Resilience Moderates the Association Between Childhood Sexual Abuse and Depressive Symptoms Among Women with and At-Risk for HIV

Moderating and mediating effects of resilience between childhood trauma and psychotic-like experiences among college students

BACKGROUND

Extensive literature revealed that childhood trauma serves as a significant risk factor for developing psychotic-like experiences (PLEs) among the general population. Resilience has been regarded as a protective factor against PLEs. However, it remains unclear what role resilience plays in the relationship between childhood trauma and PLEs.

METHODS

A total of 4302 college students completed the web-based survey in January 2021. Participants completed self-report measures of sample characteristics variables, childhood trauma, and PLEs. Moderation and mediation analyses were adopted to examine the associations linking childhood trauma, resilience, and PLEs.

RESULTS

PLEs were positively associated with childhood trauma while negatively associated with resilience. Resilience played a partially mediating role in the relationship between childhood trauma and PLEs. Additionally, resilience moderated the association of childhood trauma with PLEs.

CONCLUSIONS

These findings indicated that resilience plays a crucial role in mediating the relationship between childhood trauma and PLEs, suggesting the potential clinical implication of enhancing resilience for the prevention and intervention of PLEs among college students.

To what extent do social support and coping strategies mediate the relation between childhood maltreatment and major depressive disorder: A longitudinal community-based cohort

This study aimed to articulate the roles of social support and coping strategies in the relation between childhood maltreatment (CM) and subsequent major depressive disorder (MDD) with a comprehensive exploration of potential factors in a longitudinal community-based cohort. Parallel and serial mediation analyses were applied to estimate the direct effect (DE) (from CM to MDD) and indirect effects (from CM to MDD through social support and coping strategies, simultaneously and sequentially). Sociodemographic characteristics and genetic predispositions of MDD were considered in the modeling process. A total of 902 participants were included in the analyses. CM was significantly associated with MDD (DE coefficient (β) = 0.015, 95% confidence interval (CI) = 0.002∼0.028). This relation was partially mediated by social support (indirect β = 0.004, 95% CI = 0.0001∼0.008) and negative coping (indirect β = 0.013, 95% CI = 0.008∼0.020), respectively. Social support, positive coping, and negative coping also influenced each other and collectively mediated the association between CM and MDD. This study provides robust evidence that although CM has a detrimental effect on later-on MDD, social support and coping strategies could be viable solutions to minimize the risk of MDD. Intervention and prevention programs should primarily focus on weakening negative coping strategies, then strengthening social support and positive coping strategies.

Influence of childhood trauma, HIV infection, alcohol use disorder, and resilience on health-related quality of life in adulthood

Experience of childhood trauma, especially physical, emotional, and sexual abuse, carries a risk for developing alcohol use disorder (AUD) and engaging in risky behaviors that can result in HIV infection. AUD and HIV are associated with compromised self-reported health-related quality of life (HRQoL) possibly intersecting with childhood trauma. To determine whether poor HRQoL is heightened by AUD, HIV, their comorbidity (AUD + HIV), number of trauma events, or poor resilience, 108 AUD, 45 HIV, 52 AUD + HIV, and 67 controls completed the SF-21 HRQoL, Brief Resilience Scale (BRS), Ego Resiliency Scale (ER-89), and an interview about childhood trauma. Of the 272 participants, 116 reported a trauma history before age 18. Participants had a blood draw, AUDIT questionnaire, and interview about lifetime alcohol consumption. AUD, HIV, and AUD + HIV had lower scores on HRQoL and resilience composite comprising the BRS and ER-89 than controls. Greater resilience was a significant predictor of better quality of life in all groups. HRQoL was differentially moderated in AUD and HIV: more childhood traumas predicted poorer quality of life in AUD and controls, whereas higher T-lymphocyte count contributed to better quality of life in HIV. This study is novel in revealing a detrimental impact on HRQoL from AUD, HIV, and their comorbidity, with differential negative contribution from trauma and beneficial effect of resilience to quality of life. Channeling positive effects of resilience and reducing the incidence and negative impact of childhood trauma may have beneficial effects on health-related quality of life in adulthood independent of diagnosis.

Structural equation model of intersectional microaggressions, discrimination, resilience, and mental health among black women with hiv

OBJECTIVE

Compared to non-Black women, Black women in the United States are more likely to be diagnosed with HIV, living with HIV, and have suboptimal HIV outcomes, disparities largely linked to structural and psychosocial factors that may impact mental health.

METHOD

151 Black women living with HIV (BWLWH) enrolled in a longitudinal cohort study completed baseline assessments between October 2019 and January 2020 in the Southeastern United States. Measures captured microaggressions (gendered-racial, HIV, and Lesbian/Gay/Bisexual/Transgender/Queer), "macro" discrimination acts (gender, race, HIV, sexual orientation), resilience factors (self-efficacy, trait resilience, posttraumatic growth, positive religious coping, and social support), and mental health (depressive symptoms, posttraumatic stress disorder (PTSD) symptoms, and posttraumatic cognitions). Four structural equation models were estimated with latent discrimination (LD), latent microaggression (LM), and latent resilience (LR) as predictors and depressive symptoms, PTSD symptoms, posttraumatic cognitions, and latent mental health (LH) as outcomes. Indirect pathways from LD and LM via LR and LR as a moderator were estimated.

RESULTS

Models fit well based on indices. There were significant direct pathways from LM and LR to depressive symptoms, posttraumatic cognitions, and LH and a significant direct pathway from LM to PTSD symptoms, but not from LD to any mental health outcome. Indirect pathways were not significant. However, LR moderated the relationships between both LM and LD with PTSD symptoms.

CONCLUSION

Intersectional microaggressions and resilience factors may play key roles in BWLWH's mental health. Research is needed to examine these pathways overtime and provide opportunities to improve mental health and HIV outcomes among BWLWH. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Examining the Associations Between Childhood Trauma, Resilience, and Depression: A Multivariate Meta-Analysis

TOPIC OF REVIEW

Childhood trauma has been associated with increased depression; however, resilience has been found to reduce this association.

METHOD OF REVIEW

Present analyses were based on multivariate meta-analytical techniques, an extension of univariate meta-analysis. All computations were performed using the metafor package and the metaRmat package from R. Bivariate associations (r) between trauma, resilience, and depression were utilized as the pooled effect sizes.

CRITERIA FOR INCLUSION

Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, articles were coded based on the following inclusion criteria: (a) sample participants had a history of childhood trauma; (b) studies included one of the four instruments of trait resilience; (c) studies included measures of individual outcomes of depression; (d) studies were published in peer-reviewed journals, dissertations, book chapters since 2009, or provided by leading scholars who had yet to publish their data; (e) all manuscripts were written in English; and (f) studies included the Pearson Product Moment Correlation Coefficient (r) for the effect size.

CRITERIA FOR REVIEW

We systematically coded for the following items for each study: year of publication, type of report, peer-reviewed, funding, sampling strategy, sample size, gender, mean age, country of study, measure of resilience, measure depression, and measure of childhood trauma.

MAJOR FINDINGS

The pooled correlations indicate that trauma, resilience, and depression are significantly associated. There were no significant differences in symptoms of depression for high versus low reports of resilience for individuals with a history of trauma. Year of publication was a significant moderator for the associations between trauma, resilience, and depression. Resilience significantly mediated the association between trauma and depression.

Psychological resilience is an independent correlate of health-related quality of life in middle-aged and older adults with HIV in the Deep South

Older people living with HIV (PLWH) are at risk for poorer health-related quality of life (HRQoL). Psychological resilience may protect HRQoL in this population. The sample included 174 predominately African American PLWH (age 40-73). Results indicated associations between resilience, socioeconomic status, cognitive performance, instrumental activities of daily living, personality, and depressive symptoms. HIV factors (e.g. viral load, duration of HIV) were not associated with resilience. Adjusting for confounders, resilience was associated with mental HRQoL. Understanding factors associated with resilience among older PLWH and the translation of resilience to HRQoL may inform interventions to improve well-being among individuals aging with HIV.

Black Women Living with HIV: A Latent Profile Analysis of Intersectional Adversities, Resilience, and Mental Health

Black women living with HIV (BWLWH) face adversities, including discrimination (race, HIV, and gender related) and trauma. This study examines which latent profiles of resilience (R) and adversity (A) are most prevalent and their relationships to mental health among 119 BWLWH [age = 44.1 (standard deviation = 10.9)]. Questionnaires measured resilience (post-traumatic growth, trait/coping resilience, religious coping, social support), adversity (discrimination, trauma, microaggressions), and mental health [post-traumatic stress disorder (PTSD) symptoms, post-traumatic cognitions (PTC), and depressive symptoms]. Four salient profiles emerged through latent profile analysis and mental health differences were evaluated. Profile 1 (19.8%) reported lowest scores on 4 resilience measures, lowest traumas, and second lowest on discrimination (low resilience/low adversity-LR/LA). Profile 2 (13.8%) had second lowest on 3 resilience measures but second highest social support, highest/second highest on traumas and discrimination and microaggressions (low resilience/high adversity-LR/HA). Profile 3 (59.5%) exhibited higher scores on resilience and lowest scores on 3 of 4 adversity measures (high resilience/low adversity-HR/LA). Profile 4 (6.9%) reported high on 3 resilience measures, but third lowest on social support, and second highest/highest traumas, discrimination, and microaggressions (high resilience/high adversity-HR/HA). For PTC, the HR/LA group had significantly lower scores compared with the LR/LA and LR/HA groups; and LR/HA had higher PTC scores than the HR/HA group. PTSD scores were significantly lower for HR/LA than all profiles. Depression scores were significantly higher for LR/LA and LR/HA groups than HR/LA. Findings indicate that lower adversity alongside higher resilience leads to better mental health. Policies must address intersectional discrimination and prevent trauma impacting BWLWH; interventions are needed to improve social support and healing. Clinical Trial Registration number NCT02764853.

Resilience Following Child Maltreatment: Definitional Considerations and Developmental Variations

Resilience following childhood maltreatment has received substantial empirical attention, with the number of studies on this construct growing exponentially in the past decade. While there is ample interest, inconsistencies remain about how to conceptualize and assess resilience. Further, there is a lack of consensus on how developmental stage influences resilience and how protective factors affect its expression. The current systematic review uses a developmental lens to synthesize findings on resilience following child maltreatment. Specifically, this article consolidates the body of empirical literature in a developmentally oriented review, with the intention of inclusively assessing three key areas-the conceptualization of resilience, assessment of resilience, and factors associated with resilience in maltreatment research. A total of 67 peer-reviewed, quantitative empirical articles that examined child maltreatment and resilience were included in this review. Results indicate that some inconsistencies in the literature may be addressed by utilizing a developmental lens and considering the individual's life stage when selecting a definition of resilience and associated measurement tool. The findings also support developmental variations in factors associated with resilience, with different individual, relational, and community protective factors emerging based on life stage. Implications for practice, policy, and research are incorporated throughout this review.

Living With Chronic HIV Disease in the Antiretroviral Era: The Impact of Neurocognitive Impairment on Everyday Life Functions

Although there is extensive literature around the biologic correlations of neurocognitive function in HIV/AIDS, less is known about the impact in everyday living. We conducted a systematic review of the association of neurocognitive impairment with everyday life functions in people with HIV on antiretroviral therapy. We specifically focused on attention, executive function, processing speed, and the central executive component of the working memory. We considered 3 domains of everyday functions: (1) autonomy, (2) decision making and adherence to treatment, and (3) quality of life and psychologic wellbeing. The relationship between neurocognitive impairment and mental health was examined, given its correlation with everyday life functions. Results indicate that people with HIV do experience problems with autonomy of daily living (especially if aged older than 50 years) and with decision making, and neurocognitive impairment plays a role in this regard. Psychologic wellbeing is associated with executive function and processing speed. These patients may also have a reduced quality of life, but the relationship between quality of life and cognition is uncertain or could be mediated by other factors. Neurocognitive impairment correlates with depression and anxiety; however, the relationship of cognitive performance with apathy is still controversial.

Examining the relationship between physical and sexual violence and psychosocial health in young people living with HIV in rural South Africa

Introduction

Experiences of violence during youth contravene young people’s rights and increase the risk of depression and poor human immunodeficiency virus (HIV) care outcomes among youth living with HIV (YLWH). Intervention targets for mitigating the negative psychosocial effects of violence are needed, particularly in areas like rural South Africa where violence remains pervasive and mental healthcare is limited. This study aims to quantify the associations between physical and sexual violence and depressive symptoms in YLWH in rural South Africa and explore the modification of these associations by key measures of psychosocial well‐being.

Methods

We conducted a cross‐sectional survey among 362 YLWH ages 12 to 24 in rural South Africa to ascertain participants’ history of physical and sexual violence, current depressive symptoms (Center for Epidemiological Studies‐Depression Scale) and levels of social support (Medical Outcomes Social Support Scale), resilience (Conner‐Davidson Resilience Scale) and self‐esteem (Rosenberg Self‐Esteem Scale). Log‐binomial regression was used to estimate the association between history of physical or sexual violence and clinically meaningful depressive symptoms (scores ≥16). Effect measure modification by high versus low resilience, social support and self‐esteem was assessed using likelihood ratio tests (α = 0.20).

Results

A total of 334 individuals with a median age of 21 (interquartile range: 16 to 23) were included in this analysis. Most participants were female (71.3%), single (81.4%) and attending school (53.0%). Ninety‐four participants (28.1%) reported a history of physical or sexual violence and 92 individuals (27.5%) had clinically meaningful depressive symptoms. Meaningful depressive symptoms were significantly higher among participants with a history of physical or sexual violence as compared to those with no history of violence (adjusted prevalence ratio: 2.01; 95% CI: 1.43, 2.83). However, this association was significantly modified by social support (p = 0.04) and self‐esteem (p = 0.02).

Conclusions

In this setting, the prevalence of meaningful depressive symptoms was significantly higher among YLWH with a history of physical or sexual violence as compared to those without a history of violence. However, higher levels of self‐esteem or social support appeared to mitigate this association. Programmes to improve self‐esteem and social support for youth have the potential to minimize depressive symptoms in YLWH who have experienced physical or sexual violence.

Challenges to the conceptualization and measurement of resilience in HIV research

The purpose of this study was to evaluate the conceptualization and measurement of resilience in HIV research. Terms related to resilience and HIV were searched in three databases to identify peer-reviewed research articles. Of the 156 articles identified, 49 were included in the analyses. Applied thematic analysis was used to analyze the definitions and measurement of resilience. Articles were reviewed independently by two raters to establish inter-rater reliability. Six recurring themes were identified in the definitions of resilience: adaptation, positive mental health symptoms, the absence of negative mental health symptoms, hardiness, coping, and the ability to "bounce back". Among the articles examined, 14 measures were used to assess resilience, half of which were indirect. These findings help make sense of the available literature on resilience and highlight the importance of clearly operationalizing resilience and measuring it in a way that is congruent with its definition in future HIV research studies.

Resilience among Cisgender and Transgender Women in Street-Based Sex Work in Baltimore, Maryland

INTRODUCTION

Resilience represents adaptability and empowerment and can buffer against the consequences of traumatic events. Cisgender and transgender women in street-based sex work are at high risk for trauma, yet data on their resilience are sparse. A clearer understanding of resilience and its correlates is useful for informing sex worker-centered interventions.

METHODS

Using the Connor-Davidson 10-item Resilience Scale (range, 0-40), we describe resilience among 165 cisgender and 42 transgender street-based women sex workers in Baltimore, Maryland. Longitudinal cohort data were used to examine correlates of resilience in each population. Analyses are conducted using multiple linear regression.

RESULTS

The mean resilience score was 24.2 (95% confidence interval, 23.6-24.8) among cisgender women sex workers and 32.2 among transgender women sex workers (95% confidence interval, 30.8-32.7). Among cisgender participants, positive correlates of resilience were being Black, Hispanic, or other race (ß = 2.7; p = .004), having housing (ß = 1.9; p = .034), social cohesion score (ß = 0.18; p = .047), and daily drug injection (ß = 3.7; p < .001); negative correlates of resilience were sexual violence (ß = -4.8; p = .006) and exposure to egregious police acts (ß = -0.6; p = .015). Among transgender participants, higher education level (ß = 8.8; p < .001), food security (ß = 3.5; p = .005), and housing stability (ß = 2.0; p < .001) were associated with increased resilience, and daily noninjection drug use (excluding marijuana; ß = -3.3; p < .001) and physical violence (ß = -2.9; p < .001) were associated with reduced resilience.

CONCLUSIONS

This study is the first to characterize factors that may influence resilience among cisgender and transgender women sex workers. Results highlight tangible intervention targets for promoting mental health and safety among a uniquely vulnerable population of women.

Resilience Moderated the Predictive Effect of Dual Stigma on Distress Among Chinese Newly Diagnosed HIV-Positive Men Who Have Sex With Men

Previous studies have examined the distinct stigmas of people living with HIV or of men who have sex with men (MSM). To capture the composite stress of HIV-positive MSM and the mixed stigma they experience, we conceptualized a compound stigma combining HIV status and homosexual identity. At two waves with an interval of 6 months, the results of 112 Chinese newly diagnosed HIV-positive MSM showed that dual stigma at baseline increased distress symptoms 6 months later. Resilience moderated these effects, as the dual stigma increased, distress symptoms intensified more rapidly for individuals with lower resilience than they did for those with higher resilience. Our findings highlight that dual stigma, as an intensified risk factor, predicted distress among the Chinese newly diagnosed HIV-positive MSM, conditioned by the protective factor of resilience. The results have strong implications for developing resilience-based intervention programs in this population.

Resilience and HIV Treatment Outcomes Among Women Living with HIV in the United States: A Mixed-Methods Analysis

Resilience is defined as the ability and process to transform adversity into opportunities for growth and adaptation. Resilience may be especially important for people living with HIV (PLWH), who are susceptible to anxiety and depressive disorders, which are commonly linked to risk behaviors (i.e., alcohol and drug abuse), poor adherence to medical regimens, increased risk of morbidity and mortality, and related stigma and discrimination. To date, few studies have examined the impact of resilience on health-related behaviors and outcomes among PLWH, particularly among minority women living with HIV (WLWH) who are dealing with multiple stressors impacting their health. This study used a convergent parallel mixed-methods design to collect, analyze, and integrate qualitative and quantitative data from a subsample of WLWH enrolled in the Women's Interagency HIV Study (WIHS). The aims of the study were to (1) qualitatively examine the resilience perspectives of 76 marginalized WLWH, and; (2) quantitatively assess the associations of resilience with HIV health outcomes-adherence to antiretroviral therapy and viral suppression-in the context of differing levels of internalized HIV-related stigma and depressive symptoms (n = 420). Findings from this mixed-methods study suggest that resilience is an important resource that can aid WLWH in coping constructively with adversity by capitalizing on intrapersonal traits and states, interpersonal and institutional resources, and spiritual and/or religious practices. Given the complex medical and social needs of marginalized WLWH, intervention strategies should focus on mitigating psychosocial burdens of stigma and depression, in addition to building resilience.

Examining Multilevel Factors Associated with the Process of Resilience among Women Living with HIV in a Large Canadian Cohort Study: A Structural Equation Modeling Approach

Objectives:

We examined how multiple, nested, and interacting systems impact the protective process of resilience for women living with HIV (WLWH).

Methods:

Using data from a Cohort Study, we conducted univariate analyses, multivariable logistic regression, and a 2-step structural equation modeling for the outcome, high resilience (N = 1422).

Results:

Participants reported high overall resilience scores with a mean of 62.2 (standard deviation = 8.1) and median of 64 (interquartile range = 59-69). The odds of having high resilience were greater for those residing in Quebec compared to Ontario (adjusted odds ratio [aOR] = 2.1 [1.6, 2.9]) and British Columbia (aOR = 1.8 [1.3, 2.5]). Transgender women had increased odds of high resilience than cisgender women (aOR = 1.9 [1.0, 3.6]). There were higher odds of resilience for those without mental health diagnoses (aOR = 2.4 [1.9, 3.0]), non-binge drinkers (aOR=1.5 [1.1, 2.1]), and not currently versus previously injecting drugs (aOR = 3.6 [2.1, 5.9]). Structural equation modeling confirmed that factors influencing resilience lie at multiple levels: micro, meso, exo, and macro systems of influence.

Conclusion:

There is a need to consider resilience as the interaction between the person and their environments, informing the development of multilevel interventions to support resilience among WLWH.

The Moderating Effect of Resilience on the Relationship between Adverse Childhood Experiences (ACEs) and Quality of Physical and Mental Health among Adult Sexual and Gender Minorities

Sexual and gender minority (SGM) individuals experience a greater burden of poor mental health compared to heterosexual individuals. One factor that helps to explain this disparity is trauma experienced during childhood. SGM are more likely to report traumatic experiences during childhood contributing to this disparity. Previous research has shown that resilience moderates the relationship between childhood trauma and adults mental health outcomes. As part of the Strengthening Colors of Pride project, data on 463 SGM adults living in San Antonio were collected using surveys. A diverse recruitment strategy was used in conjunction with a community advisory board. The brief resilience scale (BRS) was used to assess intrapersonal level resilience to determine if there was an effect on the relationship between ACEs and quality of mental and physical health. Differences were noted for some items across low, normal, and high levels of resilience. Both ACEs and BRS significantly predicted quality of mental and physical health. We also noted a significant interaction between ACEs and BRS with regard to quality of mental health. Findings suggest there is a relationship between intrapersonal level resilience, ACEs, and quality of mental health.

Gendered Racial Microaggressions Associated with Depression Diagnosis among Black Women Living with HIV

Black women are disproportionately impacted by HIV and depression has been linked to negative HIV outcomes. Little attention has been given to social/structural factors that may drive depression among Black women living with HIV (BWLWH), including discrimination and gendered racial microaggressions (GRM). One hundred BWLWH completed measures on GRM, race- and HIV-related discrimination, and depressive symptoms, as well as a clinical interview for major depressive episode (MDE). GRM and race- and HIV-related discrimination were significantly associated with depressive symptoms and increased likelihood of MDE, but only GRM contributed uniquely in associations with both. Interventions targeting depression among BWLWH should address GRM and race- and HIV-related discrimination.

Correlates of resilience after childhood sexual abuse among men who have sex with men

Men who have sex with men (MSM) are at high risk for physical and mental health conditions and are often discussed in the health literature as "at risk" versus "at promise". However, there is an ongoing need to examine factors that place MSM "at promise" for optimal well-being. This manuscript examines correlates of resilience, the ability to "bounce back" and function adaptively after adversities, among MSM. One hundred and five MSM with a history of childhood sexual abuse, who were enrolled in a randomized control trial were recruited for a supplemental study assessing resilience and other psychosocial factors. Participants completed measures assessing resilient trait and coping (i.e. "I am able to adapt" and "I tend to bounce back"), symptoms of trauma, trauma-related thoughts, and distress tolerance (ability to regulate unpleasant feelings). Findings from multivariable linear regressions controlling for covariates (age, education, race/ethnicity, and income) indicated that higher resilience was associated with (a) lower trauma scores on reexperiencing severity (b = -1.41, SE = .53, p = .01) and avoidance severity (b = -1.61, SE= .67, p = .02), (b) lower post-traumatic cognitions (b = -11.39, SE = 5.08, p = .03) especially negative cognitions about the self (b = -.44, SE = .16, p = .007), and (c) higher distress tolerance (b = .26, SE = .10, p = .01). Our preliminary findings suggest that resilient coping/traits are important to research after childhood sexual abuse among MSM, potentially assess in clinical settings, and address in interventions.

Using Motivational Interviewing to Increase PrEP Uptake Among Black Women at Risk for HIV: an Open Pilot Trial of MI-PrEP

Black women in the USA are at the highest risk among women for HIV. Pre-exposure prophylaxis (PrEP) prevents HIV transmission, but uptake among Black women remains low. An open pilot trial was conducted on MI-PrEP, a brief culturally tailored intervention incorporating motivational interviewing (MI) strategies to improve PrEP uptake and motivation. MI-PrEP is the first behavioral intervention developed to promote PrEP uptake among women in the USA. In Miami, FL, ten Black women who met eligibility criteria (e.g., sexual partner with HIV) were enrolled. These women participated in the two sessions of MI-PrEP and a 1-month follow-up. Participants completed measures on PrEP (motivation, uptake [verified via medical records], adherence, and barriers), medical mistrust, and an exit interview. These preliminary findings showed acceptability and feasibility with high satisfaction ratings; increases in PrEP uptake, knowledge, and motivation to use; and decreases in PrEP barriers and medical mistrust. Greater attention is needed on the psychosocial and structural factors among Black women who may benefit from PrEP.

The People Living with HIV (PLHIV) Resilience Scale: Development and Validation in Three Countries in the Context of the PLHIV Stigma Index

Supporting resilience among people living with HIV (PLHIV) is crucial to their sustained uptake of HIV services as well as psychological and social wellbeing. However, no measures exist to assess resilience specifically in relation to living with HIV. We developed the PLHIV Resilience Scale and evaluated its performance in surveys with 1207 PLHIV in Cameroon, Senegal and Uganda as part of the PLHIV Stigma Index-the most widely used tool to track stigma and discrimination among PLHIV worldwide. Factor analyses demonstrated satisfactory psychometric properties and reliability (alphas = 0.81-0.92). Levels of resilience (e.g., whether one's self-respect has been positively, negatively, or not affected by one's HIV status) varied substantially within and across countries. Higher resilience was associated with less depression in each country (all p < 0.001), and, in Cameroon and Uganda, better self-rated health and less experience of stigma/discrimination (all p < 0.001). The final 10-item PLHIV Resilience Scale can help inform interventions and policies.

Effects of childhood emotional maltreatment on depressive symptoms through emotion dysregulation in treatment-seeking patients with heroin-dependence

BACKGROUND

Although individuals who experience childhood emotional maltreatment (CEM) are more likely to use maladaptive emotion regulation strategies, resulting in vulnerability to depression, no research has examined whether emotion dysregulation may explain the association between CEM and current depressive symptoms in a clinical sample of heroin-dependent individuals.

OBJECTIVES

The current study aimed to assess the direct effect of CEM on current depressive symptoms and its indirect effect via emotion dysregulation in a treatment-seeking sample of males with heroin dependence. In a cross-sectional design, participants (N = 350) completed the Childhood Trauma Questionnaire-Short Form (CTQ-SF), the Difficulties in Emotion Regulation Scale (DERS), the Obsessive-Compulsive Drug Use Scale (OCDUS), and the Beck Depression Inventory-II (BDI-II).

RESULTS

Emotional abuse and neglect severity had significant direct effects on current depressive symptoms and significant indirect effects through emotion dysregulation after controlling for clinical factors related to heroin use.

LIMITATIONS

Study limitations include the cross-sectional design and use of self-report scales.

CONCLUSIONS

Findings suggest emotion dysregulation may increase depressive symptoms in heroin users who experienced CEM. Training in emotion regulation strategies may decrease depressive symptoms in heroin-dependent individuals with CEM. Additional research with a longitudinal design to confirm these results is warranted.

Resilience resources among African American women living with HIV in Southern United States

OBJECTIVES

African American women living with HIV (WLH) often face various challenges to access to and benefit from healthcare across the HIV treatment cascade. Despite experiencing multiple forms of ongoing adversity, some African American WLH are able to adapt and stand strong. The current study aims to identify resources at various socioecological levels that facilitate resilience and explore how these resources interact with each other.

DESIGN

Guided by the theories of resilience, we collected qualitative data through in-depth interviews with 14 African American WLH in South Carolina, United States.

METHODS

Participants were purposely recruited and interviewed in private settings in 2016. With appropriate consent, each interview was recorded and was transcribed verbatim. Data analysis was conducted using NVivo 11.0.

RESULTS

The participants described six major resilience resources including first, internal strength; second, religion and spirituality; third, hopefulness about life and future; fourth, self-awareness and self-care; fifth, social support from family and community; and sixth, HIV-related health facilities. The themes that occurred in qualitative data also show how resilience resources at the family/community level and institutional level affected individual resources, and how these resources collaborated with each other.

CONCLUSION

The findings suggest that resilient African American WLH maintain hope in the face of adversity and seek out and obtain social support. Self-care, social support, and health facilities are particularly critical resources for African American WLH. Comprehensive interventions are needed to integrate these resources across multiple socioecological levels to enhance resilience and treatment outcomes in African American WLH.

Depression and aging with HIV: Associations with health-related quality of life and positive psychological factors

BACKGROUND

Depression is prevalent among persons living with HIV (PLWH). This study investigated the relationships between depressive symptomatology, health-related quality of life (HRQoL), and positive psychological factors in PLWH and age-matched HIV-individuals.

METHODS

One hundred twenty-two PLWH and 94 HIV- individuals, recruited in three age cohorts (36-45, 46-55, 56-65 years old), completed self-report questionnaires on depressive symptoms (CES-D), HRQoL, and positive psychological factors (resilience, grit, and self-rated successful aging [SRSA]). Participants were classified based on HIV status (H+ vs H-) and elevated depressive symptoms (D+ vs D-) into four groups (H+/D+; H-/D+; H+/D-; H-/D-).

RESULTS

Fifty-eight percent of PLWH had elevated depressive scores, compared to 33% of HIV- individuals (p < 0.001). The proportion of individuals reporting elevated depressive symptoms only differed among individuals 36-45 years old (H+: 61.5%; H-: 17.9%; p < 0.001). Individuals in the H+/D+ group reported the lowest HRQoL, resilience, grit, and SRSA across age cohorts. However, there were no differences on HRQoL or positive psychological factors between H+/D- and H-/D- groups; in fact, individuals 56-65 years in the H+/D- group endorsed aging the most successfully.

LIMITATIONS

Small sample size within the groups and the cross-sectional nature of the analysis limit the ability to address onset of depressive symptoms in relation to HRQoL or positive psychological factors.

CONCLUSIONS

Among PLWH depressive symptoms show a strong association with HRQoL and positive psychological factors compared to HIV- individuals. In the absence of elevated depressive symptoms, however, PLWH report similar HRQoL and positive psychological factors to HIV- individuals.

Factors associated with resilience among Black women living with HIV and histories of trauma

In the United States, Black women living with HIV face various individual (e.g. trauma) and structural (e.g. racism) adversities. However, resilience is understudied among Black women living with HIV. A total of 100 Black women living with HIV in the United States completed measures of resilience, general self-efficacy, self-esteem, post-traumatic growth, trauma symptoms, trauma-related cognitions, and depressive symptoms. Regressions controlling for age and education indicated that higher resilience was associated with higher general self-efficacy (β = .39, p < .001), higher self-esteem (β = .48, p < .001), higher post-traumatic growth (β = .34, p < .01), lower post-traumatic cognitions (β = -.36, p < .001), lower trauma symptoms (β = -.29, p < .01), and lower depressive symptoms (β = -.38, p < .001). Our findings suggest potential targets for interventions.

Resilience and HIV: a review of the definition and study of resilience

We use a socioecological model of health to define resilience, review the definition and study of resilience among persons living with human immunodeficiency virus (PLWH) in the existing peer-reviewed literature, and discuss the strengths and limitations of how resilience is defined and studied in HIV research. We conducted a review of resilience research for HIV-related behaviors/outcomes of antiretroviral therapy (ART) adherence, clinic attendance, CD4 cell count, viral load, viral suppression, and/or immune functioning among PLWH. We performed searches using PubMed, PsycINFO and Google Scholar databases. The initial search generated 14,296 articles across the three databases, but based on our screening of these articles and inclusion criteria, n = 54 articles were included for review. The majority of HIV resilience research defines resilience only at the individual (i.e., psychological) level or studies individual and limited interpersonal resilience (e.g., social support). Furthermore, the preponderance of HIV resilience research uses general measures of resilience; these measures have not been developed with or tailored to the needs of PLWH. Our review suggests that a socioecological model of health approach can more fully represent the construct of resilience. Furthermore, measures specific to PLWH that capture individual, interpersonal, and neighborhood resilience are needed.

Resilience takes a village: black women utilize support from their community to foster resilience against multiple adversities

Black women living with HIV (BWLWH) represent the highest percentage of women with HIV in the U.S. and experience worse health outcomes than other women living with HIV, in part due to experiences of trauma, racism, HIV-stigma, and stressors they face as women. However, their own stories of resilience in the face of multiple adversities and insights of community stakeholders may inform our field on how to best empower this population to strive despite adversities. Thirty BWLWH in the U.S. and fifteen community stakeholders were interviewed about women's experiences and adaptive coping strategies used to cope with trauma, racism, HIV-stigma, and gender-related stressors. Interviews were coded using thematic content analysis. A major theme that spanned across interviews with BWLWH and community stakeholders was that resilience was fostered by members of their "village". In the midst of or following adverse experiences BWLWH used social support from their children, grandchildren, other family members, friends/peers, and caring providers in order to overcome their adversities and focus on their health and well-being. Promoting resilience among BWLWH requires an understanding of the most adaptive strategies utilized to "bounce back" following or in the face of adversities. Our findings highlight that both BWLWH and community stakeholders recognize social support from their "village" as an importance resilience resource. Research and applied efforts need to be geared at strengthening both BWLWH and their "village" in order to promote resilience and reduce health disparities.

Resilience as a moderator between syndemics and depression in mothers living with HIV

Physical and emotional adversities in mothers have rippling effects across the family system. While an association between individual maternal adversities and problematic mental health outcomes has been established, less is known about co-existing adversities in mothers. Consistent with the syndemic conceptual framework, we examined the co-occurrence of Substance Abuse, Violence, and AIDS/HIV (i.e., SAVA), which are three adversities that uniquely affect racial/ethnic minorities, individuals living in poverty, and people in urban communities. We assessed the relationship between SAVA adversities and depressive symptoms among mothers living with HIV, as well as the moderating effect of resilience on this relationship. Participants included 55 mothers (M_age= 41.24, SD = 9.01; 81% Black) living with HIV in the U.S. MidSouth. Mothers were recruited from community agencies serving individuals living with HIV and completed hour-long interviews about SAVA, depression, resilience, life stressors, and their child's mental health. Analyses were conducted in PROCESS for SPSS to test the relationship between SAVA and depression, as moderated by resilience. Analyses controlled for the influence of child maladaptive functioning (given known associations with maternal mental health) and maternal life stressors (given established associations with depressive symptoms). Findings indicated that experiencing more than one SAVA variable was associated with greater depressive symptoms (p < .05). Higher resilience was associated with lower depressive symptoms (r = -.45; p < .01). Moderation was supported (β = -.80; p < .01) as the relationship between more SAVA epidemics and higher depressive symptoms was stronger when resilience was low and weaker when resilience was high. Results not only highlight how co-occurring adversities exacerbate depressive symptoms, but also underscore the role of resilience as a key protective factor among mothers living with HIV. Resilience could therefore be a target of strengths-based treatment to reduce the negative effects of SAVA on depressive symptoms among mothers.

Striving Towards Empowerment and Medication Adherence (STEP-AD): A Tailored Cognitive Behavioral Treatment Approach for Black Women Living With HIV

In the U.S. Black women with HIV face numerous psychosocial challenges, particularly trauma, racism, HIV-related discrimination, and gender role expectations, that are associated with negative HIV health outcomes and low medical treatment adherence. Yet many of these factors are unaddressed in traditional cognitive behavioral approaches. This study presents a case series of a tailored cognitive behavioral treatment approach for Black women living with HIV. Striving Towards EmPowerment and Medication Adherence (STEP-AD) is a 10-session treatment aimed at improving medication adherence for Black women with HIV by combining established cognitive behavioral strategies for trauma symptom reduction, strategies for coping with race- and HIV-related discrimination, gender empowerment, problem-solving techniques for medication adherence, and resilient coping. A case series study of five Black women with HIV was conducted to evaluate the preliminary acceptability and feasibility of the treatment and illustrate the approach. Findings support the potential promise of this treatment in helping to improve HIV medication adherence and decrease trauma symptoms. Areas for refinement in the treatment as well as structural barriers (e.g., housing) in the lives of the women that impacted their ability to fully benefit from the treatment are also noted.

Pre-exposure prophylaxis for HIV prevention in women: current perspectives

There are ~900,000 new HIV infections among women every year, representing nearly half of all new HIV infections globally. In the US, nearly one-fifth of all new HIV infections occur among women, and women from racial and ethnic minority communities experience disproportionately high rates of new HIV infections. Thus, there is a need to develop and implement effective HIV prevention strategies for women in the US and internationally, with a specific need to advance strategies in minority communities. Previous studies have demonstrated that oral HIV pre-exposure prophylaxis (PrEP), the use of antiretroviral medications by HIV-uninfected persons to prevent HIV acquisition, can reduce HIV incidence among women who are adherent to PrEP. However, to date, awareness and uptake of PrEP among women have been very limited, suggesting a need for innovative strategies to increase the knowledge of and access to PrEP among women in diverse settings. This narrative review summarizes the efficacy and safety data of PrEP in women, discusses considerations related to medication adherence for women who use PrEP, and highlights behavioral, social, and structural barriers to maximize the effectiveness of PrEP in women. It also reviews novel modalities for PrEP in women which are being developed and tested, including topical formulations and long-acting injectable agents that may offer advantages as compared to oral PrEP and proposes a community-oriented, social networking framework to increase awareness of PrEP among women. If women are provided with access to PrEP and support to overcome social and structural barriers to adhere to PrEP, this prevention strategy holds great promise to impact the HIV epidemic among women in the US and globally.

Moderating and mediating effects of resilience between childhood trauma and depressive symptoms in Chinese children

BACKGROUND

Childhood trauma has been regarded as a risk factor for adolescent depression. Resilience has been found to be a protective factor for adolescent mental health. However, it is not clear about the role of resilience in the relationship between childhood trauma and depression.

METHODS

School attending adolescents (n=6406) aged 9-17 years were drawn from five primary schools, three middle schools and two high schools in Wuhan city of China in 2015. The participants were invited to complete self-report questionnaires, including demographics, childhood trauma, resilience and depressive symptoms.

RESULTS

Resilience played a partially mediating role in the relationship between childhood trauma and depressive symptoms. Resilience also moderated the association of childhood trauma with depressive symptoms.

LIMITATION

The limitations of this study include cross-sectional study and self- reported instruments.

CONCLUSIONS

We conclude that resilience may play an important role in the relationship between childhood trauma and depressive symptoms. Our results suggest that enhancing resilience may provide new possibilities for prevention and intervention of depression in adolescents.

A Prospective Study of Intimate Partner Violence as a Risk Factor for Detectable Plasma Viral Load in HIV-Positive Women Engaged in Transactional Sex in Mombasa, Kenya

We conducted a prospective cohort study to evaluate intimate partner violence (IPV) as a risk factor for detectable plasma viral load in HIV-positive female sex workers (FSWs) on antiretroviral therapy (ART) in Kenya. IPV in the past year was defined as ≥1 act of physical, sexual, or emotional violence by the index partner (i.e. boyfriend/husband). The primary outcome was detectable viral load (≥180 copies/ml). In-depth interviews and focus groups were included to contextualize results. Analyses included 195 women (570 visits). Unexpectedly, IPV was associated with significantly lower risk of detectable viral load (adjusted relative risk 0.21, 95 % CI 0.05-0.84, p-value = 0.02). Qualitative findings revealed that women valued emotional and financial support from index partners, despite IPV. IPV was not a major barrier to ART adherence. The observed association between IPV and lower risk of detectable viral load in FSWs may be due to unmeasured personal and relationship factors, warranting further research.

Fate control and well-being in Chinese rural people living with HIV: mediation effect of resilience

Fate control has been often misconceptualized as a superstitious belief and overlooked in health psychology. It is not known how this cultural belief might impact the well-being of Chinese people living with HIV. This study examined the protective role of fate control for well-being and the potential mediation effect of resilience. Participants in this study were rural patients who contracted HIV via commercial blood donation. In this cross-sectional survey, 250 participants completed measures of fate control, well-being, and resilience. The results showed that fate control and resilience were positively associated with well-being. Resilience mediated the association between fate control and well-being. Our findings provide insight into the adaptive function of fate control as a cognitive defensive mechanism and highlight the need to incorporate this cultural belief in developing culturally sensitive intervention programs for resilience enhancement tailored for this understudied population infected with HIV living in rural China.

A Review of Recent Literature on Trauma Among Individuals Living with HIV

Persons living with HIV (PLWH) report disproportionately high levels of exposure to traumatic events in childhood and adulthood. Traumatic experiences are associated with negative health and behavioral outcomes. Current research in this area seeks to further explicate the myriad health effects of trauma on PLWH and the pathways through which trauma operates. In this paper, we review articles published in English between January 2014 and June 2015 that examine traumatic experiences among PLWH, including intimate partner violence (IPV), domestic abuse, child abuse, and other forms of violence. A selection of studies examining trauma among PLWH and its associations with mental health, antiretroviral medication adherence, clinical outcomes, HIV disclosure, and sexual risk behaviors were included. Studies describing trauma coping strategies and interventions were also included. We conclude with recommendations for care of trauma-exposed PLWH and directions for future research.