Negative HIV-specific expectancies and AIDS-related bereavement as predictors of symptom onset in asymptomatic HIV-positive gay men

The structure of coping among older adults living with HIV/AIDS and depressive symptoms

One-third of adults living with HIV/AIDS are over the age of 50. This study evaluated the structure of coping among 307 older adults living with HIV/AIDS. Participants completed 61 coping items and measures of anxiety, depression, loneliness, and coping self-efficacy. Exploratory factor analyses retained 40 coping items loading on five specific first order factors (Distancing Avoidance, Social Support Seeking, Self-Destructive Avoidance, Spiritual Coping, and Solution-Focused Coping) and two general second order factors (Active and Avoidant Coping). Factors demonstrated good reliability and validity. Results suggest that general coping factors should be considered with specific factors when measuring coping among older adults.

Expectancy and the Treatment of Depression: A Review of Experimental Methodology and Effects on Patient Outcome

Expectancies are a class of psychological and neurobiological processes that may be responsible for part of the improvement observed with psychiatric treatments. Patients' expectations can substantially affect the results of clinical trials, and managing them is an important part of clinical care. This review describes the history of research on expectancy effects in Major Depressive Disorder (MDD), the relationship between expectancies and placebo effects, and what is currently known about the mechanisms of action of expectancy. Meta-analyses of antidepressant trials show that placebo response rates are high (typically ~30%) and often larger than the difference in response rates between drug and placebo (typically ~10%). Some of the response to placebo is due to natural history, but a growing literature suggests that much of the improvement on placebo treatment is due to active neurobiological processes related to expectancy. Several studies have shown that higher expectation of therapeutic improvement leads to greater improvement in psychiatric symptoms, particularly in MDD. New research on the mechanisms of action of expectancy is therefore a priority that could lead to improved interventions. This review discusses the evidence to date and methodological considerations in the design of new studies.

Health-related quality of life in bereaved HIV-positive adults: relationships between HIV symptoms, grief, social support, and Axis II indication

OBJECTIVE

This study evaluated a model of the impact of borderline and antisocial personality disorder indications on HIV symptoms and health-related quality of life (HRQoL) in AIDS-bereaved adults, accounting for grief severity, social support, and years since HIV diagnosis.

DESIGN

Structural equation modeling was used to test the proposed model in a sample of 268 HIV-seropositive adults enrolled in an intervention for coping with AIDS-related bereavement.

MAIN OUTCOME MEASURES

Functional assessment of HIV infection, HIV symptoms.

RESULTS

The proposed model demonstrated excellent fit with study data and all hypothesized paths were supported. Personality disorder indication was directly related to HIV symptoms and HRQoL and indirectly related through both social support and grief severity. Social support was negatively related to HIV symptoms and positively related to HRQoL, while grief severity was positively related to HIV symptoms and negatively related to HRQoL. Finally, HIV symptoms had a direct negative relationship with HRQoL.

CONCLUSION

Personality disorders have a direct negative effect on HIV symptoms and HRQoL and indirect effects through grief severity and social support.

Positive emotion following a stroke

OBJECTIVE

Interest in exploring the positive emotional health of adults has increased. The current study investigated the positive emotion of adults with stroke at discharge from in-patient medical rehabilitation and 3 months post-discharge.

DESIGN

A longitudinal study in which information was collected during in-patient medical rehabilitation stay and 3 months post-discharge.

SUBJECTS

The study included 856 persons with stroke aged 55 years or older.

RESULTS

Mean age for the sample was 72.5 years, 78.7% of subjects were non-Hispanic white and 51.9% were women. Mean length of hospital stay was 20.2 days. More than one-third of patients reported higher positive emotion over the 3-month follow-up, while 29.7% reported lower positive emotion. In addition to discharge positive emotion, 4 factors, including depression, level of education and motor and cognition functional status score, significantly predicted lower depression at 3-month follow-up.

CONCLUSION

A large percentage of adults reported high positive emotion in the initial months following a stroke. This finding adds to work on stroke recovery and indicates the emotional resilience of adults when faced with a health challenge. Understanding the role of positive emotion in persons living with stroke may provide insight into long-term recovery.

Improvements in health-related quality of life following a group intervention for coping with AIDS-bereavement among HIV-infected men and women

BACKGROUND

AIDS-related bereavement is a severe life stressor that may be particularly distressing to persons themselves infected with HIV. Increasing evidence suggests that psychological health is associated with disease progression, HIV-related symptoms, and mortality.

PURPOSE

This study assessed change in health-related quality of life among HIV + persons following a group intervention for coping with AIDS-related loss.

METHODS

The sample included 235 HIV + men and women of diverse ethnicities and sexual orientations who had experienced an AIDS-related loss within the previous 2 years. Participants were randomly assigned to a 12-week cognitive-behavioral bereavement coping group intervention or offered individual psychotherapy upon request. Quality of life was assessed at baseline and 2 weeks after the intervention.

RESULTS

Participants in the group intervention demonstrated improvements in general health-related and HIV-specific quality of life, while those in the comparison remained the same or deteriorated. Effect sizes indicated that the majority of change occurred in women.

CONCLUSION

This bereavement group aimed at improving coping with grief also had a positive impact on health-related quality of life among HIV + men and women, and suggests that cognitive-behavioral interventions may have a broad impact on both emotional and physical health.

A focus for nursing intervention: Realistic acceptance or helping illusions?

Despite having a life-threatening disease, some people decide to live every remaining moment with intensity. Although they have accepted that their deaths might be imminent, they do not dwell on the possibility. They choose life and are sustained by vivid thoughts and inspirations. What can a nurse do to nourish such thoughts? Traditional theories of grief and loss maintain that one way to adjust to advanced stages of progressive disease is to accept death and prepare for it. Is it possible that these theories are simplistic and limiting in their assumptions about the way people "work through" the stage of adjusting to loss? This article is a critical reflection of the process.

Dispositional optimism and the mechanisms by which it predicts slower disease progression in HIV: proactive behavior, avoidant coping, and depression

The issue of whether optimism may prospectively protect against disease progression is one that has generated much interest, with mixed results in the literature. The purpose of this study was to determine whether dispositional optimism predicts slower disease progression in HIV. Two indicators of disease progression, CD4 counts and viral load, were assessed over 2 years in a diverse group (men, women, White, African American, Hispanic) of 177 people with HIV in the midrange of disease at entry to the study. Optimism predicted slower disease progression (less decrease in CD4 and less increase in viral load) controlling for baseline CD4 and viral load, antiretroviral treatment, gender, race, education, and drug use. Those low on optimism (25th percentile) lost CD4 cells at a rate 1.55 times faster than those high on optimism (75th percentile). Optimists had higher proactive behavior, less avoidant coping, and less depression: These variables mediated the linear optimism-disease progression relationship. Thus, optimists may reap health benefits partly through behavioral (proactive behavior), cognitive (avoidant coping), and affective (depression) pathways. Implications, limitations, and interpretations are discussed.