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In people living with HIV (PLWH), menopause (natural or surgical) contributes to the greater symptom burden in women: results from an online US survey. Menopause 2019; 25:744-752. [PMID: 29509596 DOI: 10.1097/gme.0000000000001083] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVE The majority of people living with HIV in the United States are now over the age of 50, but symptom burden research has seldom included older women or the potential role of menopause. The aim of the study was to examine the influence of menopause as part of sex differences in HIV symptom burden. METHODS A cross-sectional study was conducted that included both a sex-based analysis of previously reported HIV symptom characteristics of 1,342 respondents to an online survey (males, n = 957; female, n = 385) and a follow-up online survey of menstrual bleeding patterns (inferred menopause) in eligible females (n = 242) from the respondent pool. Using linear mixed models, we identified predictors of symptom burden scores in female respondents. RESULTS For the most troublesome symptoms assessed in the sex-based analysis, depression scores were similar (P > 0.05), but higher (worse) burden scores for fatigue (P = 0.013) and muscle aches/pains (P = 0.004) were exclusively observed in females after adjusting for covariates. Respondents to the female survey (n = 222) were predominantly Black, heterosexual, nonsmokers, and obese, with an HIV diagnosis of approximately 16 years and at least one comorbid condition. Burden scores were higher in women reporting amenorrhea due to natural menopause or hysterectomy (n = 104) versus the menstruating group (n = 118) for muscle aches/pains (P = 0.05), fatigue (P = 0.03), and difficulty falling asleep (P = 0.04), independent of age, HIV duration, and number of HIV-associated non-AIDS conditions. CONCLUSIONS Two of the most common symptoms in people living with HIV-fatigue and muscle aches/joint pains-invoke additional burden in women. Independent of aging, symptom burden may be exacerbated after menopause, supporting a shifting paradigm for HIV care management.
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Schnall R, Siegel K, Jia H, Olender S, Hirshfield S. Racial and socioeconomic disparities in the symptom reporting of persons living with HIV. AIDS Care 2018; 30:774-783. [PMID: 29353489 PMCID: PMC5911686 DOI: 10.1080/09540121.2017.1417532] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Persons living with HIV (PLWH) today can survive decades with the disease, making the symptom experience much more relevant to their lifestyle and health outcomes. The goal of the research reported here was to assess the symptom reporting of PLWH in the Unites States (US) in the combined antiretroviral therapy (cART) age of the epidemic. We conducted an anonymous online survey of symptomatic PLWH in the US and asked participants to report the frequency and intensity of 28 frequently occurring symptoms in the past 30 days. The relationship between symptom reporting and demographic factors was investigated using the adaptive least absolute shrinkage and selection operator (LASSO) method. Fatigue was the most frequently reported symptom in our study population. Those with the lowest income were more likely to report more burdensome symptoms. In comparison to other racial and ethnic groups, Black non-Hispanic participants were significantly more likely to report a lower symptom burden score for fatigue, depression, muscle aches, anxiety, difficulties with memory and concentration. There were no racial/ ethnic differences in the burden of the symptoms related to sleep or neuropathy. Findings from this study present new evidence on the symptom reporting of PLWH in the US. Neuropathy continues to be a pervasive neurological symptom with no difference noted between racial/ ethnic groups.
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Affiliation(s)
| | - Karolynn Siegel
- b Mailman School of Public Health , Columbia University , New York , NY , USA
| | - Haomiao Jia
- c Division of Infectious Diseases, College of Physicians and Surgeons , Columbia University , New York , NY , USA
| | - Susan Olender
- c Division of Infectious Diseases, College of Physicians and Surgeons , Columbia University , New York , NY , USA
| | - Sabina Hirshfield
- d Public Health Solutions, Research and Evaluation Division , New York , NY , USA
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Intimate Partner Violence Correlates With A Higher HIV Incidence Among MSM: A 12-Month Prospective Cohort Study in Shenyang, China. Sci Rep 2018; 8:2879. [PMID: 29440761 PMCID: PMC5811488 DOI: 10.1038/s41598-018-21149-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2017] [Accepted: 01/29/2018] [Indexed: 01/05/2023] Open
Abstract
Intimate partner violence (IPV) and HIV are highly prevalent worldwide among MSM. However, the association between IPV and HIV seroconversion is virtually unknown. This 12-month prospective cohort study was conducted among MSM in Shenyang, China to explore the causality between IPV and the incidence of HIV. Adjusted Hazard Ratios (aHRs) of HIV acquisition were derived from a multivariate time-dependent Cox model and applied to calculate population attributable fractions (PAFs). Among 476 HIV-negative MSM subjects, 89(18.7%) reported being victims of IPV in the past 3 months (P3M). IPV was significantly correlated with lower education, having more condomless anal intercourse (CAI) and being depressed (each P < 0.05). The incidence of HIV among IPV victims was 11.3/100 PY compared to 3.8/100 PY in non-IPV-victims. Furthermore, IPV victimization was independently associated with HIV seroconversion (aHR = 4.1, PAF = 37.9%). Other predictors for seroconversion included non-local residence in Liaoning province (aHR = 3.9, PAF = 45.2%), engaging in condomless receptive anal intercourse (CRAI)(aHR = 3.1, PAF = 24.2%) or CAI with casual male partners (aHR = 3.8, PAF = 26.3%) in the P3M and syphilis infection (aHR = 4.7, PAF = 33.7%) (each P < 0.05). IPV increased the HIV seroconversion risk of MSM, with a high PAF. HIV prevention programs should integrate IPV screening and intervention, and MSM affected by IPV need to be preferentially enrolled in pre-exposure prophylaxis.
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Gore-Felton C, Koopman C, Spiegel D, Vosvick M, Brondino M, Winningham A. Effects of Quality of Life and Coping on Depression among Adults Living with HIV/AIDS. J Health Psychol 2016; 11:711-29. [PMID: 16908468 DOI: 10.1177/1359105306066626] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
This prospective study examined the effect of maladaptive coping strategies and psychological quality of life (QOL) on depression at two time points in a diverse sample of persons living with HIV/AIDS ( N = 85). The use of maladaptive coping strategies to deal with the stress of living with HIV/AIDS, particularly engaging in various kinds of avoidant behaviors, was significantly associated with greater depression at baseline and increased depression at three months. QOL was the single most important predictor of depression. In an effort to develop effective clinical methods aimed at decreasing depression among adults living with HIV, future studies need to focus on improving quality of life and increasing adaptive coping strategies associated with the stress of living with HIV/AIDS.
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Affiliation(s)
- Cheryl Gore-Felton
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA 94305, USA.
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Metts S, Manns H, Kruzic L. Social Support Structures and Predictors of Depression in Persons Who Are Seropositive. J Health Psychol 2016; 1:367-82. [DOI: 10.1177/135910539600100309] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Survey data from 87 seropositive individuals were analysed to assess the extent to which: (1) the social-support network changes over the course of three levels of seropositivity (HIV asymptomatic, HIV symptomatic and AIDS); (2) certain types of support providers are associated with lower depression; and (3) the relative contribution of support network diversity, emotional support from several categories of providers (family of origin, friends, spouses/partners, and weak ties) and locus of control to depression. Results indicate that the support-network structure changes when symptoms appear, most notably reliance on weak ties decreases and on family of origin increases. Results also indicate that persons drawing on a particular support provider are no less depressed than persons not drawing on that support provider. However, health, social locus of control and increasing levels of emotional support from friends, family and weak ties all make independent contributions to lower depression. Future research is suggested to explore the transition points among HIV asymptomatic, HIV symptomatic and AIDS conditions.
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Abstract
Quantitative and qualitative data were gathered from a sample of 66 seropositive and 67 seronegative men and women about the impact of an HIV diagnosis upon psychosocial well-being. No significant differences between seropositives and seronegatives were found on any of the psychosocial measures except hopelessness. Nor was there significant variation by disease progression (but this may be due to the restricted size of the sample). The qualitative data are used to illustrate these findings and explore their meaning. It is concluded that, with the exception of a hopeless future orientation, psychosocial disturbance of seropositives tends to be episodic and short-lived and thereby difficult to measure.
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Affiliation(s)
| | - Stephen Platt
- MRC Medical Sociology Unit, Glasgow, Health Education Board for Scotland
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Abstract
The emerging empirical and clinical literature on the psychosocial issues of human immunodeficiency virus (HIV) has only begun to guide clinicians in their work with seropositive clients. This article presents a model that provides a conceptual framework for assessing the client's resources as he or she attempts to address the psychosocial issues that may occur as a result of this disease. The model has four components: special characteristics, social supports, situation, and client characteristics. It is hypothesized that these client resources predict or moderate the clients response to HIV infection. Responses to HIV infection are discussed followed by counseling strategies and interventions to address each response or reaction. Case management issues are presented including ethical dilemmas, rethinking clinical goals, the changing boundaries of the therapeutic relationship, transference, and countertransference.
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Longitudinal Changes Over 10 Years in Free Testosterone Among HIV-Infected and HIV-Uninfected Men. J Acquir Immune Defic Syndr 2016; 71:57-64. [PMID: 26761271 DOI: 10.1097/qai.0000000000000821] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Aging in males is associated with lower testosterone levels and a decrease in diurnal variation of testosterone secretion. Cross-sectional studies have shown lower than expected testosterone levels among HIV-infected men, but whether age-related changes in serum testosterone differ by HIV serostatus are not known. METHODS HIV-infected men from the Multicenter AIDS Cohort Study (MACS), age ≥ 45 years at highly active antiretroviral therapy initiation, who had ≥ 2 samples from the subsequent 10 years, were matched to HIV-uninfected men by age, race, MACS site, and calendar time of samples. Linear mixed-effects regression models were used to determine whether free testosterone (FT) and its rate of change differed by HIV serostatus. RESULTS One hundred eighty-two HIV-infected and 267 HIV-uninfected men were included, median age: 48.8 years (interquartile range: 45.8-53.4), median numbers of FT measurements per participant 4 (interquartile range: 3-5), 65% were drawn in the adjusted morning (AM). Mean-adjusted FT levels were lower among HIV-infected than HIV-uninfected men in AM samples {-6.1 ng/dL [95% confidence interval (CI): -9.8 to -2.4], P = 0.001}, but not in afternoon samples [-1.7 ng/dL (-6.0 to 2.6), P = 0.441]. The rate of FT decline with age did not differ by HIV serostatus: 9.2 ng/dL (95% CI: -13.4 to -5.0) per 10 years for HIV-infected vs. 7.9 ng/dL (95% CI: -10.2 to -5.5) for HIV-uninfected men, P = 0.578. CONCLUSIONS FT decreased similarly with increasing age regardless of HIV serostatus. The lower AM, but not adjusted afternoon, FT levels among HIV-infected men compared with HIV-uninfected men suggest a loss of diurnal variation in FT levels among HIV-infected men.
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Davison SE, Aylward EH, McArthur JC, Selnes OA, Lyketsos C, Barta PE, Pearlson GD. A Quantitative MRI Study of the Basal Ganglia in Depression in HIV Seropositive Men. ACTA ACUST UNITED AC 2016; 1:29-41. [PMID: 16873169 DOI: 10.1300/j128v01n03_02] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
UNLABELLED HIV (Human Immunodeficiency Virus) infection is associated with high rates of depressive symptomatology. There is evidence that such infection is associated with damage to the basal ganglia. It has also been suggested that the basal ganglia are implicated in the aetiology of affective disorders. OBJECTIVE This study examined the association between basal ganglia atrophy and depression in HIV seropositive men. We hypothesized that depressed HIV seropositive patients would have smaller basal ganglia compared with nondepressed HIV positive comparison subjects. METHOD Using quantitative magnetic resonance imaging (MRI) techniques we compared for the basal ganglia volumes of sixteen depressed, and sixteen group-matched nondepressed HIV seropositive homosexual men. RESULTS We found no significant difference in basal ganglia volumes between the two groups. CONCLUSIONS We suggest that depression, at least in the early stages of HIV infection, is not associated with basal ganglia atrophy.
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Affiliation(s)
- S E Davison
- , Broadmoor Hospital, Crowthorne, Berkshire, RG11 7EG, England
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Kee MK, Lee SY, Kim NY, Lee JS, Kim JM, Choi JY, Ku NS, Kang MW, Kim MJ, Woo JH, Kim SW, Song JY, Baek JH, Choi BY, Kim SS. Anxiety and depressive symptoms among patients infected with human immunodeficiency virus in South Korea. AIDS Care 2015. [PMID: 26197063 DOI: 10.1080/09540121.2015.1035861] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Patients infected with human immunodeficiency virus (HIV) may develop mental health problems such as anxiety and depression, which negatively impact of disease progression. We investigated factors associated with the prevalence of anxiety and depression symptoms among HIV-infected patients in Korea. A total of 840 HIV-infected patients who participated in the Korea HIV/AIDS Cohort Study from 2006 to 2012 were evaluated. Socio-demographic, epidemiologic, and clinical variables were obtained through standardized questionnaires. The State-Trait Anxiety Inventory and Beck Depression Inventory were used to assess the symptoms of anxiety and depression. Multiple logistic regression analyses were performed to identify factors associated with symptoms of anxiety and depression. The prevalence of anxiety and depressive symptoms among HIV-infected patients was 32% and 36%, respectively. Ex-smoker and persistent symptoms for more than one week within the past six months and diagnosis of HIV infection within one year were associated with increased anxiety symptoms (odds ratio [OR] 1.71, 95% confidence interval [CI] 1.09-2.69; OR 1.52, 95% CI 1.09-2.11; OR 1.49, 95% CI 1.02-2.20) and current smoking and persistent symptoms were also associated with increased depressive symptoms (OR 2.10, 95% CI 1.31-3.30; OR 1.87, 95% CI 1.25-2.79). Marital status, current smoking, current drinking, and persistent symptoms were associated with both increased anxiety and depressive symptoms (OR 1.75, 95% CI 1.07-2.88; OR 1.66, 95% CI 1.06-2.61; OR 1.88, 95% CI 1.18-2.99). The prevalence of anxiety and depressive symptoms among HIV-infected patients is higher than those estimated for the general population. This study shows the necessity to evaluate symptoms of anxiety and depression and suggest psychological support for HIV-infected patients who smoke or have persistent symptoms or have sexual partner or drink.
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Affiliation(s)
- Mee-Kyung Kee
- a Division of AIDS , Center for Immunology and Pathology, Korea National Institute of Health , Chungbuk , Republic of Korea
| | - Sae-Young Lee
- a Division of AIDS , Center for Immunology and Pathology, Korea National Institute of Health , Chungbuk , Republic of Korea
| | - Na-Young Kim
- a Division of AIDS , Center for Immunology and Pathology, Korea National Institute of Health , Chungbuk , Republic of Korea
| | - Joo-Shil Lee
- b Korea National Institute of Health , Chungbuk , Republic of Korea
| | - June Myung Kim
- c Department of Internal Medicine , Yonsei University College of Medicine , Seoul , Republic of Korea.,d AIDS Research Institute, Yonsei University College of Medicine , Seoul , Republic of Korea
| | - Jun Yong Choi
- c Department of Internal Medicine , Yonsei University College of Medicine , Seoul , Republic of Korea.,d AIDS Research Institute, Yonsei University College of Medicine , Seoul , Republic of Korea
| | - Nam Su Ku
- c Department of Internal Medicine , Yonsei University College of Medicine , Seoul , Republic of Korea.,d AIDS Research Institute, Yonsei University College of Medicine , Seoul , Republic of Korea
| | - Moon Won Kang
- e Division of Infectious Diseases, Department of Internal Medicine , College of Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea , Seoul , Republic of Korea
| | - Min Ja Kim
- f Division of Infectious Diseases, Department of Internal Medicine , Korea University College of Medicine , Seoul , Republic of Korea
| | - Jun Hee Woo
- g Department of Infectious Diseases , Asan Medical Center, University of Ulsan College of Medicine , Seoul , Republic of Korea
| | - Shin-Woo Kim
- h Department of Internal Medicine , School of Medicine, Kyungpook National University , Daegu , Republic of Korea
| | - Joon Young Song
- f Division of Infectious Diseases, Department of Internal Medicine , Korea University College of Medicine , Seoul , Republic of Korea
| | - Ji-Hyeon Baek
- i Department of Internal Medicine , Inha University School of Medicine , Incheon , Republic of Korea
| | - Bo Youl Choi
- j Department of Preventive Medicine , College of Medicine, Hanyang University , Seoul , Republic of Korea
| | - Sung Soon Kim
- a Division of AIDS , Center for Immunology and Pathology, Korea National Institute of Health , Chungbuk , Republic of Korea
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Herrick A, Stall R, Egan J, Schrager S, Kipke M. Pathways towards risk: syndemic conditions mediate the effect of adversity on HIV risk behaviors among young men who have sex with men (YMSM). J Urban Health 2014; 91:969-82. [PMID: 25146488 PMCID: PMC4199441 DOI: 10.1007/s11524-014-9896-1] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Research shows that young men who have sex with men (YMSM) engage in higher rates of health risk behaviors and experience higher rates of negative health outcomes than their peers. The purpose of this study is to determine if the effects of adversity on HIV risk are mediated by syndemics (co-occurring health problems). Participants were 470 ethnically diverse YMSM ages 18 to 24 recruited between 2005 and 2006 and surveyed every 6 months for 24 months. Regression analyses examined the impact of adversity on syndemics (emotional distress, substance use, and problematic alcohol use) and the effects of both adversity and syndemics on HIV risk behaviors over time. Gay-related discrimination and victimization-among other adversity variables-were significantly associated with syndemics and condomless sex (CS). Syndemics mediated the effects of adversity on CS in all models. Adverse events impact HIV risk taking among YMSM through syndemics. These findings suggest that prevention programs aimed at reducing adversity may reduce both the synergistic effect of multiple psychosocial health problems and HIV risk taking.
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Affiliation(s)
- Amy Herrick
- Graduate school of Public Health, Department of Behavioral and Community Health Sciences, University of Pittsburgh, Pittsburgh, PA, USA,
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Lucille Sanzero Eller RN. Effects of two cognitive-behavioral interventions on immunity and symptoms in persons with HIV. Ann Behav Med 2013; 17:339-48. [PMID: 24203601 DOI: 10.1007/bf02888599] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
Investigations in both healthy and clinical populations support the effectiveness of cognitive-behavioral interventions for immune enhancement and symptom reduction. However, there is a paucity of research examining these interventions in human immunodeficiency virus (HIV) positive populations, and existing studies lack precision in design. In this study, HIV seropositive subjects, blocked by illness stage, were randomized to a guided imagery (N=23) or progressive muscle relaxation (PMR) (N=22) treatment, or a control group (N = 24). The six-week treatments were delivered via audiotape following brief face-to-face instruction, and effects on fatigue, depression, and three measures of cellular immunity were examined. Pre and posttreatment measures included the Center for Epidemiologic Studies Depression Scale (CES-D), Sleep and Rest subscale of the Sickness Impact Profile (SIP), CD4+ and CD16+ lymphocyte numbers, and CD4+:CD8 + T lymphocyte ratio. Data were analyzed using a hierarchical multiple regression model, holding pretreatment effects constant while assessing the contribution of each treatment to the dependent variables. The guided imagery group had a significant decrease in depression and fatigue, while the PMR group demonstrated an increased CD4+ T lymphocyte count and a reduction in depression. Findings supported the effectiveness of both interventions for symptom alleviation, and of PMR for immune enhancement in persons with HIV, and suggest a differential effect for the two treatments in this population.
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It gets better: resolution of internalized homophobia over time and associations with positive health outcomes among MSM. AIDS Behav 2013; 17:1423-30. [PMID: 23283578 DOI: 10.1007/s10461-012-0392-x] [Citation(s) in RCA: 88] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Health disparities research among gay and bisexual men has focused primarily on risk and deficits. However, a focus on resiliencies within this population may greatly benefit health promotion. We describe a pattern of resilience (internalized homophobia (IHP) resolution) over the life-course and its associations with current health outcomes. 1,541 gay and bisexual men from the Multi-Center AIDS Cohort study, an ongoing prospective study of the natural and treated histories of HIV, completed a survey about life-course events thought to be related to health. The majority of men resolved IHP over time independent of demographics. Men who resolved IHP had significantly higher odds of positive health outcomes compared to those who did not. These results provide evidence of resilience among participants that is associated with positive health outcomes. Understanding resiliencies and incorporating them into interventions may help to promote health and well-being among gay and bisexual men.
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Herrick AL, Lim SH, Plankey MW, Chmiel JS, Guadamuz TE, Guadamuz TT, Kao U, Shoptaw S, Carrico A, Ostrow D, Stall R. Adversity and syndemic production among men participating in the multicenter AIDS cohort study: a life-course approach. Am J Public Health 2012; 103:79-85. [PMID: 23153154 DOI: 10.2105/ajph.2012.300810] [Citation(s) in RCA: 110] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We tested a theory of syndemic production among men who have sex with men (MSM) using data from a large cohort study. METHODS Participants were 1551 men from the Multicenter AIDS Cohort Study enrolled at 4 study sites: Baltimore, Maryland-Washington, DC; Chicago, Illinois; Los Angeles, California; and Pittsburgh, Pennsylvania. Participants who attended semiannual visits from April 1, 2008, to March 31, 2009, completed an additional survey that captured data about events throughout their life course thought to be related to syndemic production. RESULTS Using multivariate analysis, we found that the majority of life-course predictor variables (e.g., victimization, internalized homophobia) were significantly associated with both the syndemic condition and the component psychosocial health outcomes (depressive symptoms, stress, stimulant use, sexual compulsivity, intimate partner violence). A nested negative binomial analysis showed that the overall life course significantly explained variability in the syndemic outcomes (χ(2) = 247.94; P < .001; df = 22). CONCLUSIONS We identified life-course events and conditions related to syndemic production that may help to inform innovative interventions that will effectively disentangle interconnecting health problems and promote health among MSM.
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Affiliation(s)
- Amy L Herrick
- Department of Behavioral and Community Health Sciences, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA 15260, USA.
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Dyer TP, Shoptaw S, Guadamuz TE, Plankey M, Kao U, Ostrow D, Chmiel JS, Herrick A, Stall R. Application of syndemic theory to black men who have sex with men in the Multicenter AIDS Cohort Study. J Urban Health 2012; 89:697-708. [PMID: 22383094 PMCID: PMC3535137 DOI: 10.1007/s11524-012-9674-x] [Citation(s) in RCA: 134] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
This study analyzed data from a large prospective epidemiologic cohort study among men who have sex with men (MSM), the Multicenter AIDS Cohort Study, to assess syndemic relationships among black MSM in the cohort (N = 301). We hypothesized that multiple interconnections among psychosocial health conditions would be found among these men, defining syndemic conditions. Constituents of syndemic conditions measured included reported depression symptoms, sexual compulsiveness, substance use, intimate partner violence (IPV), and stress. We found significant evidence of syndemics among these black men: depression symptoms were independently associated with sexual compulsiveness (odds ratios [OR]: 1.88, 95% CI = 1.1, 3.3) and stress (OR: 2.67, 95% CI = 1.5, 4.7); sexual compulsiveness was independently associated with stress (OR: 2.04, 95% CI = 1.2, 3.5); substance misuse was independently associated with IPV (OR: 2.57, 95% CI = 1.4, 4.8); stress independently was associated with depression symptoms (OR: 2.67, 95% CI = 1.5, 4.7), sexual compulsiveness (OR: 2.04, 95% CI = 1.2, 3.5) and IPV (OR: 2.84, 95% CI = 1.6, 4.9). Moreover, men who reported higher numbers of syndemic constituents (three or more conditions) reportedly engaged in more unprotected anal intercourse compared to men who had two or fewer health conditions (OR: 3.46, 95% CI = 1.4-8.3). Findings support the concept of syndemics in black MSM and suggest that syndemic theory may help explain complexities that sustain HIV-related sexual transmission behaviors in this group.
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Affiliation(s)
- Typhanye Penniman Dyer
- Department of Epidemiology and Biostatistics, School of Public Health, University of Maryland, College Park, MD, USA.
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Flowers P, Davis MM, Larkin M, Church S, Marriott C. Understanding the impact of HIV diagnosis amongst gay men in Scotland: An interpretative phenomenological analysis. Psychol Health 2011; 26:1378-91. [DOI: 10.1080/08870446.2010.551213] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Ndlovu U, Ion A, Carvalhal A. "My children and my home": the most recent and challenging stressors of HIV-positive women. Arch Womens Ment Health 2010; 13:215-22. [PMID: 20182756 DOI: 10.1007/s00737-010-0148-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2009] [Accepted: 01/08/2010] [Indexed: 11/24/2022]
Abstract
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.
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Affiliation(s)
- Uitsile Ndlovu
- The Ontario HIV Treatment Network, 600-1300 Yonge Street, Toronto, ON M4T 1X3, Canada.
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Marhefka SL, Lyon M, Koenig LJ, Orban L, Stein R, Lewis J, Tepper VJ. Emotional and behavioral problems and mental health service utilization of youth living with HIV acquired perinatally or later in life. AIDS Care 2009; 21:1447-54. [DOI: 10.1080/09540120902883085] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Stephanie L. Marhefka
- a Department of Community and Family Health , University of South Florida , Tampa , FL , USA
| | - Maureen Lyon
- b Children's National Medical Center, Division of Adolescent and Young Adult Medicine , Children's Research Institute , Washington , DC , USA
| | - Linda J. Koenig
- c Centers for Disease Control and Prevention, Division of HIV/AIDS Prevention , Atlanta , GA , USA
| | - Lisa Orban
- d Department of Pediatrics , New York University School of Medicine , New York , NY , USA
| | - Renee Stein
- c Centers for Disease Control and Prevention, Division of HIV/AIDS Prevention , Atlanta , GA , USA
| | - Jennifer Lewis
- d Department of Pediatrics , New York University School of Medicine , New York , NY , USA
| | - Vicki J. Tepper
- e Department of Pediatrics , University of Maryland School of Medicine , Baltimore , MD , USA
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Abstract
BACKGROUND Care and support play a critical role in assisting people who are HIV-positive to understand the need for prevention and to enable them to protect others. As the HIV/AIDS pandemic progresses and HIV-seropositive individuals contend with devastating illness, it seemed timely to inquire if they receive support from family members. It also was important to develop a normative idea of how much family support exists and from whom it emanates. OBJECTIVES To assess the effect of family support on morbidity, mortality, quality of life, and economics in families with at least one HIV-infected member, in developing countries. SEARCH STRATEGY The following databases were searched:The Cochrane Central Register for Controlled Trials (CENTRAL), the Cochrane Database of Systematic Reviews, MEDLINE, AIDSLINE, CINAHL, Dissertation Abstracts International (DAI), EMBASE, BIOSIS, SCISEARCH, the Cochrane HIV/AIDS group specialized register, INDMED, Proquest, and various South Asian abstracting databases, will be included in the database list. The publication sites of the World Health Organization, the US Centers for Disease Control and Prevention, and other international research and non-governmental organizations. An extensive search strategy string was developed in consultation with the trial search coordinator of the HIV/AIDS Review Group. Numerous relevant keywords were included in the string to get an exhaustive electronic literature search. The search was not restricted by language. Articles from other languages were translated into English with the help of experts. A hand search was carried out in many journals and abstracts of the conference proceedings of national and international conferences related to AIDS (e.g. the International Conference on HIV/AIDS and STI in Africa [ICASA]). Efforts also were made to contact experts to identify unpublished research and trials still underway. SELECTION CRITERIA Intervention studies. Randomized control trials (RCTs) and quasi-RCTs involving HIV-infected individuals with family support in developing countries. DATA COLLECTION AND ANALYSIS We independently screened the results of the search to select potentially relevant studies and to retrieve the full articles. We independently applied the inclusion criteria to the potentially relevant studies. No studies were identified that fulfilled the selection criteria. MAIN RESULTS We were unable to find any trials of family support in reducing the morbidity and mortality in HIV-infected persons in developing countries. AUTHORS' CONCLUSIONS There is insufficient evidence to bring out the effect of family support in reducing the morbidity and mortality of HIV-infected persons in developing countries. This review has highlighted the dearth of high-quality quantitative research about family support. There is a clear need for rigorous studies of the clinical effects of family support on people with HIV in developing countries.
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Affiliation(s)
- Padma Mohanan
- Kasturba Medical CollegeDepartment of Community MedicineMangaloreKarnatakaIndia575001
| | - Asha Kamath
- Kasturba Medical CollegeDepartment of Community MedicineManipalKarnatakaIndia
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Li L, Wu S, Wu Z, Sun S, Cui H, Jia M. Understanding family support for people living with HIV/AIDS in Yunnan, China. AIDS Behav 2006; 10:509-17. [PMID: 16741672 PMCID: PMC2795327 DOI: 10.1007/s10461-006-9071-0] [Citation(s) in RCA: 65] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
This study examines how family support affects people living with HIV/AIDS (PLHA) in China. In-depth, semi-structured interviews (n=30) were conducted with people living with HIV/AIDS who were infected through different routes (e.g., intravenous drug use, sex) and of different age groups. Findings showed that all of the participants were in great need of help and the primary source of support came from their families. Family support included financial assistance, support in the disclosure process, daily routine activities, medical assistance, or psychological support. This study illustrates that the support provided by family makes multiple levels of positive impact on people living with HIV/AIDS, suggesting the importance of including families in HIV/AIDS interventions.
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Affiliation(s)
- Li Li
- UCLA-NPI Center for Community Health, University of California, Los Angeles, CA 90024, USA.
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21
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Hough ES, Magnan MA, Templin T, Gadelrab HF. Social Network Structure and Social Support in HIV-Positive Inner City Mothers. J Assoc Nurses AIDS Care 2005; 16:14-24. [PMID: 16435527 DOI: 10.1016/j.jana.2005.05.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
It has been documented that social support influences health outcomes of persons with chronic illnesses. The incidence of HIV and AIDS among minority women is growing at an alarming rate, but little is known about social support in this vulnerable population, and even less is known about the social network conveying that support. Guided by the convoy of social networks model, this study describes the social networks in a sample of HIV-positive, urban-dwelling mothers (N = 147) by stage of disease (i.e., asymptomatic, symptomatic, AIDS) and examines relationships between social network structure and social support. Hierarchical linear modeling showed that women's social networks were disproportionately populated by children, and network members of women with AIDS were significantly older than network members of HIV-positive women with or without symptoms. Profile analyses showed that women's perceptions of the quality of social support differed according to the proportion of family members populating different segments of the social network.
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Affiliation(s)
- Edythe S Hough
- College of Nursing, Wayne State University, Detroit, MI, USA
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22
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Worthington C, Myers T, O'Brien K, Nixon S, Cockerill R. Rehabilitation in HIV/AIDS: development of an expanded conceptual framework. AIDS Patient Care STDS 2005; 19:258-71. [PMID: 15857198 DOI: 10.1089/apc.2005.19.258] [Citation(s) in RCA: 64] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
In industrialized countries where HIV infection is becoming a chronic, episodic condition, rehabilitation services have the potential to play an expanded role for people living with HIV/AIDS (PLHAs). However, little is known about rehabilitation in the context of HIV. This paper documents the development of an enhanced, multidisciplinary conceptual framework of rehabilitation in the context of HIV, using the perceptions of PLHAs and rehabilitation professionals. Rehabilitation, broadly defined, is a dynamic process that includes all prevention and/or treatment activities and/or services that address body impairments, activity limitations and participation restrictions for an individual. The framework was developed through broad consultation and interviews with thirteen key informants. Themes that emerged from analysis of interviews related to concepts of rehabilitation in the context of HIV, rehabilitation professionals' roles in the context of HIV, and barriers to access and delivery of rehabilitation services. While there was some variation, key informants generally viewed rehabilitation as a goal-oriented and client-centered process with the potential to impact a range of life domains. Themes were presented to members of a national advisory committee (including PLHAs and health care providers), who produced the foundation of the HIV rehabilitation framework. The framework uses the perspective of the person living with HIV/AIDS, and includes individual life domains that may be affected by HIV, drawing and expanding upon the World Health Organization's (WHO's) International Classification of Functioning, Disability and Health.
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Fulk LJ, Kane BE, Phillips KD, Bopp CM, Hand GA. Depression in HIV-infected patients: allopathic, complementary, and alternative treatments. J Psychosom Res 2004; 57:339-51. [PMID: 15518668 DOI: 10.1016/j.jpsychores.2004.02.019] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2003] [Accepted: 02/24/2004] [Indexed: 11/25/2022]
Abstract
OBJECTIVES The purpose of this review article is to synthesize the current knowledge related to depression and HIV disease. METHODS The research literature was critically evaluated for several selected therapies that are prescribed for HIV-infected persons to treat depression. These therapies included pharmacotherapy, psychotherapy, alternative, and complementary therapies. RESULTS Several therapies are currently available for the treatment of depression in HIV disease. When prescribing treatments, clinicians should be aware of problems associated with diagnoses, drug-drug interactions, and the benefits of some of the new therapies that are now available. Treatment regimes should be carefully designed to meet the individual needs of the patient and will optimally include a combination of approaches including psychotherapy, pharmacotherapy, education, and/or complementary therapies. CONCLUSIONS Although HIV is now a treatable disease, the prevalence of depression in the HIV population remains high and should be continually addressed.
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Affiliation(s)
- L J Fulk
- Department of Exercise Science, University of South Carolina, 1300 Wheat Street, Columbia, SC 29208, USA
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24
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Abstract
The growing incidence of HIV infection among low-income and minority women makes it important to investigate how these women adjust to living with HIV and AIDS. Psychological distress associated with HIV infection may compound the adjustment difficulties and increase the barriers to care associated with living in poverty. The authors surveyed 100 women who were receiving HIV care at a public hospital in the southeastern United States on measures of depression, anxiety, life stress, social support, and coping; they also assessed demographic and medical characteristics of the sample. Participants' annual incomes were low (87% < $10,000), and most participants were minorities (84% African American). Their levels of depression, stress, and anxiety symptoms were elevated relative to community norms. Greater anxiety and depression symptoms were associated with women who reported higher stress, using fewer active coping strategies, and perceiving less social support (ps < .001).
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Affiliation(s)
- Sheryl L Catz
- Center for AIDS Intervention Research (CAIR), Department of Psychiatry and Behavioral Medicine, Medical College of Wisconsin, Milwaukee, USA.
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25
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Chan KS, Orlando M, Joyce G, Gifford AL, Burnam MA, Tucker JS, Sherbourne CD. Combination antiretroviral therapy and improvements in mental health: results from a nationally representative sample of persons undergoing care for HIV in the United States. J Acquir Immune Defic Syndr 2003; 33:104-11. [PMID: 12792362 DOI: 10.1097/00126334-200305010-00015] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To test whether mental health improvements observed in a nationally representative sample of 2466 HIV+ persons receiving care in the United States during the dissemination of combination antiretroviral therapy (ART) is a result of global optimism or directly related to treatment. ANALYSIS Data were analyzed by means of a linear regression model of the change in psychiatric symptoms from baseline (January 1996-April 1997) to the first follow-up interview approximately 8 months later as a function of changes in CD4+ counts, opportunistic infection treatments, and HIV physical symptoms in the overall sample and separately in participants who maintained ART, initiated ART, never received ART, or transitioned to a less recommended regimen during the study period. RESULTS The reduction in psychiatric symptoms was comparable across all treatment groups (p >.05), suggesting a global effect. In patients who initiated or maintained ART, fewer psychiatric symptoms were significantly related to higher CD4+ and fewer opportunistic infection treatments and HIV symptoms, however, suggesting a treatment effect. CONCLUSION ART appears to be responsible for both a treatment-specific and global improvement in the mental health of HIV+ patients, possibly through the promise of extended survival and a better quality of life.
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Affiliation(s)
- Kitty S Chan
- RAND Health, Santa Monica, California 90407-2128, USA.
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26
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Neidig JL, Smith BA, Brashers DE. Aerobic exercise training for depressive symptom management in adults living with HIV infection. J Assoc Nurses AIDS Care 2003; 14:30-40. [PMID: 12698764 DOI: 10.1177/1055329002250992] [Citation(s) in RCA: 75] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Aerobic exercise training may help prevent or reduce depressive symptoms experienced by persons living with HIV infection. However, the psychological effects of aerobic exercise have not been studied extensively. This study evaluated the effects of an aerobic exercise training program on self-reported symptoms of depression in HIV-infected adults and examined the convergent validity of two widely used depressive symptom scales. Sixty HIV-infected adults participated in a randomized, controlled trial of a supervised 12-week aerobic exercise training program. As compared to study controls, exercise participants showed reductions in depressive symptoms on all indices, and total depressive symptoms scores were highly correlated. Additional study of the psychological effects of aerobic exercise programs in the target population is recommended.
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Affiliation(s)
- Judith L Neidig
- Office of Responsible Research Practices, Ohio State University, Columbus, Ohio, USA
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27
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Robbins M, Szapocznik J, Tejeda M, Samuels D, Ironson G, Antoni M. The Protective Role of the Family and Social Support Network in a Sample of HIV-Positive African American Women: Results of a Pilot Study. JOURNAL OF BLACK PSYCHOLOGY 2003; 29:17-37. [PMID: 16609750 PMCID: PMC1435682 DOI: 10.1177/0095798402239227] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This study examined the role of family functioning and social support in protecting HIV-positive African American women from the adverse psychological consequences associated with deterioration in their CD4 cell count. Participants were 38 African American HIV-positive women who had recently given birth. Results demonstrated that changes in CD4 cell counts were inversely predictive of psychological distress and were moderated by family functioning and social support satisfaction. Women with good family functioning were less affected by changes in their CD4 cell counts, and women with poor family functioning were more emotionally responsive to changes in CD4 cell count. Unexpectedly, women from families where conflicts tended to be clearly laid out and discussed were also more responsive to both changes in CD4 cell counts. Interventions are recommended that increase a client's social support satisfaction, foster an adaptive level of connectedness to family, and enhance the family's range of conflict resolution styles.
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Kaaya SF, Fawzi MCS, Mbwambo JK, Lee B, Msamanga GI, Fawzi W. Validity of the Hopkins Symptom Checklist-25 amongst HIV-positive pregnant women in Tanzania. Acta Psychiatr Scand 2002; 106:9-19. [PMID: 12100343 PMCID: PMC6300056 DOI: 10.1034/j.1600-0447.2002.01205.x] [Citation(s) in RCA: 162] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To validate the Hopkins Symptom Checklist-25 (HSCL-25) for use as a depression screen amongst human immuno-deficiency virus (HIV) positive pregnant women. METHOD Amongst 903 (mean age 24.8 years) HIV-positive pregnant women, a two-phased design included measures for health-related quality of life, perceived social support, and the HSCL-25 screen for depressive (HSCL-15 subscale) and anxiety symptoms. The Structured Clinical Interview for DSM-IV (SCID) was independently administered on a stratified random subsample. RESULTS Internal consistency of the HSCL-25 (alpha 0.93) and HSCL-15 (alpha 0.9) was adequate, with expected findings demonstrated in discriminant validity analysis. A depression-anxiety construct explained nearly 40% of the variance. Eight individual HSCL-25 items demonstrated an area under the curve (AUC) greater than 0.6 for DSM-IV major depression and the HSCL-25 and HSCL-revised had an optimal depression cut-off score of 1.06 and 1.03 for the HSCL-15. CONCLUSION The HSCL-25 demonstrated utility as a screen for depression; its inability to gauge severity of symptoms in this cultural context is discussed.
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Affiliation(s)
- S F Kaaya
- Department of Psychiatry, Muhimbili University College of Health Sciences, Dar es Salaam, Tanzania.
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29
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Johnson JM, Endler NS. Coping with human immunodeficiency virus: Do optimists fare better? CURRENT PSYCHOLOGY 2002. [DOI: 10.1007/bf02903156] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Erlen JA, Mellors MP, Sereika SM, Cook C. The use of life review to enhance quality of life of people living with AIDS: a feasibility study. Qual Life Res 2002; 10:453-64. [PMID: 11763207 DOI: 10.1023/a:1012583931564] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
People living with AIDS (PLWA) are confronted with uncertainty and their own mortality at an earlier than expected age. Life review, an intervention that has the potential to increase life satisfaction in the elderly experiencing transition points in their lives, may have a similar effect when used with PLWA. Therefore, the purpose of this feasibility study was to explore the use of life review in a sample of 20 PLWA through a randomized controlled trial of its effectiveness in decreasing depressive symptoms and in increasing self esteem, quality of life, and purpose in life. Compared to the control group, the treatment group had an improved overall quality of life and self-esteem over 12 months, less depressive symptoms over 12 months, and a greater purpose in life at 3 months. The effects that were seen were mainly small to medium effects. The findings from this feasibility study suggest the potential value of life review to enhance quality of life, purpose in life, and self-esteem, and to decrease depressive symptoms in PLWA. Further research is needed with a larger sample and with other groups such as PLWA experiencing virologic failure.
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Affiliation(s)
- J A Erlen
- Center for Research in Chronic Disorders, School of Nursing, University of Pittsburgh, PA 15261, USA.
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Depressive symptomatology in relation to emotional control and chronic pain in persons who are HIV positive. Rehabil Psychol 2002. [DOI: 10.1037/0090-5550.47.4.402] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Berger BE, Ferrans CE, Lashley FR. Measuring stigma in people with HIV: psychometric assessment of the HIV stigma scale. Res Nurs Health 2001; 24:518-29. [PMID: 11746080 DOI: 10.1002/nur.10011] [Citation(s) in RCA: 1031] [Impact Index Per Article: 44.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
An instrument to measure the stigma perceived by people with HIV was developed based on the literature on stigma and psychosocial aspects of having HIV. Items surviving two rounds of content review were assembled in a booklet and distributed through HIV-related organizations across the United States. Psychometric analysis was performed on 318 questionnaires returned by people with HIV (19% women, 21% African American, 8% Hispanic). Four factors emerged from exploratory factor analysis: personalized stigma, disclosure concerns, negative self-image, and concern with public attitudes toward people with HIV. Extraction of one higher-order factor provided evidence of a single overall construct. Construct validity also was supported by relationships with related constructs: self-esteem, depression, social support, and social conflict. Coefficient alphas between .90 and .93 for the subscales and .96 for the 40-item instrument provided evidence of internal consistency reliability. The HIV Stigma Scale was reliable and valid with a large, diverse sample of people with HIV.
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Affiliation(s)
- B E Berger
- Department of Medical Surgical Nursing, College of Nursing, University of Illinois at Chicago, Chicago, IL 60612-7350, USA
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Tomakowsky J, Lumley MA, Markowitz N, Frank C. Optimistic explanatory style and dispositional optimism in HIV-infected men. J Psychosom Res 2001; 51:577-87. [PMID: 11595246 DOI: 10.1016/s0022-3999(01)00249-5] [Citation(s) in RCA: 42] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE This study examined associations of two types of optimism (Peterson and Seligman's optimistic explanatory style and Scheier and Carver's dispositional optimism) with each other as well as with symptoms and immune status among human immunodeficiency virus (HIV)-infected men. METHOD We related both types of optimism to HIV symptoms and to CD4 counts in a cross-sectional study of 78 men, and to change in CD4 counts in a 2-year prospective study of a subsample of these men. RESULTS Analyses controlled for age, education, employment status, duration since diagnosis, and azidothymidine (AZT) use. The two types of optimism were only minimally related to each other (r=.25). Cross-sectionally, higher levels of both types of optimism were associated with having fewer HIV symptoms, but a more optimistic explanatory style was related to having poorer immune status (lower CD4). Prospectively, an optimistic explanatory style was a substantial predictor of greater decline in CD4 counts after 2 years, after controlling for baseline CD4. Dispositional optimism was unrelated to CD4 counts. Neither health behaviors nor coping strategies mediated these relationships, and the relationships of optimistic explanatory style (and to a lesser extent, dispositional optimism) were independent of negative affectivity. CONCLUSIONS These optimism measures tap different types of optimism, and although both are related to better subjective health in HIV-infected men, an optimistic explanatory style predicts greater decline in immune status over time. This latter relationship may be related to the unique stress and life experiences associated with having HIV.
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Affiliation(s)
- J Tomakowsky
- Department of Psychology, Wayne State University, 71 West Warren Avenue, Detroit, MI 48202, USA
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Murphy DA, Durako SJ, Moscicki AB, Vermund SH, Ma Y, Schwarz DF, Muenz LR. No change in health risk behaviors over time among HIV infected adolescents in care: role of psychological distress. J Adolesc Health 2001; 29:57-63. [PMID: 11530304 DOI: 10.1016/s1054-139x(01)00287-7] [Citation(s) in RCA: 129] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
PURPOSE To investigate the association of psychological distress and health risk behaviors among HIV infected adolescents. It was hypothesized that higher levels of distress would be associated with increased sexual risk behaviors, and increased use of alcohol and drugs. METHODS HIV infected adolescents (N = 323) were recruited into an observational study in 15 clinical sites; for the 323 subjects, a total of 1212 visits were used in a repeated measures analysis. Data on depression (using the CES-D), anxiety (manifest anxiety scale), sexual behaviors and alcohol and marijuana use were obtained through computer-assisted self-administered interview. RESULTS Approximately 65% of the sample was sexually active across all six study visits, with approximately 43% consistently reporting having unprotected sex at last intercourse. Higher levels of depression were associated with frequent alcohol use and with unprotected sex at last intercourse, with depressed adolescents significantly more likely to have had unprotected sex than those who were not depressed. Health anxiety was associated with frequent marijuana use and with recent sexual activity, and physiological anxiety was also associated with recent sexual activity. CONCLUSIONS Despite the fact that these HIV infected adolescents are all engaged in primary care, overall the sample is maintaining its high-risk sexual behavior. In addition, these adolescents may be self-medicating to deal with health-related anxiety. Health interventions for HIV infected adolescents should examine whether psychological distress is contributing to maintenance health risk behaviors.
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Affiliation(s)
- D A Murphy
- Health Risk Reduction Projects, Integrated Substance Abuse Program, Department of Psychiatry, University of California, Los Angeles, California 90025-7510, USA.
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Richardson J, Barkan S, Cohen M, Back S, FitzGerald G, Feldman J, Young M, Palacio H. Experience and covariates of depressive symptoms among a cohort of HIV infected women. SOCIAL WORK IN HEALTH CARE 2001; 32:93-111. [PMID: 11451159 DOI: 10.1300/j010v32n04_05] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
OBJECTIVES The objectives of this study are to assess (a) the level of depressive symptoms among a cohort of HIV infected women and comparable controls and (b) the relationship with covariates including socioeconomic status, substance use, social relations, disease status. METHODS Participants were enrolled in the Women's Interagency HIV Study (WIHS). Depressive symptoms were measured using the Center for Epidemiological Studies Depression Scale (CESD). Data from 1993 HIV seropositive and 551 seronegative women are presented. RESULTS Of HIV positive women 57.7% of HIV positive women scored 16 or higher on the CESD (ns) as compared to 55.0% of HIV negative women; at a cutoff of 23, the percents were 40.4% and 35.9% respectively (p = .06). The mean score was high 19.8 but not significantly different between groups. Scores were higher among women who had less education, lower income, were of Hispanic ethnicity, used alcohol or drugs, experienced domestic abuse, had more than one partner, or had less supportive relationships. Among infected women, higher CESD scores were not significantly associated with CD4 cell count but were elevated for self-reported Class C AIDS defining clinical conditions. CONCLUSIONS The scores on the CESD were elevated for both HIV positive and HIV negative women and the differences between the groups were small. Lower socioeconomic status and social support and higher substance use and domestic abuse were associated with depressive symptoms similarly for both groups.
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Abstract
Biomedical advances, new HIV testing technologies, and policy shifts in the last 15 years have created substantial new challenges and opportunities for service providers, policy makers, and researchers regarding broad scale identification of HIV-seropositive persons. Effective HIV testing will be achieved when we: (1) increase the number of high-risk persons tested; (2) decrease the time from HIV infection to detection; (3) increase testing acceptability; (4) increase the proportion of individuals tested who receive their results; and (5) increase the proportion of individuals tested seropositive who are linked to care. Strategies to enhance effectiveness include implementing new testing technologies and delivery modalities; expanding access to client-controlled testing; targeting providers' knowledge, attitudes, and behaviors regarding HIV testing; mainstreaming HIV testing as routine clinical care; targeting persons who engage in high-risk behaviors and those in high-risk groups; and implementing a national behavioral surveillance system. Addressing these challenges will improve HIV detection in the United States, which is vital to both HIV prevention and treatment.
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Affiliation(s)
- M J Rotheram-Borus
- AIDS Institute, Center for HIV Identification, Prevention, and Treatment Services, Department of Psychiatry, University of California, Los Angeles 90024, USA
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Murphy DA, Moscicki AB, Vermund SH, Muenz LR. Psychological distress among HIV(+) adolescents in the REACH study: effects of life stress, social support, and coping. The Adolescent Medicine HIV/AIDS Research Network. J Adolesc Health 2000; 27:391-8. [PMID: 11090741 DOI: 10.1016/s1054-139x(00)00158-0] [Citation(s) in RCA: 83] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
PURPOSE To investigate the effects of life events, social support, and coping on anxiety and depression among human immunodeficiency virus (HIV)-infected adolescents. It was hypothesized that higher levels of stressful events would be associated with higher levels of anxiety and depression, but that this association would be moderated by satisfaction with social support and by adaptive coping. METHODS HIV-infected adolescents from 16 locations in 13 U.S. cities (N = 230, median age 16.09 years, standard deviation 1.2, range 13-19; 77% females) were recruited into the Reaching for Excellence in Adolescent Care and Health (REACH) project. REACH is the first large-scale disease progression study of HIV(+) adolescents infected through sexual behavior or injection drug use. The adolescent assessment was conducted by audio-computer assisted self-interview. Least squares regressions were used to test hypotheses. RESULTS Life events with high impact were associated with higher levels of depression and anxiety. Frequently reported events included: being prescribed medications (74%), family financial problems (61%), and parental alcohol abuse (20%). Contrary to expectations, the buffering hypotheses of social support and adaptive coping were not supported. Satisfaction with social support and adaptive coping methods were both associated directly with lower levels of depression, but no association was detected between these two measures and anxiety. CONCLUSIONS Although life event distress was directly associated with psychological distress, neither social support nor adaptive coping seemed to moderate this association. However, both satisfaction with support and adaptive coping were associated directly with depression in HIV-infected adolescents.
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Affiliation(s)
- D A Murphy
- Health Risk Reduction Projects, Department of Psychiatry, University of California at Los Angeles, Los Angeles, California, USA.
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Fleishman JA, Sherbourne CD, Crystal S, Collins RL, Marshall GN, Kelly M, Bozzette SA, Shapiro MF, Hays RD. Coping, conflictual social interactions, social support, and mood among HIV-infected persons. HCSUS Consortium. AMERICAN JOURNAL OF COMMUNITY PSYCHOLOGY 2000; 28:421-453. [PMID: 10965385 DOI: 10.1023/a:1005132430171] [Citation(s) in RCA: 84] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
This study considers the interrelationships among coping, conflictual social interactions, and social support, as well as their combined associations with positive and negative mood. Research has shown that each of these variables affects adjustment to stressful circumstances. Few studies, however, examine this full set of variables simultaneously. One hundred forty HIV-infected persons completed a questionnaire containing measures of coping, social support, conflictual social interactions, and positive and negative mood. Factor analyses showed that perceived social support and conflictual social interactions formed separate factors and were not strongly related. Compared to perceived social support, social conflict was more strongly related to coping behaviors, especially to social isolation, anger, and wishful thinking. Conflictual social interactions were more strongly related to negative mood than was perceived social support. Coping by withdrawing socially was significantly related to less positive and greater negative mood. The findings point to the importance of simultaneously considering coping, supportive relationships, and conflictual relationships in studies of adjustment to chronic illness. In particular, a dynamic may occur in which conflictual social interactions and social isolation aggravate each other and result in escalating psychological distress.
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Affiliation(s)
- J A Fleishman
- Center for Cost and Financing Studies, Agency for Healthcare Research and Quality, Rockville, Maryland 20852, USA
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40
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El-Bassel N, Schilling RF, Gilbert L, Faruque S, Irwin KL, Edlin BR. Sex trading and psychological distress in a street-based sample of low-income urban men. J Psychoactive Drugs 2000; 32:259-67. [PMID: 11061676 DOI: 10.1080/02791072.2000.10400448] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
This article examines the relationship between sex trading and psychological distress and assesses sexual human immunodeficiency virus (HIV) risk behaviors and HIV seroprevalence in a sample of young men recruited from the streets of Harlem. The authors interviewed 477 men, aged 18 to 29 years, of whom 43 (9.0%) had received money or drugs in exchange for sex in the preceding 30 days and were categorized as sex traders. Psychological distress was measured by using the Brief Symptom Inventory (BSI). Sex traders scored significantly higher than non-sex traders on the General Severity Index and on all nine subscales of the BSI. According to multivariate analysis after adjusting for perceived HIV risk, current regular crack cocaine use and homelessness, sex traders scored 0.173 units higher on the General Severity Index than non-sex traders (p < .001). More of the sex traders tested positive for HIV (41% versus 19%, p < .001). The alarmingly high HIV seroprevalence rate in sex traders in this sample underscores the need to redouble HIV prevention efforts for this population. The high levels of psychological distress and crack cocaine dependence among sex traders may undermine their ability to adopt safer sex behaviors and should be considered in intervention designs.
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Affiliation(s)
- N El-Bassel
- Social Intervention Group, School of Social Work, Columbia University, New York, New York 10025, USA.
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41
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Summers J, Robinson R, Capps L, Zisook S, Atkinson JH, McCutchan E, McCutchan JA, Deutsch R, Patterson T, Grant I. The influence of HIV-related support groups on survival in women who lived with HIV. A pilot study. PSYCHOSOMATICS 2000; 41:262-8. [PMID: 10849459 DOI: 10.1176/appi.psy.41.3.262] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
To determine the effect of support groups on survival, the authors retrospectively studied 21 HIV-seropositive women who died during the course of participation in a natural history study of HIV. Groups were composed of women who self-selected HIV support groups before death (n = 11) and a comparison group (n = 10). Survival analysis found group participation to be associated with increased longevity (73 months vs. 45 months; P = 0.011). Proportional-hazards regression demonstrated that HIV-related support groups and smaller family size significantly influenced survival (P = 0.0002). Factors related to group participation and ways in which support groups might promote longevity are discussed.
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Affiliation(s)
- J Summers
- University of California, Berkeley (UCB) School of Social Welfare, USA.
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42
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Abstract
Patients with acquired immunodeficiency syndrome (AIDS) often suffer from weight loss manifested by a loss of body cell mass (BCM). The causes of human immunodeficiency virus (HIV)-associated wasting may include anorexia, malabsorption, and a variety of altered metabolic states. Malabsorption and diarrhea may result from gastrointestinal tract opportunistic infections or from direct effects of HIV on the gastrointestinal tract. Infection with HIV may produce metabolic derangements that alter nutrient utilization, resulting in loss of BCM. Nutritional assessment of the patient with AIDS should include an evaluation of BCM and physical and psychosocial functioning. Antiretroviral therapy and eradication of opportunistic infections do not always reverse wasting. Treatment should include nutritional counseling. Total parenteral nutrition is sometimes of benefit, particularly in patients with damaged gastrointestinal tracts. Dronabinol and megestrol acetate may promote weight gain; however, dronabinol may have adverse effects, and most of the gain with megestrol acetate is in fat rather than BCM. If gonadal dysfunction is present, testosterone replacement therapy should be included in the treatment plan. Some studies suggest that oral anabolic steroids may improve muscle strength and body composition. In randomized, placebo-controlled trials, mammalian-derived human growth hormone (rhGH[m]) has produced sustained weight and BCM gains in AIDS patients. If a patient continues to lose BCM after the above factors have been addressed and corrected, a 12-week course of rhGH[m] is indicated. Halting the progression of HIV-associated wasting may improve survival, enhance physical and social functioning, and enrich quality of life.
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Affiliation(s)
- P M Nemechek
- Nemechek Health Renewal, Prairie Village, Kan. 66208, USA
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44
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Low-Beer S, Chan K, Yip B, Wood E, Montaner JS, O'Shaughnessy MV, Hogg RS. Depressive symptoms decline among persons on HIV protease inhibitors. J Acquir Immune Defic Syndr 2000; 23:295-301. [PMID: 10836751 DOI: 10.1097/00126334-200004010-00003] [Citation(s) in RCA: 70] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To ascertain whether initiation of protease inhibitors was associated with a change in depressive symptoms among persons infected with HIV. METHODS Study subjects included men and women who were enrolled in the HIV/AIDS Drug Treatment Program and who had completed an annual participant survey before and after initiating triple combination therapy with a protease inhibitor. Depressive symptoms were assessed using the Centre for Epidemiologic Studies-Depression scale (CES-D). Statistical analyses to determine the change in CES-D total and subscale scores before and after protease inhibitor use were conducted using parametric and multivariate methods. RESULTS Our analysis was restricted to 453 participants. Of these 234 (52%) were depressed at baseline (CES-D score > or = 16). Compared with nondepressed participants, depressed participants were slightly younger (p = .048), less likely to be employed (p < .001) and more likely to have an annual income less than $10,000 per annum (p < .001). After adjusting for CD4 count, employment status, income, age, and CES-D total or subscale score at baseline, we found a significant improvement in total scale score (p = .001) and depressive mood (p = .002), positive affects (p = .005), and somatic symptoms (p = .011) subscale scores at follow-up. There was no significant change in the interpersonal relations score over the study period. CONCLUSION Our findings indicate that in addition to conferring impressive clinical benefits, protease inhibitor use is associated with a significant improvement in HIV-positive individuals' mental health.
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Affiliation(s)
- S Low-Beer
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, Canada
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45
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Schmitz MF, Crystal S. Social Relations, Coping, and Psychological Distress Among Persons With HIV/AIDS1. JOURNAL OF APPLIED SOCIAL PSYCHOLOGY 2000. [DOI: 10.1111/j.1559-1816.2000.tb02818.x] [Citation(s) in RCA: 82] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Malbergier A, Andrade AGD. Transtornos depressivos em usuários de drogas injetáveis infectados pelo HIV: um estudo controlado. BRAZILIAN JOURNAL OF PSYCHIATRY 1999. [DOI: 10.1590/s1516-44461999000400010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJETIVO: Estudar os transtornos psiquiátricos em pacientes usuários de drogas injetáveis infectados pelo HIV. MÉTODOS: Pacientes que se apresentavam para tratamento da dependência de drogas, foram divididos em dois grupos de acordo com a sorologia para o HIV (vírus da imunodeficiência humana), vírus causador da síndrome da imunodeficiência adquirida (AIDS). Trinta pacientes HIV-positivos e 30 pacientes HIV-negativos submeteram-se a uma entrevista estruturada para avaliação de transtornos psiquiátricos. Inicialmente, foram analisados os transtornos depressivos e os relacionados ao uso de substâncias psicoativas. RESULTADOS: Os resultados revelaram que o diagnóstico de dependência de cocaína foi mais freqüente em pacientes infectados pelo HIV do que nos não-infectados. A sorologia positiva para o HIV não foi fator associado a maior prevalência de depressão. As tentativas de suicídio foram freqüentes nesta amostra, mas as freqüências foram iguais nos dois grupos. CONCLUSÃO: Os pacientes HIV-positivos tendem a diminuir ou cessar o consumo de cocaína após conhecimento de sua sorologia.
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Abstract
OBJECTIVES The aim of this paper is: to compare the utility of four approaches to the diagnosis of depression in patients with human immunodeficiency virus (HIV) disease; to examine the utility of four rating scales to assess the presence and severity of depression; and to devise a set of substitutive criteria that would be appropriate in patients with HIV disease. METHOD A group of inpatients was assessed using standard clinical interview. Patients found to have major depression using DSM-III-R (aetiological) criteria were assessed using inclusive, substitutive and exclusive criteria for the diagnosis of depression. Severity was assessed using the Hamilton Depression Rating Scale (HDRS), the Montgomery Asberg Depression Rating Scale (MADRS), the Beck Depression Inventory (BDI), and the Centre for Epidemiological Studies Depression Rating Scale (CES-D). A group of control patients were matched for age and severity of HIV illness. RESULTS Seventeen patients met DSM-III-R (aetiological criteria) for major depression. All were male; they had a mean age of 40.6 years and one-third had acquired immune deficiency syndrome (AIDS). Using alternative approaches to the diagnosis of depression, up to five additional 'depressed' patients were identified ('false positives'). All 17 patients meeting the DSM-III-R criteria also met the substitutive and exclusive criteria but only 15 exclusive criteria. Of the 17 controls (not meeting DSM-III-R criteria), two met substitutive, five inclusive and one exclusive criteria for depression. The mean (+/- SD) scores for the patients and controls were significantly different on all four rating scales. Analysis of individual items on the rating scales revealed that a number did not show significant differences between the depressed and nondepressed groups: on the MADRS the items lassitude and inner tension; on the HDRS the three items depicting anxiety symptoms, loss of libido, hypochondriasis, loss of weight, and maintenance of insight; on the BDI a sense of being punished, disappointed in self, being self-critical, a feeling of looking unattractive, fatigue, weight loss, worried about health and loss of libido; on the CES-D I felt just as good as others, hopeful, talk less, people unfriendly and felt people dislike me. CONCLUSIONS The aetiological approach used by clinicians familiar with the features of HIV disease, was found to be useful. All four rating scales differentiated equally well between depressed and non-depressed groups.
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Affiliation(s)
- A Cockram
- University of Melbourne, Department of Psychiatry, Royal Melbourne Hospital, Parkville, Victoria, Australia
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Siegel JM, Angulo FJ, Detels R, Wesch J, Mullen A. AIDS diagnosis and depression in the Multicenter AIDS Cohort Study: the ameliorating impact of pet ownership. AIDS Care 1999; 11:157-70. [PMID: 10474619 DOI: 10.1080/09540129948054] [Citation(s) in RCA: 114] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
The impact of pet ownership on depression was tested among a sample of gay and bisexual men (n = 1,872). Multivariate analyses, controlling for demographics and baseline depressive symptomatology, showed that neither pet ownership nor the presence of HIV infection was associated with depression. Depression was influenced by the presence of AIDS and by having relatively few confidants. Analyses among HIV-infected men only showed that persons with AIDS who owned pets reported less depression than persons with AIDS who did not own pets. This beneficial effect of pet ownership occurred principally among persons who reported fewer confidants. These results suggest that by enhancing companionship for some HIV-infected persons, pets may buffer the stressful impact of AIDS.
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Affiliation(s)
- J M Siegel
- University of California, Los Angeles, USA.
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49
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Sowell RL, Moneyham L, Aranda-Naranjo B. THE CARE OF WOMEN WITH AIDS. Nurs Clin North Am 1999. [DOI: 10.1016/s0029-6465(22)02369-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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50
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Rotheram-Borus MJ, Murphy DA, Swendeman D, Chao B, Chabon B, Zhou S, Birnbaum J, O'Hara P. Substance use and its relationship to depression, anxiety, and isolation among youth living with HIV. Int J Behav Med 1999; 6:293-311. [PMID: 16250672 DOI: 10.1207/s15327558ijbm0604_1] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
Reductions from lifetime to recent levels of substance use, the time since HIV diagnosis, physical health symptoms, CD4 counts, emotional distress, and social supports were examined among 227 (20% female; 22% African American, 27% Anglo, 35% Latino) youth living with HIV (YLH) ages 13 to 24 years. Substance use pervaded the lives of these youth. Male YLH had used more drugs., more often, and for longer periods than women. However, there had been major reductions in use. Being male, having high emotional distress, and having fewer negative social supports were significantly associated with greater reductions in substance use. There was a trend for the length of time that an individual was seropositive being associated with reductions in substance use. The counterintuitive findings suggest that there must be a re-examination of the role of the social support networks of youth living with HIV, as well as the ways in which emotional distress interacts with risk behaviors.
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Affiliation(s)
- M J Rotheram-Borus
- Department of Psychiatry, University of California, Los Angeles, CA, USA.
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