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Moitra E, Stein MD, Busch AM, Pinkston MM, Abrantes AM, Baker JV, Weisberg RB, Anderson BJ, Uebelacker LA. Acceptance of chronic pain in depressed patients with HIV: correlations with activity, functioning, and emotional distress. AIDS Care 2022; 34:1338-1346. [PMID: 34554879 PMCID: PMC8940733 DOI: 10.1080/09540121.2021.1981819] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Accepted: 09/09/2021] [Indexed: 01/26/2023]
Abstract
Chronic pain is highly prevalent among persons with HIV (PWH), as is depression. Both comorbidities might contribute to, as well as be maintained by, avoidance-based coping. A promising alternative to avoidance-based coping is acceptance. Acceptance of pain is associated with improved functioning and quality of life in chronic pain patients, but this relationship has not been substantially explored among PWH. Cross-sectional data from 187 adult outpatients enrolled in a randomized trial for depressed PWH with chronic pain were analyzed. Controlling for pain severity and demographics, the relationships among pain acceptance and indicators of activity, functioning, and emotional distress (i.e., anxiety and anger) were assessed in seven regression models. No significant relationships were found between self-reported physical activity or objective measurement of mean steps/day with pain acceptance. Results revealed an inverse relationship between chronic pain acceptance and pain-related functional interference (by.x = -.52, p < .01) and a positive relationship with self-reported functioning (by.x = 7.80, p < .01). A significant inverse relationship with anxiety symptoms (by.x = -1.79, p < .01) and pain acceptance was also found. Acceptance of chronic pain can facilitate decreased emotional distress, improved well-being, and better functioning and quality of life. Further investigation of chronic pain acceptance among PWH could inform the development of acceptance-based interventions.
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Affiliation(s)
- Ethan Moitra
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence RI, USA
| | - Michael D. Stein
- Behavioral Medicine and Addictions Research Unit, Butler Hospital, Providence RI, USA
- Department of Health Law, Policy and Management, Boston University School of Public Health, Boston MA, USA
| | - Andrew M. Busch
- Department of Medicine, Hennepin Healthcare, Minneapolis MN, USA
- Department of Medicine, University of Minnesota - Twin Cities, Minneapolis MN, USA
| | - Megan M. Pinkston
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence RI, USA
- Lifespan Physicians Group, The Miriam Hospital, Providence RI, USA
- Department of Medicine, Alpert Medical School of Brown University, Providence, RI, USA
| | - Ana M. Abrantes
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence RI, USA
- Behavioral Medicine and Addictions Research Unit, Butler Hospital, Providence RI, USA
| | - Jason V. Baker
- Department of Medicine, Hennepin Healthcare, Minneapolis MN, USA
- Department of Medicine, University of Minnesota - Twin Cities, Minneapolis MN, USA
| | - Risa B. Weisberg
- VA Boston Healthcare System, Boston, MA, USA
- Department of Psychiatry, Boston University School of Medicine, Boston, MA, USA
- Department of Family Medicine, Alpert Medical School of Brown University, Providence, RI, USA
| | - Bradley J. Anderson
- Behavioral Medicine and Addictions Research Unit, Butler Hospital, Providence RI, USA
| | - Lisa A. Uebelacker
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence RI, USA
- Psychosocial Research, Butler Hospital, Providence RI, USA
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Gao C, Xiao X, Zhang L, Xu H, Wang M, Wang H. The relationship between acceptance of illness and quality of life among men who have sex with men living with human immunodeficiency virus: A cross-sectional study. Int J Nurs Sci 2022; 9:313-320. [PMID: 35891907 PMCID: PMC9305002 DOI: 10.1016/j.ijnss.2022.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 03/04/2022] [Accepted: 05/12/2022] [Indexed: 11/30/2022] Open
Abstract
Objectives To explore the relationship between acceptance of illness and quality of life (QOL), and factors associated with acceptance of illness among men who have sex with men (MSM) living with human immunodeficiency virus (HIV). Methods Three hundred and one MSM were recruited from an HIV clinic between August and December 2018. The battery of measurements consisted of the Acceptance of Illness Scale, World Health Organization Quality of Life Questionnaire for HIV brief version, HIV Cognitive Appraisal Scale and a self-designed questionnaire used to collect general information. Pearson correlation test was used to examine the relationship between acceptance of illness and QOL. Univariate and multivariate ordinal logistic regression analyses were used to examine whether the general data (demographic and HIV-related clinical data) and HIV cognitive appraisal were associated with acceptance of illness levels. Results Descriptive analysis showed the acceptance level among MSM living with HIV was moderate (Mean = 26.29, SD = 5.28). Those with a better acceptance of illness had a better QOL (r = 0.69, P < 0.01). In the multivariate ordinal logistic regression model, education level, threat appraisals (OR:1.09; 95%CI [1.06–1.13]), and controllability appraisals (OR: 0.82; 95%CI [0.71–0.94]) were significantly associated with acceptance of illness. Conclusions Results showed acceptance level was moderate and had a positive correlation with QOL. High level of education, low threat appraisals and high controllability appraisals were related to high illness acceptance. This finding highlights the importance of focusing on HIV-infected MSM with low education and on their perceptions of threat and controllability about HIV-related issues when designing interventions to promote illness acceptance in this vulnerable population.
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Affiliation(s)
- Chang Gao
- Xiangya School of Nursing, Central South University, Changsha, Hunan, China
| | - Xueling Xiao
- Xiangya School of Nursing, Central South University, Changsha, Hunan, China
| | - Li Zhang
- Nursing Department, Handan Central Hospital, Handan, Hebei, China
| | - Hehua Xu
- The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Min Wang
- The Institute of HIV/AIDS, The First Hospital in Changsha, Changsha, Hunan, China
- Corresponding author.
| | - Honghong Wang
- Xiangya School of Nursing, Central South University, Changsha, Hunan, China
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Siefried KJ, Kerr S, Richardson R, Mao L, Rule J, McAllister J, de Wit J, Carr A. Socioeconomic and psychosocial factors are associated with poor treatment outcomes in Australian adults living with HIV: a case-control study. Sex Health 2020; 16:548-553. [PMID: 31514798 DOI: 10.1071/sh18138] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Accepted: 04/16/2019] [Indexed: 11/23/2022]
Abstract
Background A substantial minority of patients living with HIV refuse or cease antiretroviral therapy (ART), have virological failure (VF) or develop an AIDS-defining condition (ADC) or serious non-AIDS event (SNAE). It is not understood which socioeconomic and psychosocial factors may be associated with these poor outcomes. METHODS Thirty-nine patients with poor HIV treatment outcomes, defined as those who refused or ceased ART, had VF or were hospitalised with an ADC or SNAE (cases), were compared with 120 controls on suppressive ART. A self-report survey recorded demographics, physical health, life stressors, social supports, HIV disclosure, stigma or discrimination, health care access, treatment adherence, side effects, health and treatment perceptions and financial and employment status. Socioeconomic and psychosocial covariates significant in bivariate analyses were assessed with conditional multivariable logistic regression, adjusted for year of HIV diagnosis. RESULTS Cases and controls did not differ significantly with regard to sex (96.2% (n = 153) male) or age (mean (± s.d.) 51 ± 11 years). Twenty cases (51%) had refused or ceased ART, 35 (90%) had an HIV viral load >50 copies mL-1, 12 (31%) were hospitalised with an ADC and five (13%) were hospitalised with a new SNAE. Three covariates were independently associated with poor outcomes: foregoing necessities for financial reasons (adjusted odds ratio (aOR) 3.1, 95% confidence interval (95% CI) 1.3-7.6, P = 0.014), cost barriers to accessing HIV care (aOR 3.1, 95% CI 1.0-9.6, P = 0.049) and lower quality of life (aOR 3.8, 95% CI 1.5-9.7, P = 0.004). CONCLUSIONS Despite universal health care, socioeconomic and psychosocial factors are associated with poor HIV outcomes in adults in Australia. These factors should be addressed through targeted interventions to improve long-term successful treatment.
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Affiliation(s)
- Krista J Siefried
- St Vincent's Centre for Applied Medical Research, St Vincent's Hospital, 390 Victoria Street, Sydney, NSW 2010, Australia; and National Centre for Clinical Research on Emerging Drugs, University of New South Wales, Sydney, NSW 2052, Australia; and Corresponding author.
| | - Stephen Kerr
- St Vincent's Centre for Applied Medical Research, St Vincent's Hospital, 390 Victoria Street, Sydney, NSW 2010, Australia
| | - Robyn Richardson
- St Vincent's Centre for Applied Medical Research, St Vincent's Hospital, 390 Victoria Street, Sydney, NSW 2010, Australia
| | - Limin Mao
- Centre for Social Research in Health, University of New South Wales, Sydney, NSW 2052, Australia
| | - John Rule
- National Association of People with HIV Australia, 1 Erskineville Road, Newtown, NSW 2042, Australia; and School of Public Health and Community Medicine, University of New South Wales, Sydney, NSW 2052, Australia
| | - John McAllister
- St Vincent's Centre for Applied Medical Research, St Vincent's Hospital, 390 Victoria Street, Sydney, NSW 2010, Australia
| | - John de Wit
- Centre for Social Research in Health, University of New South Wales, Sydney, NSW 2052, Australia; and Department of Interdisciplinary Social Science, Utrecht University, PO Box 80125, 3508 TC Utrecht, The Netherlands
| | - Andrew Carr
- St Vincent's Centre for Applied Medical Research, St Vincent's Hospital, 390 Victoria Street, Sydney, NSW 2010, Australia
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Xiao X, Chen C, Gao C, Wang H, Reynolds NR. Ways of coping mediate the relationship between self-efficacy for managing HIV and acceptance of illness among people living with HIV. J Adv Nurs 2020; 76:2945-2954. [PMID: 32893375 DOI: 10.1111/jan.14488] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Revised: 06/02/2020] [Accepted: 07/06/2020] [Indexed: 12/01/2022]
Abstract
AIM The purpose of this study was to examine the relationship between self-efficacy for managing HIV and acceptance of illness and to identify the potential mediation effect of active coping and passive coping on this relationship. DESIGN The study used a cross-sectional survey. METHODS A sample of 555 people living with HIV were recruited from September-December 2018 in the HIV clinic of a tertiary general hospital in Changsha, China. Survey data were collected through face-to-face interviews that included measures of sociodemographic and HIV-related clinical characteristics, Acceptance of Illness Scale, the Simplified Coping Style Questionnaire and the Self-efficacy for Managing Chronic Disease Scale. Step-by-step linear regression models combined with bootstrap testing were used to test the relationships when controlling for gender and HIV diagnosis duration. RESULTS Self-efficacy was positively related to acceptance of illness and this relationship was partially mediated by both active coping and passive coping. Acceptance of illness increased by 0.175 for every point increase in self-efficacy indirectly through active coping, while acceptance of illness decreased by 0.034 for every point increase in self-efficacy via passive coping. CONCLUSION The findings highlighted the importance of self-efficacy for managing HIV and ways of coping, especially active coping, for illness acceptance. IMPACT The findings suggested that interventions that improve confidence in managing HIV and active coping may enhance the illness acceptance of people living with HIV.
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Affiliation(s)
- Xueling Xiao
- Xiangya School of Nursing of Central South University, Changsha, Hunan, China.,Johns Hopkins School of Nursing, Baltimore, MD, USA
| | - Chen Chen
- Xiangya School of Nursing of Central South University, Changsha, Hunan, China
| | - Chang Gao
- Xiangya School of Nursing of Central South University, Changsha, Hunan, China
| | - Honghong Wang
- Xiangya School of Nursing of Central South University, Changsha, Hunan, China
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Concomitant medication polypharmacy, interactions and imperfect adherence are common in Australian adults on suppressive antiretroviral therapy. AIDS 2018; 32:35-48. [PMID: 29135584 PMCID: PMC5732638 DOI: 10.1097/qad.0000000000001685] [Citation(s) in RCA: 55] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
OBJECTIVES We quantified concomitant medication polypharmacy, pharmacokinetic and pharmacodynamic interactions, adverse effects and adherence in Australian adults on effective antiretroviral therapy. DESIGN Cross-sectional. METHODS Patients recruited into a nationwide cohort and assessed for prevalence and type of concomitant medication (including polypharmacy, defined as ≥5 concomitant medications), pharmacokinetic or pharmacodynamic interactions, potential concomitant medication adverse effects and concomitant medication adherence. Factors associated with concomitant medication polypharmacy and with imperfect adherence were identified using multivariable logistic regression. RESULTS Of 522 participants, 392 (75%) took a concomitant medication (mostly cardiovascular, nonprescription or antidepressant). Overall, 280 participants (54%) had polypharmacy of concomitant medications and/or a drug interaction or contraindication. Polypharmacy was present in 122 (23%) and independently associated with clinical trial participation, renal impairment, major comorbidity, hospital/general practice-based HIV care (versus sexual health clinic) and benzodiazepine use. Seventeen participants (3%) took at least one concomitant medication contraindicated with their antiretroviral therapy, and 237 (45%) had at least one pharmacokinetic/pharmacodynamic interaction. Concomitant medication use was significantly associated with sleep disturbance and myalgia, and polypharmacy of concomitant medications with diarrhoea, fatigue, myalgia and peripheral neuropathy. Sixty participants (12%) reported imperfect concomitant medication adherence, independently associated with requiring financial support, foregoing necessities for financial reasons, good/very good self-reported general health and at least 1 bed day for illness in the previous 12 months. CONCLUSION In a resource-rich setting with universal healthcare access, the majority of this sample took a concomitant medication. Over half had at least one of concomitant medication polypharmacy, pharmacokinetic or pharmacodynamic interaction. Concomitant medication use was associated with several adverse clinical outcomes.
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Socioeconomic factors explain suboptimal adherence to antiretroviral therapy among HIV-infected Australian adults with viral suppression. PLoS One 2017; 12:e0174613. [PMID: 28369066 PMCID: PMC5378347 DOI: 10.1371/journal.pone.0174613] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2016] [Accepted: 03/13/2017] [Indexed: 12/23/2022] Open
Abstract
Background Missing more than one tablet of contemporary antiretroviral therapy (ART) per month increases the risk of virological failure. Recent studies evaluating a comprehensive range of potential risk factors for suboptimal adherence are not available for high-income settings. Methods Adults on ART with undetectable viral load (UDVL) were recruited into a national, multi-centre cohort, completing a comprehensive survey assessing demographics, socio-economic indicators, physical health, well-being, life stressors, social supports, HIV disclosure, HIV-related stigma and discrimination, healthcare access, ART regimen, adherence, side effects, costs and treatment beliefs. Baseline data were assessed, and suboptimal adherence was defined as self-reported missing ≥1 ART dose/month over the previous 3-months; associated factors were identified using bivariate and multivariate binary logistic regression. Results We assessed 522 participants (494 [94.5%] men, mean age = 50.8 years, median duration UDVL = 3.3 years [IQR = 1.2–6.8]) at 17 sexual health, hospital, and general practice clinics across Australia. Seventy-eight participants (14.9%) reported missing ≥1 dose/month over the previous three months, which was independently associated with: being Australian-born (AOR [adjusted odds ratio] = 2.4 [95%CI = 1.2–4.9], p = 0.014), not being in a relationship (AOR = 3.3 [95%CI = 1.5–7.3], p = 0.004), reaching the “Medicare safety net” (capping annual medical/pharmaceutical costs) (AOR = 2.2 [95%CI = 1.1–4.5], p = 0.024), living in subsidised housing (AOR = 2.5 [95%CI = 1.0–6.2], p = 0.045), receiving home-care services (AOR = 4.4 [95%CI = 1.0–18.8], p = 0.046), HIV community/outreach services linkage (AOR = 2.4 [95%CI = 1.1–5.4], p = 0.033), and starting ART following self-request (AOR = 3.0 [95%CI = 1.3–7.0], p = 0.012). Conclusions In this population, 15% reported recent suboptimal ART adherence at levels associated in prospective studies with subsequent virological failure, despite all having an undetectable viral load. Associations were with social/economic/cultural/patient engagement factors, but not ART regimen/clinical factors. These associations may help identify those at higher risk of future virological failure and guide patient education and support.
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Relationship between acceptance of illness and functional outcomes following cardiac rehabilitation. J Cardiopulm Rehabil Prev 2012; 32:187-91. [PMID: 22691940 DOI: 10.1097/hcr.0b013e31825859c1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE Acceptance, a cognitive-behavioral concept successfully applied to chronic pain and chronic illness in an HIV/AIDS population, was examined for applicability in patients in a cardiac rehabilitation program. The study examined the internal reliability of the Activities Engagement (AE) and Illness Willingness (IW) scales of the Chronic Illness Acceptance Questionnaire (CIAQ), their relationships with functional outcomes, and their ability to predict functional outcomes after controlling for demographic and medical variables. METHODS Subjects were 36 patients recruited from a cardiac rehabilitation program at an urban Midwestern Medical Center. Subjects completed the CIAQ and physical and emotional functional outcome measures including the Minnesota Living with Heart Failure Questionnaire, 36-item Short Form Health Survey (SF-36), and Beck Depression Inventory. RESULTS Internal reliability scores of the AE and IW scales of the CIAQ were modest. The AE scale was significantly related to measures of emotional functioning, but not physical functioning. The IW scale was not related to any of the emotional or physical outcomes. In multiple regression analyses, AE was a significant predictor of the 2 emotional outcome measures beyond demographic and medical variables, but not the physical measures. Illness Willingness was not predictive of any of the functional outcome variables. CONCLUSIONS The AE aspect of acceptance was related to emotional outcomes and predicted these outcomes beyond demographic and medical variables. Lack of a relationship between IW and any outcomes may have been due to a small sample size or that acceptance is a one-dimensional construct.
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Rivet Amico K. A situated-Information Motivation Behavioral Skills Model of Care Initiation and Maintenance (sIMB-CIM): An IMB Model Based Approach to Understanding and Intervening in Engagement in Care for Chronic Medical Conditions. J Health Psychol 2011; 16:1071-81. [DOI: 10.1177/1359105311398727] [Citation(s) in RCA: 91] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
A sizable portion of adults living with chronic medical conditions (CMCs) delay initiation of care or maintain it inconsistently, which has tremendous personal and public costs. However, few explanatory models with high yield for intervention development and implementation have been proposed to date that would help to characterize and support care use for CMCs. A situated Information, Motivation, Behavioral Skills model of Care Initiation and Maintenance (sIMB-CIM) is presented here as an application of the IMB model to medical care use for CMCs. An example of a sIMB model for characterizing and intervening to support maintenance in HIV-care is provided.
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