Psychological well-being in persons receiving HIV-related mental health services: the role of personal meaning in a stress and coping model

Presence of meaning, search for meaning, religiousness, satisfaction with life and depressive symptoms among a diverse Israeli sample

The present study explored the structure and correlates of meaning in life (MIL) among an Israeli sample. The sample consisted of 559 adults. The average age of participants was 48.24 and 61.3% of them were females. Participants provided demographic information and completed measures of MIL, satisfaction with life, and depressive symptoms. The MIL Questionnaire showed a very good fit for the proposed 2-factor model (i.e. presence of meaning, search for meaning) to the data collected from the current sample. Presence of meaning correlated positively with both search for meaning and satisfaction with life, and negatively with depressive symptoms. Search for meaning was positively and weakly tied to satisfaction with life, but was unrelated to depressive symptoms. Religiousness appeared as a significant moderator between the two meaning factors, and between them and life satisfaction. Specifically, as religiousness became stronger: (a) the link between presence of meaning and search for meaning became weaker; (b) the link between presence of meaning and life satisfaction became stronger and (c) the link between search for meaning and life satisfaction became weaker. The findings suggest that there are differential implications of presence search for meaning on the health and well-being, and the important role religiousness plays in this regard.

Association between coping strategies, social support, and depression and anxiety symptoms among rural Ugandan women living with HIV/AIDS

Poor mental health detrimentally affects quality of life among women living with HIV/AIDS. An improved understanding of how coping and social support relate to depression and anxiety in this population can facilitate the design and implementation of appropriate mental health treatment and support services. Secondary analysis was conducted on baseline data from 288 HIV-positive women enrolled in a parenting intervention in Uganda. Depression and anxiety symptoms, social support, and coping were assessed with the Hopkins Symptom Checklist and adapted versions of the Multidimensional Scale for Perceived Social Support and Ways of Coping Questionnaire. General linear regression models were used to estimate associations between coping and mental health. Based on report of elevated symptoms, approximately 10% of women were categorized as having clinically-relevant depression or anxiety. Emotion-focused (EF: p < .001) and problem-focused (PF: p = .01) coping were associated with more depressive symptoms while greater family support (EF: p = .002; PF: p = .003) was associated with fewer depression symptoms. More anxiety symptoms were associated with reporting both coping strategies (EF: p < .001; PF: p = .02) and higher community support (EF&PF: p = .01). The cross-sectional nature of the study limits our ability to rule out the role of reverse causation in the significant relationship between coping and mental health. Findings do suggest that high family support can be protective against depression and anxiety symptoms among women living with HIV.

A Meaningful Life is a Healthy Life: A Conceptual Model Linking Meaning and Meaning Salience to Health

Accumulating evidence suggests that a global sense of meaning in life is related to physical health, including increased longevity and reduced morbidity. However, the mechanisms responsible for these relationships remain largely unknown and uninvestigated. Moreover, there is no unifying conceptual framework linking meaning in life to physical health. Our aims are to (a) review the literature linking meaning in life to potential mechanisms associated with better physical health; (b) offer a comprehensive conceptual framework associating meaning in life with physical health; and (c) introduce a new construct, meaning salience, as a potentially important intermediary mechanism. Specifically, we review the evidence suggesting that meaning in life is associated with reduced stress, more adaptive coping, and greater engagement in health-promoting behaviors. Our model proposes that effects of global sense of meaning are potentiated through increased meaning salience, or daily awareness of meaning in the moment, which enhances self-regulation. Suggestions are proposed for empirically examining this new model.

Patient Reported Outcome Measure of Spiritual Care as Delivered by Chaplains

Chaplains are employed by health organizations around the world to support patients in recognizing and addressing their spiritual needs. There is currently no generalizable measure of the impact of these interventions and so the clinical and strategic worth of chaplaincy is difficult to articulate. This article introduces the Scottish PROM, an original five-item patient reported outcome measure constructed specifically to address this gap. It describes the validation process from its conceptual grounding in the spiritual care literature through face and content validity cycles. It shows that the Scottish PROM is internally consistent and unidimensional. Responses to the Scottish PROM show strong convergent validity with responses to the Warwick and Edinburgh Mental Well-Being Scale, a generic well-being scale often used as a proxy for spiritual well-being. In summary, the Scottish PROM is fit for purpose. It measures the outcomes of spiritual care as delivered by chaplains in this study. This novel project introduces an essential and original breakthrough; the possibility of generalizable international chaplaincy research.

Health-related quality of life and associated factors in people with HIV: an Irish cohort study

Background

Considering the chronic and debilitating nature of HIV infection, health-related quality of life (HRQoL) is an important patient-reported clinical outcome to better understand the effects of this infection and its treatment on patients’ lives. The purpose of this study was to assess the HRQoL and its association with sociodemographic, behavioural, clinical, nutrition-related factors and social support in an Irish HIV cohort.

Methods

A cross-sectional, prospective study using the Medical Outcomes Study HIV Health survey assessed the 10 dimensions of HRQoL and summarised as Physical Health Summary (PHS) and Mental Health Summary (MHS) scores. Participants were categorised as having good or poor PHS and MHS using the standardised mean score of 50. The variables independently associated with PHS and MHS were identified using multivariable logistic regression models.

Results

Overall, 521 participants completed the HRQoL questionnaire. The median (IQR) PHS and MHS scores were 56 (47–60) and 51 (41–58) respectively. All the covariate groups had lower MHS than PHS. Participants with symptoms of HIV reported the lowest median (IQR) PHS score 44.7 (32.–54.5) and MHS score 36.1 (28.6–48.4). Of the 10 dimensions of HRQoL, the lowest scores were for the energy level and general health. Symptoms of HIV, co-morbidities, social support, employment and ethnicity had independent association with both PHS and MHS. Gender, education, alcohol intake and HIV-complications were associated with PHS. Age, illicit drugs, BMI and malnutrition were associated with MHS. However, CD4 count and viral load were not independently associated with PHS and MHS in multivariable regression models.

Conclusion

Overall, HIV-infected people in this cohort had an average level of HRQoL. However, it is impaired in people with symptoms and co-morbidities, and not independently associated with CD4 and viral load. Alleviating HIV symptoms and preventing co-morbidities are important in managing HIV. Providing psychosocial supports for behaviour modification and return to work or exploring new opportunities will help to improve HRQoL. Healthcare providers and policy makers need to plan and implement programs to routinely assess the HRQoL in a systematic method to facilitate a holistic management of HIV.

Illness appraisals and depression in the first year after HIV diagnosis

Illness appraisals provide important context to help understand the way individuals cope with chronic illness. In the present study, a qualitative approach to the analysis of HIV diagnosis experience narratives in a sample of 100 people newly diagnosed with HIV revealed five groups that differed in their initial illness appraisals: HIV as Chronic Illness, Concern about Dying, Stigmatization, Threat to Identity, and Other Threats Overshadow HIV. When compared on quantitatively measured depressive mood, the groups differed on level and trajectory over the course of the first year post-diagnosis. Although the experience of living with HIV has changed significantly with the advent of effective Antiretroviral Therapies (ART), there were a number of similarities between the appraisals of this group of participants who were diagnosed post ART and groups who were diagnosed before ART became widely available. Posttest counselors and other HIV service providers should take individual differences in illness appraisals into account in order to help newly HIV-positive clients manage their healthcare and cope adaptively with their diagnosis.

Personal meaning as a predictor of psychological well-being over time in individuals receiving HIV-related mental health services

OBJECTIVE

This study examined the utility of personal meaning as a resilience variable in predicting psychological well-being over time in individuals enrolled in an HIV-related mental health services program. It was hypothesized that meaning assessed at the time of enrollment for mental health services would significantly predict well-being at the 3-month follow-up visit. A secondary hypothesis was that meaning would predict well-being in a model that also included social support as a predictor variable.

METHOD

Participants completed self-report measures of psychological well-being, personal meaning and social support at the time of their initial mental health services visit. Well-being was measured again at the time of the 3-month follow-up visit. Regression methods were used for statistical analysis.

RESULTS

Personal meaning assessed at the baseline visit was predictive of psychological well-being assessed at the 3-month follow-up visit when baseline well-being was controlled. Additionally, social support mediated the association between personal meaning and psychological well-being at the 3-month follow-up visit.

CONCLUSIONS

Assessing personal meaning as a resilience variable in this clinical psychiatric sample of individuals enrolled in an HIV mental health services program was useful in predicting psychological well-being over time.