Meaning of illness and psychological adjustment to HIV/AIDS

Meaning in life, goals, and adherence to antiretroviral treatment in people living with HIV

Patients living with HIV who do not adhere to antiretroviral treatment (ART) have a high viral load, increasing the risk of developing AIDS, as well as new treatment-resistant strains. There are several psychological factors that must be studied to understand the reasons for non-adherence to ART. We studied whether the goals reported by patients with HIV, as well as their sense of meaning in life, influence ART adherence in a sample of adult patients attending HIV outpatient care in Mexico. Participants completed the Antiretroviral Treatment Adherence Assessment Questionnaire, the Dimensional Scale of Meaning in Life and were asked to write both short-term and long-term goals. The most frequent goals reported were those categorized as "personal development," followed by "being healthy." Participants with the highest adherence had more short-term "personal development" goals. Moreover, they showed the lowest levels of existential vacuum (lack of meaning in life). These variables predicted treatment adherence. We conclude that the design of programs to improve ART adherence should promote the establishment of personal development goals and offer tools that allow having a sense of meaning in life to reduce AIDS-related complications.

Psychological interventions to foster resilience in healthcare students

BACKGROUND

Resilience can be defined as maintaining or regaining mental health during or after significant adversities such as a potentially traumatising event, challenging life circumstances, a critical life transition or physical illness. Healthcare students, such as medical, nursing, psychology and social work students, are exposed to various study- and work-related stressors, the latter particularly during later phases of health professional education. They are at increased risk of developing symptoms of burnout or mental disorders. This population may benefit from resilience-promoting training programmes.

OBJECTIVES

To assess the effects of interventions to foster resilience in healthcare students, that is, students in training for health professions delivering direct medical care (e.g. medical, nursing, midwifery or paramedic students), and those in training for allied health professions, as distinct from medical care (e.g. psychology, physical therapy or social work students).

SEARCH METHODS

We searched CENTRAL, MEDLINE, Embase, 11 other databases and three trial registries from 1990 to June 2019. We checked reference lists and contacted researchers in the field. We updated this search in four key databases in June 2020, but we have not yet incorporated these results.

SELECTION CRITERIA

Randomised controlled trials (RCTs) comparing any form of psychological intervention to foster resilience, hardiness or post-traumatic growth versus no intervention, waiting list, usual care, and active or attention control, in adults (18 years and older), who are healthcare students. Primary outcomes were resilience, anxiety, depression, stress or stress perception, and well-being or quality of life. Secondary outcomes were resilience factors.

DATA COLLECTION AND ANALYSIS

Two review authors independently selected studies, extracted data, assessed risks of bias, and rated the certainty of the evidence using the GRADE approach (at post-test only).

MAIN RESULTS

We included 30 RCTs, of which 24 were set in high-income countries and six in (upper- to lower-) middle-income countries. Twenty-two studies focused solely on healthcare students (1315 participants; number randomised not specified for two studies), including both students in health professions delivering direct medical care and those in allied health professions, such as psychology and physical therapy. Half of the studies were conducted in a university or school setting, including nursing/midwifery students or medical students. Eight studies investigated mixed samples (1365 participants), with healthcare students and participants outside of a health professional study field. Participants mainly included women (63.3% to 67.3% in mixed samples) from young adulthood (mean age range, if reported: 19.5 to 26.83 years; 19.35 to 38.14 years in mixed samples). Seventeen of the studies investigated group interventions of high training intensity (11 studies; > 12 hours/sessions), that were delivered face-to-face (17 studies). Of the included studies, eight compared a resilience training based on mindfulness versus unspecific comparators (e.g. wait-list). The studies were funded by different sources (e.g. universities, foundations), or a combination of various sources (four studies). Seven studies did not specify a potential funder, and three studies received no funding support. Risk of bias was high or unclear, with main flaws in performance, detection, attrition and reporting bias domains. At post-intervention, very-low certainty evidence indicated that, compared to controls, healthcare students receiving resilience training may report higher levels of resilience (standardised mean difference (SMD) 0.43, 95% confidence interval (CI) 0.07 to 0.78; 9 studies, 561 participants), lower levels of anxiety (SMD -0.45, 95% CI -0.84 to -0.06; 7 studies, 362 participants), and lower levels of stress or stress perception (SMD -0.28, 95% CI -0.48 to -0.09; 7 studies, 420 participants). Effect sizes varied between small and moderate. There was little or no evidence of any effect of resilience training on depression (SMD -0.20, 95% CI -0.52 to 0.11; 6 studies, 332 participants; very-low certainty evidence) or well-being or quality of life (SMD 0.15, 95% CI -0.14 to 0.43; 4 studies, 251 participants; very-low certainty evidence). Adverse effects were measured in four studies, but data were only reported for three of them. None of the three studies reported any adverse events occurring during the study (very-low certainty of evidence).

AUTHORS' CONCLUSIONS

For healthcare students, there is very-low certainty evidence for the effect of resilience training on resilience, anxiety, and stress or stress perception at post-intervention. The heterogeneous interventions, the paucity of short-, medium- or long-term data, and the geographical distribution restricted to high-income countries limit the generalisability of results. Conclusions should therefore be drawn cautiously. Since the findings suggest positive effects of resilience training for healthcare students with very-low certainty evidence, high-quality replications and improved study designs (e.g. a consensus on the definition of resilience, the assessment of individual stressor exposure, more attention controls, and longer follow-up periods) are clearly needed.

Psychological interventions to foster resilience in healthcare professionals

BACKGROUND

Resilience can be defined as the maintenance or quick recovery of mental health during or after periods of stressor exposure, which may result from a potentially traumatising event, challenging life circumstances, a critical life transition phase, or physical illness. Healthcare professionals, such as nurses, physicians, psychologists and social workers, are exposed to various work-related stressors (e.g. patient care, time pressure, administration) and are at increased risk of developing mental disorders. This population may benefit from resilience-promoting training programmes.

OBJECTIVES

To assess the effects of interventions to foster resilience in healthcare professionals, that is, healthcare staff delivering direct medical care (e.g. nurses, physicians, hospital personnel) and allied healthcare staff (e.g. social workers, psychologists).

SEARCH METHODS

We searched CENTRAL, MEDLINE, Embase, 11 other databases and three trial registries from 1990 to June 2019. We checked reference lists and contacted researchers in the field. We updated this search in four key databases in June 2020, but we have not yet incorporated these results.

SELECTION CRITERIA

Randomised controlled trials (RCTs) in adults aged 18 years and older who are employed as healthcare professionals, comparing any form of psychological intervention to foster resilience, hardiness or post-traumatic growth versus no intervention, wait-list, usual care, active or attention control. Primary outcomes were resilience, anxiety, depression, stress or stress perception and well-being or quality of life. Secondary outcomes were resilience factors.

DATA COLLECTION AND ANALYSIS

Two review authors independently selected studies, extracted data, assessed risks of bias, and rated the certainty of the evidence using the GRADE approach (at post-test only).

MAIN RESULTS

We included 44 RCTs (high-income countries: 36). Thirty-nine studies solely focused on healthcare professionals (6892 participants), including both healthcare staff delivering direct medical care and allied healthcare staff. Four studies investigated mixed samples (1000 participants) with healthcare professionals and participants working outside of the healthcare sector, and one study evaluated training for emergency personnel in general population volunteers (82 participants). The included studies were mainly conducted in a hospital setting and included physicians, nurses and different hospital personnel (37/44 studies). Participants mainly included women (68%) from young to middle adulthood (mean age range: 27 to 52.4 years). Most studies investigated group interventions (30 studies) of high training intensity (18 studies; > 12 hours/sessions), that were delivered face-to-face (29 studies). Of the included studies, 19 compared a resilience training based on combined theoretical foundation (e.g. mindfulness and cognitive-behavioural therapy) versus unspecific comparators (e.g. wait-list). The studies were funded by different sources (e.g. hospitals, universities), or a combination of different sources. Fifteen studies did not specify the source of their funding, and one study received no funding support. Risk of bias was high or unclear for most studies in performance, detection, and attrition bias domains. At post-intervention, very-low certainty evidence indicated that, compared to controls, healthcare professionals receiving resilience training may report higher levels of resilience (standardised mean difference (SMD) 0.45, 95% confidence interval (CI) 0.25 to 0.65; 12 studies, 690 participants), lower levels of depression (SMD -0.29, 95% CI -0.50 to -0.09; 14 studies, 788 participants), and lower levels of stress or stress perception (SMD -0.61, 95% CI -1.07 to -0.15; 17 studies, 997 participants). There was little or no evidence of any effect of resilience training on anxiety (SMD -0.06, 95% CI -0.35 to 0.23; 5 studies, 231 participants; very-low certainty evidence) or well-being or quality of life (SMD 0.14, 95% CI -0.01 to 0.30; 13 studies, 1494 participants; very-low certainty evidence). Effect sizes were small except for resilience and stress reduction (moderate). Data on adverse effects were available for three studies, with none reporting any adverse effects occurring during the study (very-low certainty evidence).

AUTHORS' CONCLUSIONS

For healthcare professionals, there is very-low certainty evidence that, compared to control, resilience training may result in higher levels of resilience, lower levels of depression, stress or stress perception, and higher levels of certain resilience factors at post-intervention. The paucity of medium- or long-term data, heterogeneous interventions and restricted geographical distribution limit the generalisability of our results. Conclusions should therefore be drawn cautiously. The findings suggest positive effects of resilience training for healthcare professionals, but the evidence is very uncertain. There is a clear need for high-quality replications and improved study designs.

Experiences of patients with primary HIV diagnosis in Kermanshah-Iran regarding the nature of HIV/AIDS: A qualitative study

Background

A diagnosis of HIV (human immunodeficiency virus) infection causes a wide range of mental challenges regarding the meaning and understanding of such a diagnosis because of the specific nature of HIV and its social consequences. AIDS patients perceived their disease as multidimensional Stigma and rejection and even discrimination and insult in receiving health services. Therefore, a deep awareness and understanding of an individual's meaning and interpretation of a HIV-positive diagnosis and their relevant experiences are essential for providing better care.

Objective

This study aimed to examine the attitude, understanding, and interpretation of a positive diagnosis of HIV.

Methods

The present qualitative study was based on the descriptive phenomenological method. Participants included 13 HIV-positive patients who had been referred to the Kermanshah Counseling Center for Behavioral Diseases in Iran and diagnosed at most 6 months before being interviewed. The data were collected via semi-structured in-depth interviews.

Results

The continuous analyses of the data and the interview notes resulted in the identification of five main themes: contagious disease with two subthemes Illness and Harm to others, new self with a Crisis of identity subtheme, disappointment with the life ending and impending death subtheme, unmentionable disease with two subthemes secretive and horrifying diseases, and loss with Frustration subtheme.

Conclusion

Because the attitudes and behaviors of other people, such as relatives and people in society had a negative impact on the participants' mental status, as well as on their perceptions and understanding about the positive diagnosis, the focus of care for people with HIV/AIDS should shift from therapeutic issues to socio-cultural ones. These issues play a major role in forming an individual's understanding of HIV and can be a vital factor in improving their activities and adaptations to a positive diagnosis.

Assessing Stigma, Disclosure Regret and Posttraumatic Growth in People Living with HIV

Posttraumatic growth after a diagnosis of HIV is positively associated with adjustment, yet stigma and disclosure regret are negatively associated with adjustment. Research into whether posttraumatic growth is experienced while perceiving stigma and disclosure regret is still growing. This study aimed to determine whether posttraumatic growth maintains a positive relation with life satisfaction after controlling for disclosure regret and perceived stigma. Using a cross-sectional design, a questionnaire measuring life satisfaction, health status, depression, posttraumatic growth, disease severity, perceived stigma, disclosure regret, and demographical information was completed by 73 people living with HIV (PLWH). Results showed that all participants had disclosed to at least one person. Regression results showed that after controlling for other variables, including stigma and disclosure regret, posttraumatic growth was positively associated with life satisfaction. The importance of the relation of posttraumatic growth with subjective measures of adjustment may be important for interventions aimed at supporting PLWH.

Stigma Management Trajectories in Youth with Perinatally Acquired HIV and Their Families: A Qualitative Perspective

This study explores how family, secrecy and silence contribute to the adoption of stigma management strategies among youth with perinatally acquired HIV (PAHIV). A qualitative method was used. Eighteen youths with PAHIV aged 13-22 years old took part in a semi-structured interview. An exploratory content analysis was performed. Analyses of interviews allowed identification of two HIV stigma management trajectories, both sensitive to the family context: [1] a consolidation of family ties, which contributes to solidarity in stigma management; and [2] a weakening or dissolution of family ties, which contributes to solitary stigma management strategy. Family conditions that support the children in their efforts to develop active stigma management strategies are described. Children likely to experience weakening or dissolution family ties must build strong bonds in the clinical environment and maintain these into adulthood so as to afford them the support they need.

Antiretroviral Adherence Perspectives of Pregnant and Postpartum Women in Guyana

The Caribbean region has the second highest HIV prevalence after Sub-Saharan Africa. Guyana's adult HIV prevalence is 1.9% among pregnant women, with women accounting for an estimated 58% of all persons living with HIV. However, there are few studies on ART adherence in the Caribbean, none from Guyana, and none focusing on adherence in pregnancy and the postpartum period. The objective of this study was to explore the perspectives of HIV-infected pregnant and postpartum women and healthcare providers in Guyana about barriers and facilitators to ART adherence. Data was collected using semi-structured interviews with 24 HIV-infected pregnant and postpartum women and nine healthcare professionals at five clinics between February and April 2012. The Framework Method for analysing qualitative data identified facilitators and barriers related to five core themes: (i) Concern for wellbeing of children; (ii) ART-related factors; (iii) Disclosure; (iv) Socio-economic issues; and (v) Religious and cultural beliefs. Non-disclosure did not adversely affect adherence, contrary to other studies in the literature. Two broad categories emerged from the lived experiences of women in Guyana. The first is related to the act of actually taking their medication where their tenacity is displayed in efforts made to ensure ART is taken. The second relates to the significance of ART to them in terms of reduced risk of MTCT, and the possibility of better health for themselves to enable them to care for their children. However, issues related to poverty, food insecurity and side effects reduced adherence need to be adequately addressed.

HIV Testing Behavior and Social Network Characteristics and Functions Among Young Men Who have Sex with Men (YMSM) in Metropolitan Detroit

HIV testing promotion is a critical HIV prevention strategy, especially among at-risk groups such as young men who have sex with men (YMSM). Based on a web survey of 194 YMSM (18-24), we examine the association of social network characteristics and functions, and of individual-level characteristics, with three HIV testing behaviors (ever, repeat, and recent testing). Network homophily was associated with recent testing in multivariable models. The network function of information acquisition was associated with ever testing and repeat testing. Perceived stigma regarding HIV-related help-seeking was negatively related to recent testing. Individual characteristics were associated with testing outcomes in all models; age, perceived behavioral control, and positive attitudes had the greatest influence. Individual characteristics had a stronger association with ever testing and repeat testing than network characteristics and functions; however, this relationship was reversed for recent testing. Findings support the value of multi-level and network-focused interventions for promoting HIV testing among YMSM.

Meaning Construction in Palliative Care: The Use of Narrative, Ritual, and the Expressive Arts

Individuals and families make sense of the world and their experiences through a process of meaning construction. Narrative is an important means of constructing meaning. The diagnosis of life-threatening or life-altering illness often forces revision in the life narrative and the reconstruction of meaning. This article discusses the process of meaning construction and highlights the use of narrative, the expressive arts, and ritual to create meaning and connection. All members of the palliative care team play an important role in helping patients and families tell the stories of their illness and their lives and find meaning and purpose at the end of life. The use of rituals is discussed along with verbal and art-based methods for eliciting patient and family narratives. The relationships among patient, family, and practitioner are seen as powerfully therapeutic and potentially transformative for all involved.

Finding meaning in life while living with HIV: validation of a novel HIV meaningfulness scale among HIV-infected participants living in Tennessee

BACKGROUND

People living with HIV who maintain a positive outlook on their future may manage stress better than those who do not, leading to improved coping behaviors and better health outcomes.

METHODS

While studying 125 HIV+ adults participating in two clinical trials of expressive writing we assessed their HIV-specific meaningfulness of life with a short, unidimensional scale (the HIVMS).

RESULTS

The HIVMS had a strong Cronbach's alpha (0.80) and acceptable test-retest reliability (0.70). HIVMS scores were strongly correlated with measures of perceived control, optimism, and psychological well-being. Participants with lower HIVMS scores had higher probability of non-adherence to antiretroviral medication, suggesting a decreased ability to manage their illness successfully. Neither the control nor expressive writing intervention groups showed increased HIVMS scores.

CONCLUSIONS

Future research is necessary to determine the effect of HIV meaning on long-term health outcomes and to develop interventions that can significantly improve a person's perception of their meaning in life.

Illness appraisals and depression in the first year after HIV diagnosis

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

Utility of a partner communication scale and a personal meaning scale in newly diagnosed HIV-infected persons

No studies to our knowledge have examined the Lepore Social Constraint Scale or Fife Constructed Meaning Scale in recently diagnosed HIV-infected persons. Twenty-four participants in a prospective observational cohort completed the social-constraint measure, and 47 completed the constructed-meaning scale at either 3 or 9 months after diagnosis. Participants completed a 4-week visual analogue scale to assess adherence to antiretroviral therapy, and validated depression and self-efficacy scales. Spearman correlation coefficients compared measures. In cross-sectional analyses, participants with higher social-constraint scores had lower constructed meaning and adherence. Higher social constraint correlated negatively with self-efficacy and positively with depression. Higher constructed-meaning scores did not correlate with adherence but correlated positively with self-efficacy and negatively with depression. The quality of HIV-infected individuals' discussions of HIV with their partners and positive constructed meaning were associated with better mental health and could be targets for improving medication adherence.

Family functioning and coping styles in families of children with cancer and HIV disease

Disease-specific characteristics of pediatric illnesses may influence the functioning of families and the coping responses they enact. This study compared family functioning and coping styles within and between 2 different medical groups: families of children with cancer (n = 44) and HIV disease (n = 65). Most caregivers reported healthy family functioning, and no between-group differences in functioning emerged. However, with regard to coping, more reliance on social support was indicated among the cancer group. Also, the HIV group largely sought support from family, whereas both family and nonfamily support were sought among the cancer group. Better functioning was related to reframing, an active coping style, within the cancer group and passive coping within the HIV group. Thus, coping strategies and their implications for family functioning vary by condition. Researchers should avoid combining various illness groups indiscriminately. Likewise, clinicians should be sensitive to disease-specific factors when helping families learn to cope with illness-related stressors.

A systematic review of resilience in the physically ill

BACKGROUND

Resilience is the capacity of individuals to maintain, or regain, their mental health in the face of significant adversity, including physical illness.

OBJECTIVE

We conducted a systematic review of resilience and related concepts in the physically ill to determine factors associated with predicting or promoting resilience.

METHODS

An electronic search of PsychInfo, Medline, and CINAHL databases between 1950 and May 2009 was performed using the terms resilience, and various types of physical illnesses. Inclusion criteria were broad and exclusion criteria were not published in English or not focused on resilience in physical illness.

RESULTS

A total of 475 articles were retrieved and 52 articles met inclusion/exclusion criteria. Psychological factors associated with resilience were self-efficacy, self-esteem, internal locus of control, optimism, mastery, hardiness, hope, self-empowerment, acceptance of illness, and determination. Social support was highly predictive of, and associated with, resilience. Coping strategies such as positive cognitive appraisal, spirituality, active coping, and mastery were also associated with resilience. Resilience factors directly salient to physical illness such as self-care, adherence to treatment, health related quality of life, illness perception, pain perception, exercise adherence, and physical outcomes were also found.

DISCUSSION

These findings need to be considered and when appropriate incorporated into the psychological and psychiatric care of physically ill individuals.

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

OBJECTIVE

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

METHOD

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

RESULTS

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

CONCLUSIONS

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

Expanding coping goodness-of-fit: religious coping, health locus of control, and depressed affect in heart failure patients

The goodness-of-fit coping hypothesis posits that problem-focused (PF) coping is particularly helpful under high controllability conditions, while emotion-focused (EF) coping is more helpful in low controllability situations. However, little research has examined whether the goodness-of-fit hypothesis applies to religious coping, a distinct set of coping resources and efforts. Further, little goodness-of-fit research has been conducted in the context of life-threatening illness. We tested coping goodness-of-fit for PF and EF as well as religious coping resources and strategies in 202 congestive heart failure (CHF) patients. Multiple regression analyses examined the extent to which each type of coping, health locus of control (HLOC) regarding their CHF, and their interactions related to subsequent depressed affect. Neither religious coping efforts nor religious resources were related to depressed affect. However, when examined in conjunction with internal HLOC, active coping and organized religious commitment were related to less depression for those higher in internal HLOC, while daily spiritual experience was related to less depression for those lower in HLOC. These results partially support the goodness-of-fit hypothesis and indicate a need to consider the perceived controllability of situations when examining the associations of religious coping resources and activities on depressive symptoms in the context of illness.

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

OBJECTIVE

This investigation examined the association of personal meaning to psychological well-being in adults living with HIV/AIDS receiving mental health services. Personal meaning refers to a framework for delineating the purposes and goals that make life worth living and for evaluating the degree to which these purposes and goals are being fulfilled. Personal meaning was hypothesized to be positively associated with psychological well-being and to contribute independently to the variance in psychological well-being over and above social support, dispositional optimism and coping behavior.

METHOD

With the use of a cross-sectional design, a set of self-report measures were completed by 132 adults living with HIV disease at the time of their initial mental health services evaluation. Data were analyzed using correlation and regression techniques.

RESULTS

Personal meaning was positively associated with psychological well-being, although it did not contribute significantly to the variance in well-being over and above social support, optimism and coping behavior in a multifactorial regression model. Post hoc analysis showed partial mediation by optimism of the association between personal meaning and well-being.

CONCLUSIONS

Personal meaning should be considered along with other psychological and behavioral coping factors in understanding and intervening clinically with individuals living with HIV disease and co-occurring psychiatric concerns.

"I washed and fed my mother before going to school": understanding the psychosocial well-being of children providing chronic care for adults affected by HIV/AIDS in Western Kenya

With improved accessibility to life-prolonging antiretroviral therapy, the treatment and care requirements of people living with HIV and AIDS resembles that of more established chronic diseases. As an increasing number of people living with HIV and AIDS in Kenya have access to ART, the primary caregivers of poor resource settings, often children, face the challenge of meeting the requirements of rigid ART adherence schedules and frequent relapses. This, and the long-term duty of care, has an impact on the primary caregiver's experience of this highly stigmatized illness - an impact that is often described in relation to psychological deprivation. Reflecting the meanings attached to caregiving by 48 children in Western Kenya, articulated in writing, through photography and drawing, individual and group interviews, this paper presents three case studies of young caregiving. Although all the children involved in the study coped with their circumstances, some better than others, we found that the meanings they attach to their circumstances impact on how well they cope. Our findings suggest that only a minority of young caregivers attach either positive or negative meanings to their circumstances, whilst the majority attaches a mix of positive and negative meanings depending on the context they are referring to. Through a continuum of psychosocial coping, we conclude that to provide appropriate care for young carers, health professionals must align their understanding and responses to the psychosocial cost of chronic care, to a more nuanced and contextual understanding of children's social agency and the social and symbolic resources evident in many African communities.

Coping with HIV: Caribbean people in the United Kingdom

Although Caribbean people in the United Kingdom are increasingly being affected by HIV/AIDS, there has been no examination of how they are coping with the illness. We investigate the coping strategies of HIV-positive Caribbean people using in-depth interviews with a purposively selected group of 25 residents of South London. The main coping strategies were more cognitive than behavioral: restricted disclosure, submersion, faith, and positive reappraisal. These strategies were intertwined in complex ways, and most were rooted in contextual factors, particularly cultural ones. Themes of loss, silence, and reinvention suffused respondents' narratives. Interventions should consider the high degree of stigmatization of HIV/AIDS in the Caribbean community, reluctance to disclose, the likelihood of an initial severe reaction to diagnosis, and external stressors. HIV-positive Caribbean people who are coping well could serve as mentors and role models for poor copers and newly diagnosed patients; establishing Caribbean-specific support groups might also assist coping.

Loneliness, social support and family function of people living with HIV/AIDS in Anhui rural area, China

The main purpose of this study was to investigate how loneliness was associated with social support and family function among people living with HIV/AIDS (PLWHA) in an HIV-stricken area of China. Two hundred and nineteen PLWHA were surveyed using the UCLA (University of California at Los Angeles)-Loneliness Scale, the Social Support Rate Scale and the Family APGAR (Adaptability, Partnership, Growth, Affection and Resolve) Index. The results indicated that the majority (84.5%) of PLWHA had moderate to high levels of loneliness, with a mean score of 47.62 and a standardized score of 59.53. The level of loneliness was significantly different in subjects' occupations, but not in other sociodemographic variables. Social support, family function and all dimensions except utilizations of support were significantly negatively associated with loneliness. Multiple regression revealed that less social support and poor family function were associated with more loneliness. In conclusion, loneliness prevails among PLWHA. It may limit PLWHA's ability or access to social relationship. These findings support the hypothesis that if PLWHA are better supported and cared for, their negative psychosocial consequences might be prevented or at least reduced.

A Chinese version of the Meaning in Caregiving Scale: an assessment of its reliability and validity

PURPOSE

To evaluate the reliability and construct validity of the Meaning in Caregiving Scale (MICS) by confirmatory factor analysis and to explore whether the MICS meets the goodness-of-fit criteria for the 3-factor model.

DESIGN AND METHODS

Four hundred and eighty subjects in Taiwan were recruited. The hypothesized confirmatory factor analysis model specifies the items to measure the reordering priority, relationship fidelity, and transcendent belief as indicators of latent factors.

FINDINGS

The data show that the hypothesized 3-factor model does not fit the data well and indicate that the 3 factors might share a high-order common factor. Cross-cultural issues may account for this shortcoming.

PRACTICE IMPLICATIONS

This scale offers better understanding around caregivers for psychiatric patients and the issues they face.

The association of benefit finding to psychosocial and health behavior adaptation among HIV+ men and women

Psychological and behavioral adaptation to HIV is integral to long-term survival. Although most research on coping with HIV has focused on factors associated with poor adaptation, recent research has expanded to include positive concomitants of adaptation, such as benefit finding. This study examined the occurrence of benefit finding among HIV+ men and women and evaluated the potential relevance of benefit finding to positive health behavior and psychosocial adaptation. HIV+ participants (N = 221) recruited during outpatient care completed self-report assessments of benefit finding, social support, depression, HAART adherence, substance use, and physical activity. In a series of multivariate analyses that controlled for demographic and health status variables, benefit finding was associated with lower depression scores, greater social support, and more physical activity, but showed no association to HAART adherence or substance use. The association of benefit finding to depression was partially mediated by differences in social support. Thus, benefit finding may improve psychological adjustment by motivating patients who experience stress-related growth to seek social support.

Promoting adaptive coping by persons with HIV disease: evaluation of a patient/partner intervention model

This study evaluated an intervention to facilitate adaptive coping by persons living with HIV (PLWH), with the participation of their cohabiting partners as a dimension of the intervention. An experimental design with randomization was used, and 84 PLWH and their partners were recruited. The intervention was based on a psychosocial educational model that incorporated four 2-hour sessions focused on communication, stress appraisal, adaptive coping strategies, and building social support. Both members of the dyad were included in each session. The comparison control included four supportive phone calls to the PLWH alone. Data were collected from both the PLWH and their partner in each of the two groups at baseline, immediately following the intervention, and 3 months and 6 months posttreatment. Data were analyzed using repeated measures analysis of variance, with change scores from the partner data being covariates. Results indicated that the design was a feasible model, which demonstrated potential for the management of stress and possibly problems such as adherence in PLWH. A manual was developed as a part of this intervention and is currently available.

Coping with HIV-related stigma in five African countries

People living with HIV (PLWH) and their families are subjected to prejudice, discrimination, and hostility related to the stigmatization of AIDS. This report examines how PLWH cope with HIV-related stigma in the five southern African countries of Lesotho, Malawi, South Africa, Swaziland, and Tanzania. A descriptive qualitative research design was used to explore the experience of HIV-related stigma of PLWH and nurses in 2004. A total of 43 focus groups were conducted with 251 participants (114 nurses, 111 PLWH, and 26 volunteers). In describing incidents of stigma, respondents reported strategies used or observed to cope with those incidents. Nurse reports of coping strategies that they used as well as observed in HIV-infected patients were coded. Coping strategies used by PLWH in dealing with HIV-related stigma were coded. A total of 17 different self-care strategies were identified: restructuring, seeing oneself as OK, letting go, turning to God, hoping, changing behavior, keeping oneself active, using humor, joining a support or social group, disclosing one's HIV status, speaking to others with same problem, getting counseling, helping others to cope with the illness, educating others, learning from others, acquiring knowledge and understanding about the disease, and getting help from others. Coping appears to be self-taught and only modestly helpful in managing perceived stigma.

Balancing between normality and social death: Black, rural, South African women coping with HIV/AIDS

The millions of people living with HIV/AIDS are in urgent need of effective care and support interventions. Such interventions should take people's reported needs, coping strategies, and context into account. Usually, active problem-focused coping strategies have been encouraged because they are considered to be more beneficial than passive emotion-focused strategies. However, this may not be the case in the South African context. This study was based on in-depth interviews with Black, rural, South African women about their coping strategies. The overriding aim of coping was to solve the tasks of physical, psychological, and social survival. Strategies involving avoidance of, escaping from, or minimizing HIV/AIDS and its accompanying emotional distress were predominant. We argue that such strategies could be adaptive in a society with scarce resources and marked by gender inequalities. Our findings suggest that care and support interventions should be sensitive to culture and context, should be holistic and participatory, and should include income generation and child care services.

Is AIDS chronic or terminal? The perceptions of persons living with AIDS and their informal support partners

Viewed as a terminal disease just a decade ago, HIV/AIDS is now often characterized as a chronic yet manageable disease. The goal of this study is to assess the perceptions of the course of the disease among persons living with AIDS and their informal support partners and to identify the themes that distinguish the differing perceptions of the epidemic. The findings from this research reveal that 41% of persons living with AIDS and 39% of their informal support partners perceive AIDS as chronic. By contrast, 37% of persons living with AIDS and 39% of the informal support partners perceive AIDS to be terminal rather than chronic. Among persons living with HIV/AIDS, those with lower levels of education and higher levels of perceived race-based discrimination were significantly more likely to view AIDS as a terminal rather than chronic condition. In addition, informal support partners in poor health were significantly more likely than others to view AIDS as terminal rather than chronic. Content analyses of the qualitative data revealed five broad themes related to the specific perceptions of AIDS, including medications, personal experience, cure, time/eventuality and education. The implications of these findings are discussed.

Psychological status, coping, and social support of people living with HIV/AIDS in central China

OBJECTIVE

To investigate psychological status, coping, social support, and psychosocial factors associated with people living with HIV/AIDS in a highly HIV-infected area of central China.

DESIGN

Cross-sectional descriptive correlation study.

SAMPLE

Of 200 individuals with HIV/AIDS registered at the "Warm Homestead" health care center (central China), all who met the eligibility criteria (n=103) were recruited; 94 of these completed questionnaires.

MEASUREMENTS

Four anonymous self-administered questionnaires were used: (a) demographic data questionnaire, (b) Symptom Checklist-90 (SCL-90), (c) Medical Coping Modes Questionnaire, and (d) Perceived Social Support Scale questionnaire.

RESULTS

Participants had low education levels and family incomes. The majority (n=87, 92.6%) had become infected due to improper procedures during plasma donations. Participants reported moderately high levels of perceived social support, but their high SCL-90 scores indicated high levels of psychological distress. The most frequently used coping style was confrontation. Both acceptance-resignation and avoidance coping styles were significantly correlated with high distress (high SCL-90 total and subscale scores).

CONCLUSION

Public health personnel and AIDS professionals may consider further interventions to promote psychological health in HIV/AIDS-positive individuals in highly HIV-infected areas of China, as the available social support did not seem to be effective in decreasing psychological pathology or mobilizing their coping strategies.

Effect of Brief Behavioral Intervention Program in Managing Stress in Medical Students from Two Southern California Universities

The study aims to assess 1) the prevalence of stress among a group of third and fourth year medical students (MS) from two Southern California universities and 2) the effect of a brief behavioral intervention program (BBIP) on stress management among the students instructed on stress intervention techniques. The stress level was determined by using the General Well Being Scale (GWBS), a self-report questionnaire designed by the National Center for Health Statistics.1 The stress testing was done prior to the psycho-educational lecture on stress. The prevalence of stress and the variation of stress based on gender, academic year (third vs. fourth year) and time of testing (beginning vs. end of rotation) was measured in 104 medical students. To assess the effect of the psycho-educational lectures on stress, the last 32 students who rotated in our service had the pre-test and the lecture at the beginning of the rotation and the post-test at the end of the rotation. Among the medical students studied, 53/104 (51%) reported stress; among this group, 20/53 (37.7%) reported severe stress or distress. The prevalence of stress in this group of students was not significantly different if the stress level was measured at the beginning (46.9%) vs. the end of the rotation (52.8%, p = 0.57). The total stress score was lower (suggesting higher stress) in the fourth vs. third year MS (69.7+/-16.3 vs. 73.2+/-12.7, p=0.2), and in female students vs. male students (69.9+/-14.5 vs. 73.7+/-13.8, p=0.17). Female students, when compared to their male counterparts, had a lower anxiety score (12.2+/-4.4 vs. 15.4+/-4.3, p p0.005), consistent with higher anxiety level, since the polarity for the anxiety questions is reversed. Among the students who had both a pre and post-test (N=32) after the BBIP (deep diaphragmatic breathing, self-control relaxation, walking meditation), the reported stress decreased from 46.9 % (15/32) to 21.9% (7/25) (p 0.05). In addition, scores indicated that the brief behavioral intervention program significantly decreased the anxiety level and improved the positive well-being. Our study showed that stress is very prevalent among the medical students tested, affecting 51% of the students. Among those who reported stress, 37.7% reported distress. Female students reported a higher level of anxiety compared to their male colleagues. Following the implementation of a brief behavioral program, the prevalence of stress in this group of students decreased by 46.7 %. This was associated with a decrease in the reported anxiety and an increase in the positive well-being. Since stress is very prevalent among medical students, increased awareness of stress and early intervention may prevent burnout, improve job satisfaction and ultimately improve health care delivery.

A relationship-based framework of spirituality for individuals with HIV

Twenty HIV-positive individuals (10 male, 10 female) participated in interviews on their spiritual life. Interview themes suggest that the HIV diagnosis facilitated a relationship-based framework of spirituality. Relationships that formed this framework were: relationship with God/Higher Power, renewed engagement with life, and relationship with family. Within ''relationship with God/Higher Power,'' subthemes included gratitude for God's benevolent influence, spiritual struggles, and building connections with their Higher Power. Self care, transformation of life goals, and accepting mortality were subthemes for ''renewed engagement with life.'' Subthemes within ''relationship with family'' included finding a sense of purpose, finding support through families, and families as a source of strain. Overall, results suggest that interventions that integrate spirituality need to consider a notion of spirituality that goes beyond church attendance, prayer, and Bible reading. These interventions must include the positive aspects of spirituality and spiritual struggles that individuals with HIV may experience.