Stress processes in HIV-positive African American mothers: moderating effects of drug abuse history

Racial/Ethnic Differences in Stress, Coping, and Distress Among Mothers With a Child in the ICU

BACKGROUND

Having a child in the intensive care unit (ICU) is a stressful event that can cause negative mental health outcomes for parents, but little is known about the experience of parental stress among members of racial/ethnic minority groups.

OBJECTIVE

To examine the stress and coping process in a racially/ethnically diverse sample of mothers of a child who was acutely admitted to an ICU.

METHODS

Participants (N = 103) completed a cross-sectional self-report survey; 86.4% completed it within a week of their child's ICU admission. Analysis of variance was used to examine racial/ethnic differences in perceived ICU-related stressors, coping behaviors, and distress level. Linear regression was used to examine the moderating effects of race/ethnicity on the relationships between stressors, coping behaviors, and distress.

RESULTS

Mothers across racial group experienced similar stressors during the acute phase of their child's ICU admission. African American mothers reported greater overall use of coping behaviors, particularly avoidance coping, and experienced higher levels of distress than did Hispanic or non-Hispanic White mothers. Hispanic mothers experienced the least distress. The interaction of race/ethnicity and emotion-focused coping moderated the stress and coping process.

CONCLUSIONS

Racial and ethnic diversity in sampling should be a priority in future studies of the stress and coping process of mothers with a child in an ICU. Critical care nurses should minimize known stressors for these mothers and encourage and support their preferred coping behaviors, recognizing that these may differ across racial/ethnic groups.

Health Correlates of Abuse History and Moderating Effect of Parenting Stress for Mothers with Mental Disorders

Parenting stress is common and may lead to worsening health, particularly in the context of other risk factors such as mental disorders or a history of abuse. This study investigated how parenting-related stress impacts the effect of abuse experiences on health among mothers with mental health disorders. Survey data was analyzed from 172 predominantly Hispanic mothers receiving outpatient behavioral health services. Most (80.2%) mothers had experienced abuse. Those reporting childhood abuse had 3.82 greater odds of experiencing abuse in adulthood. Findings demonstrated worse health outcomes among those experiencing abuse in both childhood and adulthood and those with a greater number of abuse experiences. Caregiving load intensified the relationship between abuse and anxiety and sleep disturbance. Parenting self-agency intensified the relationship between abuse and cigarette use. These findings have important implications for mental health nursing practice by identifying parenting-stress as an important target for interventions to improve health among women with histories of abuse and mental health disorders.

Social Support and Coping Strategies in Patients with Traumatic Brachial Plexus Injury

BACKGROUND

Emotional and social characteristics may influence rehabilitation and recovery after traumatic brachial plexus injury.

PURPOSES

We sought to investigate if traumatic brachial plexus injury patients have different levels of social support and employ distinct coping strategies from uninjured control subjects. In addition, we studied which coping strategies are more commonly used among traumatic brachial plexus injury patients.

METHODS

Questionnaires for social support (Interpersonal Support Evaluation List and Social Support Questionnaire) and coping strategies (Brief-Coping Orientation to Problems Experienced) were administered to traumatic brachial plexus injury patients and an age- and sex-matched volunteer cohort (without brachial plexus injury).

RESULTS

There were no differences in interpersonal support (mean [SD] = 26.0 [8.6], 26.5 [6.8]), number of persons available for emotional support, and satisfaction with support between traumatic brachial plexus injury patients (n = 36) and volunteers (n = 43). The following coping strategies were more common among traumatic brachial plexus injury patients: active coping, self-distraction, denial, behavioral disengagement, venting, planning, self-blame, and acceptance.

CONCLUSION

Patients with traumatic brachial plexus injury have similar levels of social support as healthy volunteers but are more likely to use an array of coping strategies. Surgeons and other clinicians should be aware of coping strategies favored by patients, particularly the potential for behaviors detrimental to recovery such as behavioral disengagement, self-blame, and denial. This work will inform future investigations into the influence of social support and coping strategies on clinical outcomes after traumatic brachial plexus injury.

A Mental Health-Physical Health-Violence (MPV) Syndemic Factor in Women with Mental Disorders

This study extended research on syndemics for women with mental disorders by including self-reported mental and physical health conditions. Syndemics explain complex relationships among co-occurring conditions, and the social circumstances that influence their overlap. Data were from the baseline assessment of a randomized trial of Healthy Home, a nursing home-visit intervention for women with children. 172 adult women who were in mental health or substance use treatment completed measures (in Spanish or English) of anxiety, depression, violence during adulthood, physical health, and cigarette use. Structural Equation Modeling was used to evaluate a single-factor syndemic, and to test the relationships of theoretical predictors of the syndemic: income, number of children, women's abuse during childhood, mental health stigma, social support, and stress. Results supported a single factor syndemic model that explained variation in mental health, physical health, and violence during adulthood. Stress, β = .45, p < .001, and stigma, β = .22, p = .007, were related to the syndemic factor. There was evidence that self-reported mental and physical health share covariation, which suggested that integrated services for women with mental disorders may have synergistic effects on health. Findings suggest the need to develop and test interventions that address stress and stigma as a means of reducing health disparities for women with mental disorders.

Health status, sexual and drug risk, and psychosocial factors relevant to postrelease planning for HIV+ prisoners

The prevalence of HIV infection among male prison inmates is significantly higher than in the U.S. population. Adequate planning to ensure continued medication adherence and continuity of care after release is important for this population. This study describes the prerelease characteristics of 162 incarcerated HIV-positive men (40 from jails and 122 from prisons). The results include a demographic description of the sample and the participants' sexual risk behaviors, substance use, health status and HIV medication adherence, health care utilization, mental health, and family and social support. The results highlight a potentially high level of need for services and low levels of support and social connectedness. Postrelease planning should include support for improving HIV medication adherence as well as reducing both sexual and injection drug-related transmission risk for these individuals.

Effects and processes linking social support to caregiver health among HIV/AIDS-affected carer-child dyads: a critical review of the empirical evidence

There is evidence to suggest that social support may be an important resource for the mental and physical health of caregivers and children affected by HIV/AIDS, especially in HIV-endemic areas of the developing world. Drawing from theory on social relations and health, in this paper we argue that it is important to assess not only the existence and direction of associations, but also the effects and processes explaining these. We refer to House et al's (in Annu Rev Sociol 14;293-318, 1988) theoretical framework on social support structures and processes as a guide to present and discuss findings of a systematic review of literature assessing the relationship between social support and health among caregivers living with HIV or caring for HIV/AIDS-affected children. Findings confirm the importance of social support for health among this population, but also expose the absence of empirical work deriving from the developing world, as well as the need for further investigation on the biopsychosocial processes explaining observed effects.

Stress and coping in women living with HIV: a meta-analytic review

To examine effects between stressors and coping mechanisms on behavioral health outcomes a meta-analysis was conducted using forty empirical articles which sampled 7,602 adult women living with HIV/AIDS in the U.S. (M = 36.3 years). Three independent reviewers conducted searches in abstract databases from 1997 to present day. Articles reporting effect sizes amongst psychosocial stressors and coping mechanisms with indices of behavioral/mental health were selected. The meta-analyses revealed that in a time frame characterized by the widespread availability of anti-retroviral medication, poor mental health outcomes were predicted, in a similar manner, by psychosocial stress and HIV/AIDS symptomology. Significant effects were also observed with functional impairment, though to a lesser degree. Coping by avoidance and social isolation predicted more severe mental health outcomes. Spirituality and positive reappraisal predicted greater psychological adaptation than did social support seeking. Despite advancements in anti-retroviral treatment for women, HIV/AIDS symptoms and acute and/or chronic psychosocial stress pose the same threat to behavioral and mental health. In the face of these stressors, positive reframing appears to promote psychological adaptation in a way which may lead to positive health outcomes in women living with HIV/AIDS.

Stress buffering effects of oxytocin on HIV status in low-income ethnic minority women

BACKGROUND

Elevated perceptions of psychosocial stress and stressful life events are linked to faster disease progression in individuals living with HIV and these associations may be stronger for women from ethnic minority populations. Levels of neurohormones such as oxytocin (OT), cortisol, and norepinephrine (NE) have been shown to influence the effects of psychosocial stress in different populations. Understanding how intrinsic neuroendocrine substances moderate the effects of stressors in minority women living with HIV (WLWH) may pave the way for interventions to improve disease management.

METHODS

We examined circulating levels of plasma OT as a moderator of the effects of stress on disease status (viral load, CD4+ cell count) in 71 low-income ethnic minority WLWH.

RESULTS

At low levels of OT, there was an inverse association between stress and CD4+ cell counts. Counter-intuitively, at high levels of OT there was a positive association between stress and CD4+ cell counts. This pattern was unrelated to women's viral load. Other neuroendocrine hormones known to down-regulate the immune system (cortisol, norepinephrine) did not mediate the effects of OT and stress on immune status.

CONCLUSIONS

OT may have stress buffering effects on some immune parameters and possibly health status in low income ethnic minority WLWH reporting elevated stress.

"My children and my home": the most recent and challenging stressors of HIV-positive women

Because of negative health consequences and differences in exposure and vulnerability to stressful encounters, it is important to examine and understand the stressful experiences faced by women living with HIV. The goal of this study was to examine the most recent and challenging stressors faced and coping strategies adopted by a sample of women living with HIV. Using mixed methodology, narratives of six women's most recent and stressful experience and answers to the Ways of Coping questionnaire were collected and analysed. Two main themes arose from the stressor narratives: child-related concerns and housing issues. To address these stressors, each woman used a variety of coping strategies, the most common being seeking social support even when stressors were analysed separately according to their main themes. Implications of these findings within service provision are discussed.