with cervical lesions. The findings suggest that it may be important to evaluate the impact of cognitive and behavioral avoidance on progression of precancerous cervical lesions.
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Affiliation(s)
- Carolyn Y Fang
- Division of Population Science, Fox Chase Cancer Center, Cheltenham, PA 19012, USA.
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26
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Koopman C, Gore-Felton C, Azimi N, O'Shea K, Ashton E, Power R, De Maria S, Israelski D, Spiegel D. Acute stress reactions to recent life events among women and men living with HIV/AIDS. Int J Psychiatry Med 2003; 32:361-78. [PMID: 12779186 DOI: 10.2190/ck2n-33nv-3pvf-glvr] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE This study examined the prevalence of acute stress reactions to recent life events among persons living with HIV/AIDS. A second aim was to investigate the relationship of acute stress reactions among HIV-infected men and women to posttraumatic stress disorder (PTSD) symptoms to previous traumatic life events. METHOD Participants included 64 HIV-seropositive persons (33 men and 31 women) drawn from a larger study examining the effects of group therapy on quality of life and health behavior. These individuals were assessed at baseline on demographic and medical status characteristics and (PTSD) symptoms andthen randomly assigned to either receive group therapy plus education or education alone. Three months later they were assessed for acute stress reactions to recent life events. RESULTS Nearly a third (31.3 percent) of the participants reported levels of acute stress reactions to recent life events that met all symptom criteria for the diagnosis of acute stress disorder. However, only 9.4 percent of the respondents described a recent stressful life event that was threatening to the life or physical integrity of themselves or others. Acute stress reactions to recent life events were significantly and positively related to experiencing PTSD symptoms to prior traumatic life events. Acute stress did not differ significantly by gender, AIDS status, or whether or not participants had received 12 weeks of group therapy. CONCLUSIONS A subset of individuals with HIV/AIDS experience high levels of acute stress reactivity to life events considered non-traumatic. HIV-infected individuals who react strongly to ongoing life stressors are more likely to have developed PTSD symptoms in response to previous traumatic life events.
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Affiliation(s)
- Cheryl Koopman
- Department of Psychiatry and Behavioral Sciences, Stanford University, California 94305-5718, USA.
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27
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Abstract
Research has found suggestive links between emotional distress and immune and neuroendocrine measures in cancer patients. Furthermore, several studies have reported that participation in psychological support groups is associated with better health outcomes for cancer patients. However, controversy exists surrounding these findings, and the mechanisms behind such effects are unclear. This article integrates current evidence from several lines of research concerning the relations among coping, psychological adjustment, cortisol and immune function, and disease progression in breast cancer patients. A biopsychosocial model is evaluated in which coping and psychological adjustment are associated with alterations in cortisol levels, immune function, and potential long-term medical outcomes in breast cancer patients. Although strong evidence suggests that coping and psychosocial intervention can improve psychological outcomes for breast cancer patients, potential effects on physiological outcomes remain speculative.
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Affiliation(s)
- Linda J Luecken
- Department of Psychology, Arizona State University, Tempe 85287, USA.
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Turner-Cobb JM. Psychological and neuroendocrine correlates of disease progression. INTERNATIONAL REVIEW OF NEUROBIOLOGY 2003; 52:353-81. [PMID: 12498111 DOI: 10.1016/s0074-7742(02)52016-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/28/2023]
Affiliation(s)
- Julie M Turner-Cobb
- Department of Psychology, University of Kent at Canterbury, Canterbury, Kent CT2 7NP, United Kingdom
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Robbins M, Szapocznik J, Tejeda M, Samuels D, Ironson G, Antoni M. The Protective Role of the Family and Social Support Network in a Sample of HIV-Positive African American Women: Results of a Pilot Study. JOURNAL OF BLACK PSYCHOLOGY 2003; 29:17-37. [PMID: 16609750 PMCID: PMC1435682 DOI: 10.1177/0095798402239227] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This study examined the role of family functioning and social support in protecting HIV-positive African American women from the adverse psychological consequences associated with deterioration in their CD4 cell count. Participants were 38 African American HIV-positive women who had recently given birth. Results demonstrated that changes in CD4 cell counts were inversely predictive of psychological distress and were moderated by family functioning and social support satisfaction. Women with good family functioning were less affected by changes in their CD4 cell counts, and women with poor family functioning were more emotionally responsive to changes in CD4 cell count. Unexpectedly, women from families where conflicts tended to be clearly laid out and discussed were also more responsive to both changes in CD4 cell counts. Interventions are recommended that increase a client's social support satisfaction, foster an adaptive level of connectedness to family, and enhance the family's range of conflict resolution styles.
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30
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Molassiotis A, Callaghan P, Twinn SF, Lam SW, Chung WY, Li CK. A pilot study of the effects of cognitive-behavioral group therapy and peer support/counseling in decreasing psychologic distress and improving quality of life in Chinese patients with symptomatic HIV disease. AIDS Patient Care STDS 2002; 16:83-96. [PMID: 11874640 DOI: 10.1089/10872910252806135] [Citation(s) in RCA: 64] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Forty-six Chinese patients with symptomatic human immunodeficiency virus (HIV) participated in a comparative study assessing the effectiveness of cognitive-behavioral group therapy (CBT) and peer support/counseling group therapy (PSC) in relation to improving mood and quality of life and decreasing uncertainty in illness as compared to a group receiving routine treatment with no formal psychosocial intervention. The CBT group consisted of 10 subjects, the PSC group of 10 subjects, and the comparison group of 26 subjects. There was a 24% attrition rate. The intervention groups received 12 weekly sessions of therapy over 3 months. Assessment of mood states was carried out before randomization (baseline data), immediately postintervention (3-month time point) and followed-up 3 months later (6-month time point). Assessment of quality of life and uncertainty in illness was carried out before randomization and at the 6-month follow-up time point. Results indicated that the mood of the participants in the CBT group improved in terms of anger, tension-anxiety, depression, confusion, and overall mood. The quality of life in this group was significantly improved compared to the other two groups, as was uncertainty in illness. In the PSC group a worsening of psychologic functioning was observed immediately postintervention, but this picture dramatically improved at the follow-up assessment with improvements of up to 34%. Quality of life also improved over time in this group by almost 5%, but results did not reach statistical significance. This study demonstrated that psychologic interventions could decrease psychologic distress and improve quality of life in symptomatic HIV patients, indicating their use should be incorporated in the management of care of people living with HIV/AIDS.
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Affiliation(s)
- A Molassiotis
- School of Nursing, University of Nottingham, Nottingham, United Kingdom
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31
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Feaster DJ, Szapocznik J. INTERDEPENDENCE OF STRESS PROCESSES AMONG AFRICAN AMERICAN FAMILY MEMBERS: INFLUENCE OF HIV SEROSTATUS AND A NEW INFANT. Psychol Health 2002; 17:339-363. [PMID: 16609749 PMCID: PMC1435377 DOI: 10.1080/08870440290029584] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
This study makes a theoretical contribution to stress process research by using a systemic approach to contextualize individual outcomes within the framework of other family members' experience. Utilizing a mixed model approach, indicators of the stress process of urban low-income HIV(+) African American recent mothers were found to affect the psychological distress and perceived adequacy of coping of multiple other family members. These relationships were found to be strongest proximal to birth and to be exacerbated by HIV infection. Social support to the mother was found to have differential effects depending on whether it was from the immediate family or outside sources. HIV infection of the recent mother was found to affect family members both through relationships of the mother's stress process and through their own coping responses.
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Affiliation(s)
- Daniel J Feaster
- Center for Family Studies, Department of Psychiatry and Behavioral Sciences, University of Miami School of Medicine, 1425 N.W. 10th Ave (D-22), Miami, FL 33136
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Stowell JR, Kiecolt-Glaser JK, Glaser R. Perceived stress and cellular immunity: when coping counts. J Behav Med 2001; 24:323-39. [PMID: 11523331 DOI: 10.1023/a:1010630801589] [Citation(s) in RCA: 95] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
This cross-sectional study investigated whether active and avoidance coping methods were differentially related to immune function depending on stress level. Perceived stress and coping method were assessed in 173 healthy older adults and related to the number and percentage of CD3+, CD4+, and CD8+ T lymphocytes as well as the proliferative response of peripheral blood leukocytes to phytohemagluttinin (PHA) and concanavalin A (Con A). Both active and avoidance coping significantly interacted with perceived stress on proliferative responses to both mitogens. Higher levels of active coping were significantly related to a more vigorous proliferative response to PHA and Con A, particularly at high stress levels. At low stress levels, active coping was not significantly related to proliferative responses, whereas avoidance coping was significantly associated with a greater proliferative response to Con A. These results suggest that the relationships between certain coping methods and immune function depend on perceived stress level.
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Affiliation(s)
- J R Stowell
- Department of Psychiatry, Ohio State University, USA.
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33
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Molassiotis A, Callaghan P, Twinn SF, Lam SW. Correlates of quality of life in symptomatic HIV patients living in Hong Kong. AIDS Care 2001; 13:319-34. [PMID: 11397334 DOI: 10.1080/09540120120043973] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
This cross-sectional study assessed quality of life (QOL), coping styles, mood and uncertainty in illness in a non-random sample of 46 (out of 91 eligible) symptomatic HIV patients living in Hong Kong. QOL was moderate and the main concerns were related to the environmental aspects of QOL, spirituality and social relationships. Considerable mood disturbance was demonstrated in the sample, especially with regards to depression, fatigue and tension/anxiety. High levels of uncertainty in illness were also reported. A median split of the uncertainty score demonstrated that high uncertainty was related to lower levels of overall QOL (p = 0.04), higher psychological dysfunction (p = 0.05), worse adjustment with the environment (p < 0.001) and higher mood disturbance (p = 0.008). The sample predominantly used internal coping, which also correlated well with higher QOL scores. Through regression analysis it was shown that QOL could be predicted with the combined effects of uncertainty in illness and fatigue (adjusted R2 = 0.51, p < 0.001). Findings indicate that efforts should be directed towards improving QOL issues in the Chinese HIV patients and interventions could be introduced to alleviate those factors that were found to affect QOL. It is suggested that such interventions may include group or individual psychological therapies, management of fatigue and teaching patients more effective coping techniques.
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Affiliation(s)
- A Molassiotis
- Department of Nursing, Chinese University of Hong Kong, Hong Kong.
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34
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Avants SK, Warburton LA, Margolin A. How injection drug users coped with testing HIV-seropositive: implications for subsequent health-related behaviors. AIDS EDUCATION AND PREVENTION : OFFICIAL PUBLICATION OF THE INTERNATIONAL SOCIETY FOR AIDS EDUCATION 2001; 13:207-218. [PMID: 11459357 DOI: 10.1521/aeap.13.3.207.19742] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
At entry into methadone maintenance treatment, 94 HIV-positive injection drug users (IDUs) completed the Coping Reponses Inventory, which asked them to "describe your feelings and experiences when you first learned you were HIV positive." Controlling for time since HIV testing, a reliance on avoidance coping following HIV testing was correlated with high levels of recent HIV risk behavior and poor health at entry into the study. The use of any coping strategy, particularly approach strategies, was related to medication adherence. Hierarchical regression analysis showed that avoidance coping accounted for a significant proportion of the variance in recent HIV risk behavior over and above that accounted for by the other variables. Other independent predictors of continued risk behavior were poor health, lack of social support, and low levels of HIV/AIDS knowledge. The need for interventions to help injection drug users (IDUs) cope subsequent to testing HIV seropositive is discussed.
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Affiliation(s)
- S K Avants
- Yale University School of Medicine, Division of Substance Abuse, New Haven, CT 06519, USA.
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35
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Greer S. What's in a name? Neuroimmunomodulation or psychoneuroimmunology? Ann N Y Acad Sci 2001; 917:568-74. [PMID: 11268385 DOI: 10.1111/j.1749-6632.2000.tb05422.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Compelling evidence is presented to support the hypothesis that psychological processes affect immune function. Consequently, it is argued that psychological processes should be included in human immunological studies and that neuroimmunomodulation could accurately by called psychoneuroimmunology.
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Affiliation(s)
- S Greer
- St. Raphael's Hospice, London Road, North Cheam, Surrey SM3 9DX, United Kingdom
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36
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Sica C, Novara C, Carosi G, Casari S, Dorz S, Nasta P, Sanavio E. Predicting health distress and at-risk sexual behaviour in a group of Italian asymptomatic HIV-infected people. Clin Psychol Psychother 2001. [DOI: 10.1002/cpp.272] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Leserman J. The effects of depression, stressful life events, social support, and coping on the progression of HIV infection. Curr Psychiatry Rep 2000; 2:495-502. [PMID: 11123001 DOI: 10.1007/s11920-000-0008-4] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
This article reviews recent findings concerning the role of psychosocial factors on the progression of HIV. Specifically, we examine the role of depression, stressful life events, social support, and coping on changes in CD4 T-lymphocytes and other indicators of HIV disease progression. Studies have yielded important evidence that depression, stressful life events, low social support, and denial coping may have a detrimental impact on HIV disease course. Delineating the role of psychosocial factors on HIV disease progression may aid in the development of new interventions for this devastating disease.
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Affiliation(s)
- J Leserman
- University of North Carolina School of Medicine, Department of Psychiatry, CB #7160, Chapel Hill, NC 27599-7160, USA.
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38
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Dodds S, Blaney NT, Nuehring EM, Blakley T, Lizzotte JM, Potter JE, O'Sullivan MJ. Integrating mental health services into primary care for HIV-infected pregnant and non-pregnant women: Whole Life--a theoretically derived model for clinical care and outcomes assessment. Gen Hosp Psychiatry 2000; 22:251-60. [PMID: 10936632 DOI: 10.1016/s0163-8343(00)00090-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Poor women of color who are disproportionately both infected and affected by HIV/AIDS also face multiple lifestyle and psychosocial burdens that complicate effective delivery of health care, thereby contributing to their poorer prognosis. Addressing these factors within the context of HIV/AIDS primary care for women is the aim of Whole Life, a program to integrate mental health services into primary care for HIV-infected pregnant and non-pregnant women. Whole Life utilizes a theoretically derived clinical services model that provides data for both clinical care and patient outcomes research within the constraints of a clinical setting. During a woman's first two clinic visits, data are gathered in structured interviews with standardized instruments-adapted for relevance to the population-that meet clinical and service needs, as well as measure components of the Whole Life model. Interviews are conducted by existing front-line staff who have been trained in using these instruments to gather information typically recorded in clinical notes. The implementation of Whole Life to date clearly demonstrates the feasibility of mental health-primary care services integration in a publicly funded HIV primary care clinic serving poor women of color.
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Affiliation(s)
- S Dodds
- Departments of Psychiatry and Behavioral Sciences, School of Medicine, University of Miami, Miami, FL 33101, USA
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39
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Cruess S, Antoni M, Kilbourn K, Ironson G, Klimas N, Fletcher MA, Baum A, Schneiderman N. Optimism, distress, and immunologic status in HIV-infected gay men following hurricane andrew. Int J Behav Med 2000. [DOI: 10.1207/s15327558ijbm0702_5] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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40
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Abstract
Psychoneuroimmunology (PNI) is a rapidly evolving multidisciplinary field founded on the premise that psychosocial factors, the central nervous system, and the immune system are intimately linked. Following publication of scientific evidence supporting this link, a number of animal and human studies have been published, both inside and outside the area of human immunodeficiency virus (HIV) infection and acquired immunodeficiency syndrome. These studies support the existence of bidirectional feedback mechanisms operating between the brain and the immune system. To date, however, there is no all-encompassing model that predicts individual differences in the relationship among psychosocial factors, immunologic measures, and clinical disease progression in HIV type 1 (HIV-1) infection. This variability in human response has been explained by a number of cofactors (host as well as environmental) that appear to accelerate the course of the disease. Since psychosocial factors are highly amenable to behavioral interventions, several models for intervention research have been proposed to evaluate whether such interventions can enhance immune functioning, thereby curtailing disease progression. Examination of these interventions in the context of PNI and HIV-1 infection, however, is rather limited. Therefore, researchers and clinicians must not only consider conceptualizations and paradigms in this area of research, but also focus on empirically testable, theory-driven models that allow for the unique characteristics of individual patients.
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Abstract
Psychosocial resources, which include optimism, coping style, a sense of mastery or personal control, and social support, influence the relationship between SES and health. To varying degrees, these resources appear to be differentially distributed by social class and related to health outcomes. Such resources may partially mediate the impact of SES on health. For example, environments that undermine personal control may have an impact on chronic arousal and the corresponding development of disease, such as CHD. Psychosocial resources may also moderate the impact of SES on health. For example, a large number of positive social relationships and a few conflictual ones may buffer individuals against the adverse effects of SES-related stress. These psychosocial resources are moderately intercorrelated, and so a research strategy that explores their coherence as a psychosocial profile that promotes resilience to stress is tenable and merits empirical examination. The erosion of these resources as one moves lower on the SES scale and specific factors that contribute to such erosion are discussed.
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Affiliation(s)
- S E Taylor
- Department of Psychology, University of California, Los Angeles 90095-1563, USA.
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Vedhara K, Fox JD, Wang EC. The measurement of stress-related immune dysfunction in psychoneuroimmunology. Neurosci Biobehav Rev 1999; 23:699-715. [PMID: 10392661 DOI: 10.1016/s0149-7634(99)00012-3] [Citation(s) in RCA: 55] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
In recent years there has been a dramatic increase in research dedicated to the psycho-behavioural modulation of immune function, i.e. the field of Psychoneuroimmunology (PNI). This has led, necessarily, to the use of several in vitro and in vivo techniques in attempts to delineate the relationship between these two phenomena. However, since the field's inception, considerable uncertainty has existed over the significance of the immune outcomes detected and this has been compounded by the equivocal nature of some of the published data. A great deal of this uncertainty could, however, be overcome if a clearer understanding was achieved on the advantages and limitations conferred by the manifold immune assays described in the literature. This would, in turn, encourage their more appropriate use within PNI. Hence, in this review we describe the rationale behind, and offer an evaluation of, some of the more frequently used in vitro and in vivo immunological and virological techniques. We hope that a clear understanding of the rationale behind such assays and their inherent advantages and limitations will inform the discussion of the significance of stress-related immune impairment.
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Affiliation(s)
- K Vedhara
- Department of Experimental Psychology, University of Bristol, Clifton, UK.
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Miller GE, Cole SW. Social relationships and the progression of human immunodeficiency virus infection: a review of evidence and possible underlying mechanisms. Ann Behav Med 1999; 20:181-9. [PMID: 9989325 DOI: 10.1007/bf02884959] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
We review studies examining the quality and quantity of social relationships as potential risk factors for differential progression of human immunodeficiency virus (HIV) infection. Several well-conducted prospective studies suggest that the health effects associated with the presence of supportive social relationships vary according to disease stage and mode of transmission. For gay or bisexual males in the early stages of infection, the presence of supportive social relationships appears to be a risk factor for accelerated disease progression. For individuals in the later stages of infection and those who acquire HIV via intravenous drug use or transfusion, supportive social relationships appear to be associated with health protective effects similar to those observed in other disease settings. We consider a variety of potential explanations for accelerated disease progression in gay men with extensive networks of personal relationships.
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Affiliation(s)
- G E Miller
- University of California, Los Angeles, USA
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Beem EE, Hooijkaas H, Cleiren MH, Schut HA, Garssen B, Croon MA, Jabaaij L, Goodkin K, Wind H, de Vries MJ. The immunological and psychological effects of bereavement: does grief counseling really make a difference? A pilot study. Psychiatry Res 1999; 85:81-93. [PMID: 10195319 DOI: 10.1016/s0165-1781(98)00135-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
This study evaluates psychological and immunological functioning after bereavement and the influence of group counseling. Eighteen widows (bereaved within 3 months of enrolment) and a reference group of 10 married control subjects were asked to fill in self-report scales and to donate a blood sample (T1). After T1, half of the widows (the experimental group) were randomly assigned to grief counseling (13 sessions over 4 months), while the other subjects (the control group) received no treatment. Seven months after bereavement (T2) or, in the case of the experimental group, immediately after the intervention, a follow-up was conducted in the widowed subsample using the same measures. Blood samples were analyzed to determine the total number of white blood cells, number of lymphocyte subsets, natural killer cell activity (NKCA) and lymphocyte proliferative response to phytohemagglutinin (PHA), anti-CD3 and pokeweed mitogen (PWM). At T1, we found significant differences between widows and non-widows regarding both psychological and immunological measures. Widows felt more anxious, depressed, hostile and agoraphobic. At T1, widows had a lower number of the CD19+CD5+ B cell subpopulation. The cell function tests for T and B cells showed higher responses in widows (lymphocyte proliferation response to PHA, anti-CD3 and PWM). No significant difference in NKCA was found between widows and non-widows. At T2, there appeared to be no significant difference between widows and non-widows on the psychological measures. With respect to the immunological measures, widows and non-widows showed no significant differences for the total number of white blood cells, number of lymphocyte subsets and NKCA. Consistent with our findings at T1, the lymphocyte proliferation response to PHA, anti-CD3 and PWM at T2 appeared to be higher in widows than in non-widows. Comparing the experimental group (widows) and the control group (widows) with respect to psychological measures at T1, widows in the experimental group felt more insufficient and had more sleep disturbances. With respect to the immunological measures, no differences were found between those two groups. When the same two groups were again compared at T2, no differences were found in any of the psychological or immunological measures (lymphocyte sub-populations, proliferation tests and the NKCA).
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Affiliation(s)
- E E Beem
- Department of Social Science, Leiden University, The Netherlands.
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Robinson FP, Mathews HL, Witek-Janusek L. Stress and HIV disease progression: psychoneuroimmunological framework. J Assoc Nurses AIDS Care 1999; 10:21-31. [PMID: 9934667 DOI: 10.1016/s1055-3290(06)60229-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Psychoneuroimmunology (PNI) is the study of the interrelationships among behavior, neural and endocrine function, and the immune system. PNI investigates the relationships among stress, physiological dysregulation, and health outcomes. Research has supported the theory that emotional distress and the resultant neuroendocrine activation can induce immune system suppression. This suppression has significant implications for disease susceptibility and progression. HIV disease and its extensive immunological consequences are explored within this framework. Potential physiological pathways that may mediate stress-induced dysregulation within the context of HIV disease are identified. Key HIV-related PNI research studies are reviewed and critically analyzed. Implications for nursing practice and research are discussed.
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Grassi L, Righi R, Sighinolfi L, Makoui S, Ghinelli F. Coping styles and psychosocial-related variables in HIV-infected patients. PSYCHOSOMATICS 1998; 39:350-9. [PMID: 9691704 DOI: 10.1016/s0033-3182(98)71323-4] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
The study examined the relationship between coping and psychosocial variables (psychological stress symptoms, locus of control, emotional repression, and social support) among 108 human immunodeficiency virus (HIV)-infected patients. The authors administered several tests, including one that measures fighting spirit and degree of hopelessness, to assess each patient's individual coping style. The patients who were adjusting well to their HIV-positive status tended to have a higher level of fighting spirit and lower degree of hopelessness than those patients who were not adjusting well to their HIV-positive status. A coping style based on incapacity to face and confront HIV infection was associated with symptoms of psychological stress, repression of anger, external locus of control, and low social support in the latter group. These patients showed symptoms indicating maladjustment to HIV infection (43% of the sample) and differed from the "noncases" (the well-adjusted patients) in that the former group reported inadequate coping responses (lower fighting spirit and higher hopelessness, fatalistic attitude, and anxious preoccupation) and poorer social support, and had a greater tendency to repress anger and express sadness. The data support the hypothesis that coping with HIV infection is a complex phenomenon involving multiple and interacting variables. Interventions aimed at improving the coping style for many HIV patients are needed.
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Affiliation(s)
- L Grassi
- Department of Medical Sciences of Communication and Behavior, University of Ferrara, Italy.
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Goodkin K, Feaster DJ, Asthana D, Blaney NT, Kumar M, Baldewicz T, Tuttle RS, Maher KJ, Baum MK, Shapshak P, Fletcher MA. A bereavement support group intervention is longitudinally associated with salutary effects on the CD4 cell count and number of physician visits. CLINICAL AND DIAGNOSTIC LABORATORY IMMUNOLOGY 1998; 5:382-91. [PMID: 9605995 PMCID: PMC104528 DOI: 10.1128/cdli.5.3.382-391.1998] [Citation(s) in RCA: 109] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
A randomized, controlled, clinical trial was conducted to examine the impact of a semistructured, 10-week, once weekly, 90-min/session bereavement support group intervention on immunological, neuroendocrine, and clinical health status in human immunodeficiency virus type 1-seropositive (HIV-1+) and HIV-1-seronegative (HIV-1-) homosexual men, compared to a standard of care control condition. A total of 119 homosexual men (74 HIV-1+ and 45 HIV-1-) were assessed at baseline, 10 weeks, and 6 months follow-up. At the 6-month follow-up assessment, the intervention groups exhibited significant beneficial effects compared to controls on changes in CD4 cell, total T-lymphocyte, and total lymphocyte counts, when baseline levels, antiretroviral medication use, CDC stage of disease, and other potentially confounding factors were accounted for. There was no statistically significant effect on the CD4/CD8 ratio or on the CD8 cell count. The effect on CD4 cell count was associated with group attendance and with changes in plasma cortisol level. Plasma cortisol levels decreased significantly among intervention subjects, compared to controls. A significantly reduced number of health care visits over the 6-month follow-up period among the intervention subjects supported the clinical relevance of the immunological changes observed for both HIV-1+ and HIV-1- individuals. These results indicate that behavioral interventions may have salutary immunological and clinical health effects following bereavement among HIV-1-infected individuals. The effect in HIV-1- individuals suggests that this bereavement support group intervention might have similar salutary effects in the general population. Potential effects of such interventions on clinical HIV disease progression are of interest and should be studied.
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Affiliation(s)
- K Goodkin
- Department of Psychiatry and Behavioral Sciences, University of Miami School of Medicine, Florida 33136-1045, USA.
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Baldewicz T, Goodkin K, Feaster DJ, Blaney NT, Kumar M, Kumar A, Shor-Posner G, Baum M. Plasma pyridoxine deficiency is related to increased psychological distress in recently bereaved homosexual men. Psychosom Med 1998; 60:297-308. [PMID: 9625217 DOI: 10.1097/00006842-199805000-00016] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE Previous research has demonstrated that a theoretical model including measures of life stressors, social support, and coping style significantly predicts psychological distress. This study tested plasma pyridoxine (vitamin B6) deficiency status as a predictor of overall psychological distress and specific mood states in this model, controlling for HIV-1 serostatus. METHOD Subjects included HIV-1+ (N = 76) and HIV-1- (N = 58) recently bereaved homosexual men. At baseline, subjects completed a battery of psychosocial questionnaires, together with a physical examination and venipuncture. The Profile of Mood States (POMS) provided measures of overall psychological distress as well as specific mood states. Pyridoxine deficiency status (a categorical measure of deficient vs. adequate status) was determined with a bioassay of erythrocyte aspartate aminotransferase activity. RESULTS Pyridoxine deficiency was a significant predictor of increased overall psychological distress in this model, controlling for life stressors, social support, coping style, and HIV-1 serostatus. In post hoc analyses of specific mood state effects, pyridoxine deficiency status was significantly associated with increases in depressed, fatigued, and confused mood levels, but not with those of anxiety, anger, or vigor. DISCUSSION These findings suggest that adequate pyridoxine status may be necessary to avert psychological distress in the setting of bereavement. Inasmuch as pyridoxine is a cofactor for 5-hydroxytryptophan decarboxylase--an enzyme in the biosynthesis pathway of serotonin--serotonin level in the brain is implicated as the mediating factor.
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Affiliation(s)
- T Baldewicz
- Department of Psychology, University of Miami School of Medicine, Florida 33136, USA
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Eich-Höchli E, Niklowitz MW, Lüthy R, Opravil M. Are immunological markers, social and personal resources, or a complaint-free state predictors of progression among HIV-infected patients? Acta Psychiatr Scand 1997; 95:476-84. [PMID: 9242842 DOI: 10.1111/j.1600-0447.1997.tb10135.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Predictors of disease progression were studied in 89 asymptomatic HIV-infected patients who were prospectively evaluated for psychosocial variables and the development of clinical symptoms over a period of 2 years. The subjects were assessed for symptoms, laboratory measures, demographic variables, social and personal resources, mental status, alcohol, nicotine and drug use, sexual activity and risk behaviour, and sexually transmitted diseases. After 1 year, 17% of the patients had developed HIV-associated symptoms (symptomatic disease or AIDS), and after 2 years, 32% had developed symptoms or had died. In the multivariate analyses, the baseline CD4 count was the only significant predictor of disease progression during both observation periods. Psychosocial measures did not predict the progression of HIV infection.
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Affiliation(s)
- E Eich-Höchli
- Department of Medicine, University Hospital, Zurich, Switzerland
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